When the average urban Ghanaian hears the words ‘Community-based Health Planning and Services (CHPS)’ compound, one of two things may most likely come into their minds. The first being confusion because they may not be familiar with the word CHPS, and the second being that they do know what it is, but they attribute it to a characteristic of rural communities.
CHPS was a policy brought about by the government in 2005 to provide free primary healthcare services at point of use within communities. It was designed to operate in zones of up to 750 households which were chosen based on electoral areas.
The basic package of CHPS includes health promotion, disease surveillance, health interventions such as immunizations, reproductive health, communicable and non-communicable diseases as well as first aid for minor ailments.
Nurses, who are referred to as community health officers, are placed in community zones to help carry out the objectives of CHPS within the various communities.
Currently, CHPS compound located in rural areas are doing quite well in delivering healthcare services to their locals, however, that cannot be said about the compounds located in urban areas.
The Community-led Responsive and Effective Urban Health Systems (CHORUS) Ghana is a six-year multi-country research program consortium focused on building resilient urban health systems with funding from United Kingdom’s Foreign, Commonwealth and Development Office.
The research program consortium embarked on a study titled ‘Assessing provision, awareness of and access to Primary Health Care in urban poor neighbourhoods in Accra’ which focused on co-producing with stakeholders, implementing and evaluating packages of interventions that will improve primary health care services, in particular, CHPS in urban poor settings in Ghana.
The concerns that the researchers had were that although rural areas had relatively healthier environments to live in compared to urban regions, some people in rural areas for various reasons, leave the rural areas to the already highly-populated urban areas.
A lead researcher at CHORUS, Dr. Ada Nwameme, mentioned that urban areas are currently overpopulated, according to a UN 2018 report. “It stated that 55 per cent of the world’s population lives in urban communities and is expected to increase to 68 per cent by 2015,” she shared.
Dr Ada also stated that, “The proportion of households that use one room for sleeping is higher in urban areas than rural areas with the percentage at urban areas being 65 per cent and rural areas at 57 per cent.”
This indicates that the current number of people in urban cities is so high that sharing one room for sleeping is the only option for some families. This shows how illnesses can easily spread among family members in urban areas.
The current population has created a lot of issues in urban areas in the country as not only has quality food, shelter, water, and other basic amenities become hard to come by but diseases have also increase in urban areas.
With infectious diseases being deadly and easily contagious in urban areas-especially in single room situations- it has also been shown that non-communicable diseases are on the rise in urban areas as well.
Speaking at a training programme on urban health organized by CHORUS to present their research findings to journalists, Executive Director of the organization Women, Media and change (WOMEC), Dr. Charity Binka, pressed on how illnesses are on the rise in major cities in the country.
“Diseases such as diabetes, hypertension, strokes, and cardiac issues are increasing in the urban areas as compared to the rural areas because of the poor quality of life in these major cities. With these issues on the rise, the urban healthcare system is sitting on a major ticking time bomb,” she said.
With the already stressed health system in the country where basic hospital amenities are hard to come by, if an effective healthcare system is not put in place, things are bound to become worse in no time.
For this reason, CHORUS embarked on a journey to research on CHPS compounds in urban areas and how they could support the current healthcare system in the country therefore absorbing some of the burdens affecting higher level hospitals and giving immediate healthcare services to those who will need it in communities, especially the poor in urban areas.
The project chose 4 communities in 2 municipalities in the Greater Accra Region, which are Ashaiman communities; Fitterline and Taifa and Madina communities Madina Zongo and Social Welfare. In these areas, CHPS compounds were identified and visited to assess the day to day activities of the compounds and some of the people that visit the compounds for healthcare services.
In their findings, they realised that people most vulnerable to poor health were the ones who visited CHPS compounds. This means that people who are disabled, homeless persons, kayaye, women, children, and people who worked in dangerous environments visited these places.
“The most common healthcare concerns included malaria, typhoid and other diarrheal diseases, drug addiction, STD’s, non-communicable diseases, workplace injuries such as injuries gotten from scrap metal dealing and cement works, etc. and respiratory diseases which can largely be attributed to air pollution in these areas,” Dr. Lauren Wallace, a CHORUS qualitative researcher highlighted during the presentations of their findings.
Some things the researchers also noticed was that although people in the communities were aware of the existence of a CHPS compound in their communities, they believed that the compound was meant for only reproductive services such as family planning and child welfare services. Most people in the communities had limited knowledge of the services that the CHPS compound offers.
The challenges the researchers noticed include limited number of nurses to issue care as most of them had to take on task shifting method in executing services. Obtaining and sustaining volunteers was also a big issue as the nurses sometimes have to use their personal funds to motivate the volunteers because although they do come to help for free, if they aren’t supported financially, they lose their interest in supporting the compound and they were seriously understaffed.
Dr. Wallace also shared that a very surprising challenge they found was the lack of a permanent physical structure to operate as the CHPS compounds within these areas were mostly church buildings, shops, or residents homes, and security issues.
“This created a further issue of having proper storage facilities for logistics and tools and which also created the problem of inadequate logistics for home care services since they had no place to store them,” she said.
By the end of the research it was realised that although CHPS could be used as an effective service to make proper healthcare services available to locals and reduce pressure on existing hospitals in the cities, it has been poorly developed and maintained in urban cities thus has made its operation difficult limiting the awareness of its activities in urban areas.
All these challenges have created some negative mindsets about the CHPS in the minds of urban settlers as the research found that people would prefer to go to hospitals rather than go to CHPS compounds, no matter how basic their health needs may be because they felt the hospitals would do a better job than the compound although it costs more to go to the hospital.
The citizens also preferred to self-prescribe medication for themselves and visit pharmacies for them rather than go to CHPS compound for the right diagnoses.
From their findings, it can be noticed that the government would help achieve a better healthcare system, especially for the urban poor, if CHPS compounds in the cities could be developed and made strong enough to provide primary healthcare, this way hospitals are alleviated from their burdens.
CHORUS recommended that if sanitation in compounds was improved, the NHIS was enhanced to resolve co-payment issues, awareness of CHPS compounds and their functions were increased, infrastructure and logistics were provided, and staffing needs were settled, this could help resolve some of the misconceptions people have about CHPS.
“We also suggest that there be an improved linkage between CHPS and private healthcare providers so as to make transferring of cases easier and also that relevant stakeholders such as opinion leaders, assemblies, as well as others be engaged in the CHPS programme,” Dr. Wallace added.
Urban health has to be taken seriously if we want to improve our healthcare systems in the country. Policy makers must avail themselves to working with researchers to create the best policies to curtail the growing menace of ailments increasing in the cities.
The media must also create space to talk about these issues and most importantly, highlight people who are being disadvantaged by the current health system in order to put out more evidence and force the government to combat it.
The CHPS compound can be an effective way to help reduce the stress of the current healthcare system. And as research has been taken to prove that it can go a long way if only it is given some attention, policy makers should turn their attention to it. It may help us much more than we know.
By Abigail Atinuke Seyram Adeyemi