The pro-poor Community-based Health Planning and Services (CHPS) concept is one of the innovative ideas of making health services available to Ghanaians at their doorsteps.

The CHPS strategy, recognized by policy makers, development partners and public health providers, has led to increased access to healthcare services in communities where they have been well organized and implemented.

However whether it has led to the promotion of “accessible, quality and equitable healthcare services to all and eliminated disparities in access to basic health services” remains quite debatable.

This was what led to a stakeholders policy dialogue on the CHPS zones organized by the Adentan District Citizen Monitoring Committee (DCMCs) with support from two non-governmental organizations.

These were Intervention Forum (IF), the focal NGO for the Adentan Municipal Assembly (AdMA), and Send-Ghana, which seeks to promote good governance practices of accountability, transparency and citizens’ participation in local governance.

In a brief but succinct opening address, Ms Nora Ollenu, Chief Executive Officer of IF, and also focal person for the Adentan DCMC, on February 13, this year, referred to data collected on all the CHPS zones, health directorate, sub-districts, 40 households.

The IF and Send-Ghana followed it up with focus discussions at the community level to know and understand the issues surrounding the CHPS initiative in the Adentan Municipality.

Ms Ollenu indicated that the dialogue was to give feedback on a research report carried out by Send-Ghana on the implementation of the CHPS, identify gaps in its implementation.

It was also to ascertain “whether the households who were the primary producers of health had access to healthcare at their doorstep” and find out the challenges and the way forward.

This, she noted, would enable the participants, drawn from the various communities, Non-Governmental Organizations, and the AdMA, to improve the community-based health service delivery at the doorstep of the citizens.

“This will help promote good governance practices of accountability, transparency and citizen participation,” Madam Ollenu added.

Ms Sandra Sarkwah, a senior official of Send-Ghana, who presented the research report, said the CHPS strategy since its implementation had increased access to healthcare services and improved health outcomes in communities where they existed.

The research had also proven that infant and maternal mortality had reduced drastically in areas where the programme had properly been managed, citing the three northern regions and Greater Accra region.

Speaking on compliance with implementation guidelines of the CHPS strategy, Ms Sarkwah said her outfit’s study had revealed that 86 percent of Sub-Districts Health Management Teams (SDHMTs) did not prepare budgets for CHPS Compounds “though they are the supervisory body of the CHPS programme”.

The 14 percent of the SDHMTs that prepared budgets did not have separate budgets for the activities of CHPS.
Again, she said over three-fourths of the CHPS Compounds were assisted by Community Health Volunteers (CHVs), thus leaving less than a quarter without any budgetary support.

However, 93 percent of CHPS compounds with CHVs support had received some training in primary healthcare but lacked motivation to perform effectively.
Ms Sarkwah said the success of the CHPS programme could only be sustained when implementation guidelines and structures put in place worked effectively and efficiently.

She therefore stressed the need to provide the CHV and Community Health Officers (CHOs) with the required logistics, motivation and skills for effective healthcare delivery.
Ms Sarkwah urged government to increase budgetary allocations and disbursement to the health sector and ensure the transfer of funds to sub-District Health Management
Teams (SDHMTs), as well as provide capacity to professionals who run the CHPS and develop separate budgets for them.

“The GHS (Ghana Health Service) and communities must motivate CHVs in the form of logistics, such as bicycles and working gear,” she pleaded.

This brought Dr Justice Hoffman, Adentan Municipal Director of Health Services, to his feet, stressing the need for the stakeholders to set their priorities right and initiate proper community sensitization on the CHPS concept.

He drew attention to the fact that there were even no committees in place in some communities, and stressed the need to get the CHPS firmly established on the ground.
Dr Hoffman stated that his outfit was willing to come onboard to hold frank discussions with all stakeholders on how best to deliver health services to the communities or make the CHPS work.

He drew the attention of the meeting to budgetary constraints faced by the SDHMT that did not allow for adequate funding of the CHPS operations.
Dr Mrs Catherine Deynu, assembly member (government appointee) representing the

Presiding Member, noted the importance of the CHPS zones, and called for a stakeholders’ meeting with the SDHMT to discuss the way forward.
“Such a sensitization, if well managed, could help a lot,” she stated, suggesting that private public sector participation rather than relying solely on government subvention in the CHPS programme could help sustain it.

The dialogue revealed inadequate sensitization and knowledge among some assembly members of the Adentan Municipal Assembly, with some of them saying they had no firm grasp of the concept and its operations.

Others complained of poor logistics or lack of structures for CHOs and CHVs, leading to low morale and poor patronage of the CHPS programme.

However, the dialogue was quite a useful multi-stakeholder interactive session that revealed all the missing gaps in the implementation of this pro-poor health service programme.

Community health care is a laudable initiated that goes a long was to meet the Millennium Development Goals, particularly of eradiating extreme poverty, achieving universal primary education, promoting gender equality and employment of women, reducing under-five mortality, improving maternal health, and combating HIV//AIDS and malaria, among others.

The AdMA, IF and Send-Ghana, as well as the other stakeholders must make progress with the CHPS programme. They need to re-strategize, embark on a comprehensive sensitization programme and work in unison to achieve maximum results.

The World Health Organization says the right to health care entails availability of functioning public health and health care facilities, goods and services. With an overburdened Ministry of Health, the only option, as suggested by the dialogue, is to pursue a private public partnership venture to keep the CHPS running well and sustainably.

GNA