Strengthening Community Health Systems in Ghana Introducing the - - PowerPoint PPT Presentation

Strengthening Community Health Systems in Ghana

Introducing the GhCHW Concept September 4, 2014 Bolga, Ghana Chief Nat Nsarko Local Consultant

Evidence to Policy

• Earlier achievements/challenges guided

subsequent steps and efforts to address access to quality health care for all in Ghana

Pilot Experiments & Studies -> Knowledge Factorial Studies -> Compare Options CHPS – Home Grown PHC Strategy

• 1. Mobilized Communities in a

CHPS ¡Zone ¡with ¡…

• 2. Active Community Health

Management ¡Committees ¡and ¡…

• 3. Motivated Community Health

Volunteers ¡…

• 4. ¡… ¡and ¡a ¡CHPS ¡Compound ¡for ¡CHO ¡

residence and treatment of minor ailments

The Health Worker / Community interphase Within the CHPS Zone Composite Complex

• 1. Mobilized

Communities

• 2. CHMCs
• 4. CHPS Compound

With CHO

• 3. Community

Health Volunteers

Ref 14

THE CHALLENGE IS

SOMETIMES WE ADVOCATE FOR CHPS COMPOUNDS WITHOUT THE ACTIVE INVOLVEMENT OF THE COMMUNITY.

SO THIS IS WHAT WE ¡GET……

• 1. No Mobilized Communities

in ¡a ¡CHPS ¡Zone ¡with ¡…

• 2. No Community Health

Management ¡Committees ¡and ¡…

• 3. ¡Unreliable ¡Health ¡Volunteers ¡…
• 4. ¡… ¡But ¡procure ¡CHPS ¡Compound ¡for ¡CHO ¡

residence and treatment of minor ailments

The Health Worker / Community interphase Within the CHPS Zone Composite Complex

• 4. CHPS Compound

With lonely CHO

Ref 14

GhCHW CONCEPT!

A proposed reward system to appreciate long serving volunteers and encourage others to do same.

• The GHCHW strategy is to animate the community health system:-
• Mobilize the community to actively own the concept
• Establish conscientized CHMCs
• Recruit, train and equip long serving trainable volunteers as CHWS
• Re-orient CHOs to supervise the CHWs
• Re-orient and empower SDHTs to provide supportive supervision
• Empower and support DHMTs to consolidate all community based

health interventions to ensure efficiency

• Empower and Reposition RHMTs to monitor and supervise a robust

community health system

Aim of the Consolidation & GHCHW

• To maximize cost effectiveness and the

potentials of CHWs

• Increase health coverage and contribute to

achieving MDGs 4, 5 and 6

• To ensure effective involvement of the

community in health planning and health service delivery

THE CHW

• A CHW is a long serving trainable community health

volunteers or a committed unemployed school leaver trained, equipped and deployed to bring basic healthcare services to the doorsteps of rural populations and hard-to-reach areas;

• This cadre, with terminal performance -based

renewable appointment of three years,will work directly under the CHO and with active CHMCs.

• The CHW

– must come from the community – Will be present in each community – Will work closely with the CHMCs and other Volunteers

…CHW ¡at ¡a ¡glance

THE CHWS CONCEPT AND STRENGTHENING CHPS….

• recruitment, hiring, training, firing, and management of leave of absence and attrition will be

handled by local NGOs ( vendors), in close relationship with the district, sub-district health and community health management teams.

• The guidelines and norms for recruitment will be set by the Ministry of Health and Ghana

Health Service

• Specific CHW number needs will be determined at the regional level.
• The Regional Health Team will also be charged with quality assurance of vendor engagement

processes in the region.

• Sensitization of communities and selection of potential CHWs will be conducted at the district

and sub-district level starting from a nomination and endorsement by Community Health Management Committees.

• Long serving community volunteers and school leavers living in the respective communities

they apply from are earmarked to be considered for a three year terminal-renewable engagement.

• These CHWs will extend essential health services to the household level, functioning as a core

component of the community-based health services team within the infrastructure and human resources already in place.

• Furthermore, the CHW will be used as a platform to strategically consolidate all vertical

community health interventions under CHPS

Ref 7

GHANA COMMUNITY HEALTH WORKER CONCEPT INTERPHSAING WITH CHPS

CHWS PROMPTING COLLECTIVE ACTION- From a faint signal at the COMMUNITY-National level

Merge & Analyze DISTRICT LEVEL INFO CHPS-COM Collective understanding Event Characterization Response initiation Real time feedback and support Immediate analysis & Decision making capacity CHOs–peer information sharing and collaboration

CHW / CHMC interphase at community level

Proactive education & preparation

SUB-DISTRICT LEVEL REGION ROBUST COMMUNITY HEALTH SYSTEM with CHWS DHMT RHMT Stronger data collection with CHWS

Roll-out Timeline

• In total, the national CHW concept will require approximately

25,261 CHWs to cover 100% of the rural population by 2019.

• The concept aims to roll-out this cadre gradually, aiming for 20% of

the CHWs to be deployed in 2014, 40% by 2015, 60% by 2016.

• In 2014, the first 20% of the CHWs (4,735) will be rolled out to

approximately 4 CHPS zones per region (40 zones).

• In 2015, an additional 5,037 CHWs will be added to approximately

3-4 CHP zones per region.

• By 2016, we aim to have 15,157 total CHWs covering 60% of the

rural population.

Key Stakeholders at the February Meeting

Consultative Stakeholder Activities

• Team Ghana worked with the 1mCHW campaign-

EICU New York to develop a detailed road map and drew an action plan,

• Team Ghana met and briefed the following

stakeholders:

– Divisional Directors at the MoH – Divisional Directors at the GHS HQ – Program Managers for GFTAM, UNICEF, WB, WHO – Managers of iCCM to align and integrate iCCM with GhCHW campaign – GHS Regional Directors and Senior Managers

Post February Stakeholder Activities

• The Minister of Health and the Director General of the

Ghana Health Service are in agreement and have caused the following to be done:

– iCCM and TAG to develop a joint TOR to align/streamline all community health interventions in the country – All health interventions at the community level hence forth to be integrated and delivered through a unitary Community Health System under the CHPS – GhCHW campaign now incorporated into the following documents: National HR Policy, POW 2014, MTHSP etc

• The GhCHW is simply a system designed to

strengthen our community health system and support the implementation of CHPS.

• To consolidate all Community-based Health

Interventions

• No verticalization, ¡No ¡‘silosification’, ¡Rather ¡

Integration from the Start

Open Forum

• Comments, Contributions and Discussions