Access, effectiveness, and efficiency of community-based health planning and services (CHPS) strategy implementation in Ghana: A scoping review

Background Community-Based Health Planning and Services (CHPS) is Ghana's flagship strategy for delivering equitable primary healthcare at community level. However, uneven implementation and service readiness raise uncertainty about whether geographic expansion consistently produces accessible, effective and efficient care. This scoping review synthesised evidence across access, effectiveness and efficiency. Methods Following Joanna Briggs Institute methodology and PRISMA-ScR guidance, Web of Science, Scopus, ScienceDirect, PubMed and Google Scholar were searched. Three reviewers independently screened quantitative, qualitative, mixed-methods and implementation studies conducted in Ghana. Data were extracted using a standardised template and synthesised narratively across access, effectiveness and efficiency domains. Results Forty-four studies met the eligibility criteria. CHPS was associated with improved geographic access and increased utilisation of antenatal care, skilled delivery, immunisation, family planning and other preventive services. Programme and longitudinal evaluations reported improvements in maternal and child health service use, child survival and third-dose diphtheria-tetanus-pertussis-containing vaccination. Operational evidence suggested potential efficiency gains from decentralised delivery, appropriate workforce deployment and reduced reliance on higher-level facilities for basic care. Nevertheless, outcomes varied according to implementation context, workforce availability, medicine supply, referral capacity, financing, logistics and community participation. Conclusion CHPS remains an important platform for strengthening primary healthcare and advancing Universal Health Coverage in Ghana. However, the predominance of observational and context-specific evidence limits causal interpretation. Future investments and evaluations should prioritise implementation quality, workforce capacity, governance, logistics, functional referral systems, medicine availability, community engagement and rigorous economic assessment to determine effectiveness, efficiency and value for money across diverse implementation settings nationally over time.