The Concept Of Community-Based Health Planning And Service (chps) In Ghana

Good health is one of the most vital contributors to individual ability to perform effectively in all aspects of life. It is essential to the enjoyment of almost any other aspect of life. A wealthy life or a good education will yield much less satisfactory to someone chronically sick. Poor health which leads to death will make all other sources of satisfaction not enjoyable, sickness affects the quality of life

Ghana’s attempt to improve the health status of its members has not been encouraging since independence, the rates of new and existing cases of certain common diseases has been quiet alarming. According to GHS, 28,975 cases of cholera with 243 death was recorded in 2014

To improve health conditions in Ghana, the ministry of health emphasized the conduct of health service research in the 1970’s out which a lot of policies were formulated. Ghana adopted a number of programmes to ensure an improved health sector for the delivery of quality healthcare services and wider access to the poor in rural and deprived areas.

This eventually led to the adoption and introduction of the Community-Based Health Planning and Service concept in Ghana.

The ministry of health through the Ghana health service pioneered the implantation of this national programme called CHPS which began as a Community Health and Family Planning (CHFP) project in Ghana based on lessons learnt from Bangladesh (Phillips, 1988) as a close -to-client doorstep health delivery with household and community involvement. The project was launched in Navrongo as an operations research in 1994 piloted in three sub-districts namely; districts of Nkwanta, Brim North and Asebu-Abura-Kwamankese. The CHPS programme was approved for implementation in 1999 and it relies on community resources for construction labour, service delivery and program oversight.

Community-based Health Planning and Services (CHPS) is defined as the mobilization of community leadership, decision making systems and resources in a defined catchment area (Zone), the placement of reoriented frontline health staff (CHO), with logistic support and community volunteer systems to provide services according to the principles of primary health care. CHPS is a national strategy to deliver essential community- based health services involving health planning and service delivery with the communities. It focuses primarily on communities in deprived sub-districts by bringing health services close to these communities. It is considered as one of the pragmatic strategies for achieving Universal Health Coverage of a basic package of essential PHC services and has gained international recognition. The CHPS initiative is therefore the national strategy for implementing the community based service delivery by reorienting and relocating primary health care from sub-district health centers to convenient community locations. CHPS is made of 6 principles considered as the general principles namely:Community participation, empowerment, ownership, gender considerations and volunteerism; Focus on community health needs to determine the package of CHPS services; Task shifting to achieve universal access; Communities as social and human capital for health system development and delivery; Health services delivered using systems approach; CHO as a leader and community mobilizer.

CHPS is composed of ; CHPS zone which is a demarcated geographical area where activities would be carried; CHPS compound, an approved structure consisting of a service delivery point and accommodation complex; community health officer, a trained and oriented health personnel mostly act as the leader and community mobilizer and Community Health Volunteers (CHVs), non-salaried community members identified and trained persons supporting CHOs in a Community within the CHPS zone

The key elements of CHPS includes the community as a social capital, households and individuals as the targets, community participation and community centered. CHPS moves health services to community locations, develops sustainable volunteerism and community health action, empowers women and vulnerable groups and improves the provision of health care. The aim of CHPS is to improve the health status of its members by bringing provision of healthcare to the household and community levels.

Furthermore, the focus of the CHPS approach is to achieve three important objectives;

First, to improve equity in access to basic health services; the mal-distribution and problems associated with geographical and financial access means that new ways of working are required to deal with the basic ailments that plague the poor. The CHPS strategic response takes into consideration working with households and communities to ensure that all barriers to access at the local levels are removed

Second, to improve efficiency and responsiveness to client needs; community-based service provision can only be effective if services are efficiently delivered and are responsive to client needs. This can be ensured through increasing accountability and performance of health providers on quality, responsiveness and efficiency to the communities.

Third, Improve inter-sectoral collaboration and partnership in service delivery; this will require strengthening the role of the community, civil society and community-based organization to support strategy implementation, client access to services and protect client right to quality health services.

The last was to develop effective community engagement systems to support service delivery.

Again, in implementing the CHPS process, reorienting and restructuring the health delivery system of Ministry of Health is crucial. This requires clear definition and acceptance of the roles and responsibilities of the District Health Management Team (DHMT) and the Sub-District Health Teams. The organizational layout of CHPS is a five tier system:

National level; at the national level, the MOH and GHS have the main function of defining policy direction, facilitating policy implementation and ensuring that the appropriate resources are channeled to support policy implementation.

The Regional level; at the regional level, the Regional Health Directorate provides a coordination, support and supervision oversight for Districts, Sub-districts and CHPS zones. The regional hospitals also provides specialist referral services to these levels

The District level; the District is the major unit of primary health care organization and management of service in Ghana. The District Health Management Team serves as the decision making, programme development and co-ordination for CHPS. It also oversees the identification, orientation, training and posting of the Community Health Officers (CHOs) to the sub-districts and communities

Sub-district level; the sub-district health team supervises CHOs and Community Health Volunteers and provides a liaison to District level offices. They manage the flow of essential medicines supply between the DHMT and the Community Health Committee who distribute them to the volunteers to complete actual delivery.

The Community level; the CHPS zone has a maximum of two trained CHO to provide services to households within the communities. The services should focus on outreach and house to house services, establishing community decision making systems and using community registers to trace defaulters and people with special conditions like pregnant women and children at risk. At the community level, the CHO ensures that the service delivery package is adhered to and includes treatment of minor ailments, family planning, antenatal care, delivery and postnatal care, child welfare clinics, immunizations, counseling, school health, home visits, supervision of Traditional Birth Attendants and volunteers. The community level also provides support for CHOs, and community volunteers. Within a CHPS zone, the CHO is expected, for the purpose of comprehensive health service delivery and promote activities, develop close links with the chief, health volunteers, assemblyman, traditional birth attendants (TBAs), private midwives, traditional healers, religious groups, DHMT and the District Assembly. These people are the stakeholders to ensure successful implementation of CHPS at the community level

Penultimately, the basic services provided by the various CHPS compounds include; the provision of health education related to prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; provision of adequate supply of safe water and basic sanitation; maternal and child healthcare; including family planning; immunization programs against the major infectious disease; prevention and control of locally endemic diseases;; appropriate management of the minor ailments and injuries; and provision of essential drugs, which all aim at helping ensure improved access to primary health care in these communities. Lastly, to aid the proper functioning of the various CHPS compounds, there is the need for a very strong community participation in the implementation of the CHPS’s policies.

In conclusion, the introduction of the CHPS is seen as a way of making health care equitable, accessible, and affordable to the poor in society although there are “ups and downs” in the implementation of this policy which we hope it will get a strong grounds one day, it has benefited the communities because bringing healthcare to the door steps of its members has ensured a great reduction in the mortality and morbidity rates. In communities without the CHPS compounds, accessing health services has been difficult because people have to travel to other communities or bigger towns before accessing health care. With this every individual and especially the government must contribute to the improvement of the CHPS’ services.

Acknowledgment
DR. Kingsley Preko
DR. A.T. Derrick
MS. Victoria Yeleduor
MENSAH DAMOAH JERRYPAX
LEVEL 200
PHYSICIAN ASSISTANT STUDIES
UNIVERSITY OF CAPE COAST