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

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

Comparable to the global situation, the scope of practice for CHWs lacks clarity and remains undefined in Ghana. There has been a long-standing debate as to what exactly their roles should be and to what extent they are supposed to act in providing healthcare. 21 62 According to a report by UNICEF, in South Asia, one CHW can provide healthcare services to about 10 to 1000 households. 63 Generally, CHWs tend to provide more preventive and promotive healthcare, rather than curative. 11 27 In other settings, the roles of CHWs have been observed to vary from community mobilisation for immunisation campaigns, health talks, first aid, creating awareness on disease control and health promotion to activities such as registration of births and deaths. 12 21 27 64 In Ghana, owing to the acute shortage of health personnel, CHWs' scope of practice has broadened beyond prevention and health promotional activities to encompass some curative care such as treatment for malaria and diarrhoea. Generally, the scope of practice of CHWs in Ghana varies widely, including serving as aids to community health officers, home visits, disease surveillance, maintaining environmental sanitation, nutrition education, home management of minor ailments like uncomplicated malaria, social mobilisation, and providing a limited range of reproductive and child health services. 38 65 While this varied and flexible scope of practice may be a unique strength, it is therefore to be inferred that the lack of clarity on the operational mandates of CHWs in Ghana has often undermined the effectiveness and efficiency of their roles in healthcare delivery at the community level. As observed by some researchers, a reasonable involvement of CHWs in limited activities has the tendency to enhance outcomes in community-based health interventions compared with an unlimited scope of practice. 31