Beyond the Hospital Walls: Business Opportunities in Home and Community-Based Care

Ghana’s health system is at an inflection point. Demographic change, the rise of noncommunicable diseases (NCDs), policy commitments to universal health coverage, and long-standing innovations in community-level primary care (notably the Community-Based Health Planning and Services, CHPS initiative) create fertile ground for commercially viable, socially beneficial models of home and community-based care (HCBC). This article synthesizes evidence on Ghana’s HCBC landscape, analyzes market drivers and barriers, and proposes strategic business models and policy levers for private and public actors to expand high-quality, equitable care beyond hospitals. Key opportunities include technology-enabled remote monitoring, integrated home health services aligned with CHPS, geriatric and long-term care services, community mental health platforms, and value-based contracting with insurers and employers. Strategic success will hinge on aligning business incentives with Ghana’s regulatory architecture, workforce realities, and existing community health platforms.

Why Ghana, and why now?

Ghana’s health policy trajectory and population dynamics make HCBC not only feasible but necessary. The CHPS initiative, a national policy since 1999, has institutionalized community-level primary care as the first point of contact for many Ghanaians and demonstrates that decentralized services can improve maternal and child health while increasing service uptake in rural settings. Recent evaluations reaffirm CHPS’s continued relevance for delivering prevention, health promotion, and basic clinical care close to households.

Concurrently, Ghana faces an aging cohort and a growing burden of chronic disease: older age groups have increased substantially over recent decades, and NCDs now account for a rising share of morbidity and health system costs. These demographic and epidemiological shifts increase demand for longitudinal, home-based management and support services, domains that hospital-centric systems have historically underserved.

Policy signals also incentivize HCBC adoption. Ghana’s National Health Insurance Scheme (NHIS) has materially changed care utilization patterns. It remains a critical payer, although benefit design and coverage gaps (notably around rehabilitation, long-term care, and some home services) shape what markets can sustain under public financing.

Market drivers and value pools

1. Primary-care augmentation through CHPS integration

CHPS compounds and community health officers (CHOs) form a widely dispersed service platform that private HCBC providers can partner with or complement. CHPS provides legitimacy, referral pathways, and community trust, which reduce acquisition and uptake costs for new home-based services. Businesses that design interoperable clinical workflows and training programs for CHOs will gain scale quickly by co-delivering services (e.g., chronic disease coaching, medication reconciliation, and teleconsultation).

2. Aging, long-term care, and private willingness-to-pay

Recent household surveys in Ghana indicate substantial willingness-to-pay for formal residential and home-based elderly care, suggesting nascent demand that can be met by fee-for-service, subscription, or hybrid insurance models. Given cultural preferences for aging in place, market solutions that combine personal-care aides with clinical oversight (nurse visits, telemedicine, medication management) can capture value while reducing pressure to institutionalize.

3. Chronic care management and digital health

The clinical management of hypertension, diabetes, chronic respiratory disease, and post-discharge recovery is amenable to remote patient monitoring (RPM), SMS/IVR adherence support, and task-sharing to community health workers. Payors (NHIS, private insurers, employers) have incentives to underwrite RPM if it demonstrably reduces admissions and total cost of care. Technology firms can sell integrated platforms (hardware + analytics + care coordination) on a subscription or outcomes-linked basis.

4. Behavioral health and home-based psychosocial supports

Barriers to accessing facility-based mental health services (stigma, workforce shortages, and geographic distribution) create openings for community-anchored, digitally supported behavioral health programs. Hybrid models, digital CBT modules, community counseling supervised by mental-health professionals, and referral linkages with CHPS can attract payments from employers, NGOs, and donors as well as fee-paying households.

Viable business models for Ghana

a. CHPS-Enabled Franchise/Partnership Model

A private operator partners with district health authorities to upgrade selected CHPS compounds into CHPS+ service hubs offering expanded home visitation, teleconsultation, and supply chain integration for essential medicines. Revenue is a mix of NHIS reimbursements (where applicable), private payments for enhanced services, and capitation from corporate clients (e.g., employer groups). This model leverages existing public assets and minimizes initial capital outlay.

b. Subscription-Based Home Health and Caregiving Services

Targeted at urban and peri-urban middle-income households and expatriate families, firms can offer tiered subscriptions bundling nurse visits, physiotherapy, medication delivery, and caregiver staffing. Digital scheduling, outcome dashboards, and optional third-party financing partners (microcredit or health loans) make subscription uptake feasible.

c. Digital Chronic Care Platform with Community Workforce

A platform provider sells RPM devices and a cloud care coordination suite to hospitals, district health administrations, and private insurers while contracting CHOs and community volunteers to perform in-home onboarding and basic triage. Revenue streams: per-patient subscriptions, device sales, and performance bonuses tied to readmission reductions.

d. Social-Enterprise Long-Term Care (LTC) Residences + Home Care

A blended finance model where a social enterprise builds small, community-context LTC residences for frail elders and simultaneously offers home-care teams for aging-in-place clients. Cross-subsidization (private payers subsidize subsidized beds) plus donor capital for initial capex can make this sustainable.

Operational and regulatory constraints

Workforce and informal caregiving

Direct care workers and CHOs are essential but underpaid and stretched. Any scalable HCBC business must invest in workforce development, career pathways, and productivity tools (mobile job aids, remote supervision) to maintain quality and limit turnover. Recent studies document caregiver burden and the need for formal supports, both of which are social and economic imperatives.

Financing and NHIS coverage gaps

NHIS benefit exclusions (e.g., many rehabilitation services and durable medical equipment) limit the reimbursable revenue HCBC providers can expect to receive. Successful ventures will either design services that fit within reimbursable bundles, negotiate new benefit arrangements with regional NHIS offices, or develop private pay offerings with value propositions compelling enough to secure out-of-pocket payments or corporate sponsorships.

Digital infrastructure and equity considerations

Broadband and smartphone penetration are improving but remain uneven, especially in rural districts where CHPS is most active. Business models must therefore be hybrid: low-bandwidth SMS/USSD and IVR solutions, offline data collection tools for CHOs, and human touchpoints for populations with limited digital literacy. Equity means intentionally subsidizing services for remote or poorer communities through cross-subsidies, donor funds, or blended finance.

Policy levers and public-private collaboration

To unlock HCBC’s potential at scale, coordinated policy action can align incentives:

1. NHIS benefit expansion pilots that reimburse defined home-based bundles (e.g., post-discharge home visits, RPM for high-risk NCD patients). Pilot results should be rigorously evaluated for cost-offsets.
2. Accreditation and quality frameworks for home health agencies and caregivers, developed in partnership with the Ghana Health Service (GHS), to ensure clinical standards and build payer confidence.
3. Workforce investment programs, scholarships, in-service training, and formal career ladders for CHOs and home-care aides, to professionalize the sector and reduce attrition.
4. Digital health interoperability standards that allow CHPS, district hospitals, and private platforms to share essential clinical data while safeguarding privacy.

Risk, measurement, and impact evaluation

Commercial actors should embed evaluation into operations: randomized or pragmatic trials of RPM and hospital-at-home pilots, cost-effectiveness analyses comparing hospital stays with home alternatives, and qualitative work on caregiver burden and cultural acceptability. Demonstrable reductions in avoidable admissions, measurable improvements in disease control (e.g., blood pressure, HbA1c), and positive patient experience metrics will be the primary sell to payers and investors.

Conclusion

Ghana’s HCBC ecosystem offers diverse, investible pathways that align commercial returns with public health value. The most promising ventures will (1) partner with CHPS and district health systems to leverage trust and reach; (2) design hybrid digital-human services that work in low-bandwidth settings; (3) create sustainable revenue models through mixed payer strategies (NHIS, private pay, corporate contracts); and (4) invest in workforce professionalization and rigorous measurement. For policymakers, enabling pilots, adjusting NHIS packages when cost-effective, and establishing regulatory clarity will catalyze private-sector entry while safeguarding equity.

The transformation beyond hospital walls is both a public health necessity and a commercially attractive frontier in Ghana. Realizing these potential demands patient, context-sensitive business models that honor local community structures, invest in people, and demonstrate measurable health and economic impact.

About the Author:

Dr. Isaac Mawuko Adusu, DHA is a policy advocate and health and human services management expert who focuses on nonprofit healthcare systems and their leadership development.

By Isaac Mawuko Adusu, DHA

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