Health2Go Technical Overview

Health2Go is a distributed healthcare social franchise designed to strengthen and extend the Integrated Community Case Management (iCCM) strategy in hard-to-reach and underserved communities in emerging market settings.

Developed by Professor Stephen Alder and Mr. Rick Haskins, Health2Go was created to address a persistent challenge in global health: how to reliably deliver high-quality, community-level primary care at scale while remaining fully integrated within national health systems. The model focuses on effective community-based management of priority childhood conditions, improved household health literacy, and reliable referral and follow-up within established clinical care pathways.

Health2Go utilizes community health workers, known as Community-Based Agents (CBAs), who: (1) directly manage priority health conditions among children following the iCCM protocol (malaria, respiratory disease, severe diarrhoea, nutritional deficits), (2) improve community health literacy and practices through home-based health education, and (3) provide critical links to clinical systems.

Ensign Global University, in partnership with CastAPebble, works closely with Ghana Health Service and district health leadership to test, refine, and package Health2Go for safe, affordable, and scalable implementation.

Health2Go recognizes health as fundamental to socioeconomic development. By increasing preventive practices and improving access to timely, effective primary care, the model supports healthier households and communities as the basis for long-term prosperity.

Health2Go has adapted the community health worker model into a social franchise and strengthened it with operational and systems innovations that support reliable, high-quality delivery of the Integrated Community Case Management (iCCM) strategy across multiple locations. This structure reflects established principles of social franchising, including ensuring clear quality standards, shared branding and identity, and coordinated operational systems that enable consistent implementation at scale.

Each participating district franchisee operates a franchise in partnership with Health2Go that is structured, practical, and accountable. Training is competency-based and delivered using checklists, skills demonstrations, and an 80% mastery threshold at scheduled refresher assessments. Supervision is routine and supportive, with monthly visits involving Community-Based Agents (CBAs) and Ghana Health Service nurses, complemented by announced and unannounced site checks. Reliable logistics systems support continuous availability of medicines and supplies through durable kits and defined reorder procedures.

The Health2Go brand is consistent across all district franchisees and supports community recognition and trust in services delivered. CBAs maintain regular engagement with households under this shared identity, and standardized monitoring systems carry field-level data into routine district reviews that inform supervision and local decision-making. Together, these elements align with core attributes described in the social franchising literature, including operational manuals, quality assurance mechanisms, and ongoing training and support.

Health2Go fully integrates within Ghana’s formal health system. The model aligns with Community-based Health Planning and Services (CHPS) supervision structures and involves district leadership so that prevention, health promotion, early treatment within the iCCM scope, and timely referral follow established clinical care pathways. This provides capacity critical to supporting the Free Primary Health Care (FPHC) Programme.

Through this social franchise model, Health2Go strengthens iCCM delivery with operational discipline, data-informed oversight, and a structure designed for scalability and sustainability.

The Center for Leadership, Innovation, and Prosperity (CLIP) at Ensign Global University, in partnership with the Center for Business Health and Prosperity at the University of Utah, hosts the research and development office supporting training, operations, and continuous improvement for Health2Go. Since 2016, Ensign Global University has partnered with the Cast A Pebble foundation to support the initial development, field testing, and consumer-facing design of the Health2Go model.

Together, these partnerships provide the technical backbone required to support district-engaged implementation of the Health2Go social franchise while maintaining alignment with Ghana Health Service standards and national priorities.

Ensign Global University leads monitoring, evaluation, and continuous improvement for Health2Go to ensure program quality, accountability, and evidence-informed decision-making at community, district, and national levels. Monitoring and evaluation activities are embedded within routine implementation and aligned with Ghana Health Service reporting and supervision structures.

Routine Program Data

Community-Based Agents (CBAs) complete standardized registers documenting service delivery and community engagement activities. Supervising nurses verify records during routine field visits. Tracked indicators include childhood illness episodes managed, rapid diagnostic tests conducted and results, treatments provided, referrals made and completed, household health education visits, supervision completion, and medicine stock status. Together with district partners and the Ghana Health Service, Ensign Global University reviews program data monthly and compiles written quarterly performance reports to support local oversight and operational improvement.

Independent Impact Evaluation

In partnership with researchers from the University of North Carolina at Chapel Hill and the University of Utah, Ensign Global University conducted an independent observational retrospective cohort study examining Health2Go’s impact over a ten-year period (2012–2022). The analysis evaluated changes in under-five mortality and health facility utilization before and after Health2Go implementation.

The study found that exposure to Health2Go was associated with a 67.7 % reduction in the hazard of under-five mortality and an 83 % reduction in clinic visits for uncomplicated malaria, with cases effectively managed at the community level. These findings demonstrate Health2Go’s potential to improve child health outcomes while reducing unnecessary burden on health facilities.

Results are published in the peer-reviewed journal BMJ Global Health.

Read the study in BMJ Global Health

Learning and Continuous Improvement

Monitoring and evaluation findings are used to inform training updates, supervision practices, supply chain adjustments, and district-level planning. This continuous feedback loop allows Ensign Global University and health system partners to refine Health2Go implementation while maintaining alignment with national priorities and standards.

Ensign Global University works with the Ministry of Health and the Ghana Health Service at community, district, regional, and national levels to develop, test, and align Health2Go with policy and routine practice. This includes facility-level integration of referrals and resupply, monthly reviews with District Health Management Teams, engagement with regional leadership, and national coordination on strategy and standards. In 2024, Ensign Global in partnership with Cast A Pebble hosted the National Health2Go Summit to convene CBAs, district and regional leaders, national professional associations, and representatives from GHS and MOH. A formal Memorandum of Understanding among EGU, GHS, and MOH was also established in 2024, signaling system-level commitment to Health2Go’s potential for deployment across Ghana.