Busunu Clinic promotes quality health care
Busunu Clinic serves a rural community of about 8,000 inhabitants in the West Gonja District in the Northern Region of Ghana.
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For sick children in Busunu, most parents obtain treatment from traditional healers or chemical sellers (small-scale drug stores in the community) and only bring them to the clinic as a last resort.
When parents bring their children to the health facility very late, the children sometimes die needlessly. The reasons for the delay in seeking care include sociocultural beliefs against modern medicine, financial hardship, distance, previous bad experience with the health system, and perception that health facilities are places of death.
Traditional healers and chemical sellers encourage self-medication by selling herbal preparations and drugs that do not actually treat the child’s condition, and may either worsen it or even lead to deaths from preventable causes such as malaria and pneumonia.
Through the assistance of Project Fives Alive!, the Busunu Clinic established a quality improvement (QI) team which, in partnership with chemical sellers and women’s groups, undertook an improvement project to reduce delays in care-seeking for sick children less than five years old (Under-5s) in their community.
After collecting data for three weeks, the QI team found that there was an average of four days between the onset of illness and presentation at the clinic. Curious to ascertain what parents were doing during this period that their Under-5 children were sick, the QI team interviewed a sample of parents, who indicated that they had treated the child with drugs obtained from chemical sellers.
Further assessment suggested that most of these drugs were antipyretics or analgesics, which provided symptomatic relief but were not curative or were the wrong drugs for the child’s condition.
Eager to reduce the time between onset of illness and presentation at the clinic, the QI team pursued specific change ideas (interventions) that would reduce the number of days of waiting after the onset of an illness down to two. Guided by information gathered, the clinic team held meetings with chemical sellers and women’s groups to discuss early care-seeking for Under-5s in their community to obtain their support for early referral to the clinic.
They also invited chemical sellers to participate in the clinic’s QI meetings, which led to the development of a documentation system to track referral compliance. Also, the team educated community members on the need for early care-seeking for Under-5s and encouraged all parents to register with the National Health Insurance in order to avoid point-of-service payment.
Even though the clinic’s hospital QI team meant well, there were some challenges. Some chemical sellers and traditional healers suspected that the QI team undermined their competence and sought to deprive them of their livelihood, and some mothers still considered the health facility as a place for either the elite or emergency. Intensified community education coupled with partnership with the chemical sellers and women’s groups helped the team to surmount this challenge.
By Dennis Ocansey/Daily Graphic/Ghana