#### Introduction
Transnational Health Projects (TNHPs) are a form of planned engagement of a diaspora community for their country of origin in the area of health. International organizations and governments of northern countries point out that diaspora communities can positively contribute to the development of their countries of origin by remittances and transfer of know-how. The Ghanaian community is a diaspora of particular relevance in Germany. People with a Ghanaian migration background account for the largest group of immigrants from Sub-Sahara Africa (approx. 40,000). They form a socially and economically active community that has developed extensive transnational networks over the years. The motives as well as the thematic focus of commitment vary; areas of interest are for example health, education or infrastructure. However, activities in the health sector (e.g. establishing healthcare centers, sending medical equipment, etc.) account for one of the main areas of engagement.
#### Aim
The study aims at exploring the social phenomenon of TNHPs. For this purpose, respective interactions between Ghanaians living in Germany and relevant actors in Ghana are investigated and analyzed. This includes the identification of the projects' topics, actors involved, activities, resources and motivations. In addition, strategies (logic of action) as well as factors inherent in the transnational setting are examined. The projects' possible effects on availability, access and perception of health services in Ghana as well as the potential influence on transnational networks are evaluated and discussed.
#### Methods
A qualitative research design was chosen to pursue the objectives stated above. The transnational character of the research topic is reflected in the fact that, over a period of almost two years, a total of 50 semi-structured interviews were conducted in Ghana as well as Germany. The sampling followed the network structures of the projects, covering donors, recipients and supporters as well as actors holding knowledge about the processes of transnational engagement, e.g. representatives of institutions and organizations. Five TNHPs were identified and served as the basis for developing a typology of transnational engagement in the area of health.
#### Results
TNHPs are characterized by constellations of actors in Ghana and Germany who bring in their interests from donors‟, recipients‟ and supporters‟ perspective. Depending on the topic of the TNHPs, different resources are needed. Monetary resources and funding were often explicitly described as a prerequisite of a TNHP. While the resources that individuals provide for a project can be very beneficial for the development of a project, the dependence on a singular person also poses high risks: his or her withdrawal can have a hampering impact on the development of the project. By contextualizing the characteristics identified, the motivation of actors and the availability of resources, three different types of engagement have evolved, namely “continuous engagement” (Type I), “single action” (Type II) and “planning” (Type III). Type I is characterized by a pragmatic approach that, in combination with available resources, results in the realization of projects. With new ideas and the perspective of further development evolving, actors are encouraged to stay involved and maintain or advance their engagement. Type II is characterized by a fixed goal and the limitation to one project, which is completed under difficult circumstances. A lack of resources is the major factor for discontinuation. Type III is characterized by a project idea that develops over time. The engagement is motivated by an optimistic attitude, and even if the conditions to accomplish a project are not supportive, the actors remain optimistic and stick to their commitment.
#### Discussion/ Conclusion
TNHPs have been identified from the literature as a part of civil society and of the (transnational) community that has the potential to take an active role in the context of health sector development (Primary Health Care and Universal Health Coverage). The TNHPs accumulate different forms of resources and take shape in heterogeneous forms of engagement (Type I-III). The study has shown how difficult it is for researchers to identify strategies and to demonstrate how they contribute to the development of the Ghanaian health system. However, the examples show that TNHPs, within the limits of their resources, do contribute to the availability, accessibility and quality of Ghanaian health services. While the projects cannot compete with or substitute activities of other actors (e.g. Ghanaian government, non-governmental organizations, private for profit providers), the current development of guidelines and policies (e.g. National Migration Policy, Sustainable Development Goals) are meant to strengthen the TNHP's contribution as civil society actors. In order to better understand the potential of transnational engagement, further research on the phenomenon of TNHPs is needed, e.g. collecting data on a larger scale to quantify the phenomenon for Ghana and internationally, or applying a participatory research approach. This holds the opportunity to increase the actors' agency and to strengthen their role in a competitive field and to reaffirm the importance of community engagement for health in times of global migration.
