The influence of the Community-based Health Planning and Services (CHPS) program on community health sustainability in the Upper West Region of Ghana

Community-Based Health Planning and Services (CHPS) concept and access to healthcare delivery in Sefwi Wiawso Municipal, Ghana

BACKGROUND

In spite of the successes of the community-based health planning and services (CHPS) policy since its inception in the mid-1990s in Ghana, data pertaining to the implementation and use of CHPS facilities in Sefwi Wiawso Municipal is scant. We assessed access to healthcare delivery and factors influencing the use of CHPS in Sefwi Wiawso Municipal.

METHODS

An analytical community-based cross-sectional study was conducted in the Sefwi Wiawo Municipal from September to October 2020. Respondents for the study were recruited through multi-stage sampling. Information was collected on their socio-demographic characteristics, knowledge and use of CHPS facilities through interviews using a structured pre-tested questionnaire. Factors influencing the use of CHPS facilities were assessed using univariable and multivariable logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P ≤ 0.05 was considered statistically significant.

RESULTS

A total of 483 respondents were recruited for the study. The mean age of the respondents was 43.0 ± 16.3 years, and over 70% were females or married/cohabiting with their partners. Most respondents (88.2%) knew about the CHPS concept and more than half (53.4%) accessed healthcare in the CHPS facilities. Most respondents rated the quality of health services (> 65%) and staff attitude (77.2%) very positively. Significant factors influencing the use of the CHPS facilities were; knowledge of the CHPS concept (AOR 6.57, 95% CI 1.57-27.43; p = 0.01), longer waiting time for a vehicle to the facility, and shorter waiting time at the facility before being provided with care. People who waited for 30-60 min (AOR 2.76, 95% CI 1.08-7.07; p = 0.01) or over an hour (AOR 10.91, 95% CI 3.71-32.06; p = 0.01) before getting a vehicle to the facility, while patients who waited for less than 30 min (AOR 5.74, 95% CI 1.28-25.67; p = 0.03) or 30-60 min (AOR 2.60, 95% CI 0.57-11.78; p = 0.03) at the CHPS facility before receiving care were more likely to access care at the CHPS facilities.

CONCLUSION

Knowledge, and use of healthcare services at the CHPS facilities were high in this population. Interventions aimed at reducing waiting time at the CHPS facilities could greatly increase use of healthcare services at these facilities.

Constraints on the functioning of Community-based Health Planning and Services facilities: A qualitative study in the Jirapa Municipality, Ghana

The declaration of the Alma-Alta on primary health care (PHC) in 1978 enjoined nations to make health care accessible, affordable, and situated within their cultural contexts. The Ghana Community-based Health Planning and Services (CHPS), as a strategy to achieve the goal of PHC, has shown significant successes in communities where it has been implemented. However, a number of challenges continue to affect the effective functioning of CHPS. This study explored the community level and health system constraints on the effective functioning of CHPS in the delivering of PHC services in the Jirapa Municipality. A qualitative approach was implemented. A criterion-based purposive sampling technique was employed to recruit 51 managers and health service providers of CHPS for key informant interviews. The respondents included 25 community health management committee members, 25 health officers in charge of CHPS facilities, and one municipal CHPS coordinator. The interviews were held from September 18 to November 23, 2020. All interviews were face-to-face, audio-recorded and transcribed verbatim. Thematic analysis based on the constant comparative method was employed to analyse the data. The results showed that low community involvement in CHPS activities, disputes over the location and naming of CHPS zones, inadequate understanding of the CHPS concept and religious beliefs were the key community level factors which negatively affected the functioning of CHPS. Also, lack of logistics, financial constraints, poor attitude of health workers and inadequate staff motivation were the health sector constraints on the effective functioning of CHPS. In conclusion, concerted efforts are needed to tackle the community level and health system constraints to improve the overall functioning and effectiveness of the CHPS strategy. We recommend the strengthening of community sensitization, timely disbursement of funding, and provision of infrastructure and supplies to improve upon the effective functioning of CHPS as a strategy for delivery PHC in Ghana.

Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why

Background

Despite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub-Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme.

Methods

We conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understand the different impacts and implementation lessons of the CHPS programme.

Results

N = 58 out of n = 117 full text studies retrieved met the inclusion criteria, of which n = 28 were quantitative, n = 27 were qualitative studies and n = 3 were mixed methods. The geographical spread of studies highlighted uneven distribution, with the majority conducted in the Upper East Region. The CHPS programme is built on a significant body of evidence and has been found effective in reducing under-5 mortality, particularly for the poorest and least educated, increasing use and acceptance of family planning and reduction in fertility. The presence of a CHPS zone in addition to a health facility resulted in increased odds of skilled birth attendant care by 56%. Factors influencing effective implementation included trust, community engagement and motivation of community nurses through salaries, career progression, training and respect. Particular challenges to implementation were found in remote rural and urban contexts.

Conclusions

The clear specification of CHPS combined with a conducive national policy environment has aided scale-up. Strengthened health financing strategies, review of service provision to prepare and respond to pandemics, prevalence of non-communicable diseases and adaptation to changing community contexts, particularly urbanization, are required for successful delivery and future scale-up of CHPS.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214006, identifier: CRD42020214006.

Towards quality primary health care: the dilemma of Community-Based Health Planning and Services (CHPS) in health service provision in Ghana

PURPOSE

Over the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana.

DESIGN/METHODOLOGY/APPROACH

Using a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides.

FINDINGS

The findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs.

RESEARCH LIMITATIONS/IMPLICATIONS

Due to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study.

PRACTICAL IMPLICATIONS

The article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities.

ORIGINALITY/VALUE

The paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community's use of the facilities.

Climate change, women's workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.

Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

Access to primary health care among women: the role of Ghana's community-based health planning and services policy

Background:

Ghana in 1999 adopted the Community-based Health Planning and Service (CHPS) policy to enhance access to primary health care (PHC) service. After two decades of implementation, there remains a considerable proportion of the country’s population, especially women who lack access to basic health care services.

Aim:

The aim of this paper is to understand the contribution of Ghana’s CHPS policy to women’s access to PHC services in the Upper West Region (UWR) of Ghana.

Methods:

A logistic regression technique was employed to analyse cross-sectional data collected among women (805) from the UWR.

Findings:

We found that women who resided in CHPS zones (OR = 1.612; P ≤ 0.01) were more likely to have access to health care compared with their counterparts who resided in non-CHPS zones. Also, rural-urban residence, distance to health facility, household wealth status and marital status predicted access to health care among women in the region. Our findings underscore the need to expand the CHPS policy to cover many areas in the country, especially rural communities and other deprived localities in urban settings.