Is there any role for community involvement in the community-based health planning and services skilled delivery program in rural Ghana?

BMC Health Services Research

Henry V Doctor³  Samuel Mills⁵  Kojo Yeboah-Antwi¹  Judith Bernstein²  Lois McCloskey²  Evelyn Sakeah⁴ 

[1] Department of Global Health, Boston University School of Public Health, Boston, MA, USA;Department of Community Sciences, Boston University School of Public Health, Boston, MA, USA;Integrated Programme and Oversight Branch, Division for Operations, United Nations Office on Drugs and Crime, Abuja, Nigeria;Social Science Unit, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana;Health, Nutrition, and Population, Human Development Network, The World Bank, Washington, DC, USA

关键词: Community health workers;    Community participation;    Skilled birth attendance;    Ghana;    Community-based service delivery;   

Others  :  1126769
DOI  :  10.1186/1472-6963-14-340

 received in 2014-01-15, accepted in 2014-08-06,  发布年份 2014

【 摘 要 】

Background

In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). CHO-midwives collaborated with community members to provide skilled delivery services in rural areas. This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness.

Methods

We employed an intrinsic case study design with a qualitative methodology. We conducted 29 in-depth interviews with health professionals and community stakeholders. We used a random sampling technique to select the CHO-midwives in three Community-based Health Planning and Services (CHPS) zones for the interviews and a purposive sampling technique to identify and interview District Directors of Health Services from the three districts, the Regional Coordinator of the CHPS program and community stakeholders.

Results

Community members play a significant role in promoting skilled delivery care in CHPS zones in Ghana. We found that community health volunteers and traditional birth attendants (TBAs) helped to provide health education on skilled delivery care, and they also referred or accompanied their clients for skilled attendants at birth. The political authorities, traditional leaders, and community members provide resources to promote the skilled delivery program. Both volunteers and TBAs are given financial and non-financial incentives for referring their clients for skilled delivery. However, inadequate transportation, infrequent supply of drugs, attitude of nurses remains as challenges, hindering women accessing maternity services in rural areas.

Conclusions

Mutual collaboration and engagement is possible between health professionals and community members for the skilled delivery program. Community leaders, traditional and political leaders, volunteers, and TBAs have all been instrumental to the success of the CHPS program in the UER, each in their unique way. However, there are problems confronting the program and we have provided recommendations to address these challenges.

【 授权许可】

   
2014 Sakeah et al.; licensee BioMed Central Ltd.

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