Using community-based approach to solve health needs of rural Ghana

BY: Rebecca Quaicoe-Duho, GHANA

In 2003, GHANA adopted the Community-based Health Planning and Service (CHPS) compound as a way of providing quality health care to people especially, in the rural area.

Managed by a community health officer (CHO), the model works to transform rural health care service delivery from clinic based care to outreach workers who actively seek patients in their homes. This relocation of services extends primary health care to underserved communities.

The CHOs who are accommodated on the compound of the health facility provide reproductive, maternal and child health services, manage diarrhoea, treat malaria, acute respiratory infections and childhood illness and provide comprehensive family planning and childhood immunization outreach.

The CHPS model was launched in 1994 as a pilot study in three villages and it was aimed at removing geographic barriers to health care through its “close to client” service. CHPS has been accepted by all health partners as a good strategy to attain national coverage of health services.

According to Ghana’s Ministry of Health, as at 2013, there were 2,226 CHPS zones, 1,896 of which were functional. The country, however, needs 4,000 functional CHPS zones across the country to achieve its aim.

However, the challenge now is that some of these CHPS zones have failed to implement all of the necessary milestones, such as building compounds, placing CHOs in the compounds and providing training for them. So far, only 86.2 per cent of CHPS zones have CHOs. Out of that number, only 12.7 per cent of them received initial training on how they were going to implement the programme.

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Another hurdle that the programme is facing is that as CHPS started as a community-based trial in primary health care access and not a systems level initiative, there have been several road blocks to successful scale up.

Also there is a need to acknowledge the larger political and developmental context of CHPS scale up. The main issues faced in the scale up include leadership problems, unclear definition of the CHPS concept, and issues with resource mobilization at the national, regional, district and community levels.

As CHPS has grown, it appears to have dissipated from the original model. This unclear definition of CHPS has led to confusion of roles and responsibilities of various stakeholders. For example, communities are expecting a variety of clinical services and demanding curative services.

Communities also expect a more active role in the governance and oversight of the programme.

Community members do not understand the roles and responsibility of the CHOs and do not recognize the distinction between community-based health care delivery and a facility based system. The confusion surrounding the definition of CHPS has led to its transformation in some areas to a clinic-based programme with emphasis on curative treatment.

Another issue in the scaling up of CHPS involves the deployment, distribution, retention and productivity of CHOs in needed zones. Due to the poor deployment plan, many CHOs are not resident in the zones, while those with compounds are becoming occupied with providing curative services and are not able to offer preventative and promotive services. Also, many CHOs desire to continue their education, leading to dissatisfaction with their current placement.

Although the Ministry of Health is expected to, in the next five years, expand the CHPS programme to cover 85 per cent of the country, to help develop a resilient community-based health system infrastructure that would ensure universal health coverage based on primary health care, it is not taking into account the training and other teething problems that the programme is still encountering.

At a validation meeting recently to review a revised policy that will bring clarity and agreement on how CHPS is to be operated in the country, the then Minister of Health, Dr Kwaku Agyemang-Mensah underscored the fact that CHPS as a concept was being implemented with varied understanding.

He pointed out that the variations in design have led to a non-standardised approach to service delivery. The meeting was, therefore, used to validate an implementation guideline to direct the CHPS implementation and a road map that articulates results to be achieved and resource mobilisation.

Dr Agyemang-Mensah called for innovative approaches to rapidly scale up the training and management of human resources, building of facilities and provision of services, saying that, “we will look favourably at possible public-private partnerships to rapidly achieve this goal.”

So until all the teething problems confronting the CHPS programme are resolved, Ghana cannot use the community-based approach to resolve its healthcare needs, especially in the rural areas.

Fact Sheet
* In 1999, a consensus was reached to adopt CHPS, as a national strategy to improve access, efficiency and quality of health care
* The Community-based Health Planning and Services (CHPS) is a national initiative which started as a Community Health and Family Planning Project, based on advancements in Bangladesh.


A Daily Graphic publication in collaboration with Ouestaf News and with support from Osiwa.