Ghanas CHPSInitiative
Ghana Health ServiceWith USAID support
Jane WickstromSr. Technical Advisor for Reproductive Health USAID/GhanaJune 2002
Outline of presentationWhat is the Community-based Health Planning and Services (CHPS) Initiative
Where are we now?
The way forward
Background Governments desire to improve health status of GhanaiansPoor performance of health sector over the yearsRecognition of the need for a change in health delivery strategy
CHPS At A Glance National strategy for extending access to basic health services
Initiative based on research evidence from Navrongo Health Research Center (1994)
Nation-wide implementation begun in 2001
Navrongo in NE Ghana
Where it all began
Navrongo Experimentassessed the demographic impact of convenient community health and FP services on fertility
tested the hypothesis that changes in service delivery can induce and sustain reproductive change
Navrongo Findings:Community health improves with both nurse relocation and social mobilization
The result is a fertility decline of one birth in the marital TFR in 3 years
Communities Truly Involved
CHPS At A Glance Community Health Committees, Volunteers and Mobilization of community leaders
Community-based Health Officer deployed to the periphery and is mobile!
CHPS At A Glance (cont)Resource Package: Transport, Community Health Compound (housing), and means of communication
Defined service package based on National Treatment Guidelines
Defined catchment area
CHPS differs since it Deploys CHO to the community
Home visits instead of static clinicsHeading out for service delivery
The Community Health Officer (CHO)
Volunteers, TBAs and Councils
Community Leaders Committed
Political Leaders CommittedCentral and district levels must be involved
Ghanaian Initiative Run by GhanaiansDirector Generals Initiative Director PPME runs M&ERegional Directors manage TADistrict Directors mobilize health staffSub-district supervises CHO
Technical and Financial Support from USAID and DANIDAJHU/PCS - community mobilizationPRIME II - train CHOsEngenderHealth - counselingPopulation Council - M&EDonors transport, communications, some equipment
Integrated Services is the KeyCommunities want full range of services:Maternal careChild healthHealth educationFamily PlanningMinor Injuries
For Safe MotherhoodCommunities want CHO to:Monitor pregnant womenProvide simple ante-natal care (nutrition counseling, malaria prevention, etc.)Map out delivery planAssist TBAs, deliver (if a midwife) or referPost-partum follow-up
Communities & Safe MotherhoodCHPS communities support CHO to:arrange or conduct clean deliveriesrecognize complicationsarrange transportationHelp establish community fund for health emergencies and transport
National Scope of CHPS The Lead District Approach
Location
Number
Regions
10
Districts
20
Sub-districts
40
CHOs
80
First Year TOTAL
80 sites
Districts Starting CHPS Dec. 31, 2000 Dec. 31, 2001
Quarterly reporting form Database Two-way Information sharing (CD-ROM) CHPS website: www.ghana-chps.orgCHPS M&E Secretariat
Continued Research, Monitoring and Evaluation Lead District Assessment (2001) Strategic Assessment Method Rapid Survey Method (RSM). MIS Mobilization CHPS cost analysis.
Lead District AssessmentResults from Year One
Successes to date
Increased awareness of health services and healthy behaviors
Services closer to people and people seeking care earlier
Construction of CHCs; formation of VHCs and volunteer services
Starting to obtain District Assembly support
Constraints to dateLack of support materials for CHOs, volunteers and committees
Lack of housing for CHOs and visiting supervisors
Lack of human resources to meet demand; lack of training for volunteers
Lack of motivation/incentives for CHOs
20 Lead Districts using CHPS 94% selected communities54% have CHOs assigned 56% receive support from District Assembly75% believe resources are not adequate to enable CHOs to perform
District Health Managers aware of CHPS
Chart6
0.96
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DHMT
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DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
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0
0
0
DHMT
DHMT Level of Awareness
Sheet2
0
0
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DHMT Level of Awareness
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HighMediumLow
DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
Sheet3
0
0
0
DHMT
DHMT Level of Awareness
0
0
0
District Assembly
District AssemblyLevel of Awareness
0
0
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Community
CommunityLevel of Awareness
District Assemblies know CHPS
Chart7
0.44
0.31
0.25
District Assembly
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HighMediumLow
DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
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0
0
0
DHMT
DHMT Level of Awareness
Sheet2
0
0
0
DHMT
DHMT Level of Awareness
Sheet3
HighMediumLow
DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
Sheet3
0
0
0
DHMT
DHMT Level of Awareness
0
0
0
District Assembly
District AssemblyLevel of Awareness
0
0
0
Community
CommunityLevel of Awareness
Community awareness of CHPS
Chart9
0.7
0.26
0.04
Community
Sheet1
HighMediumLow
DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
Sheet1
0
0
0
DHMT
DHMT Level of Awareness
Sheet2
0
0
0
DHMT
DHMT Level of Awareness
Sheet3
HighMediumLow
DHMT96%4%0%
HighMediumLow
District Assembly44%31%25%
HighMediumLow
Community70%26%4%
Sheet3
0
0
0
DHMT
DHMT Level of Awareness
0
0
0
District Assembly
District AssemblyLevel of Awareness
0
0
0
Community
CommunityLevel of Awareness
CHOs Want More Training in:
Priority
Module Title
1
Advocacy and Mobilization
2
Managing CHO Activities
3
Deliveries
4
Supporting TBAs and Volunteers
5
Disease Surveillance
6
Behavior Change Communication
7
Ante-natal Care
8
Family Planning Services
9
Managing Common Ailments/Emergencies
10
Immunizations
11
Home Visiting
12
Post-natal and Neonatal Care
The Way Forward
We are all in this boat together!
The Way ForwardNeed clear priorities, indicators and targets for success
Health Leadership and Supervisors must facilitate organizational support
CHOs need clear career path and incentives to relocate to periphery
The Way Forward
Comprehensive training strategy needed, in-service and pre-service
Resource mobilization key (Districts Assemblies, MOH, Common Basket, donors)
Improve flow of finances to regions and districts
The Way Forward
Innovations and Monitoring ContinueRadio Distance LearningCommunity Decision Making SystemUse CHEST Kit, Journey of Hope and Life Choices IEC materials for educationRefine M&E system
Learn from Navrongo
Training Site for CHOsCommunity Entry and Mobilization trainingLink Theory and Practice in community health service delivery
Learn from Navrongo
Demystify CHPSLearn about variations on CHPS implementation Teach Districts to document their own storiesDevelop dissemination materialsWhat works, What failsVideos
Next stepsUSAID support for training, M&E, and transport/equipment
Continue monitoring results of CHPS to assess impact
Disseminate results within Ghana and internationally
Thank You !
Health volunteer schemes have been used in the past with limited success. In a different approach to improving access to healthcare, the Ghanaian Ministry of Health decided to use Community Health Nurses (CHN) instead of volunteers. In the 1990s, this paramedical cadre was recruited, trained, and assigned to sub-district clinics throughout the country to provide ambulatory care for malaria, acute respiratory infections, and diarrheal diseases. The CHN also provided immunization services, family planning, and health education activities. Outreach to the communities surrounding each sub-district clinic was an important feature of the plan. The CHN program failed to improve health care coverage for many reasons, including the reality that the nurses stayed close to the sub-district clinic. Ministry officials began to hypothesize, perhaps if the nurse were truly community-based, maybe access to health services would improve? The Navrongo Health Research Center (NHRC) in northern Ghana was charged with an experiment to test strategies to improve accessibility and reduce mortality and fertility, using existing resources of the Ministry for community-based health care. USAID supported the research, with technical assistance from the Population Council.
Quote from community leader in Nkwanta, if the CHO is posted here, we shall get a house for herIf there are problems at her residence and she informs the community, we shall assist herwe will provide foodstuff to make her comfortable. (Feb. 2002)The Nkwanta nurse describes her job, a nurse is put in a community where she works with the health committee and people in the community. The nurse does on home visits in the surrounding communities; she gives education on nutrition, health and help with minor ailments. (Feb. 2002)
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