Stakeholders in Primary Health Care (PHC) in Ghana, have reiterated that a strong primary health care system was critical in pursuit of Universal Health Coverage.
They stressed that programmes such as CHPS and the NHIS needed to work in synergy to promote continuity, comprehensiveness, and first-contact access.
Speaking at the end of a day’s meeting, which discussed the improvement of PHC in Ghana, panelists debated the mechanisms for achieving the synergy work, which included performing provider payment systems to promote preventive, community-based services; increasing the comprehensiveness of CHPS facilities; and re-examination of the role of CHPS as gatekeepers to higher-level care.
The meeting was organised by the Alliance for Reproductive Health Rights and PAI to learn about and discuss new research findings related to the performance of Ghana’s primary health care (PHC) system and was attended by over 70 people participated in the forum.
The meeting attracted participants from civil society including key health sector advocates, researchers, high level government officials from the National Development Planning Commission (NDPC), the National Population Council (NPC), the Ghana Health Service (GHS) and the Ministry of Health and Parliament.
Dr. George Amofah Former Deputy Director-General of the Ghana Health Service said the Community-Based Health Planning and Services (CHPS) system in Ghana was frequently cited as an exemplar approach to service delivery and community engagement in primary health care. The CHPS initiative he explained targeted remote areas of high need to deliver cost-effective and quality primary care services to individuals and households, whilst engaging the community in the planning and delivery of services several areas needed further research and exploration.
Dr Amofah noted that Ghana has affirmed its commitment to increasing financial protection and access to needed health services and Ghana has made progress toward achieving universal health coverage, however, gaps in coverage still remained same.
The research was conducted by Ariadne Labs and Kwame Nkrumah University of Science and Technology (KNUST through the PMA2020 platform, which included a study of over 140 primary health care facilities in Ghana as well as the first nationally-representative survey of patient experience of primary health care in West Africa.
The study was supported by the PHC Performance Initiative as a means of testing novel measures of PHC performance in low and middle-income countries.
Dr. Easmon Otupiri of KNUST who conducted the research giving the highlights of the findings of said NHIS has expanded insurance coverage and nearly all facilities were eligible for NHIS reimbursements and the program covered almost two-thirds of women.
Despite this achievement, over one third of women reported that it was difficult for them to afford the cost of their last visit and nearly 25% of women reported that they had to borrow or sell something to pay for their last visit.
“Some facilities also struggle to maintain the revenue needed to provide high-quality care. The average wait time for reimbursements to the facilities from the insurance agency was nearly 9 months. This kind of delay is likely to have a negative impact on facility finances and service delivery”.
Ms Hannah Ratcliffe of Ariadne Labs presenting her findings said most women sought care from a public facility, but frequently bypassed CHPS facilities and health centers in favor of hospitals, even for basic care needs such as vaccinations and family planning services, particularly in urban areas.
This she said could be due to the fact that hospitals had much higher availability of medicines than CHPS or health centers; but there was no clear understanding of the cause.
She explained that facilities excelled at community engagement and population health management particularly compared to similar countries in the region.
“The quality of care reported by patients was generally high. However, the data show that reports of respectfulness of care are relatively low. Additional progress is needed to ensure that health care facilities are providing respectful and responsive, person-centered care”, she added.
Participants at the end discussion called for an increase in education of citizens on the NHIS and CHPS concepts and expressed concern that many citizens were unaware of their rights under the package and highlighted that NHIS should invest in educating citizens effectively on the health insurance contract to ensure that their rights as policyholders were upheld.
Other issues discussed centered on the need to regulate service hours of providers at the CHPS compound as well as the impact of delay in NHIS reimbursement and its associated challenges related to the late submission of claims by public health facilities.