It was near the turn of the first half of the month of September, 2018 that Ghana recorded, in Nangurma community of the Northern Region, the sad fate of a pregnant woman who had stillbirth when crossing a river to a nearby Health Center due to the breakdown of the Community-based Health Planning and Services (CHPS) in her community (YEN, 2018). This denotes that the malfunction of CHPS in several communities comes with it some fatal repercussions that should arouse our attention in curtailing the challenges leading to CHPS malfunction. However, in recent years, the challenges facing the CHPS have received less attention, though the CHPS is considered one of the pragmatic strategies for achieving Universal Health Coverage of basic package of essential Primary Health Care (PHC) services. It is seen as if there are no challenges facing the CHPS but a research conducted by the Social Enterprise Development (SEND) Ghana in 2014, headed by Mr. Adamu Munkaila, brought to focus some pervasive difficulties hampering the implementation of the CHPS in Ghana. Thus, it is imperative that we obtain an extensive understanding of the challenges of the CHPS, the solution of which will lead to an improvement in the health status of the people of Ghana. It is premised on this that this paper discusses some challenges – inadequate logistics, inadequate skilled personnel, and poor documentation – facing the CHPS compounds which are making access and delivery of services very poor.
Inadequate logistics is one of the major challenges facing most CHPS compounds across the country. Per the guidelines of the CHPS, all CHPS compounds are to be equipped and furnished. Each facility is expected to have access to potable water, electricity with standby lights, motorbike(s) and well-furnished rooms for the Community Health Officer(s) (CHOs) to make them comfortable as they work in the community. Again, the CHPS zones are to get medical equipment like BP apparatus (sphygmomanometer), thermometers, catheters, drugs and cold chains where drugs are treated and preserved. According to the research conducted by the SEND Ghana (2014), most of the CHPS facilities lack most of the things a CHPS zone is expected to have, especially, electricity, potable water, motorbike, and cold chains and about 71 percent do not have standby lights such as flash or torch lights for delivery of pregnant women where necessary. Besides, on referring a patient from a CHPS zone to the nearest health Center, the CHO(s) encounter(s) difficulties due to the unavailability of motorbikes or vehicle. The CHO, when referring more serious afflictions to the nearest Health Center, which is their sole duty, has to roam in the community for hours in search of a motorbike or a vehicle to convey the patient. Also some CHPS facilities have to wash used catheters so they can reuse them again. A CHO I know in a small village in Northern Region has to walk miles to fetch water to serve the centre where she works every morning. Again, there are some CHPS compounds, especially in the Northern part of the country which, though established and staffed, have no structures. They are found under trees with one or two tables and chairs and a bed with screens which have to close down when dark clouds are formed. All these make working at the CHPS tedious and deter people from going to such villages to work.
Aside inadequate logistics, there are inadequate skilled staffs, especially midwives leading to provision of limited services. According to the CHPS policy directive 2, which talks about human resources for the CHPS, the staffing of the CHPS should have at least three staff of right mix of Community Health Nurses (CHNs), Midwives or Traditional Birth Attendants (TBAs), Community Health Volunteers (CHVs) and Community Health Management Committee (CHMC). But here lies the case where there are more than required CHNs for a single CHPS zone in a ratio of 1:11 (Ministry of Health [MoH], 2014) and few midwives. So in a situation where there is no midwife or TBA and the nearest maternity home or Health Center is very far, what do you think can happen? There may be complications on her way to the distant health center. Again, in most CHPS zones, members of the CHMC and the CHVs are untrained and the trained ones may be inactive. About 65% of CHPS zones across all regions in the country experience this problem (MoH, 2014). Due to this, there are limited services provided by the CHPS since the CHN is not allowed to deliver a pregnant woman unless the CHN sees the head of the baby in the vagina. Again community entry and appropriate community mobilization to support the CHPS programme are hardly done since most of the CHVs and CHMC are untrained and inactive.
There are also cases of poor documentation at the CHPS level due to huge workload. The data obtained from the documentation is very important in surveillance system and in controlling diseases, so they are needed badly. Since it is very important, the CHOs are tasked to document cases and activities done at the center but due to huge workload, they are unable to document them well. The activities at the level are too much making them to forget to document cases brought to them and document other important activities undertaken there. Aside forgetting to document due to tiredness, they may either fail to do it or do it anyhow, thereby decreasing the effectiveness of the health care service.
This paper has discoursed that scanty logistics, insufficient skilled staff, and improper documentation among other factors are the major challenges facing the CHPS. Attention should be drawn to these challenges facing the CHPS when addressing the challenges of the health sector because the CHPS are the level at the door step of the people, preventing and reducing the cases of preventable diseases and deaths. Measures like: providing necessary logistics to CHPS compounds bereft of those logistics, training more midwives for the CHPS compounds and/or training the CHNs how to deliver a mother at the facility (because one of the focus as to the establishment of the CHPS was on children and pregnant mothers), and motivating the CHOs by restoring the packages they used to enjoy in order for them to do their maximum best, should be put in place to achieve the strategic goal of CHPS, which is improving the health status of people living in Ghana by facilitating actions and empowerment at households and the community level.
University of Cape Coast
BSc Physician Assistant
- Small Enterprise Development (SEND) Ghana. (2014). SEND Ghana Finds Challenges Facing CHPS Compounds. Retrieved from http://ghananewsagency.org/science/send-ghana-finds-challenges-facing- chps-compounds-71489 on 30th April, 2019.
- The Ministry of Health (MoH). (2014). National Community Health Planning Services (CHPS) Policy. (November 2014). Retrieved from http://www.moh.gov.gh/wp-content/uploads/2016/02/CHPS-policy-final- working-draft-validation.pdf on 30th April,2019 .
- YEN.com.gh . Pregnant Woman Carried Over River Loses Baby in Stillbirth. (September 14, 2018). Retrieved from https://yen.com.gh/115953- pregnant-woman-carried-river-loses-baby-stillbirth.html#115953 on 1st May, 2019.
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