Capabilities mandated by official policies: | Respondent perceptions of primary health care capabilities: | Examples of possible program responses: |
---|---|---|
General system capabilities: | ||
Medical procedures that require specialists: Blood transfusion, surgery, caesarean sections, medical scans | Some discussants expect such services to be provided by CHPS | Expand community education about services that are appropriately provided at each level. |
Hospital personnel: Medical doctor available | Some respondents requested access to personnel with a higher skills than existing nurses | Develop and promote an affordable emergency referral system |
Staffing of sub-district clinics: Clinics have the full range of paramedical staff posted to facilities including medical assistants, midwives and registered nurses | More staff should be posted to Sub-district Health Centers. Most facilities have only two types of nurses and many lack medical assistants. | Conduct a total district systems appraisal: Review staffing policy, training norms, and implementation strategies at each level of the system. |
CHPS capabilities: | ||
✓ ĴStaffing | ||
One midwife with one or two Community Health Officers in each service zone | CHPS facilities do not always have the full complement of CHOs. Many CHPS facilities lack midwives. | The Ghana Health Service is expanding midwife training and deployment. However, consideration of training CHO as interim birth attendants is warranted. |
✓ CHPS patient relations: | ||
• Prioritize patients coming from afar | First come first served | In-service training on client relations is urgently needed [12] |
• Patient oriented staff attitudes | Some discussants encountered rude and impersonal care | |
• Staff responsive to emergency situations | Discussants noted that CHPS care is not always available after office hours. | There is a need for time-use analysis and a revised policy statement on worker hours of access. |
✓ CHPS logistics: | ||
The facility has space to ensure privacy and reasonable comfort for its clientele | Limited space in CHPS facilities, particularly in temporary facilities. | Interim CHPS facilities are being replaced by properly constructed facilities. Plans and prospects should be communicated to communities to ensure involvement. |
Emergency service capabilities | Few communities are reached by ambulances. Community engagement is lacking. | Urgently needed scale-up is needed, based on successful demonstration of emergency care [13]. |
✓ Pregnancy related CHPS services | ||
• Delivery of all types of pregnancies | Delivery of uncomplicated pregnancies only; emergency obstetric care is often unavailable. | Scale-up emergency referral systems. Improve community-engagement in referral operations [14] |
• ANC, PNC, CWC | (No deviation from expectations) | The high coverage of ANC should be combined with worker immediate post-partum follow-up procedures and mortality audit methods that are restricted to facility delivery [8] |
• Availability of all GHS essential drugs at CHPS facilities | Limited range of essential drugs; limited capacity to administer first aid | Conduct a comprehensive review of logistics and supply operations [15] |
✓ CHPS family planning services: | ||
Comprehensive doorstep and CHPS facility-based family planning information and care | Family planning services in facilities only; limited community communication activities or household services. Absence of outreach to men | Review strategies of experimental projects and pilot studies that successfully introduced and sustained family planning [16] Implement proven male involvement strategies [17] |
✓ CHPS worker deployment and time use: | ||
CHPS never “closes”: Services are available on weekends, emergency services by resident CHO are available for 24 h, and clinical service hours start at 6 am. | • Services are usually limited to week days and routine office hours. • CHPS services are available for eight hours and unavailable at night. • Usual work hours start at 8 am to 9 am | Develop a revised policy on work hours and facilitative supervision that clarifies CHO coverage hours [18] |
Other expectations | ||
• Outreach and services that promote accessible safe water and sanitation | Limited focus on community water and sanitation | Develop community outreach that utilizes traditional communication mechanisms for consensus building and social action |
• Addressing social discord or spousal problems that restrict access to CHPS care. | Gender and social problems are neglected. | Revisit CHPS strategies that successfully engaged communities in program governance and action [19, 20]. Build total social system outreach as a core organizing strategy of CHPS [21] |