Community Participation in the Community based Health Planning and Services (CHPS) Programme in Nkwanta District, Volta Region, Ghana

Abstract

The main strategy used in the Community-based Health Planning and Services (CHPS) initiative in Ghana has been the incorporation of community participation in the planning and delivery of basic Primary Health Care services. Accordingly the thrust has been on two main processes: mobilization and reorientation of the health care system as well as mobilization of the traditional society and social systems within which the programme operates. The CHPS programme has been adopted and is being implemented in the Nkwanta district for four years now. Rapid assessments indicate some positive results in health status indicators of the people. An in-depth assessment of the two main processes has become imperative. While the DHMT tried to evaluate its own performance in mobilizing the health care system, this study also tried to concurrently assess the communities’ participation, with the hope that this would complement efforts to achieve a combined result that will offer a sense of direction and sustainability of the programme. Methodology used in this study involved mainly qualitative techniques such as Focus Group Discussions with community opinion leaders; in-depth interviews with care providers and in-depth interviews with administrative managers of the programme. The Focus Group Discussions were done in all the six CHPS zones. Views on the level and kinds of community support and involvement in the programme were solicited. Analysis was based on themes that centred on the five components of the Rifkin Model for assessing community participation: Needs assessment, Leadership, organization, Resource mobilization and Management. Findings indicate that involvement of the community members in the planning, implementation and evaluation of programme activities has been high. Their in-kind support has been the main motivation for the direct service providers (i.e. the Community Health Officers) to continue to stay and work with the people. The people are generally satisfied working with the programme managers and some NGOs as their main source of cash flows and teclmical support while demonstrating a sense of ownership for the programme and feeling they equally contribute to its operation and sustainability. However, how long the often-overworked care providers would continue to be motivated by the communities’ modest support systems is of great concern to community members themselves as well as to the programme managers. It is recommended that steps be taken to explore workable mechanisms to sustain the self-help and self-reliant spirit of the people as well as workable motivational packages for the care providers. Community enthusiasm for CHPS provides the possibility of developing community “hospitals” at least in Nkwanta district. This could be intimation that hospitals per se would not continue to be the ultimate means of acquiring health care in rural communities. As such the steps taken by government and the MOH/GHS to implement CHPS in other parts of Ghana is in the right direction.