Abstract
Ghana launched the Community-based Health Planning and Services (CHPS) initiative in the year 2000 in furtherance of the ideals of primary health care. The CHPS strategy was adopted by the MOH as a national programme to bridge the gap in access to healthcare. It provides for a Community Health Officer (CHO) to be resident in a community and with the help and support of the community members, to render some basic packages of PHC especially preventive services including home visiting, educational programmes and other health promotion activities and not sedentary clinical services at the health facility. With the introduction of the National Health Insurance Scheme (NHIS), which is a form of Health care financing in order to serve as a conduit for providing financial access to health care. This has perceptively resulted in an increase in out-patient attendance at all facilities especially CHPS facilities. This tended to constrain the CHOs from embarking on their mandated task of home visitation, educational programmes and other health promotion packages. It is against this background that this research work has been carried out to ascertain why the focus of CHPS is shifting from a preventive to a curative approach. The methodology adopted was a case study using a before and after approach to make comparison of the preventive health care activities of the CHO before and after the introduction of NHIS as well as access of people to the Vieri CHPS compound. Simple random sampling was used to select 165 households who were interviewed. We purposively sampled CHOs, the Community Health Management Committee (CHMC) and Community Health Volunteers (CHVs) who have in-depth knowledge on the operations of the CHPs. The study revealed that the frequency of household visitation and the educational programmes organized by the CHOs have declined. This is due to the net effect of NHIS on the facility and the CHOs due to increased attendance at the facility. This did not only negatively affect the activities that the CHOs are supposed to carrying out but also on the health infrastructure. The study also revealed various challenges faced by CHMCs and CHVs.
Highlights
Primary Health Care (PHC) is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination (WHO, UNICEF 1978)
Ghana has adopted the Primary Health Care concept, and this is indicated in the Ministry of Health (MOH) public health care policy in 1978 which states that, most disease problems that cause the high rates of illness and deaths among Ghanaians are preventable or curable if diagnosed promptly by simple basic and primary health care procedures (Health Policies for Ghana, NHPU, 1977, cited in Community-based Health Planning and Services (CHPS) policy Document, 2005)
Community-based Health Planning and Services is “the mobilization of community leadership, decision making systems and resources in a defined catchment area, the placement of re-oriented frontline health staff known as Community Health Officer (CHO), with logistics support in community volunteer systems to provide services according to the principles of Primary Health Care (PHC-Plus)
Summary
Primary Health Care (PHC) is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination (WHO, UNICEF 1978). Ghana has adopted the Primary Health Care concept, and this is indicated in the Ministry of Health (MOH) public health care policy in 1978 which states that, most disease problems that cause the high rates of illness and deaths among Ghanaians are preventable or curable if diagnosed promptly by simple basic and primary health care procedures (Health Policies for Ghana, NHPU, 1977, cited in CHPS policy Document, 2005) The rational of this concept is to provide preventive services, and bring health care close to the door steps of the people. This continued until 1985 when the Government was compelled under International Monetary Fund (IMF) and its Structural Adjustment Programme (SAP) pre-conditions to introduce user fees for all medical conditions except for certain specified communicable diseases and selected vulnerable groups such as the underfives, elderly and antenatal services for pregnant women This led to the creation of financial barriers towards access to health care, especially for the poor and needy, which resulted in delays in seeking health care, non-compliance to treatment regimes and premature deaths. The National Health Insurance Scheme (NHIS) was introduced in the Upper West Region of Ghana in October 2004
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