Abstract
BackgroundThe Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study.MethodApplying a qualitative research methodology, this study analysed transcripts from 20 focus group discussions (FGDs) in four functional CHPS zones in separate districts of the Northern and Volta Regions of Ghana to understand the community’s assessment of CHPS. The study employed the thematic analysis to explore the content of the CHPS service provision, delivery and how community members feel about the service. In addition, ordinary least regression model was applied in interpreting 126 scores consigned to CHPS by the study respondents.ResultsTwo broad areas of consensus were observed: general favourable and general unfavourable thematic areas. Favourable themes were informed by approval, appreciation, hard work and recognition of excellent services. The unfavourable thematic area was informed by rudeness, extortion, inappropriate and unprofessional behaviour, lack of basic equipment and disappointments. The findings show that mothers of children under the age of five, adolescent girls without children, and community leaders generally expressed favourable perceptions of CHPS while fathers of children under the age of five and adolescent boys without children had unfavourable expressions about the CHPS program. A narrow focus on maternal and child health explains the demographic divide on the perception of CHPS. The study revealed wide disparities in actual CHPS deliverables and community expectations.ConclusionsA communication gap between health care providers and community members explains the high and unrealistic expectations of CHPS. Efforts to improve program acceptability and impact should address the need for more general outreach to social networks and men rather than a sole focus on facility-based maternal and child health care.
Highlights
The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities
The CHPSs programme was a scale-up of an experimental study conducted at the Navrongo Health Research Centre in the Upper East Region of Ghana
CHPS is a national initiative with policy oversight provided by the Ghana Health Service’s (GHS) Policy Planning Monitoring and Evaluation Division (PPME) and operates at the periphery of a multi-level system
Summary
The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. The Ghana Community-based Health Planning and Services (CHPS) initiative was established to improve access to primary health care in underserved areas. Inspired by the Alma-Ata Declaration [1], and structured to replicate an experimental study [2, 3], CHPS was constituted to empower rural communities in the governance of health care services in their communities [4, 5]. About a third of the CHC have resident midwives This configuration of primary health care represented a major shift in health policy following the Alma-Ata Declaration’s emphasis on balancing the authority of central health administrations with the needs and perceptions of communities that the system serves. Since top down approaches that rely on impersonal clinical strategies have not yielded expected results [7,8,9,10], CHPS represents an attempt to implement people centred primary health care [11]
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