Community health workers in Ghana: the need for greater policy attention

Baatiema, Leonard; Sumah, Anthony Mwinkaara; Tang, Prosper Naazumah; Ganle, John Kuumuori

The preceding analysis points to a general policy deficit regarding CHWs in Ghana, given the lack of a national framework to guide activities of CHWs such as recruitment, credentialling, scope of practice, remuneration, career development, performance management, supervisory mechanisms, integration into the formal health system, capacity development and logistical requirement and deployment. Despite the active involvement of CHWs in the health system, they are invisible nationally and subnationally in terms of policies, strategies and budgeting. 78 We therefore recommend the following immediate and long-term measures to forestall anticipated and existing challenges faced by CHWs: 1. The establishment or enactment of a national policy on CHWs which should define and outline the relevant aspects of their recruitment, credentialling, scope of practice, remuneration, career development, performance management, supervisory mechanisms, integration into the formal health system, capacity development and logistical requirement and deployment. 2. The establishment of a professional and/or regulatory body that will exercise oversight over CHWs by defining, monitoring or enforcing the standards and practice of CHWs in Ghana including licensing or a form of certification. 3. The development of a long-term strategy that will see the gradual replacement or absorption of CHWs into the mainstream or formal health service in Ghana. 4. That the proposed One Million CHW Campaign project should incorporate an integration plan aimed at enlisting existing deserving CHWs who have a wealth of experience and skill to their credit and to further develop the capacities of those with inadequate skills to enable them to enlist and participate in the programme. 5. Finally, policy steps should be taken to critically review the WHO position on TBAs' roles in promoting maternal health. Given the shortage of skilled birth attendants (SBAs) in Ghana and across sub-Saharan Africa as indicated by the latest WHO report on the 'state of the world's midwifery', 79 it is clear that the ideal of ensuring skilled attendance at all births is not feasible or achievable in the short term. Therefore, reasonably acceptable equity and efficiency arguments can be made for the building of working partnerships with and incorporation of TBAs into the maternal healthcare system in contexts such as Ghana where skilled maternal healthcare provision is acutely limited. 30 Indeed, widespread collaboration through policy support for the healthcare system to identify, train and enhance the skill sets of TBAs is recommended. Partnerships between TBAs and SBAs would also be critical for helping healthcare workers to learn from TBAs how best to address the cultural needs and concerns of childbearing women. 30 Thus, even if the Ghanaian health system were to train and deploy sufficient numbers of SBAs to all parts of the country in the future, TBAs could still play important roles in helping healthcare workers to provide culturally competent care. 30 Conclusion This relatively modest contribution by CHWs to healthcare delivery in Ghana suggests the need for state and non-state actors alike to build better working partnerships with CHWs, provide financial remuneration, create career opportunities and other means of motivations to boost their productivity and sustain gains associated with their activities. In addition, there is the need for policy definition to harmonise the issues relating to CHWs in