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

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

The Navrongo Experiment is one of the areas where CHWs' contributions to healthcare delivery have been acknowledged globally. The Navrongo Community Health and Family Planning Project, popularly referred to as the Navrongo Experiment, which culminated in the birth of the current CHPS programme in Ghana, sought to improve access to healthcare in deprived communities using mostly community-driven resources and structures. The intervention was conceptualised under the assumption that by recruiting, training and deploying community health officers to rural communities, inequities in access to healthcare services between urban and rural settings could be bridged. Under the Navrongo Experiment, CHWs played several critical roles, including outreach services, community mobilisation for health educational talks and referral to health facilities. 32 33 The Navrongo Experiment resulted in increased access to healthcare services, immunisation coverage, reduced child and maternal mortality while improving the rural population's overall health. For example, within a period of 3 years of its implementation, the results pointed to a 50% reduction in childhood mortality rate and 15% reduction in fertility rate. 24 Given this landmark success, results from this experimental intervention led to the conceptualisation and implementation of the CHPS programme as the country's main policy enactment aimed at improving access to health services in rural Ghana. Owing to its overall success, Ghana's CHPS programme has been acclaimed as among the most successful community-based health programmes globally. [32] [33] [34] [35] Guinea worm eradication Without the diverse contributions of CBSVs, Ghana's current success in eradicating the guinea worm (Dracunculiasis) would have been unlikely. Ghana was ranked second globally in 2006 among the guinea worm endemic countries. 36 37 Currently, however, Ghana is guinea worm free. Studies and reports from the Ghana Health Service and non-state actors (NGOs) have underscored the critical roles played by CHWs in eradicating the guinea worm in Ghana. [38] [39] [40] [41] Their roles included community mobilisation for awareness raising campaigns on the spread of the guinea worm, administration of palliative care, door-to-door distribution of drugs, referral to health centres for treatment, and distribution of water filters in communities. 38 39 42 43 Indeed, their role was so critical that both the National Guinea Worm Eradication Programme and some development partners (eg, Carter Center) have acknowledged it as being the most important factor in Ghana's guinea worm eradication campaign. 44 Promotion of maternal and child health Globally, CHWs have been acclaimed as having played a tremendous role in decreasing childhood illnesses and mortalities. 13 45 46 Notably, case management of childhood illness is one area where their contribution has been highly commended by the WHO and UNICEF. 47 A study in Ghana reported that CHWs were instrumental in establishing community health post, making home visits to provide healthcare services such as administration of antibiotics, oral rehydration solution and zinc to treat childhood illnesses such as pneumonia, diarrhoea and malaria. 48 Similar results have been reported by other studies globally. 20 23 24 49 50 Again in Ghana, the role of TBAs has been reported to double the number of women referred to clinics and hospitals for potentially life-saving care and support. 51 Indeed, in sever