Health care, a field of public health, is a discipline that concerns itself with the study and improvement of the health care of communities. It provides basic health care in communities and the rural areas. It eases the burden on other levels of care. The community health type of care is one of the most important objectives targeted in achieving primary health care as proposed by World Health Organization(WHO). With this, community health care should be a prime focus in health care delivery system in every country. The Health Care System in Ghana operates on five levels of providers: the Health Posts, Health Centers and Clinics, District Hospitals, Regional Hospitals, and Teaching Hospitals. Community Health Care plays an integral role and is the first step to Health Care Delivery in Ghana. In Ghana, Community Health Care is mainly delivered in polyclinics such as the Ampabame Polyclinic in Kumasi in the Ashanti Region, health centers like the Kasoa health center and community-based health and planning service (CHPS) zones. Community Health Care Providers should include Disease Control Officers, Nurses, Community health officers Midwives, Nurse Assistant Preventive (NAP), Nurse Assistant Clinical (NAC), formally known as Health Assistant Clinical (HAC), and Traditional Birth Attendants (TBAs). Their role is to alleviate pain, provide preventive, promotive, and therapeutic care. Their main objectives are to improve equity in access to basic health services, improve efficiency and responsiveness to client needs, and develop effective inter-sectoral collaboration. Their importance are to reduce the burden on District Health Care, Improve Health Service Delivery through making health information and service accessible to every member of the community, Improve the health of the people in the communities, Cost effective in terms of prevention of diseases, Improve the capacity of health workers at the community level. It is an undeniable fact that the inception of the Community health care system is a major link between health promotion services as well as health delivery services at the community level, where most morbidity and co-morbidity cases are realized or observed.
All notwithstanding, Community Health Care services in Ghana has been plagued with a lot of challenges that entirely mar the beauty of the service, as well as hinder the persistent efforts being made in the achievement of our Primary Health care targets as a country. The indicators and determinants of health have been pointing to the fact that, Ghana has performed abysmally when it comes to attaining Primary health care, and we undoubtedly continue to struggle with the concept all because we find it difficult to effectively implement the Community Health Care services. The challenges are numerous but first amongst them is the problem of community participation. Our cultural beliefs and traditional practices coupled with various dogma about western medicine play an important role in our decision to access these health care posts within the community. By and large, we can say that it has been a problem with education on the choices of health available within the community but it has a lot to do with our attitude to change and to conform to new standards. For instance, some societies hold the view that the hospitals within their communities are death traps for pregnant women. With this kind of assertion, it would be very difficult for members of the community to access such health care post. Secondly, there is lack of motivation on the part of the health workers to accept postings to these communities. This is mainly as a result of the low standard of living within the communities, coupled with the lack of access to specialty programmes for the staff to upgrade themselves. Aside this, there are no special incentives to woo health workers into these communities. Obviously, this impacts negatively on the health of the people and the achievements of primary health care. Thirdly, there is lack of proper educational facility for staff wards in the communities. One of the major setbacks is the low levels of educational provision at the community level. Mostly, the communities provide a poor education up to the basic level. Most medical staff would prefer to have better forms of education and at a higher level for their wards. Imperatively, this happens to be a major stakeholder in the decision making process of the choice of health facility to work in. Because the future of their wards largely depends on it and they will not like to jeopardize the future of their children on the altar of sacrifice. The fourth is, lack of proper accommodation and safe water for staff. It is an open fact that there is a huge disparity in the accessibility of social amenities and housing between the rural and urban areas. It is the duty of the community health worker in the rural areas to look for decent accommodation for themselves and at costs to them. However, in the urban areas, various flats have been provided for some of these health workers providing curative care. Finally, there are lack of motorable roads making referral cases very difficult and also decreasing attendance of individuals to facilities. There are also lack of ambulances to transport seriously ill patients to higher levels of health care. Lack of X-ray facilities, Laboratory services, and pharmacies at CHPS zones also make it difficult for the workers to provide proper health care. To add to it, there are also inadequate equipments and other hospital items such as Delivery beds, instruments, sterilizers, etc. that enhances service delivery and many more.
THE WAY FORWARD
· Frequent education on health in the form of durbars, house to house education to let them know the whole concept about health by chiefs and also Community Health Providers.
· Ghana Health Service should introduce specialty programmes specially for Community Health Providers for upgrading after some years of service such as CRITICAL CARE NURSING, OPTHALMIC CARE etc.
· Apparently, this might be out of the hands of Ghana Health Service but within the scope of Ghana Education Service and the government. The chiefs and opinion leaders of the community can liaise with Ghana Education Service and the government to put up better schools and educational facilities. This would attract Community Health Providers to go to communities since their wards would have a feel of better education in the communities.
· Ghana Health Service and government of Ghana can liaise together to provide good and conducive accommodation and safe water for Community Health Care Providers in various communities .if they put up the CHPS compound and other Community Health centers, they should also put up accommodation with safe drinking water and a conducive environment for them to work efficiently.
· Ghana Health Service should liaise with government and Non-Governmental Organizations to provide motorable roads in communities making referrals easier
· Ghana Health Service should provide X-ray facilities to diagnose simple fractures, Laboratories for simple tests (malaria parasites, urine routine exam), and Pharmacies to get the required drug for the simple conditions diagnosed for treatment instead of referring these simple cases to the District Hospitals and other higher levels of health care .All these improve client patronage, reduce hospital stay, improve working performance, and client satisfaction.
· Ghana Health Service, Non-Governmental Organizations and other Benevolent societies can come together to help these community centers in providing equipment and other hospital items to improve Health care delivery
In conclusion, we can practise the suggested points to be able to better our Community Health Care system to achieve Primary Health Care (the primary goal in health care delivery) within the country. This generally improves community health status, reduces hospital waiting time, enhances community participation, and also improves financial and socioeconomic status in communities and the country as a whole.
Dr. Kingsley Preko
Dr. A. T. Derrick
NORCH RAYMOND, SARFO
PHYSICIAN ASSISTANT STUDIES STUDENT
UNIVERSITY OF CAPE COAST
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