1. Ghana’s CHPS Initiative Ghana Health Service With USAID support Jane Wickstrom Sr. Technical Advisor for Reproductive Health USAID/Ghana June 2002

2. Outline of presentation n What is the Community-based Health Planning and Services (CHPS) Initiative n Where are we now? n The way forward

3. Background  Government’s desire to improve health status of Ghanaians  Poor performance of health sector over the years  Recognition of the need for a change in health delivery strategy

4. CHPS At A Glance n National strategy for extending access to basic health services n Initiative based on research evidence from Navrongo Health Research Center (1994) n Nation-wide implementation begun in 2001

5. Navrongo in NE Ghana

6. Navrongo Experiment assessed the demographic impact of convenient community health and FP services on fertility tested the hypothesis that changes in service delivery can induce and sustain reproductive change

7. Navrongo Findings: n Community health improves with both nurse relocation and social mobilization n The result is a fertility decline of one birth in the marital TFR in 3 years

8. Communities Truly Involved

9. CHPS At A Glance n Community Health Committees, Volunteers and Mobilization of community leaders n Community-based Health Officer deployed to the periphery and is mobile!

10. CHPS At A Glance (con’t) n Resource Package: Transport, Community Health Compound (housing), and means of communication n Defined service package based on National Treatment Guidelines n Defined catchment area

11. CHPS differs since it Deploys CHO to the community

12. Home visits instead of static clinics Heading out for service delivery

13. Volunteers, TBAs and Councils CHO and volunteers work together

14. Community Leaders Committed Traditional leaders attend a community durbar

15. Political Leaders Committed Central and district levels must be involved

16. “Ghanaian Initiative Run by Ghanaians” n Director General’s Initiative n Director PPME runs M&E n Regional Directors manage TA n District Directors mobilize health staff n Sub-district supervises CHO

17. Technical and Financial Support from USAID and DANIDA n JHU/PCS - community mobilization n PRIME II - train CHOs n EngenderHealth - counseling n Population Council - M&E n Donors – transport, communications, some equipment

18. Integrated Services is the Key n Communities want full range of services: –Maternal care –Child health –Health education –Family Planning –Minor Injuries

19. For Safe Motherhood n Communities want CHO to: –Monitor pregnant women –Provide simple ante-natal care (nutrition counseling, malaria prevention, etc.) –Map out delivery plan –Assist TBAs, deliver (if a midwife) or refer –Post-partum follow-up

20. Communities & Safe Motherhood CHPS communities support CHO to: n arrange or conduct clean deliveries n recognize complications n arrange transportation n Help establish community fund for health emergencies and transport

21. National Scope of CHPS The Lead District Approach

22. Districts Starting CHPS Dec. 31, 2000 Dec. 31, 2001

23. Quarterly reporting form Database Two-way Information sharing (CD-ROM) CHPS website: www.ghana-chps.org CHPS M&E Secretariat

24. Continued Research, Monitoring and Evaluation Lead District Assessment (2001) “Strategic Assessment Method” Rapid Survey Method (RSM). MIS Mobilization CHPS cost analysis.

25. Lead District Assessment n Results from Year One

26. Successes to date n Increased awareness of health services and healthy behaviors n Services closer to people and people seeking care earlier n Construction of CHCs; formation of VHCs and volunteer services n Starting to obtain District Assembly support

27. Constraints to date n Lack of support materials for CHOs, volunteers and committees n Lack of housing for CHOs and visiting supervisors n Lack of human resources to meet demand; lack of training for volunteers n Lack of motivation/incentives for CHOs

28. 20 Lead Districts using CHPS n 94% selected communities n 54% have CHOs assigned n 56% receive support from District Assembly n 75% believe resources are not adequate to enable CHOs to perform

29. District Health Managers aware of CHPS

30. District Assemblies know CHPS

31. Community awareness of CHPS

32. CHOs Want More Training in:

33. The Way Forward n We are all in this boat together!

34. The Way Forward n Need clear priorities, indicators and targets for success n Health Leadership and Supervisors must facilitate organizational support n CHOs need clear career path and incentives to relocate to periphery

35. The Way Forward n Comprehensive training strategy needed, in-service and pre-service n Resource mobilization key (Districts Assemblies, MOH, Common Basket, donors) n Improve flow of finances to regions and districts

36. The Way Forward Innovations and Monitoring Continue n Radio Distance Learning n Community Decision Making System n Use CHEST Kit, Journey of Hope and Life Choices IEC materials for education n Refine M&E system

37. Learn from Navrongo Training Site for CHOs Community Entry and Mobilization training Link Theory and Practice in community health service delivery

38. Learn from Navrongo Demystify CHPS Learn about variations on CHPS implementation Teach Districts to document their own stories Develop dissemination materials –“What works, What fails” –Videos

39. Next steps USAID support for training, M&E, and transport/equipment Continue monitoring results of CHPS to assess impact Disseminate results within Ghana and internationally

40. Thank You !