The evolution of a primary health care programme: the Danfa experience 1970-1977.

Abstract

The Danfa Comprehensive Rural Health and Family Planning Project was established in Ghana as a demonstration service teaching and research program. Originally population coverage was poor. To improve coverage of preventive and curative services a number of village-based programs were developed that progressively increased community participation. 60% of the children attend school; 60% of the men and 32% of the women in the 15-44 year age group are literate. 1/2 the population is Christian. The rest hold traditional religious beliefs. 18% of the population are children under 5; 49% are children under 15 18% are women age 15-44; only 3% are over age 65. At the beginning of the project the infant mortality rate was estimated to be 100/1000 live births; the maternal mortality was approximately 5/1000 live births; and expectation of life at birth was 55 years. The birth rate was 47/1000 population; the crude death rate was 15/1000/year. Health service priorities are the major causes of mortality. In children these are malaria measles respiratory infections poliomyelitis intestinal parasites whooping cough diarrhea and malnutrition. Treatment of acute illness and maternal and child welfare programs were carried out at the beginning of the project. The progressive involvement of the community can be divided into 3 phases. Phase I included: 1) health education; 2) sanitation; and 3) training of traditional birth attendants. Phase II introduced 3 new programs: 1) malaria chemoprophylaxis; 2) family planning; and 3) immunization. Phase III is the village health worker program which seeks to improve and co-ordinate village-based health programs to increase health care coverage and to reduce costs. It is estimated that less than 30% of the countrys population of 10 million has access to modern health care.