Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

English version

Autoři: Margaret Kweku ^aff001; Hubert Amu ^aff001; Adam Awolu ^aff001; Martin Adjuik ^aff001; Martin Amogre Ayanore ^aff001; Emmanuel Manu ^aff001; Elvis Enowbeyang Tarkang ^aff001; Joyce Komesuor ^aff001; Geoffrey Adebayo Asalu ^aff001; Fortress Yayra Aku ^aff001; Nuworza Kugbey ^aff001; Fidelis Anumu ^aff002; Laud Ampomah Boateng ^aff003; Justine Sefakor Alornyo ^aff003; Roland Glover ^aff003; Timothy Letsa ^aff003; Ayaga A. Bawah ^aff004; Nicholas S. Kanlisi ^aff005; John Koku Awoonor-Williams ^aff006; James F. Phillips ^aff005; John Owusu Gyapong ^aff002
Působiště autorů: School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana ^aff001; Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana ^aff002; Volta Regional Health Directorate, Ghana Health Service, Ho, Ghana ^aff003; Regional Institute of Population Studies, University of Ghana, Legon, Accra, Ghana ^aff004; Mailman School of Public Health, Columbia University, New York, New York, United States of America ^aff005; Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana ^aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226808

Souhrn

Background

In 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017.

Methods

This exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed.

Results

Negative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals, lack of proper community entry and engagement, non-availability of essential logistics, distance of CHPS compounds from communities, and inadequate funding were challenges associated with the health system. Lack of community ownership of the CHPS programme, lack of security at CHPS compounds, and late reporting of cases by the community members were also realised as challenges emanating from the community members. Priority areas for capacity development of health workers identified included logistics management, community entry and engagement, emergency delivery, managing referrals at the CHPS level, and resuscitation of newborns.

Conclusion

Health-worker, community, and health systems-based challenges inhibit the implementation of CHPS in Ghana. Capacity development of health professionals and continuous community engagement are avenues that can improve implementation of the programme.

Klíčová slova:

Neonates – Resuscitation – Nurses – Public and occupational health – Health services administration and management – Ghana – Communication in health care – Health systems strengthening

Zdroje

1. World Health Organisation (WHO). Social determinants of health: WHO called to return to the Declaration of Alma-Ata; 2018a. http://www.who.int/social_determinants/tools/multimedia/alma_ata/en/

2. World Health Organisation (WHO). Primary health care. 2018b. Retrieved from http://www.wpro.who.int/topics/primary_health_care/en/

3. Mona M. Key elements of primary health care (PHC); 2016. http://nursingexercise.com/primary-health-care-elements-principles/

4. Magawa R. Primary health care implementation: A brief review. Public Health Discussion Paper. Consultancy Africa Intelligence. 2012; 16.

5. World Health Organisation (WHO). Flawed but fair: Brazil’s health system reaches out to the poor. Bulletin of the World Health Organization. 2008; 86 : 241–320.

6. World Health Organisation (WHO). Brazil’s march towards universal coverage; 2018c. http://www.who.int/bulletin/volumes/88/9/10-020910/en/

7. Phillips JF, Awoonor-Williams JK, Bawah AA, Nimako BA, Kanlisi NS, Sheff MC, et at. What do you do with success? The science of scaling up a health systems strengthening intervention in Ghana. BMC Health Services Research. 2018;18(1):484. doi: 10.1186/s12913-018-3250-3 29929512

8. Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health policy and planning. 2005; 20(1):25–34. doi: 10.1093/heapol/czi003 15689427

9. Ghana Health Service (GHS), Community-Based Health Planning and Services (CHPS); 2018. About CHPS http://www.ghanahealthservice.org/chps/category.php?chpscid=98

10. Amu H, Kumi-Kyereme A, Darteh EK. Trends in Health Insurance Subscription at Cape Coast, Ghana: A Retrospective Study from 2005–2014. Ghana Journal of Geography. 2017; 9(3):97–111.

11. Government of Ghana. National health insurance act, 2003 (Act 650). Accra: Ghana Publishing Corporation; 2003.

12. Kanmiki EW, Bawah AA, Akazili J, Awoonor-Williams JK, Kassak K. Moving towards universal health coverage: an assessment of unawareness of health insurance coverage status among reproductive-age women in rural northern Ghana. The Lancet Global Health. 2018; 6:S32.

13. National Health Insurance Authority (NHIA). National Health Insurance Authority 2012 annual report. Accra: National Health Insurance Authority; 2012.

14. Kumi-Kyereme A, Amo-Adjei J. Effects of spatial location and household wealth on Health Insurance subscription among women in Ghana. BMC health services research. 2013; 13(1):221.

15. Jehu-Appiah C, Aryeetey G, Spaan E, De Hoop T, Agyepong I, Baltussen R. Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why? Social science & medicine. 2011; 72(2):157–65.

16. Amissh, B. Primary health care in Ghana; 2018. https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Primary-health-care-in-Ghana-647657.

17. Ghana Statistical Service (GSS). 2010 population and housing census: Regional analytical report: Volta Region. Accra: GSS; 2013.

18. Ghana Statistical Service (GSS). Projected population by district and sex, Ghana, 2010, 2015–2020; 2019. http://www.statsghana.gov.gh/docfiles/2010phc/Projections_Districts_2015%20to%202020_submit.xlsx.

19. University of Health and Allied Sciences (UHAS). General information on UHAS; 2018. https://www.uhas.edu.gh/en/about-us/overview.html.

20. Awoonor-Williams JK, Bawah AA, Nyonator FK, Asuru R, Oduro A, Ofosu A, et al. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC health services research. 2013; 13(2):S3.

21. International Alliance for Patients’ Organisation (IAPO). The Primary Health Care Performance Initiative (PHCPI); 2018. https://www.iapo.org.uk/sites/default/files/files/Final%20PHCPI%202-Pager%206_5_15.pdf.

22. Veillard J, Cowling K, Bitton A, Ratcliffe H, Kimball M, Barkley, et al. Better measurement for performance improvement in low -⁠ and middle-income countries: The Primary Health Care Performance Initiative (PHCPI): Experience of conceptual framework development and indicator selection. The Milbank Memorial Quarterly, 2017; 95; 4 : 836–883.

23. Primary Health Care Performance Initiative (PHCPI). Measuring PHC: The Measurement Gap; 2018 https://phcperformanceinitiative.org/about-us/measuring-phc.

24. Bergold J, Thomas S. Participatory research methods: A methodological approach in motion. Historical Social Research/Historische Sozialforschung. 2012 Jan 1 : 191–222.

25. Allen CG, Brownstein JN, Cole M, Hirsch G, Williamson S, Rosenthal EL. Building a framework for community health worker skills proficiency assessment to support ongoing professional development. The Journal of ambulatory care management. 2018;41(4):298–307. doi: 10.1097/JAC.0000000000000251 29923846

26. Thapa K, Dhital R, Karki YB, Rajbhandari S, Amatya S, Pande S, et al. Institutionalizing postpartum family planning and postpartum intrauterine device services in Nepal: Role of training and mentorship. International Journal of Gynecology & Obstetrics. 2018;143 : 43–8.

27. Mfrekemfon P, Okere UA. Traditional birth attendants and maternal mortality. J Dent Med Sci. 2015; 14(2):21–6.

28. Manasyan A, Chomba E, Moore J, Wallace D, McClure EM, Koso-Thomas M, et al. Association between birth attendant type and delivery site and perinatal outcomes. International Journal of Gynecology & Obstetrics. 2019;145(2):187–92.

29. Sageer R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria. BMC pregnancy and childbirth. 2019;19(1):63. doi: 10.1186/s12884-019-2202-1 30744576

30. Kitui JE, Dutton V, Bester D, Ndirangu R, Wangai S, Ngugi S. Traditional Birth Attendant reorientation and Motherpacks incentive’s effect on health facility delivery uptake in Narok County, Kenya: An impact analysis. BMC pregnancy and childbirth. 2017;17(1):125. doi: 10.1186/s12884-017-1307-7 28431565

31. Musesengwa R, Chimbari MJ. Community engagement practices in Southern Africa: Review and thematic synthesis of studies done in Botswana, Zimbabwe and South Africa. Acta tropica. 2017 Nov 1;175 : 20–30. doi: 10.1016/j.actatropica.2016.03.021 27005396

32. Ott MA, Campbell J, Imburgia TM, Yang Z, Tu W, Auerswald CL. Community engagement and venue-based sampling in adolescent male sexually transmitted infection prevention research. Journal of Adolescent Health. 2018 Mar 1;62(3):S58–64.

33. Lyons I, Cavaye J. Community-led engagement with government and the role of community brokers in East New Britain, Papua New Guinea. Society & natural resources. 2016 Apr 2;29(4):462–78.

34. Musesengwa R, Chimbari MJ. Experiences of community members and researchers on community engagement in an Ecohealth project in South Africa and Zimbabwe. BMC medical ethics. 2017 Dec;18(1):76.

35. Bhagwan R. Community engagement within a social work programme in rural India. Social Work. 2017;53(3):315–29.

36. Ushie BA, Ugal DB, Ingwu JA. Overdependence on For-Profit Pharmacies: A descriptive survey of user evaluation of medicines availability in Public Hospitals in selected Nigerian States. PloS One. 2016; 11(11):e0165707. doi: 10.1371/journal.pone.0165707 27812177

37. Muhammed KA, Umeh KN, Nasir SM, Suleiman IH. Understanding the barriers to the utilization of primary health care in a low-income setting: implications for health policy and planning. Journal of public health in Africa. 2013; 4(2).