Community Participation in Health Care Delivery and Management: A Case Study of Northern Ghana

Abstract

This study is devoted to the investigation of a common and yet anonymous phenomenon in, development management - community participation. The objective of the study has been to explicate the nature and forms of community participation in the public health sector in order to discover the modes through which communities participate in health care delivery and management issues. The study also elucidates some determinants of community participation in the public health sector. The study concentrates on the three northern regions of Ghana using case studies of community participation programmes. The bulk of the data was collected using key informants, semi-structured interviews and focus group discussions. The findings have implication not only for the northern sector of Ghana but for the entire country and developing world. The findings show that communities participate in health issues in various forms: as individuals selected and trained, as traditional health experts trained or untrained and through systems of representation in teams or committees. Communities also participate as whole groups in village /community meetings and assemblies. Communities participate in broad scope of health care delivery and management issues ranging from community entry and preparation; information, education & communication; social mobilization and curative primary health care delivery and planning. Of these aspects of participation, participation in primary curative health care delivery and management is limited in scope and the most contentious. The findings also show that the nature of health sector participation by communities is determined by the Primary Health Care system and the current decentralization policy pursued by Ghana; health sector material and human resources, especially the orientation and capacity of the human resources; and the social and cultural conditions of the participating communities. Although the PHC system and the decentralization policy are pursued nationwide, the findings show that the resources of the health sector - the infrastructure, capacity and orientation of human resources vary across the northern sector of Ghana. Similarly, social and cultural conditions also vary across the length and breadth of the three northern regions. As a result of variations in health resources and social and cultural conditions, the nature and forms of participation in health care delivery and management were found to vary between regions and sometimes within districts and sub-districts. Community participation in the public health sector of Ghana is more a means rather than an end process geared towards improvement of the health status of communities rather than confidence building and empowerment. One key factor limiting community participation in Ghana is the inward looking policies of the Ghana Ministry of Health, which has been pro-modern scientific medicine for some time now. Thus, the de-linking of the service delivery function of the Ministry of Health from its policy function by the creation of the GHS is in the right direction towards ensuring broad-based stakeholder participation in public health in Ghana. However for the participation to be genuine and empowering, a Coalition for Participation and Partnerships model together with the strategies for its implementation is proposed.