The Impact of Community-Based Primary Health Care Services on Parental Health Seeking Behavior and Child Survival in a Rural Impoverished Locality of Northern Ghana

Abstract

One out of every eleven children born in sub-Saharan Africa dies before age 5 despite accelerating improvement in child survival and growing investment in community-based primary health care. In this setting, social determinants of health seeking behavior are highly influential in determining health and survival, yet the link between health systems determinants and social system influences is poorly understood. There is therefore a need to understand how health seeking behavior interacts with the health system context to impact public health in the region. Ghana’s primary health care strategy, known as “Community-based Health Planning and Services (CHPS)”, relies on nurses trained to provide both facility-based and doorstep services, vibrant community engagement and volunteerism. Our research paper presents results from a study exploring how health seeking behavior and CHPS health services interact to affect child mortality in Ghana, using unique multilevel data resources on health seeking behavior, alternate health system service delivery strategies, and individual child mortality. We find that CHPS services are associated with increases in community level health seeking behavior. Furthermore, we find that more active health seeking behavior, at the community level, is associated with reductions in individual child mortality of up to 25% in areas without CHPS community-based provision of primary health care services. In areas with prototype CHPS services, community level health seeking behavior is not a determinant of mortality. The CHPS program with its health volunteers, vibrant community involvement, resident nurses, and routine household outreach in which nurses visited every home four times per year, lowered mortality by almost 30% even in communities with relatively low health seeking behavior.