IMPROVING MATERNAL AND CHILD HEALTH CARE USING THE COMMUNITY BASED HEALTH PLANNING AND SERVICES MODEL:

Abstract

Maternal and Child health continues to be a burden to many developing countries in sub -Saharan Africa making it imperative for the adoption of many interventions to improve the situation. In Ghana, one such primary health care intervention has been the Community-based Health Planning and Services (CHPS) model. After over two decades of implementation of the model, this study, using a systems theoretical framework, sought to examine the contributions of CHPS towards improved maternal and child health in rural communities by appraising the implementation processes, ascertaining its performance, and analyzing its implementation challenges. Using a qualitatively dominated mixed method case study design, respondents included 13 traditional birth attendants, women in their fertility age (n=635), community health officers (n=30) and community health volunteers and committee members (n=21) drawn from 13 communities within the study district. Surveys, in-depth interviews, field observation and systematic document review were utilized to obtain data. Survey data were processed using SPSS version 21, while qualitative data was processed in Microsoft Excel. Results are presented in frequency tables, figures, graphs and verbatim quotes summarizing qualitative responses placed in text boxes. The findings reveal that health services such as routine home visits, health promotions, antenatal care, immunization and postnatal care were being provided. In spite of seeming adequate staff numbers, the skills mix was flawed; there was an inadequate number of midwives, while nurses lacked sufficient midwifery training. Although most CHPS compounds were largely functional, they faced equipment and logistics challenges which affected optimum functioning. In terms of performance, maternal mortality and stillbirths rates have seen a steady improvement, while child mortality has stagnated. The main challenges confronting the implementation of the model included funding gaps, inadequate infrastructure and logistics, unclear program design, a conundrum with traditional birth attendants and issues of governance. Key recommendations include improving the skills mix of the health staff, developing strategies to improve community participation, address the design, governance and TBA problems as well as determine and adopt a more sustainable and sufficient funding regime.