Community Health Officers Extend Primary Health Care in Ghana

In the 1990s the Navrongo research center started the Community-based Health Planning and Services (CHPS) initiative 3 pilot districts. The CHPS Initiative has now become the national strategy for implementing community-based service delivery by reorienting and relocating primary health care from sub-district health centers to convenient community locations.[1] CHPS is even seen as crucial to Ghana’s broader poverty reduction agenda and policy.

CHPS Compound, Upper East region
CHPS Compound, Western region

The CHPS Operational Policy notes that, CHPS was designed to operate at the third tier of the district health system that encompassed a district hospital, sub-district health centers and community-based services by addressing the needs of zones of 3000-4,500 residents “where primary health care services will be provided to the population by a resident Community Health Officer (CHO) assisted by the Community structures and volunteer systems. The deployment of all elements necessary for the CHO to provide house-to house service shall make that zone a fully functional CHPS zone within the sub-district,” thus creating CHPS compounds. It is the CHO who represents the human resource innovation in the Ghana system

A CHO engages each Community within the zone in micro planning of health activities termed “community decision making systems,” building on the following key elements: Community (as social capital); Households and individuals (as target); Planning with the community (community participation); and Service delivery with the community (client focused).

Community health nurses (CHN) trained in the nation’s various schools of nursing would be designated a CHO once they were posted to a CHPS compound. The CHPS compound, often a building donated by the community or a philanthropist served as a health post and accommodation for the CHO. There could be two CHOs and a trained midwife, since CHNs are not trained to conduct delivery. The CHOs are expected to deliver a package of essential primary health care and promotion services at the community level that revolves around home visiting. The idea is to take services to the clients.

While the curriculum of a CHN addresses some basic issues of the CHPS program, CHNs do not exit school as ready-made CHOs. Those who opt to become CHOs must receive orientation from the regions and districts where they work in a CSPS. Depth and quality of orientation varies. CHOs could be assisted by community health volunteers who are supervised by a community health committee.

Sacks et al. report that CHNs obtain a Certificate in Community Health Nursing as part of pre-service training after completing a 2-year curriculum post-secondary school.[2] After 3-5 years of service, CHNs can enroll for higher education to become a midwife or public health nurse (PHN). Sacks and colleagues found that CHN/CHO satisfaction was often determined by professional isolation and lack of basic resources and materials to perform their jobs.

By 2002, 95 out of 110 districts had launched the CHPS program, though not every potential zone was covered. The rapid national expansion of the CHPS program may have contributed to some of the CHNs’ frustrations, as the time was not taken to recruit and train health workers from the target communities who would have spoken the same language. Facilities were not upgraded prior to the increase of health workers and communities were not prepared to provide free housing to CHNs, as originally planned, say Sacks and co-researchers. Although the original goal was for CHPS to achieve complete national coverage by 2015 through the establishment of 6,000 CHPS zones, challenges led to completion of only 3,000 CHPS zones by then.  Now, more than 20 years after the initial trial, Ghana is re-launching the CHPS policy to elevate PHC as a priority and to expand the CHPS model to parts of the country that are not yet covered.[3]

The three broad areas of work by the CHO include basic primary health care issues such as promotion and prevention, management of minor or common ailment and their referrals and case detection, mobilization and referrals. Ghana Web reports that,[4] CHPS compounds cover all 8 essential PHC services and aim at helping ensure improved access to primary health care in these communities. For proper functioning of the various CHPS compounds, there is very strong community participation in the implementation.

The article reports that, “Where there is strong community participation, traditional leaders and community members provide resources, both financial and non-financial incentives, to support implementation of the program. A CHO is expected to work in partnership with the community, households and district assemblies to ensure that, citizens are able to access services and health information as and when they need them whereas the communities are expected to also exert some levels of answerability to health providers.”

The Upper West Region serves as an example of CHPS and CHOs implementation as reported by the Ghana News Agency.[5] There are 308 functional CPHS zones out of 361 planned which cover 62% of the population. The region had 364 CHOs in the 308 functioning zones and 305 active community committees, with 1,669 volunteers. Unfortunately, only 155 of the functioning CHPS zones were fully equipped to standard. A relaunch of CHPS will focus on performance guidelines, systems strengthening and quality of services


[1] Community-Based Health Planning and Services (CHPS): The Operational Policy, Ghana Health Service, Policy Document No.20, May 2005.

[2] Emma Sacks, Soumya Alva, Sophia Magalona and Linda Vesel. Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana. Sacks et al. Human Resources for Health (2015) 13:81, DOI 10.1186/s12960-015-0082-7

[3] John Koku Awoonor-Williams, Elisabeth Tadiri, and Hannah Ratcliffe . Translating research into practice to ensure community engagement for successful primary health care service delivery: The case of CHPS in Ghana. https://improvingphc.org/translating-research-practice-ensure-community-engagement-successful-primary-health-care-service-delivery-case-chps-ghana

[4] Gabriel Frimpong. The Community-Based Health Planning and Service (CHPS) concept in Ghana, Ghana Web. Tuesday, 24 April 2018. https://www.ghanaweb.com/GhanaHomePage/features/The-Community-Based-Health-Planning-and-Service-CHPS-concept-in-Ghana-646058

[5] Prosper K. Kuorsoh, Upper West Region has 62 per cent CHPS coverage. Ghana News Agency. Thursday 9th August, 2018. http://www.ghananewsagency.org/health/upper-west-region-has-62-per-cent-chps-coverage-136932

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