Community-based Health Planning and Services (CHPS) program is an evidenced-based national strategy developed by the Ghana Health Service (GHS) to deliver healthcare at the community level. This strategy involves the community actively participating in the health decision making as well as enable communities recognize that individuals within households such as mothers play important roles in ensuring good health. The main objective of CHPS is to promote access, quality and equitable health care services to all Ghanaians, particularly those in rural and deprived communities. Some of the measures taken include deploying trained and salaried nurses, known as community health officers (CHOs), to rural communities where they provide basic preventive, curative, and promotional health services in homes. Despite successful implementation of CHPS for over a decade, the inability to provide place of residence for the community health officers within the communities have been a major challenge that needs to be tackled holistically to promote access, quality and equitable health care to deprived rural communities in Ghana. CHPS began as a Community Health and Family Planning (CHFP) project based on lessons learnt from Bangladesh (Phillips, 1988). The project was launched in Navrongo as an operations research in 1994 piloted in three sub-districts. The Navorango experiment tested means of addressing inequities in the health system through mobilization of both health sector and community resources.
CHPS moves health services to community locations, develops sustainable volunteerism and community health action, empowers women and vulnerable groups, and improves health provider, household and community interaction.
CHPS began as a Community Health and Family Planning (CHFP) project based on lessons learnt from Bangladesh (Phillips, 1988). The project was launched in Navrongo as an operations research in 1994 piloted in three sub-districts. The Navorango experiment tested means of addressing inequities in the health system through mobilization of both health sector and community resources.
Ghana has been implementing the Community-based Health Planning and Services (CHPS) program for over 15 years. Considered one of the pragmatic strategies for achieving universal health coverage of a basic package of essential primary health services, CHPS has gained international recognition. Led by a Community Health Officer and supported by volunteers drawn from the area of service, the CHPS strategy is a breakthrough in enhancing community involvement and ownership of primary health care interventions towards achieving universal health coverage (UHC).
The Ghana Health Service (GHS) 2016 annual report shows that the training of community health nurses (CHNs), acting as community health officers (CHO) over the years have led to an increase in routine childhood immunization coverage under the Expanded Program on Immunization (EPI). (Ghana Health Service, 2017) Also, there is an increased awareness of family planning methods especially among the males in the rural communities due to CHPS education and provision of family planning services. (Adongo et al., 2013) In addition, inability of the communities to provide accommodation for the CHOs within the communities has been one of the major challenges of CHPS. Also, the failure to setup Community Health Management Committees (CHMC) to augment the work of the CHOs have been impeding the smooth implementation of CHPS. (Nazzar, 2013) These challenges when tackled will promote access, quality and equitable health care delivery in deprived rural communities in Ghana.
Community Health Officers(CHOs) have responsibilities to deliver a package of essential primary health care and promote access to services at the community level. (Ghana Health Service (GHS), 2006) As a strategy to reach out and improve access to maternal and child health care, CHOs trace defaulters and people with special conditions like pregnant women and children at risk within deprived communities. (Atuoye et al., 2015) Also, CHOs ensure that the service delivery package is adhered to and deliver services which 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. (Ghana Health Service, 2014) Lastly, the CHPS program is expected to pursue a work routine that revolves around home visiting as a means to take services to clients rather than the traditional methods of expecting the client to seek out the health care provider which helps in data collection to mount surveillance. (Program & Planning, 2017).
It is worth noting that all services delivered in CHPS compounds is free of charge and all CHPS services on the NHIS benefit package is reimbursed. (Ministry of Health, 2004) Most importantly, the CHOs and their volunteers are to facilitate the registration of their populations onto the NHIS. First and foremost, the aim of this policy is to attain the goal of reaching every community with a basic package of essential health services towards attaining Universal Health Coverage and bridging the access inequity gap by 2030. (Ghana Health Service, 2016).
To understand the organizational context of relevance of CHPS, the following must be defined:
refers to an approved structure consisting of a service delivery point and accommodation complex both of which must be present.
refers to a demarcated geographical area of up to 5000 persons or 750 households in densely populated areas. Each zone may be made up of a town, part of a town or a group of villages or settlements mapped for ease of planning of itinerant services and assignment of CHOs and CHVs and there may be a health center or a hospital.
Community Health Officer (CHO);
is a trained and oriented Community Health Nurse (CHN) working in a CHPS zone and may be assigned to a community within the zone.
Community Health Volunteers (CHVs);
are non-salaried community members identified and trained to support CHOs in a community within the CHPS zone.
Community Health Management Committees (CHMC);
are community leaders drawn from the CHPS community with different competencies and responsibilities who volunteer to provide community-level guidance and mobilization for the planning and delivery of health activities and see to the welfare of CHOs in their community. Also, they supervise the activities of CHV.
In conclusion, the establishment of CHPS as the basic structure of the health care system of Ghana is seen as a way of making health care equitable, accessible, and affordable to the poor in society. Even though communities without CHPS compounds have a problem with access, CHPS has helped improved physical access to health care in deprived rural communities. Also, the introduction of NHIS has further enhanced delivery of health services in rural communities. Despite the few challenges, it can be concluded that CHPS initiative has tremendously improved access, quality, and equitable health care delivery in rural communities. Finally, the effective implementation of these recommendations would go a long way to improve access, quality, and equitable health care services for rural dwellers in particular and Ghana as a whole.
DR. KINGSLEY PREKO(Lecturer)
DR. A.T DERICK(Lecturer)
MR. EDMUND KOJO(Brother)
ALFRED YEBOAH KYEREMEH,
LEVEL 200 PHYSICIAN ASSISTANT STUDENT,
UNIVERSITY OF CAPE COAST.
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