Presentation on a health initiative in Ghana

ByAnthony Mankona

Introduction

• After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community based Health Planning and Services (CHPS) Initiative employed strategies tested in the successful Navrongo (community in Ghana) experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care.

Intro. Cont’d

• Despite a decade of trials of various strategies for achieving ‘Health for All’ in the 1980s, research demonstrated that in 1990 more than 70% of all Ghanaians still lived over 8 km from the nearest health care provider and rural infant mortality rates were double the corresponding urban rates.

What is it?

• CHPS endeavors to transform the primary health care system by shifting to a program of mobile community-based care provided by a resident professional nurse, as opposed to conventional facility-based and ‘outreach’ services. • The CHPS initiative represents the scaling-up of the successful experimental model into a national movement for health care reform.

Statistics show 2,580 CHPS compounds are presently functional across the country, though about 6,500 are needed.

Examples of CHPS compound in some communities in Ghana

Financing of CHPS• Directs that all services delivered in a CHPS compound be free and assigns government the primary responsibility for financing. • All CHPS services on the NHIS benefit package must be reimbursed. CHOs and their volunteers will facilitate the registration of their populations onto the NHIS. • Other suggested sources of Finance include: • Allocation of the National Health Insurance Fund to the Ministry of Health • Development partner contributions including possible establishment of a fenced common funding basket • Contributions from benefactors and philanthropists • The primary responsibility for financing the scale up of CHPS rests with government. Government must allocate dedicated resources for the scaled up operations of the CHPS; and provide the leadership to coordinate effective application of Development Partner resources

Financing Cont’d• Still an ambitious roadmap and will require multiple strategies to raise GHC 702,411,000 (US$243million) through public private partnership. Currently,• Ongoing DP supported programmes for CHPS services including CHPS compound

construction If well coordinated, would provide 200 CHPS compound in the most deprived zones. (eg. JICA, USAID and the World Bank).

• The 10% salary donation by H.E The President and the Executive – to be mobilized to construct and equip 2 CHPS compounds each year making a total of 10 in the 5-year period.

• MoH/GHS regular capital budget to construct 10 CHPS compounds over the five year period • With high level and sustained advocacy with the MLGRD and DAs - at least 2 CHPS

compounds constructed by each District Assembly over the 5 year period (more than 500). To be equipped and staffed by the GHS.

• Reach out to corporate organizations to support CHPS compound construction – a modest 10 CHPS compounds will be constructed by corporate organizations in the 5 years o Individual community and traditional efforts could deliver up to 20 CHPS compounds over 5 years.

Monitoring Arrangements

• National Secretariat* • Focus on creation of CHPS zones – Construction of CHPS compounds – Training of CHOs – Posting of CHOs into the built-up CHPS compounds –

Concerns about CHPS

• Slow pace of deployment • Clinical focus • Less community engagement • Inadequate financial Resources• Minimal involvement of SDHTs, DHMTs &

RHMTs • Minimal community engagement • Inadequate dialogue on CHPS at all levels

Supervision, Monitoring & Evaluation

• The policy provides for the hierarchy of supervision, monitoring and evaluation. • The District Director of Health Services providing the technical lead in the District and reporting to the District Chief Executive and the district assembly will have overall responsibility for guiding CHPS in the district. • Officer in charge of the health center in the sub-district will directly supervise CHOs. • Medical officers in the District Hospitals will have a role in mentoring and technical supervision in an assigned number of sub-districts. This will include visits to CHPS zone in their assigned sub-district. • Annual reviews by the District Chief Executive in collaboration with the District Director of Health Services on progress in CHPS implementation