Factors Influencing Utilization of Communiy-Based Health Planning and Services in BunkpuruguYunyoo Districtin Northern Region of Ghana

Abstract

Background The Community-based Health Planning and Services (CHPS) was adopted in 1999 as a national health policy initiative in Ghana, with the aim of reducing barriers to geographical access to healthcare. The CHPS strategy focuses on rural communities, with the goal of providing primary healthcare supported by a system of referrals across the various levels of care. CHPS relies mobilization of grass-roots action, resources and leadership in promoting quality health care in marginalized communities. Government and development partners have been investing heavily in the scaling up and community mobilization activities for CHPS nationwide. As a result of that there has been significant increment in the number of Functional CHPS in Bunkpurugu/Yunyoo district. Despite the increased investment in the scaling up CHPS resulting in primary health care services being brought closer to the doorsteps of many more communities and households, there has not been a corresponding improvement in utilization of CHPS in the district. This study was therefore aimed at identifying the health service delivery factors and socio-cultural and economic factors that influence the utilization of CHPS in Bunkpurugu/Yunyoo District. Methods This study was exploratory cross-sectional in design. A combination of qualitative data collection methods including Focus Group Discussions (FGD), In-depth Interviews (IDIs) and Key Informant Interviews (KII) were used to obtain in-depth information about participants’ experiences and perceptions about factors influencing the utilization of CHPS among community members in the study area. Twelve (12) FGDs were conducted with male and female community members in the study area. Four (4) IDIs and KIIs were also conducted with health workers and the District Health Management Team. QSR Nvivo 12 was used to code data from transcripts of the audio-recordings of discussions and interviews for analysis. The coded data was transformed into themes and sub-themes by application of the technique of thematic analysis. Results Utilization of antenatal and postnatal services provided through the CHPS strategy was hampered by health service delivery factors including inadequate number and skills of Community Health Officers; poor availability of health commodities; illegal charges by community health officers; and ineffective community mobilization and poor accessibility to health insurance. In addition, absence of supervised delivery services in almost CHPS in the district as well as limited availability of curative services under the strategy were perceived as unmet needs of community members that had consequences on the patronage of CHPS. On the demand side, utilization of maternal and child health services was hindered by poverty as well as unfavourable sociocultural norms that conferred much power on men over their spouses in the control of household resources and decision-making processes. The relegation of male involvement in preventive maternal and child healthcare by these sociocultural norms adversely impacted on the utilization of CHPS by community members. Conclusion On overall, the CHPS strategy improved physical access to designated CHPS services, however, other dimensions of accessibility such as the range of services and service readiness; financial accessibility and certain sociocultural norms and beliefs regarding gender roles thwarted the utilization of services of delivered through the strategy in the study area.