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Ghana’s CHPS Initiative Ghana Health Service With USAID support Jane Wickstrom Sr. Technical Advisor for Reproductive Health USAID/Ghana June 2002

Ghana’s CHPS Initiative

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Ghana’s CHPS Initiative. Ghana Health Service With USAID support Jane Wickstrom Sr. Technical Advisor for Reproductive Health USAID/Ghana June 2002. Outline of presentation. What is the Community-based Health Planning and Services (CHPS) Initiative Where are we now? The way forward. - PowerPoint PPT Presentation

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  • 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

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  • District Assemblies know CHPS

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  • Community awareness of CHPS

    Chart9

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    District Assembly

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    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)