Keeping a national health vision alive: GHS forms Groups to fix CHPS implementation challenges

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Working Group

The government of Ghana has shown commitment to making health care services accessible to rural population through its Community-based Health Planning and Services (CHPS) model.

A recently revised national policy guideline for CHPS cited the program as the strategy to help Ghana attain the UN Sustainable Development Goal (SDG) 3.8 of achieving Universal Health Coverage by 2030. To deliver this vision however, the Ministry of Health and the Ghana Health Service whose mandate it is to do so must work hard with partners to find solutions to the policy and implementation challenges affecting the CHPS program.

Ghana’s flagship primary health care program, the Community-based Health Planning and Services (CHPS) initiative has been considered one of the pragmatic programs for achieving Universal Health Coverage of basic package of essential primary health services. The program continues to receive Government’s full support and the Ghana Health Service (GHS), the agency responsible for overseeing successful CHPS implementation is committed in working to fix the implementation challenges that have been identified. As part of measures for pursuing this objective, the GHS early this year formed the CHPS Implementation Working Group (CIWG) intended to bring together major stakeholders involved in CHPS roll out onto a common platform for regular engagement to find solutions to the challenges hampering effective CHPS roll out.

At a recent meeting of the group, the Director of Policy Planning Monitoring and Evaluation Division (PPMED) at Ghana Health Service Dr. Koku Awoonor-Williams underscored the need for the creation of the CIWG and said with CHPS being high on the agenda of Government, it was important for the GHS to be on its feet and work hard to strengthen the weak areas of the program, harness the potentials, and share innovations and strategies in its implementation. He said the idea behind the formation of the group was to complement the efforts of similar steering committees on the policy front at the Ministry of Health (MoH).

According to him the key issues affecting the CHPS program implementation can be broadly categorized into policy and implementation challenges, but unlike the Ministry of Health where there exist a Technical Working Committee, the GHS who is the direct implementers of CHPS lacks such a body that would constantly engage the relevant stakeholders to swiftly respond to the implementation challenges.

Dr. Awoonor revealed that several evaluations by the GHS and its partners have identified the sub-district level as the weakest link in the country’s health care delivery system, and noted that steps are being taken to fashion training models and staff capacity building strategies to address this weakness. He appealed to health partners to continue to work in harmony with Government efforts to deliver the GHS vision of achieving “A healthy population with universal access to quality health service”. He also indicated that over the years, CHPS services tended to focus on maternal and child health service but the new consideration is to expand and to integrate other services including non-communicable diseases (NTDs), continuum of care including the integration of mental health.

The CIWG meeting provided opportunity for many presentations on various aspects of the health service. In all, three presentations were done geared at providing evidence to improve CHPS implementation and enhance quality delivery of services. Two of the presentation were focused on results of surveys conducted by Evaluate for Health (E4H) and Maternal and Child Survival Project (MCSP) both funded by USAID. The presentation by E4H looked at results from a baseline and midline surveys conducted on quality of health services at the sub-district and community levels whiles the MCSP study focused on assessment of Ghanaian health worker practice with task analysis.

Presenting the survey on quality of care, the Country Director for Evaluate for Health Dr. Frank Nyonator said preliminary results of the study showed there have been improvement in many areas of the country’s health care delivery system with a growing demand for CHPS services. He said the study also brought out a pressing need for health system strengthening and extended quality care. Dr. Nyonator who is also a former Director-General of the Ghana Health Service mentioned transport and communication for emergency referral, slow monitoring and supervision, and infrastructure deficit as some of the impediment hindering effective implementation of CHPS uncovered in the study.

Results of the survey on task analysis highlighted the need for training for Community Health Officers, importance of supervision from the sub-district level as well as peer support and networking. The final presentation looked at a recent assessment by the Policy Planning Monitoring and Evaluation Division on CHPS implementation utilizing the National CHPS Supportive Supervision Tool.

In what remains a historic move, the government of Ghana began implementing CHPS, a health care delivery strategy that places specially oriented nurses at Community Health Posts (CHPS zones) in the year 2000. Nearly two decades of the implementation, CHPS has been credited a considerably huge share of the country’s success story in improving national rates in immunization coverage, antenatal and postnatal services, family planning services, child nutrition among other key health indicators.

Purposefully designed to tackle financial and geographical barriers to health care services, CHPS has been Ghana’s cardinal health policy used to drive community support and ownership in health planning in order to bring about efficiency and improvement in child survival and maternal health.

The CHPS Implication Working Group (CIWG) comprises several stakeholders, health partners including implementing partners and would meet quarterly. The group is situated at the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service with the Director General as the Chair.

Story by: Mathias Aboba
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