Guidelines for CHPS Implementation

8/8/2019 Guidelines for CHPS Implementation

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Guidelines for CHPS implementation, Eastern Region (DRAFT)

PART ONE

General Principles of CHPS

Definition

CHPS is the acronym for Community based Health Planning and Services

The CHPS concpet means three things: a process, a policy and a strategy.

PROCESS - All stakeholders in health participate in planning, implementation, monitoring &

evaluation of health service delivery at community & household levels. The fifteen (15) steps are

all important. One step does not need to be completed before moving to the next. Sometimes you

may have to go back to strengthen a step when you realise that it is weak.

The step are broadly grouped into two: strategic and operational planning phases.

The Strategic planning phase is when the DHMT and the other key stakeholders plan to zone the

district into CHPS zones and come sout with a district coverage plan which may be updated

every year. The following steps are important:

i. Situation analysis of the districtii. Consultations among stakeholders about the concept and the process and building

consensus on the zonal centresiii. Zoning of whole district into CHPS zones

iv. Prioritising zones for implementation based degree of need for proivding access to healthservices, commitment of the communities int he zones and availability of resources

Operational(Implementation) planning. This begins when it district has decided to establish a

particular demarcated CHPS zone.

The phase involves:

i. Community entry to further introduce the concept to all communities in the zones. It

involves conducting several meetings with the leadership and the communities of each of the different communities that consitute the zone.

ii. Training and preparing the CHO to take the job

iii. Formation of a representative zonal health committeeiv. Construction or finding a suitable accommodation for the CHO(s)

v. Conducting the community profile. It involves community mapping, house to houseregistration of population and collection of other household data, records review,

interviews of key people in the community, etc.



vi. Mobilising resources ± vii. Selection and training of health volunteers. Suitable existing volunteers may presented to

the community for endorsement or otherwise.viii. Launching the CHPS zone ± usually a big durbar attended by all the communities under

the zone, health committee members, volunteers, TBAs,DHMT, SDHT, district

assembly, other stakeholders.Main aim of this grand durbar are to: Introduce the CHO, health committee members and the volunteers and to indicate

the team are to start performing their duties fully. The calrification of the roles of the various stakeholders: CHO, health committee

members, volunteers, community members, sub-district health team, DHMT andthe district assembly.

K ey issues to discuss are the security of the CHO and the mechanisms, includingthe mode of financing, for referral and transportation of emergencies to the health

centre or hospital.

What is the implication of CHPS as a PROCESS?

It means the critical steps must be followed to install the CHPS. These are making the

communities to understand the concept and play their part; and the CHO well trained in the

process and carrying out the key activities that different CHPS from the ways they were

accustomed to.

POLICY ± It is a stated government policy as an integral part of the health system orgnaisation

in the country.

The stated CHPS policy goal is to improve health status of people living in Ghana by

empowering households & communities to produce good health for wealth creation.

The Policy objectives are:

i. Improve Access to health servicesii. Improve Efficiency and Responsiveness to client needs

What is the implication of CHPS as a POLICY?

Whait it means is that it district health managers or staff have not the option not to implement

CHPS. It is mandatory for district managers led by the district director of helth services to

explain the policy to all their staff and ensure its implementation.

STRATEGY ± It a unique way of organising and providing health care. It recognises the unique

resources available in communities and their role in promoting good health and participating in

the delivery of health care. It recognises the importance of health personnel living within

communities their unique leadership and empowering role.



CHPS encourages all stakeholders to work together to empower & make health services

accessible to households through participatory planning, resources mobilisation, implementation,

monitoring & evaluation of service delivery.

The strategic focus of CHPS Implementation:

Building partnerships & collaboration among govt agencies, development partners &

NGOs for synergy

Directing all efforts towards empowerment of households & communities for good health

& wealth creation by thier active participation.

What is the implication of CHPS as a STRATEGY?

CHPS as a strategy means that it need to be implemented as its designed to have the desired

effect. It is not the usual thing. It is doing things differently from what we were doning before.

PART TWO

Operationalisation of a CHPS Zone

The following a re CRTICAL STEPS in CHPS implementation once a Zone has been selected

for operationalisation:

i. Community entry (module 14)

ii. Establishment of CHPS zone health Committee

iii. Training of a CHO(s) for the zoneiv. Production of community profile (module 14)

v. Provision of living accommodation and working unit for the CHO

vi. Launching of CHPS zone.

Community entry involves:

1. Recognizing the community, its leadership & people: Identify community leaders and

contact persons and hold meetings to understand their problems, and the place of health in

their prioritisation.

2. Learning from the community in order to adopt the most appropriate processes to interact

and work with community members

3. Introducing the CHPS concept, its relevance and importance, and actions necessary to

realise better health for the people. This should involve the leadership of all the



communities under the zone. Separate meetings may be held first then followed by a

meeting with representatives from all the communities to decide on the critical issues of

zonal centre, how to provide the CHPS compound and the formation of the community

health committee.

Establishment of CHPS zone health Committee

The CHPS zone health committee, often called community health Committee (CHC), is an

important structure that must be put in place once the people in the zone support the

establishment of the CHPS zone.

Their roles are:

1. To act as the immediate liaison with Ghana Health Service through the CHO and2. Mobilisation of the people for the CHPS activities for their active participation in health

matters.

Their duties include the following:

1. Initially they mobilise the community and resources for the CHPS compound construction.2. They develop and ensure the implementation of community health plans to address

community health problems that require community action.3. They monitor the activities of the community volunteers.

4. They monitor the activities of the CHO.5. The monitor the security siutation of the CHO.

Production of community profile

This provide the necessary information for proper planning and working with the people. It starts

with the community entry when the your gather information about the communities and the

people.

Community mapping by walking through the communities in the zone and drawing a map of the

zone showing important landmarks, facilities, etc, is an important part of developing the profile.

The actual community profile activity involves the house to house visits to interview and record

all information on population demographics, available resources, economic and socio-cultural

elements. This provides the information for the community register which needs to regularly

updated as the CHO begins having the cyclical house to hosue visits.

Launching of CHPS zone.



Launching of the CHPS zone in the form of a community durbar invloving the whole population

of the zone¶s area is a critical acitivity that must always be carried out to mproperly usher in

CHPS to a community. The objectives of the launching are as follows:

1. To announce to the population of the catchment area about the commencement of activity

service delivery by the CHO and the volunteers2. To introduce the CHO, the volunteers and community health committee members.

3. To spell out the duties of the key stakeholders: community members, community healthcommittee, volunteers, community health officer, district assembly and its substructures,

Ghana Health Servcies at sub-district and district levels, etc.4. To spell out the types of services that can be provided by the CHO5. To start the process of establisning the community mechanism of referrals and how they

can be transported to the appropriate level.6. To acknowledge the contributions of other stakeholders for their contribution to the

establishment of the zone (e.g. NGOs, prominent natives from the area).

There is often merry making because it is the culmination of the tedious processes of moilsing

the community, resources and preparing the ground for the full operation of the zone.

However, the merry making should not be allowed to overshadow the objectives outlined

above. Usually the district political and zonal traditional and religious leardership are invited

and commencement may be delayed because of the numerous schedules of these busy people.

It is thereforoe often necessary for the DHMT to esnure that the some of the above objectives

are addressed by engaging the crowd in discussions about the issues before the formally

opening begins.

A Functional CHPS Zone

A CHPS zone is described as functional when he satisfies all the following criteria:

1. The availability of an annually updated CHPS zone profile and community registers;

2. There is a functioning CHPS zone Community Health Committee (CHC); and3. There is a trained and functional community health officer (CHO) responsible for the

zone.

1. The availability of an annually updated CHPS zone profile and community registers

The following information is available at the zonal office:

i. Zonal profile document with the following information: communities, demographic,

infrastructure, social, economic, religious, resources, communication, health problems, etcii. Map of the zone in relation to other CHPS zones

iii. Evidence of annual updating of profile, especially demographic data

2. There is a functioning CHPS zone Community Health Committee (CHC)

i. There is a list of membership of CHC representing the cross-section of the communitiesconstituting the zone;



ii. The CHC meets monthly or at least quarterly with evidence of minutes kept at zonaloffice; and

iii. There exists a current CHC work plan.

3. There is a trained and functional community health officer (CHO) responsible for

the zone.

i. The nurse has received the CHO trainingii. The CHO has been officially introduced to the all zone population in a public durbar iii. The CHO conducts:

Regular house to house visits for health promotion activities Hold monthly or at least quarterly community health durbars

These are the minimum standards for a CHPS zone to qualify to be designated a functional zone.

Please, note that the CHO reports should include these indicator activities.Any of these criteria if

not verifiable disqualifies the zone as functional.

Role of Community in CHPS

1. Provide CHPS compound, if capable, or assist in the construction.

2. Assist in the maintenance of the CHPS compound3. Provide security for CHO and the CHPS compound

4. Participate in the planning, organisation and delivery of health services

Role of the District Assembly

1. Assist communities that cannot provide CHPS compounds to construct and maintainCHPS compounds

2. Provide utility services such as safe water and electricity to the compound3. Assist in providing security to the CHPS compound and the CHO

4. Support to maintian the volunteer system5. Mobilise other resources to support CHPS activities

6. Monitor the CHPS implementation in the district.

Role of District and Regional HealthManagement Teams (DHMT/RHMT)

1. Plan and coordinate CHPS implementation

2. Carry out advocacy and community mobilisation for CHPS

3. Mobilise resources for CHPS implementation

4. Provide training and technical support to CHOs & SDHTs

5. Monitor, supervise and evaluate the implementation

Role of Sub-district Health Teams (SDHTs)

1. Participate in the planning and establishment of CHPS zones in sub-district



2. Mobilise communties for CHPS

3. Provide logistics support to CHOs

4. Supervise of CHOs

5. Provide technical support to CHOs

6. Monitor CHPS activities in the zones

Roles of the Community Health Officer (CHO)

The CHO plays three key roles: as aprimary healthcare service provider,community health

change agent and community health manager.

As health professional with primary healthcare service provider function. ± He/she provide

treatment for minor ailments, providing preventive and health promotion services, including

reproductive and child health and disease control, to households and communities.

As community health change agent ± He/she works with communities and households to

identify their health problems and find solutions for them. Through mutual learning households

are empowered in health matters, and the CHO¶s professional competencies, leadership and

social skills are further enhanced.

As a community health manager -

He/she lead in the planning of community health activities and manage the CHOactivities ± priroty setting, planning weekly, monthly iterineraries, implementation,

monitoring and evaluation (Module 1) He/she manages resources made available to him/her for health in the community. These

resources include, transport, equipment, transport, medicines, other logistics and time.

The Different Options for Training and Development of the Community

HealthOfficer (CHO)

1. Two weeks orientation training on core functions/duties prior to placement

This is mandatory before a CHN is assigned to a CHPS zone. The health worker is taken

through the two weeks core orientation training.

In some cases after this traing it may be necessary to also attach the person to a more

experienced CHO for some period before final placement.

2. Attachment to acquire adequate midwifery skills preferably in district hospital ( 2-3

months)



In a CHPS zone where there is no health facility with delivery services, that CHO should receive

some additional midwifery skills training, preferably 2 -3 months attachment in a hospital.

Periodic attachments and supervision is very important to build their skills and confidence.

3. Training on IMCI ± clinical & C-IMCI

All CHOs should be given the community IMCI training to enable them supervise volunteers.

Those CHOs who are required to treat minor ailments should be given clinical IMCI trainingis as

well.

4. HIV/AIDS counselling & testing training, including PMTCT

Now that PMTCT is to be implemented at all ANC service delivery points using the opt out

strategy, it goes without saying that the ANC module in the two weeks CHOs orientation course

should be updated to include PMTCT. The CHO may also be given the repscribed PMTCT

training.

DDHS should plan for CHOs to undergo HIV/AIDS counselling training to enhance their

counselling skills. Attachment to experienced counselling during counselling sessions should

also be promoted.

5. Family Planning counselling training

The provision of family planning services is an important activity of the CHO hence DDHS

should plan and organise family planning counselling training workshops for all CHOs

6. Adolescent sexual & reproductive health training

Adolescents are important segment of the population and CHOs should be trained on adolescent

health policy and service delivery and the reproductive health protocols.

7. IEC & Behaviour Change Communication(BCC) training

The work of the CHOs mainly hinges on IEC and BCC hence the need for them to acquire these

skills. They is therefore the need to take them through regular IEC and BCC training workshops

8. Working with Communities and social groups

CHOs skills in working with communities and social groups should be built through workshops

and seminars

9. Regular In-service training & updates on new services/new knowledge.

CHOs should be seen as key service providers who should be targeted whenever new service

areas are introduced or change of policy are made.



10. Regular CHO review meetings

The DDHS should organise monthly or quarterly meetings for CHOs to meet and share their

experiences and learn from each other. It is important for SDHT and DHMTs to participate in

these meetings to follow the CHPS implementation and address any misunderstanding and problems that they may have.

During these meeting each CHO should present their performance according to a format

developed by the DDHS, followed by questions and discussions. The meeting should end with

plans to address problems identified and spelling out actions to be carried at each level.

Critical Success Factors of CHPS Implementation -These elements should therefore be given greater

attention.

1. Well informed, dedicated and resource district director of health services who believes in the concept.

2. Effective supervisory support from DHMT to sub-districts and to CHPS zones.3. Early involvement of the communities in the CHPS process.4. Active CHPS zone health committee.

Challenges to CHPS Implementation

1. The concept of CHPS not understood by some stakeholders. This is not limited to

community members alone. Some health professional are themsleves ignorant and some

some extent sceptical. Everybody needs to try to understand the concept and how it can be

operationalsied to bring health benefits to households and communities, especially rural

and deprived communities.

2. Lack of suitable CHPS compounds. Many communities cannot provide CHPS compounds.

Some CHPS compounds that are constructed are without essential utilities such as safe

water, electricity and toilet facilities. Some structures have no living accommodation for

the CHO

3. Inadequate funds for CHPS activities ± for equipment, transport and recurrent activities.

Many CHPS zones are without the necessary equipment. Funding for the training of CHOs,CHCs and volunteers, and for social mobilisation and community durbars are insufficient.

4. Many CHOs do not ride motor bikes provided.

5. Weak supervision of CHPS implementation. DHMTs and sub-districts ar enot supervising

and monitoring the activities of the CHOs. Such CHOs are not motivated to stay at their

zones, hence numerous complains from community members from such zones.



PART THREE

Operations of the CHO

CHO Activities

Arising from the the three roles above the CHO is expected to carry out activities that fall under

the following broad areas:

A. Provide reproductive and child health (MCH) services

B. Carry disease surveillance and control activities

C. Manage minor ailments & referrals

D. Carry out social mobilisation and advocacy for health promotion and nutrition activities

E. Manage health programmes and resources

A. Providing Reproductive and child health (MCH) services including antenatal care,conducting deliveries, postnatal care, family planning counseling and services, EPI, growth

monitoring and promotion, etc

i. Provision of EPI services

ii. Provide ante-natal and post-natal care

iii. Family Planning services & counselling

iv. Distribution of Condoms & non-injectable FP

v. Counselling & BCC on STIs

vi. Carry out growth monitoring and promotion for under-five children

vii. Provide School health services to Day nurseries and schools in the catchment area with

assistance from the sub-district

viii. Promote regenerative health and nutrition among all age groups.

B. Carry out disease surveillance and control activities in the catchment area by:

i. Compiling and submitting communicable disease Form CD1 to the sub-district



ii. Investigating and reporting to the district on unusual events reported from thecommunities

iii. Notifying the district immediately of any disease outbreak iv. Ensure the implementation of community based disease control activities such:

y

ITN distribution and use

y Community Directed Treatment- filariasis, Vit A, deworming, etc

y Community based DOTS for Tuberculosis treatment

y Water and sanitation programmes

C. Treament of minor ailments/injuries

i. Treatment of uncomplicated malaria and fevers

ii. Treatment of simple cough and URTIs

iii. Treatment of simple diarrhoea

iv. First Aid for Burns, cuts, other home accidents

v. Blood pressure monitoring

vi. First Aid for spontaneous delivery

vii. Referral of all conditions beyond the scope of authority

D. Carry out social mobilisation and advocacy for health promotion and nutrition activities1. Home visits

They conduct house to house visits (routine home visits) ± regularly carried in a cycle of

monthly, every two months or quarterly. The purpose is inspection, understanding household

problems and assisting family members to solve them through counseling and health

education.They also conduct special home visits for specific purposes such as:

i. Follow up of malnourished children, PLWHA, TB patients, etcii. Tracing of defaulters in receiving services e.g. EPI, ANC, TB, Family Planning,

etciii. Home Based Care e.g. postnatal care at home, home delivery, DOTs, chronic

illness, etc.2. Holding of community health durbars.

3. Mobilising communities for health actions4. Holding health education sessions for target social groups

5. Provide support for community based volunteer workers:i. Participate in the selection and training of TBAs, CBDs, CBS volunteers, etc



ii. Monitor and supervise volunteersiii. Hold regular review meetings with volunteers

iv. Ensure volunteers¶ supplies are regularly replenished.E. Manage health programmes and resources

1. Develop annual plans; and draw weekly and monthly work itineraries

2. Manage resources provided to the CHPS zone for work.3. Participate in zonal health committee meetings and guide them in planning andimplementation of their activities

i. Participate in the following sub-district and district activities:ii. Planning and conduct of mop up exercises

iii. In-service trainingiv. Review meetings

v. Special celebrations and campaigns e.g. Malaria month, National NINs, SIAs, childhealth promotion week, integrated maternal and child health campaign, etc

4. Collaborate with TBAs and chemical sellers operating in the CHPS zone.5. Write reports on acitivities carried out

6. Compile and submit service reports to sub-district.

Conducting House to House Visits

Organising Community Health Durbars

Empowering Social Groups

CHPS Information System

CHO

Records

1. CHPS zone profile file

2. CHC membership3. CHC plans

4. Minutes of CHC Meetings5. CHO Monthly itinerary file

6. CHO Annual workplans file7. CHO monthly reports file

8. CHO Activity reports file

Sub-district level

1. File for information on each CHPS zone, which should include the following:i. Zone profile



ii. CHC membershipiii. CHC plans

iv. Minutes of CHC Meetingsv. CHO Monthly itinerary file

vi. CHO Annual workplans file

vii. CHO monthly reports fileviii. CHO Activity reports file

2.



IMPORTANT ANNEX INFORMATION

Fig 1: Focus of CHPS Strategy

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CHPS targets the households who arethe primary producers of health

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Fig. 4: Pillars of Maternal, Newborn and Child Health

Focus on Pillars of Maternal, Newborn & Child

Health

EQUITY AND EDUCATION FOR WOMEN

Behaviour Change Communication targeting Households

PRIMARY HEALTH CARE (SD+CHPS+DH)

Pillars of Child Health

Essential Nutrition

Actions (ENA)

EPI+

IMCI+ (facility &

community)

Control of priority

diseases

Six pillars of Maternal Newborn

Health

1. F/Planning

2. Adolescent RH

3. ANC+

4. Skilled Deliveries

5. Emergency Obstetric &

Neonatal Care (EmONC)

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Documents

Guidelines for CHPS Implementation