The Bid to Contain Urban Health Challenges in Ghana

Story by: Mathias Aboba-Bolgatanga

A team of health officials from the School of Public Health, University of Ghana and Ga East Sub Metro Health Directorate in the Greater Accra region has paid a visit to the Upper East region on a learning tour to understudy the operations of community-based health service strategies in a bid to fashion out appropriate measures for containing growing health challenges in parts of the capital city Accra.

Their visit forms part of an implementation research being undertaken by the Ghana Essential Health Intervention Program (GEHIP) a health system strengthening initiative jointly implemented by the Ghana Health Service and the School of Public Health with funding from Doris Duke Charitable Foundation and Comic Relief of the USA and UK respectively. The aim of the project is to explore possibilities for implementing the Community-based Health planning and Service (CHPS) concept in urban Accra. The GEHIP project is being implemented in three rural districts in the Upper East region and Ga East in Greater Accra. Under its rural component, the project supports strengthening of CHPS and improves districts capacity to deliver integrated primary health care services while in Greater Accra it focuses on repackaging CHPS to suit the urban environment to effectively address the access gaps in health care for targeted urban populations in the country.

CHPS as the concept is popularly known, is a community-based health strategy where nurses are retrained and placed in communities where they reside and provide health care services with support from community members. Through the community participation in health planning the resident nurses on daily basis visit homes in their catchment area and provide vaccination for children, compound specific health education, treatment for minor ailments and referral of higher medical cases.

The Urban CHPS project in Accra commenced some two years ago and has since trained and deployed over 30 Community Health Nurses in 15 demarcated zones in Dome, Kwabenya, and Tiafa. Some of the communities currently served by CHPS include Kwabenya-Ayegbe town, Afghanistan, Grusi town, and Aunty-Mary.

The CHPS concept which is today a national health policy in Ghana traces its roots to the Navrongo Health Research Centre in the Kassena-Nankana Municipality of Upper East region where an experimental trial in community health and family planning in the 1990s showed that placing trained health workers in communities supported by the community members to plan and deliver health care services rather than using visiting health staff was more effective in meeting community health needs and improving child survival and health of families. This study also known as the ‘Navrongo experiment’ later became known as the Community-based Health Planning and Services (CHPS). The concept has since the year 2000 been adopted by the country’s Ministry of Health and is being implemented in all districts in Ghana with some African countries including Nigeria, Ethiopia, Sierra Leone, and others adopting the strategy recently.

Quite unfortunately however, CHPS over the years has been seen as a rural strategy and little effort has been made by health researchers to see how it can be adapted to suit urban environment to ease the avalanche of health challenges that confronts urban communities in the country. The GEHIP initiative is therefore a major step towards making CHPS a truly national policy and maximizing its benefits.

Receiving the team in Bolgatanga, the Upper East Regional Director of Health Service Dr. John Koku Awoonor-Williams said the region owes much of what it has achieved in health care service delivery to CHPS. He disclosed that very few health professionals are willing to stay and work in the region, as such shortage of critical health staff is nothing new. As a result heath authorities in the region have decided to train and deplore more community health nurses, midwives and other staff to all parts of the region to provide community-based health care services, a strategy he said has worked to the benefit of the people of the region. He was optimistic that the urban CHPS initiative will lead to the discovery of a sustainable local strategy for addressing the growing health challenges in some urban areas of the country. Dr. Awoonor-Williams called for greater support for the urban CHPS project to ensure ‘we come out with a strategy which will help improve child survival and family health in urban populations’.

During the two days stay, the team visited some CHPS compounds in Bongo and Builsa districts and interacted with community health officers and district supervisors to deepen their knowledge and understanding of the nature and scope of CHPS. They also took the opportunity to learn about the region’s novelty in information and data capturing tools popularly known as the simplified registers. The tools which compressed the over 24 registers previously used for data capture into five was developed recently in the Upper East region under a maternal health study project known as Mobile Technology for Community Health (MoTeCH). The innovation has not only greatly reduced time spent by health workers on paper work but also improved data quality and has been hailed as yet another important strategy from a region best known for local innovations in health management and services.

Speaking on lessons learnt on the visit the leader of the team Dr. Ada Nwameme, admitted they were now in a better position to improve on their strategies for soliciting and sustaining community participation and support for CHPS in the urban area as well as data and information management. She was hopeful the project will emerged as urban health model of the time and appealed for support for it from all stakeholders in health.