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

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

Lack of effective supervision of CHWs is one of the notable problems CHWs face in Ghana. Our experiences in northern Ghana suggest that laxity in the supervision of CHWs is mainly due to the already overstretched nature of the health system, which is attributable in part to the human resources for health crises. Given that CHWs are now taking up more curative care activities in addition to the preventive-based care interventions, their activities should be supervised and coordinated closely to potentially optimise their productivity and improve health outcomes as evident in studies from other settings. 64 76 77 Also, a further step by the Ministry of Health (MOH) to scale up the number of frontline staff to provide healthcare to the rural communities is the current partnership with the One Million CHW Campaign project to introduce a new cadre of CHWs in Ghana. This represents an important health policy direction in improving access and health outcomes of the rural populace in Ghana. The One Million CHW Campaign proposed to introduce a world-class cadre of CHWs to extend essential health services to household levels functioning as an integral component of the community health system. 78 Conceptually and based on the literature on CHWs, this category of CHWs will be an informal extension of the formal healthcare system with explicitly defined roles, training and remuneration to augment the delivery of healthcare. Notably, this new cadre of CHWs differs substantially from the CHWs who are the subject of this paper except in their duties. While the policy issues of existing CHWs still remain to be addressed, the new programme only proposes to recognise the existing CHWs provided they will be useful in providing voluntary assistance to the formally remunerated new cadre of CHWs, and their continuous existence will be dependent on the particular health district. A justifiable policy question may therefore be why introduce a new cadre of CHWs to take up duties which were essentially carried out by a particular workforce but whose contribution has hitherto not been recognised and whose integration into the new programme has not been explicitly addressed. If such concerns are not addressed, there will most likely be challenges such as conflicting roles, tension between CHWs of the One Million CHW Campaign and existing CHWs, lack of community participation and a threat to the sustainability of community-based health interventions.