EXTREME AFFORDABILITY CONFERENCE WEST AFRICA

Sustaining Health Intervention Programme: The Role of the ‘Community’ in the CHPS Compounds in the Barekese

sub-District

Aaron K. NarteyR&D, Komfo Anokye Teaching Hospital

CHPS Compounds

Functioning CHPS CompoundNon-functioning CHPS

Compound

Introduction

• The Community-based Health Planning and Services is an initiative to improve access toquality healthcare and family planning services for rural communities (Debpuur et al. 2002).Its management has been decentralized from the sub-district level to the community level tomeet the health needs of the local communities. The intended community participationranges from planning, mobilization, implementation and monitoring of the health serviceand health status of the population (Shamsu-Deen, 2015).

• Although several studies have been conducted in this area, attention has not been focusedon managers at the community level and this has created a gap in literature. This researchsought to examine the activities embarks by the Community Health Management Teams tosustain the Community-based Health Planning and Services at the Barekese sub-district inthe Ashanti region of Ghana.

Methods

• The study adopted both qualitative and quantitative method.

• Using systematic random sampling and simple random sampling 384respondents were assessed.

• A total of five Focus Group Discussions and In-depth interviews with eightstakeholders were conducted.

• Stata was used to analyze the quantitative data while the qualitative data wasanalyzed using thematic analysis.

Conceptual Framework

FindingsCommunity Involvement in Decision Making

Variables N %

Decision Makers for the CHPS Compound

Community Health Officer 184 47.92District Health Directorate 34 8.85Opinion Leaders 166 43.23Total 384 100.00Do Community members provide any support to the CHPS?Yes 160 41.67No 163 42.45Don’t Know 61 15.88Total 384 100.00Which form of support do the community members provideCommunal Labour 96 60.00Foodstuff 13 8.12Electricity 40 25.00Land 3 1.88CHPS Logistics 3 1.88Money 3 1.88Security 2 1.25Total 160 100.00

Findings Cont.Variables N %

Challenges faced by the CHPS Compounds

Alternate Healing 12 3.13

Inadequate Drugs 28 7.29

Inadequate Logistics 73 19.01

Inadequate Staff 113 29.43

Poor Community Cooperation 5 1.30

Poor Government Support 1 0.26

Poor Security System 74 19.27

Poor Staff Attitude 22 5.73

Poverty in Community 5 1.30

Unavailable Electricity 51 13.28

Total 384 100.00

Findings Cont.Variables N %

How the CHPS Compounds can be well managed

Adequate Drugs 17 4.43

Adequate Logistics 7 1.82

Adequate Health Staff 111 28.90

Security Presence 13 3.39

Available Electricity 34 8.85

Community Cooperation 89 23.18

Government Support 52 13.54

Staff Accommodation 22 5.73

Good Staff Attitude 39 10.16

Total 384 100.00

Findings Cont.Provision of Staff

• Provision of Trained Staff by Ghana Health Service

According to the research participants in the three communities, GHS provides the CHPS compounds with trained staffs. One participant from the Barekuma FGD stated;

“...Ghana Health Service provides the CHPS with trained staffs. Currently the CHPS has one midwife, twocommunity health nurses and one youth employment personnel”. (Health personnel, FGD in a community).

Another participant in the Worapong FGD reechoed;“After the establishment of the CHPS compound, Ghana Health Service provided three trained nurses for the CHPS

but currently, there is no trained staff in the CHPS”. (Community leader, FGD 1, Worapong)

• Untrained Staff

Findings Cont.• Logistical support for the CHPS compounds

Provision of Hydroelectric Power

“There was no lighting system in the CHPS compound but the community came together to purchase alight pole to transmit hydroelectric power to the CHPS compound. This was because the staffcomplained that the unavailability of electricity makes working in the CHPS compound very difficult.We bought the electricity poles, meter and paid ECG to transmit power to the CHPS compound.”(Community leader, FGD 2, Abira).

• The communities in the CHPS zone are therefore contributes to the operations of the CHPS with the provision of electricity and also keeping the surroundings of the CHPS compound clean.

Findings Cont.

• Provision of essential items“Items like fridge, bed, television, sphygmomanometer or BP apparatus were donated by the community and someindividuals. The refrigerator is used for storing of vaccines and other drugs to avoid early expiration” (Healthpersonnel, FGD 1, Barekuma).Similarly, the Worapong community which had no electricity mobilized funds and purchased a generator for the CHPS compound. Participants in the FGD were of the view that;“The community was able to purchase a generator since we have no electricity in this community. This is to make thestay of the nurses in this community not too difficult. We organize communal labour which enables cleaning andclearing of the CHPS and its surroundings from time to time. Moreover, the Member of Parliament brought to theCHPS beds, television, fridge, cylinder, stove and others” (Community leader, FGD 2, Worapong)

Findings Effectiveness of the CHMT• No Meetings• Lack of Interest in the CHPS• Nurses not part of the CHMT; which always causes aComposition of CHMT• The Community Health Officers (Nurses and Mid-wives)• Assemblyman• A representative appointed by the chief• Heads of religious groups• Representatives of women groups/ministries• A representative from the transport union (Community Emergency Transport; for

emergency referral cases).

Conclusion

This study revealed that decentralization of the management of health services at thecommunity level is not as effective as envisaged, suggesting that there is a gap betweenpolicy intent and practice. Failure can be attributed to both central government and thecommunities.

On one hand, GHS did not provide the requisite number of nurses and midwivesneeded by the CHPS including logistics such as cold chain, drugs and motorbikes.Whilst, the communities investigated also had adopted their own respective strategyfor the CHMT composition without following the standards stipulated by the GHS.

Recommendation1. It is suggested that a percentage of revenue accrued from its activities should be set aside for its

maintenance.2. Further, all communities with CHPS zones should provide CHV to the CHPS compound, the

CHMT should help upgrade the CHV by taking them to workshops, training and school toupgrade their knowledge, brilliant student should be identified within the community and besponsored in nursing education.

3. CHPS compounds must be provided with electricity for proper storage of vaccines and otherdrugs in a refrigerator to prevent the early expiration of their limited drugs.

4. Public durbars should be organized by the chiefs of the communities in partnership with GHS to educate the community on the CHPS compound; this will help the community embrace the CHPS as their own and cooperate with health officers to help provide the required health services.

5. Finally, the CHMT should ensure peaceful co-existence between the community and the health officers for smooth running of the CHPS compound.

Thank you