CHPS Navrongo Project - Ghana

The experiment that launched CHPS began by reorienting existing workers to community health care and assigning trained paramedics to village resident locations. The cultural resources of chieftaincy, social networks, village gatherings, volunteerism, and community support were then mobilised. Since these dimensions can be mobilised independently, jointly, or not at all, a four-celled experiment was utilised to test the impact of mobilising community-based health care through traditional institutions with referral support and resident ambulatory care from Ministry of Health outreach nurses.

In 1994, a three-village pilot study was launched that combined social research with project implementation. Project organisers consulted with communities about activities and worked to tailor service delivery management to local needs and existing organisational resources. In 1996, a district-wide experimental programme with geographic zones corresponding to cells of the experimental design, each representing alternative intensive, low-cost, and comprehensive service delivery operations. A demographic surveillance system that monitored births, deaths, migration, and population relationships was used to test the impact of alternative strategies for community health services on fertility and mortality.

These studies resulted in the creation of CHPS, a process of sector-wide health system change and development that aims to provide accessible primary health care to Ghanian communities. The process involves a 15-step programme in participating districts:

1. Planning and community selection: situation analysis, manpower planning, zone designation, and resource development
2. Dialogue with workers: orientation, consensus-building, lead district site visitation
3. "Community Entry": liaison with leaders, team-building
4. Community orientation: description of the CHPS programme and solicitation of open discussion
5. Community Health Officer (CHO) capacity building: CHO selection, training, orientation through counterpart assignment
6. Community Health Committee preparation: selection and training in pharmaceutical kit management, counterpart orientation
7. Community profile preparation: community mapping of CHPS zones, preparation of work routines, preparation of registers
8. Community Health Compound construction or renovation and equipment: resource development, community organisation, political awareness-building, materials procurement
9. Mobilisation of logistics: procurement of motorbikes, rider training, procurement of bicycles, purchasing of equipment or seeking of resources for equipment, training of workers in motorbike riding and safety
10. CHO-launching: introduction of CHO to communities, explanation of roles, clarification of CHPS programme goals and solicitation of community views and advice
11. Selection of volunteers: collaboration with Community Health Committees and CHO in volunteer selection, orientation of committees and volunteers to health service system and referral to CHO
12. Volunteer introduction: orientation of community members to volunteer roles, links to CHO services and CHC, referral rules, pricing guidelines
13. Volunteer training: training of volunteers in basic health care, family planning and outreach to men
14. Procurement of volunteer supplies: preparation of drug kits and storage, documentation of logistics system and revolving fund, establishment of CHO and supervisory oversight
15. Final session for volunteers: announcement of plans for routine meetings, volunteer work arrangements, CHO rounds and reintroduction, clarification of referral rules and procedures.

Health.

Programme organisers noticed that, by the early 1990s, more than 70 percent of all Ghanaians lived over 8 kilometres from the nearest health care provider, a problem exacerbated by inadequate road and transportation facilities. Infant mortality rates in rural areas were double the rates prevailing in urban areas. The CHFP study found that mortality levels were high and that cultural traditions sustained high fertility. The economy in the study area was dominated by subsistence agriculture, literacy was low, and traditions of marriage, kinship, and family building emphasised the economic and security value of large families. Health decision-making was found to be strongly influenced by traditional beliefs and poverty.

As a result of the experiment, childhood immunisation coverage increased from 30 to 83% and contraceptive use increased from 3 to 20% in the area where the nurse works in the context of active community support. Infant mortality rates declined from 141 to 96 per 1000 live births. The fertility rate declined by almost one birth per woman.

The first CHPS programme was launched in Nkwanta District. Over the 1998 - 2000 period, 71 districts out of the 110 districts in Ghana started the CHPS programme.