# Public–Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study

## TL;DR

This study examines how private health providers in Ghana help maintain healthcare during worker strikes and highlights the need for better government-private collaboration.

## Contribution

The study provides new insights into public–private engagement and health system resilience during strikes in a low-income country context.

## Key findings

- CHAG's non-striking ethos and secondment policy foster resilience during strikes.
- Limited government support and insurance system issues threaten CHAG's care quality.
- Proactive partnerships between government and private providers are recommended for crisis preparedness.

## Abstract

In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG’s non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG’s ability to provide quality, affordable care. This study underscores private providers’ pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.