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

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

Prior to the inception of the One Million CHW Campaign (to which we return later), there was no national framework to guide the recruitment of CHWs in Ghana. As a result, their recruitment was dependent on the community, the health programme, and the donor agency or development partner (NGO) involved. From the international literature 48 50 and our experiences in Ghana as well, CHWs are generally recruited from their own communities based on their level of acceptability in their respective communities, previous involvement in community-driven initiatives, high sense of dedication to duty and literacy (education) level. Although these considerations are important, they are no doubt subjective and may affect the objective assessment and recruitment of CHWs. Our experience in some communities shows that the lack of clearly defined recruitment criteria and strategy has often generated tensions among community members. Indeed, some earlier studies have indicated how recruiting CHWs from local communities often served to generate tension and/or perpetuate gender inequalities. 61 An important dimension regarding the recruitment of CHWs in Ghana is the active role of NGOs and other non-state actors. Many NGOs and other non-state actors who operate and/or implement parallel or vertical healthcare programmes in Ghana often recruit parallel CHWs. In most cases, this parallel recruitment is often without regard for existing structures. From our experience, the NGOs' style of engagement with CHWs can be problematic because recruiting CHWs without recourse to already existing structures can breed conflicts, duplication of efforts, lack of community participation and ownership of a particular health intervention and redundancies following the completion of the programmes of such organisations.