Community utilisation and satisfaction with the community-based health planning and services initiative in Ghana: a comparative study in two system learning districts of the CHPS+ project

Margaret Kweku,John Koku Awoonor-Williams,Joyce Komesuor,Norbert Ndaah Amuna,Timothy Letsa,Hubert Amu,Geoffrey Adebayor Asalu,Fortress Yayra Aku,Ayaga A Bawah,Justine Sefakor Alornyo,Laud Ampomah Boateng,Elvis Enowbeyang Tarkang,Martin Adjuik,Roland Glover,Emmanuel Manu,James F Phillips,John Owusu Gyapong

doi:10.1186/s12913-020-05678-5

Abstract

BackgroundTo strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana’s key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. We examined community utilisation and satisfaction with CHPS services in two System Learning Districts (SLDs) of the project.MethodsThis community-based descriptive study was conducted in the Nkwanta South Municipality and Central Tongu District of Ghana. Data were collected from 1008 adults and analysed using frequency, percentage, chi-square, and logistic regression models.ResultsWhile the level of utilisation of CHPS services was 65.2%, satisfaction was 46.1%. Utilisation was 76.7% in Nkwanta South and 53.8% in Central Tongu. Satisfaction was also 55.2% in Nkwanta South and 37.1% in Central Tongu. Community members in Nkwanta South were more likely to utilise (AOR = 3.17, 95%CI = 3.98–9.76) and be satisfied (AOR = 2.77, 95%CI = 1.56–4.90) with CHPS services than those in Central Tongu. Females were more likely to utilise (AOR = 1.75, 95%CI = 1.27–2.39) but less likely to be satisfied [AOR = 0.47, 95%CI = 0.25–0.90] with CHPS services than males. Even though subscription to the National Health Insurance Scheme (NHIS) was just 46.3%, NHIS subscribers were more likely to utilise (AOR = 1.51, 95%CI = 1.22–2.03) and be satisfied (AOR = 1.45, 95%CI = 0.53–1.68) with CHPS services than non-subscribers.ConclusionGhana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist. To accelerate progress towards the achievement of UHC with CHPS as the vehicle through which primary health care is delivered, there should be increased public education by the Ghana Health Service (GHS) on the CHPS concept to increase utilisation. Service quality should also be improved by the GHS and other stakeholders in Ghana’s health industry to increase satisfaction with CHPS services. The GHS and the National Health Insurance Authority (NHIA) should also institute innovative strategies to increase subscription to the NHIS since it has implications for CHPS service utilisation and satisfaction.

Highlights

To strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana’s key primary health care delivery strategy, the CHPS+ Project was initiated in 2017
Ghana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist
Service quality should be improved by the Ghana Health Service (GHS) and other stakeholders in Ghana’s health industry to increase satisfaction with CHPS services

Summary

Introduction

To strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana’s key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. PHC was identified as the key to attaining Universal Health Coverage (UHC) which was defined as essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost that the community could afford [2] This implies that the proximity, acceptance, satisfaction and perceived relevance of facilities within the catchment of communities, especially rural ones, is important in achieving UHC [3, 4]. Pursuant to the Almaty declaration, Ghana implemented various interventions towards achieving UHC One of such interventions is the Community-based Health Planning and Services (CHPS) programme which was initiated in 1999 [7, 8]. Though not to desirable levels, the implementation of CHPS has led to reduced water-borne diseases, reduced infant and child mortalities through immunization, increased household involvement in the treatment of diarrhoea, and breastfeeding [9,10,11]

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