OBJECTIVES: Ghana’s Community-based Health Planning and Service (CHPS) initiative to design a system for developing community based health care with full participation and support from community members. METHODOLOGY: The CHPS initiative scales up strategies developed and tested by a project of the Navrongo Health Research Centre in northern Ghana.  Launched in 1994 as a three village pilot to develop strategies for mobilizing volunteerism, resources, and cultural institutions for supporting community-based primary health care, the project was expanded to a district-wide four celled trial in 1996. When evidence demonstrated that Navrongo strategies reduced childhood mortality, a replication project was launched in Nkwanta district to test and develop methods for scale-up.  Using evidence from Nkwanta, national scale-up was launched in 2000 as a program of exchanges for district teams to work with Navrongo and Nkwanta implementers on designing pilot implementation of CHPS elsewhere in Ghana. RESULTS: This paper reviews operational determinants of this success and implications of the Upper East Region experience for efforts to develop evidence-based community health services elsewhere in Africa  CONCLUSIONS: Although CHPS scale-up has been launched in all 170 districts, the Upper East Region remains its lead performing region, despite challenging economic, ecological, and social circumstances for health development.