Implementing a peer learning strategy for health systems strengthening in Ghana: a qualitative study.

Introduction: Primary healthcare, through community-based care provision, is a pathway to achieving universal health coverage (UHC). Ghana adopted the Community-based Health Planning and Services (CHPS) initiative as a national health strategy to drive UHC. Challenges with the national scale-up led to strengthening CHPS in the Upper East Region through the Ghana Essential Health Interventions Programme (GEHIP). Subsequently, CHPS+ was implemented to further strengthen CHPS and sustain the gains of GEHIP. CHPS+ adopted a peer learning implementation strategy through health personnel visits to Upper East. This study reports on health personnel's experiences with the CHPS+ peer learning exchange and their perceptions of how lessons from the exchange informed healthcare services. Methods: This qualitative systems appraisal used a descriptive design comprising in-depth interviews and focus group discussions. Study participants consisted of 51 health personnel, including district health management team members, subdistrict leaders and community health officers, recruited from four systems learning districts. The data were analysed thematically, both manually and using the Dedoose software. Results: Peer-to-peer learning strengthened CHPS implementation by improving subdistrict supervision, standardising monitoring and feedback, enhancing community engagement and supporting the use of practical tools such as community health action plans, movement wheels, community maps and profiling charts. Greater involvement of chiefs, community health committees, volunteers and local government actors was reported after the exchange. However, implementation remained uneven, with some districts reporting concrete changes and others describing early-stage actions. Continued mentorship, adequate resources, routine monitoring and stronger local leadership were recommended to sustain and institutionalise the lessons learnt. Conclusions: Peer-to-peer learning offers a feasible strategy for strengthening CHPS+ implementation across districts by translating established practices into locally adaptable action. Its long-term value will depend on institutionalising follow-up mentorship, ensuring adequate resources and embedding shared learning within routine health-system structures to strengthen primary healthcare in Ghana.