ARHR calls on government to improve PHC systems

The Alliance for Reproductive Health Rights (ARHR), has called on government to urgently improve Primary Health Care (PHC) infrastructure, staffing and systems for effective service provision.

The Alliance recommended the training of more midwives to manage Community-Based Health Planning and Services (CHPS) Compounds, and to augment the cadre of staffing at Health Centres and Polyclinics.

It urged Government to take immediate steps to restock PHC facilities at the local levels with anti-malaria drugs, such as Sulfadoxine-Pyrimethamine (SP), Artesunate-Amodiaquine and Rapid Diagnostic Test (RDT) Kits which were in short supply, and strengthen adherence to supply and storage checks to rid the facilities of expired equipment and drugs for effective malaria treatment and control. It said malaria was still the major reason why people visit health facilities in Ghana.

It further called for an increase in the current 0.5 per cent health allocation to District Assemblies Common Fund for malaria control, and minimise delays in its disbursement, saying these interventions, would not only generate the needed client confidence and participation in facilities at the local levels, but also ease the current pressure on regional and national health care systems, especially in the era of the COVID-19 pandemic.

Nii Ankonu Annorbah-Sarpei, the Director of Programmes at the Alliance for Reproductive Health Rights, who shared the recommendations of the third round of the Public Health Care Performance Improvement (PHCPI) assessment, with key stakeholders at a dissemination workshop in Accra, said some serious gaps were identified in Ghana’s PHC delivery system at the local levels.

He said the three-year assessment conducted by the ARHR for Ghana’s PHC system as part of a multi-country study, looked at the readiness of health facilities to provide key services including malaria treatment, as well as client satisfaction perspectives, regarding their experiences of malaria care delivered in these centres.

He said the study was also biased towards malaria care at the PHC level in Ghana considering its high burden among OPD cases across health facilities, and to measure the preparedness of the various centres ranging from the lowest which was the CHPS, to the apex being district or local government hospitals to manage and control the illness,.

Nii Sarpei explained that the research considered the types of facilities, and rated their readiness under nine broad domain areas, which involved among other things, access in terms of distance and convenience; accessibility to information; provider-client relationship (satisfactory, friendly or not), and staffing within the facilities.

He mentioned another key area as infrastructure, under which availability of electricity, telephone, and emergency vehicles were reviewed, as well as essential equipment such as RDT kits, microscopy and clinical thermometers for health centres, which were all basic requirement for any health facilities to provide good services were also assessed.

The study also looked at water and sanitation hygiene, linking it to the COVID-19 pandemic and the need for all to observe the basic hygiene protocols to halt its further spread, while also considering the availability of essential drugs such as SP and Artesunate-Amodiaquine for the effective treatment of malaria, he said.

Nii Sarpei explained that one of the key gaps realised was the understaffing across CHPS facilities, with most of them being managed by Community Health Nurses without Midwives, hence the need to increase the training of this cadre of professionals to ensure safe pregnancy and childbirth.

He said in some of the government facilities visited, it was found out that RDT test kits still being used on patients had expired, while others had also run out of stocks of SP and Artesunate-Amodiaquine for pregnant women.

“Even though we are promoting PHC we are not really making progress in reducing the national indicators for illnesses like malaria because of the expiration of some of the drugs and equipment,” he said.

Nii Sarpei stressed on the need to strengthen community participation and private sector involvement towards improving case management, as well as the maintenance of the centres, citing instances where some community members had donated water storage containers and helped in maintaining sanitation at the centres, while others had donated parcels of land for the expansion of facilities in their localities.

Mr Leonard Shang-Quratey, the Policy and Advocacy Coordinator at the ARHR, underscored the importance of strong advocacy and lobbying to address the identified gaps in Ghana’s PHCPI, which the “Ghana PHC Advocacy Project” currently being implemented by the Alliance with funding from Population Action International (PAI), sought to achieve.

He said the objective of the project was to engage national level decision makers and stakeholders on the need to use PHC as a medium of achieving Universal Health Care (UHC), and called for the development, adoption and financing of a consolidated Essential Health Services Package (EHS) as part of national efforts towards the achievement of UHC in Ghana.

“Advocacy campaign is what changes policy, data and research by themselves do not,” he said and gave some sources of information for PHC advocacy as Vital Signs profiles which were new measurement tools that policymakers, donors, advocates and citizens could use to better understand, and improve PHC around the world, and further provided an innovative snapshot of these systems in individual countries, throwing light on areas of their strengths or weaknesses.

Mr Shang-Quratey, gave some sources for evidence for PHC advocacy as the National Budget and Appropriation Bill, Annual Reports of Key Stakeholders like the Ghana Health Service and National Health Insurance Scheme, Parliamentary Hansards, the Ghana Demographic and Health Survey and ARHR Score Card Reports, National Health Policy, National CHPS Policy, Human Resource Policies and Strategies for the Health Sector, CHPS Operational Policy, and National Health Insurance Policy Framework.