How GHSI Is Designed to Work
GHSI has conducted extensive research focusing on program evaluations of existing cardiovascular-focused initiatives in Ghana and Sub-Saharan Africa. We have studied what works, identified critical gaps, and designed our model to bridge them, leveraging partnerships to build capacity within existing programs rather than duplicating efforts.
The Transport Hub Ecosystem
GHSI does not target two separate populations. We serve one integrated economic community: the transport hub ecosystem. Trotro drivers and market women work in the same physical space, share the same risk factors, and face the same barriers to preventive care.
By screening where they already gather, at lorry stations and major markets, GHSI reaches an entire economic community in a single intervention point. This is how we maximize impact per screening event.
GHSI focuses on trotro drivers and market women in Greater Accra for a specific reason. They are the economic backbone of urban Ghana. Trotro drivers sit ten to twelve hours a day in traffic, under chronic stress, often consuming salt-heavy street food, often without health coverage. Market women stand for hours in the heat, relying on processed foods high in sodium. Both groups face elevated cardiovascular risk and are excluded from a clinical system that only serves people who walk through its doors. When a driver or market woman has a stroke, an entire family loses its primary income. This is a health crisis and an economic one.
Within Greater Accra, this population spans more than one kind of community. Public health research in Ghana distinguishes urban, rural, and peri-urban populations, because their experiences differ. Peri-urban communities sit inside or at the edge of urban areas while living with rural levels of income, services, and infrastructure. Many informal-sector workers trade at the city's commercial heart while living in communities where services are thinnest. GHSI's population model names these categories explicitly, and concentrates screening within defined communities at the district level, reaching each population deeply rather than screening thinly across many places. Depth is what makes twelve months of follow-up possible.
Three Pillars of Community Health
Every element of GHSI's model is designed to work as an integrated system, not isolated activities.
Education
Knowledge Is Protection
Before screening, GHSI will deliver accessible health education through trained peer educators using a two-track curriculum: Training of Trainers (ToT) and Community Volunteer Training. The curriculum draws on the Cohen 2025 religious-leader hypertension education framework (Mwanza, Tanzania), peer-reviewed methodology validating community religious networks as effective health educators, adapted from Dr. Jennifer Downs's NIH-funded Tanzania Religious Engagement in Health work at Weill Cornell Medicine. It also integrates Dr. Monika Safford's Patient Activated Learning System (PALS), delivered through MedExplain Health.
- What hypertension is and why it matters
- Warning signs to watch for
- Connection between hypertension and stroke
- Understanding symptoms as medical, not spiritual
- The BE-FAST method for stroke recognition
Screening
Simple, Accessible, Life-Saving
GHSI's screening process will follow an 8-station workflow designed for community field settings, using WHO-protocol blood pressure measurement.
- Brief registration and health history intake
- Rest period for accurate readings
- WHO-protocol blood pressure measurement
- Five-tier color classification for clear results
- Personalized risk counseling
- Resource packet for every participant
Referral & Follow-up
The Closed Loop
Screening events are necessary. Sustained follow-through is harder. GHSI is designed to do the longitudinal work, tracking participants for 12 months at Days 14, 30, 90, 180, and 365. Referrals route through Ghana's existing care infrastructure: NHIS-enrolled clinics, FPHC primary care, partnered pharmacies, and faith-based facilities operated by the Christian Health Association of Ghana (CHAG, the Ministry of Health's agency partner across 16 regions) and the Catholic Health Service Trust.
- Referral to practitioner network
- Follow-up at 14, 30, 90, 180, and 365 days
- Track who connects to care and stays in care
- Measure blood pressure outcomes over time
- The closed loop is the intervention
The Closed-Loop Framework: 12-Month Patient Tracking
Screening finds hypertension. The harder work begins after. GHSI is designed to track what happens next: measuring not just who was screened, but who made it to a provider, who stayed in care, and whose blood pressure improved.
This design answers a documented gap. Ghana's own Community-based Hypertension Improvement Project (ComHIP), evaluated by the University of Ghana School of Public Health, improved blood pressure control among patients who stayed in care, yet of 1,339 people enrolled in its cohort, only 338 remained at the twelve-month mark. The space between screening and sustained care is where programs lose people, and it is exactly where GHSI works. Read the evidence behind the closed loop. Along the way, GHSI connects participants to licensed clinics and pharmacies and supports NHIS enrollment; GHSI does not dispense medication.
"The closed loop is the intervention."
Five-Tier Blood Pressure Classification
GHSI uses a five-tier color classification system aligned with ACC/AHA clinical guidelines. Each tier determines the participant's pathway, from education-only to emergency referral, ensuring every individual receives the appropriate level of response.
Built for Ghana's Connectivity Reality
GHSI's twelve-month closed-loop tracking runs on DHIS2, the open-source health information platform that also underpins Ghana's national DHIMS-2 system. GHSI uses the open-source hypertension control package on the DHIS2 Capture mobile app, configured for the structured follow-up cadence at Days 14, 30, 90, 180, and 365. The system is offline-first, and its shared foundation with DHIMS-2 makes national interoperability a design goal grounded in shared infrastructure.
Offline-First Design
Built to work in low-connectivity environments, essential for screening at busy lorry stations and open-air markets in Greater Accra.
Five-Touchpoint Cadence
Automated reminders and overdue patient lists support GHSI's closed-loop tracking model at the 14, 30, 90, 180, and 365-day milestones.
DHIMS-2 Integration
Designed for interoperability with Ghana's national health information system so that pilot data contributes to national surveillance.
One Contribution to a Shared Field
Ghana's hypertension space already includes important and longstanding work by Healthy Heart Africa, the Akomapa project, ADHINCRA, TASSH, the Ghana Heart Initiative, the Ghanaian Society of Cardiology, the World Heart Federation, May Measurement Month Ghana, and others. GHSI is one contribution to a shared field, not a replacement for any of it.
In Ghana, stroke is widely attributed to spiritual forces, and many families respond with prayer rather than medical care. GHSI works with religious institutions and community leaders because they have long been Ghana's health communities. We do not ask people to choose between faith and care. We build with both.
What we contribute that is distinct:
Community trust across faith and local leadership.
Informal sector workers as the design population.
Twelve-month closed-loop follow-up tied to outcomes
Diaspora and homeland in partnership.
Vision
A Ghana Where Informal Sector Workers Receive Continuity of Care
A Ghana where informal sector workers (trotro drivers, market women, traders) receive the same twelve months of continuous hypertension care as anyone in the formal sector. By 2031, GHSI's closed-loop care architecture operates as a depth-layer of Ghana's Free Primary Healthcare Programme in Greater Accra, with informal sector treatment continuity approaching parity with the formal sector.
Mission
GHSI builds community-level infrastructure for hypertension screening, education, and twelve months of follow-up. The infrastructure is co-deployed with Ghana's Free Primary Healthcare Programme, designed in partnership with religious institutions, transport unions, and market communities across Greater Accra, and continuously refined through outcomes feedback. Screening is the beginning of care, not the end of an encounter.
Values
Nothing About Us Without Us. Programs are co-designed with the people they serve. Trotro drivers and market women are the design population, not subjects of intervention.
Closed-loop accountability. A screening is not care until follow-up sustains it. Twelve months. Five touchpoints. Outcomes, not encounters.
Faith-rooted, community-trusted. Faith communities and community leaders have long held trust in Ghana, across Christian and Muslim traditions alike. We honor that, and build with all of them.
Diaspora and homeland in partnership. Ghanaian-led implementation, diaspora-supported architecture.
Aligned with the system. We work with Ghana's national priorities, not around them.