Ahanta West District, Ghana — When community health officer Joseph Appiah-Kubi considers the stock-outs of malaria testing kits at his rural health clinic in west Ghana and the difficulty in providing malaria treatment for pregnant women, he sees opportunities, not challenges.
By identifying gaps in service and developing a plan to address them, Appiah-Kubi says he can improve health care for the estimated 8,700 Ghanaians who rely on the Akwidaa Community-Based Health Planning and Services (CHPS) center.
The Akwidaa facility is among 61 community-based health planning and service centers participating in a Jhpiego and Ghana Health Service partnership to strengthen health care services in the coastal district. Malaria is the primary cause of deaths in health institutions in Ghana’s Western Region and accounts for 39 percent of all outpatient visits, 48 percent of admissions to hospitals for children under five, and 18 percent of deaths in facilities.
Known as the STAR (Supportive Technical Assistance for Revitalizing) CHPS project, the five-year initiative has targeted malaria prevention, care and treatment as its primary focus. Jubilee Ventures Consortium — a collaboration of Tullow Oil, Kosmos Energy, Anadarka Petroleum, Ghana National Petroleum Corporation, Sabre Oil and EO Group Ltd. — is funding STAR CHPS, a unique private-public partnership.
The project is part of Jhpiego’s ongoing work in Ghana to help strengthen the health systems in collaboration with the government. The organization works with communities to increase the ability of frontline health workers to deliver lifesaving care and develops innovative, low-cost technologies to address today’s global health challenges.
In the first quarter of this year, the Akwidaa center saw an average of 55 new malaria cases a month, according to Appiah-Kubi. Continuing episodes of malaria leave children in his area suffering from anemia and convulsions. Many heads of families earn their living as fishermen. But a brush with malaria can keep a fisherman from his daily job and result in lost income.
“The project should build our capacity in malaria case management, how to do advocacy for community mobilization and participation in malaria control in the communities we serve,’’ says Appiah-Kubi, a community nurse by training.
With the Jubilee Consortium’s support, Jhpiego’s goal is to improve health outcomes for the approximately one million people who live in the coastal area by strengthening integration of services at CHPS centers, building support for health care providers and engaging local health committees and volunteers in the delivery of services.
As envisioned by the Ghana Health Service, a CHPS center is a health care model directed and supported by the community. At least one community health officer lives at the CHPS health clinic within the CHPS compound and provides basic primary care at the facility and at schools and homes in three to five surrounding communities.
The model relies on community health volunteers to provide outreach education and on a CHPS Health Committee to support the management of the operation and services. When working properly, a CHPS compound builds community support, finds local solutions to problems, increases access to care and provides much-needed integrated health services at the community level.
Since the project began in May 2011, a team of Ghana Health Service staff and Jhpiego health specialists has visited the Akwidaa CHPS as part of an initial assessment to review facility needs and develop a plan of action for the CHPS centers in the STARS CHPS project.
During a comprehensive review late last year, Appiah-Kubi shared with the team his strategy for providing basic clinical services for child health, reproductive health and other illnesses, the management of the CHPS facility and his outreach to surrounding communities. Each month, this frontline health care facility sees an estimated 365 men, women and children for a variety of conditions. Appiah-Kubi and his co-community health officer, Wisdom Adjei, also visit one school and 10 families in the community.
Appiah-Kubi demonstrated his clinical skills for the team while seeing clients and conducting a child welfare clinic. He also reviewed case studies with the team. He discussed gaps in service, the difficulty in providing intermittent treatment for prevention of malaria to pregnant women, and community residents’ reluctance to use insecticide-treated bed nets because of the heat.
“Everyone needs help, and CHPS is the last post of the Ghana Health Service working with the neediest, and that is what I love to do,” said Appiah-Kubi, referring to the location and distance of CHPS from the Ghana Health Service’s central office. Often, the CHPS is the first place community residents visit when they need care.
In reviewing 18 CHPS centers, the Jhpiego-led assessors used a comprehensive set of standards to determine the level of services provided by health officers and activities by health committees. The team offered a series of recommendations to the project. Among them: promote district health management teams on ownership and leadership of CHPS, encourage the sharing of best practices and prioritize activities for community health committees and community health volunteers.
“It is my vision that by the end of the five years, the six coastal districts will understand CHPS, use it as a vehicle to address health issues in both treatment and prevention of illnesses in addition to the promotion of health issues to people in the communities they serve,” says Dr. Linda Vanotoo, Regional Director of Health Services, Western Region. More specifically, she notes that, “there should be improvement in management of malaria in the coastal districts as compared with the other districts in the region.”
Community health officers like Appiah-Kubi and Wisdom Adjei will work with their communities to help make this vision a reality.