Contribution of DSS to Promoting g Health for All in Ghana - - PowerPoint PPT Presentation

Contribution of DSS to Promoting g Health for All in Ghana

Cornelius Debpuur Navrongo Health Research Centre Ghana

Introduction

• Access to basic health care recognized as a human

right right

• Various efforts to promote access to basic health care

for all

• Progress has been made in improving access to health

care, but more remains to be done

– Persistent inequity Persistent inequity – Inability of poor to prevent ill health despite availability of effective technology

• Research utilizing DSS platform has contributed

Research utilizing DSS platform has contributed significantly to improved access to health care

Objective Objective

• Using the example of Navrongo, demonstrate

how DSS-based research has contributed to improved health care in Ghana improved health care in Ghana

• Provide an example of Navrongo DSS-based

research being adopted in the national effort to i t b i h lth improve access to basic health care In Ghana, DSS-based health research has brought the nation at least one district closer to g achieving health for all

Demographic surveillance system Demographic surveillance system

• A critical research tool

that involves:

– Continuous monitoring of a geographically defined population – Monitoring of vital events (births, deaths and migrations) at regular intervals – Other events of interest monitored at defined intervals e.g. immunization

• DSS platform widely

employed by field research stations in the research stations in the developing world

The Navrongo Story The Navrongo Story

• DSS as the bedrock of NHRC research activities
• Vitamin A Supplementation Trial initiated basic

DSS i th K N k Di t i t DSS in the Kassena-Nankana District

• Expanded and full scale DSS initiated in 1993

Th DSS l tf h f ilit t d h

• The DSS platform has facilitated research

activities in Navrongo that have contributed to improved health care in Ghana p

NDSS and health care in Ghana NDSS and health care in Ghana

• Generating evidence of what works in promoting

health care

• Building local capacity for research and health
• Building local capacity for research and health

delivery

• Direct investment in health and development of

catchment populations

• Facilitating development of evidence-based health

programs and policies programs and policies

Generation of evidence

• Development and Testing of health technologies

– Vitamin A Supplementation Trial Vitamin A Supplementation Trial

• Vitamin supplementation reduces child mortality by

20%

– Insecticide treated bednet trial Insecticide treated bednet trial

• Use of ITN reduces child mortality by 17%
• Evaluation of health delivery strategies

– Navrongo Community Health and Family Planning project

• Possible to restructure health care delivery at

community level

• Doing so improves access and promotes health

Capacity Building Capacity Building

• Health research capacity

Health research capacity

– Academic training of scientific staff (over 10 PhD and numerous MSc/MA) – INDEPTH Leadership program INDEPTH Leadership program – Capacity to conduct research of varied designs

• Capacity for health care delivery

– Field training for public health trainees – Field training for health managers – Field training for health workers

Promoting the health of study community

• Study participants as beneficiaries

– Participation in research enhances access to health care

B fit t l l l ti

• Benefits to local population

– Scale up of successful interventions – Impact on behavior of local community – Economic impact of research on local community

Facilitating Evidence-based Programs and Policies

• Demonstration of what works

– Effective health technologies – Effective strategies for health care delivery – Effective strategies for health care delivery

• Dissemination and advocacy

– Using evidence to engage policy makers

The Navrongo Community Health and Family Planning Project

• Community Health and Family Planning (CHFP) Project, a

Community Health and Family Planning (CHFP) Project, a quasi-experimental design, launched in 1994 in Kassena- Nankana District, Upper East Region by the NHRC

• The CHFP assessed whether convenient community
• The CHFP assessed whether convenient community

health and Family Planning services can reduce fertility and mortality in a rural population

• The CHFP had four treatment cells:

– Three of the cells had a new basic primary health-care and FP program in addition to the standard clinic-based services provided by the Ministry of Health (MOH) – The fourth cell had only the basic standard services and was used as the comparison area for y p the project.

CHFP Experim ental Cells

Mobilizing traditional community

• rganization
• rganization

No Yes Mobilizing No Comparison Zurugelu only Ministry of Health

• utreach

(4) (1) Nurse Zurugelu plus Yes

• utreach
• nly (2)

nurse outreach (3)

Role of DSS in CHFP Role of DSS in CHFP

• Monitoring and Evaluation

– Provided demographic information on the district – Provided comparable fertility and mortality over time for all cells p y y – Provided platform for design and implementation of surveys to monitor trends fertility-related behaviors – Provided platform for design of management information system to guide activities of nurses activities of nurses

CHFP Impact CHFP Impact

• Increased service coverage
• Increased service coverage

– One Community Health Officer attend to many people a day than a health centre

• Impact on mortality

– Reduction in child mortality by 40% in most intensive cell

• Fertility impact

– Reduction in fertility by one birth in most intensive cell y y

CHFP demonstrated the feasibility and desirable impact of restructuring health care delivery in rural Ghana

NAVRONGO COMMUNITY HEALTH AND FAMILY PLANNING PROJECT AND FAMILY PLANNING PROJECT

• Test the fertility and mortality impact

y y p

• f restructuring health service

delivery at the community level

• Increased service coverage

f

• Reduction in fertility by one birth
• Reduction in child mortality by 40%

y y

From Research to National Policy From Research to National Policy

• Core elements of the most intensive cell of the
• Core elements of the most intensive cell of the

CHFP adopted by Ghana Health Service

– Reorientation and relocation of community health nurses M bili ti f it f h lth d li – Mobilization of community resources for health care delivery

• Community-based Health Planning and Services

as the national strategy to promote access to gy p basic health care in Ghana

Summary Summary

• NHRC’s mission is to conduct research on critical

NHRC s mission is to conduct research on critical health problems in Ghana so as to inform policy

• DSS platform as a critical resource in achieving

thi i i this mission

• Research activities of NHRC contributed in

several ways to improved health care in Ghana several ways to improved health care in Ghana

• There is reason for optimism that ongoing

studies would further contribute to making health f ll lit i Gh for all a reality in Ghana

THANK YOU!