Is the Sub-District Concept Working? A Study of the Subdistrict Health System in the Ho District

Abstract

The Primary Health Care in Ghana which started as far back as 1978 is based on the three tier structure namely the District; subdistrict and community levels. The Subdistrict level is to act as a link between the District level and the Community level. However, the subdistrict level was recognised as a weak link in translating policies into significant health impact by the Ministry of Health, (MOH). In an attempt to address these problems, subdistrict health systems were formed in the country to provide essential health services within defined catchment areas. The subdistrict concept has been operating for over three years. This study aimed at determining whether the concept is working in the Ho District. The general objectives were to verify whether the subdistrict health system is working in the Ho district and to identify factors adversely affecting the system and suggest solutions. A descriptive study was conducted using both qualitative and quantitative methods. Data was collected using a checklist, a questionnaire, an interview guide, a discussion guide and available health information in the district. The study revealed that almost all SDHTs were not functioning as a team. The support systems needed to create the enabling environment for improved health service deliver}' at the subdistrict level was weak. Consequently, the subdistrict activities were not meeting the expected outputs recommended by the subdistrict working Group of MOH. On the basis of these findings, it is recommended that the SDHTs should be reconstituted to reflect the basic composition of an SDHT. Also, SDHT should be trained after needs assessment have been done by the DHMT. It is very important that the support systems of r the SDHTs are evaluated for the necessary action to be taken to improve health service delivery. SDHTs should also play the key role of involving communities in health programmes by supporting and working closely with community structures like VHCs and IMCs.