In the last three weeks, I have been on field trips with the Ministry of Health and the Ghana Health Service to commission some polyclinics in the Greater Accra Region.

In series of remarks to inaugurate the health facilities, the Director General of the Ghana Health Service (GHS), Dr Anthony Nsiah-Asare, reiterated his outfit’s commitment to achieve at least primary universal health coverage (UHC) by 2030.

He had mentioned efforts by the service including improving access to health care by getting facilities closer to people, increasing human resource, provide needed logistics, strengthening partnerships among other interventions to promote quality health care delivery.

UHC, according to the World Health Organisation (WHO), means that all people and communities can use promotive, preventive, curative, rehabilitative and palliative health services of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

As part of the Sustainable Development Goals (SDGs), United Nations member states have agreed to work toward worldwide universal health coverage by 2030.

The GHS, last year declared zero tolerance for maternal and neonatal deaths charging all Regional and District Health Directorate to put in place pragmatic measures to effectively eradicate the phenomenon which persisted in most parts of the country.

The Community-based Health Planning and Service (CHPS) concept is expected to play a pivotal role in this national scheme, by vigorously embarking on health promotion activities at the community level.

Approved for implementation in 1999, the CHPS strategy relies on community resources to improve equity in access to basic health services, improve efficiency and responsiveness to clients and also develop effective inter-sectoral collaboration to improve the health status of residents.

In the last 15 years, various CHPS compounds have provided basic services including; the provision of health education related to prevailing health problems and methods of preventing and controlling them, promotion of food supply and proper nutrition, provision of adequate supply of safe water and basic sanitation; maternal and child healthcare including family planning, immunization programs against the major infectious disease, prevention and control of locally endemic diseases to enhance health outcomes.

Ghana has thus made steady progress in maternal and child health outcomes. Child mortality decreased substantially to reach 60 deaths per 1,000 live births in 2011 (DHS, 2014), maternal mortality almost halved to reach 380 deaths per 100,000 live births (MMEIG 2014) and the total fertility rate (TFR) declined from 6.4 children per woman in 1988 to 4.2 children per woman in 2014.

Despite this progress, large disparities remain; for instance, while 90 percent of pregnant women in urban areas deliver in health facilities, 41 percent of pregnant women in rural areas deliver at home. Furthermore, almost 80 percent of children from the lowest wealth quintile suffer some form of iron-deficiency anaemia, compared to 47 percent in urban areas (DHS, 2014).

To improve on the statusquo in line with achieving UHC and SDG goal 3, the World Bank is assisting the GHS to implement the Maternal and Child Health and Nutrition Improvement Project (MCHNP) which seeks to increase the utilization of community-based maternal and child health and nutrition services, with special focus on pregnant women and children under two years of age.

A component of the project is the Community Performance Based Financing (cPBF) module, currently being piloted in 8 districts of 4 regions in Ghana; Northern (West Gonja and North Gonja), Upper East (Talensi and Bawku West), Upper West (Nandom and Lawra) and the Volta region (Agortime Ziope and Kadjebi).

Its aim among others is to at provide logistics and incentives to CHPS zones and Community Health Teams (CHTs) towards strengthening maternal and child health care service delivery in communities.

It is of no doubt that to achieve high success with this initiative there is critical need for accurate data to not only qualify health professionals for incentives, but to track quality maternal, child health and nutrition indicators to feed into the country’s broad health outcomes.

The WHO had recently raised alarm over stagnation in global health responses to some diseases which contributed to overall mortality rates citing Ghana as part of 10 sub-Saharan Africa countries accounting for the bulk of malaria cases and deaths on the international front.

Under the cPBF implementation plan, “a Client Crosscheck and Client Satisfaction” survey is expected to be carried out to assess health care services rendered, quality of care and client or patient satisfaction with care received which is highly commendable.

Even more enthusing is the Research, Gender and Equality Department (RGED) of the National Commission for Civic Education’s (NCCE) quest to partner the GHS to provide precise information to serve as basis for the cPBF to only pay for results based on the achievement of maternal, child health and nutrition indicators by CHTs in charge of the CHPS zones.

About 24 research assistants and eight District Directors are expected to be trained to assist in the collection of primary data from both treatment and control CHPS zones and their communities.

The Commissions hopes that the results of the survey will be utilized in “determining the continuous payment of logistics and incentives to CHPS zones, provide feedback on achieved results and lessons learnt for dissemination at national and district level reviews” while ensuring that in the long term, the cPBF is replicated across the country in a sustainable manner.

This is a step in the right direction if we are to scale up progress in building healthy communities and economy at large; inter-sectorial collaborations and strengthened partnerships, where all key agencies that have bearing on the healthcare system are roped into interventions so as to reduce replications and ensure judicious use of resources to attain desired health outcomes.


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