Ghana’s CHPS Initiative Ghana Health Service With USAID support Jane Wickstrom Sr. Technical Advisor for Reproductive Health USAID/Ghana June 2002

Outline of presentation n What is the Community-based Health Planning and Services (CHPS) Initiative n Where are we now? n The way forward

Background  Government’s desire to improve health status of Ghanaians  Poor performance of health sector over the years  Recognition of the need for a change in health delivery strategy

CHPS At A Glance n National strategy for extending access to basic health services n Initiative based on research evidence from Navrongo Health Research Center (1994) n Nation-wide implementation begun in 2001

Navrongo in NE Ghana

Navrongo Experiment assessed the demographic impact of convenient community health and FP services on fertility tested the hypothesis that changes in service delivery can induce and sustain reproductive change

Navrongo Findings: n Community health improves with both nurse relocation and social mobilization n The result is a fertility decline of one birth in the marital TFR in 3 years

Communities Truly Involved

CHPS At A Glance n Community Health Committees, Volunteers and Mobilization of community leaders n Community-based Health Officer deployed to the periphery and is mobile!

CHPS At A Glance (con’t) n Resource Package: Transport, Community Health Compound (housing), and means of communication n Defined service package based on National Treatment Guidelines n Defined catchment area

CHPS differs since it Deploys CHO to the community

Home visits instead of static clinics Heading out for service delivery

Volunteers, TBAs and Councils CHO and volunteers work together

Community Leaders Committed Traditional leaders attend a community durbar

Political Leaders Committed Central and district levels must be involved

“Ghanaian Initiative Run by Ghanaians” n Director General’s Initiative n Director PPME runs M&E n Regional Directors manage TA n District Directors mobilize health staff n Sub-district supervises CHO

Technical and Financial Support from USAID and DANIDA n JHU/PCS - community mobilization n PRIME II - train CHOs n EngenderHealth - counseling n Population Council - M&E n Donors – transport, communications, some equipment

Integrated Services is the Key n Communities want full range of services: –Maternal care –Child health –Health education –Family Planning –Minor Injuries

For Safe Motherhood n Communities want CHO to: –Monitor pregnant women –Provide simple ante-natal care (nutrition counseling, malaria prevention, etc.) –Map out delivery plan –Assist TBAs, deliver (if a midwife) or refer –Post-partum follow-up

Communities & Safe Motherhood CHPS communities support CHO to: n arrange or conduct clean deliveries n recognize complications n arrange transportation n Help establish community fund for health emergencies and transport

National Scope of CHPS The Lead District Approach

Districts Starting CHPS Dec. 31, 2000 Dec. 31, 2001

Quarterly reporting form Database Two-way Information sharing (CD-ROM) CHPS website: CHPS M&E Secretariat

Continued Research, Monitoring and Evaluation Lead District Assessment (2001) “Strategic Assessment Method” Rapid Survey Method (RSM). MIS Mobilization CHPS cost analysis.

Lead District Assessment n Results from Year One

Successes to date n Increased awareness of health services and healthy behaviors n Services closer to people and people seeking care earlier n Construction of CHCs; formation of VHCs and volunteer services n Starting to obtain District Assembly support

Constraints to date n Lack of support materials for CHOs, volunteers and committees n Lack of housing for CHOs and visiting supervisors n Lack of human resources to meet demand; lack of training for volunteers n Lack of motivation/incentives for CHOs

20 Lead Districts using CHPS n 94% selected communities n 54% have CHOs assigned n 56% receive support from District Assembly n 75% believe resources are not adequate to enable CHOs to perform

District Health Managers aware of CHPS

District Assemblies know CHPS

Community awareness of CHPS

CHOs Want More Training in:

The Way Forward n We are all in this boat together!

The Way Forward n Need clear priorities, indicators and targets for success n Health Leadership and Supervisors must facilitate organizational support n CHOs need clear career path and incentives to relocate to periphery

The Way Forward n Comprehensive training strategy needed, in-service and pre-service n Resource mobilization key (Districts Assemblies, MOH, Common Basket, donors) n Improve flow of finances to regions and districts

The Way Forward Innovations and Monitoring Continue n Radio Distance Learning n Community Decision Making System n Use CHEST Kit, Journey of Hope and Life Choices IEC materials for education n Refine M&E system

Learn from Navrongo Training Site for CHOs Community Entry and Mobilization training Link Theory and Practice in community health service delivery

Learn from Navrongo Demystify CHPS Learn about variations on CHPS implementation Teach Districts to document their own stories Develop dissemination materials –“What works, What fails” –Videos

Next steps USAID support for training, M&E, and transport/equipment Continue monitoring results of CHPS to assess impact Disseminate results within Ghana and internationally

Thank You !