Navrongo — With a feisty beat on the drums, combined with a traditional song, 28-year old mother of three, Laadi Addoa could not express her joy in a better way, than to twist and turn to the tune of the song.

The venue was a durbar at Korania, a farming community in the Kassena Nankana District in the Upper East Region.

The event was to officially outdoor a Community Health Program and Service (CHPS) compound and also introduce to the local people health officers that will manage the facility.

In five minutes time, Addoa was joined by a host of other community members who could not hide their joy for the innovation designed by the Navrongo Research and Health Center (NRHC) to provide health care delivery service at their door steps.

Kassena Nankana District is the hub of the world acclaimed NRCH, an institution that focuses on the major causes of illness in the northern regions, and related problems of high fertility and maternal morbidity.

Addoa later told The Chronicle why she was in such an ecstasy mood since her community was going to enjoy the services of a health facility, after being deprived of such a facility for far too long.

"With the construction of a CHPS compound here in Korania, I no longer have to travel long distances to the War Memorial Hospital at Novrongo for health care. I weigh my child at the CHPS compound, while also being fed with information on basic health needs," the 28-year old mother asserted.

Dr. Koku Awoonor-Williams, the Upper East Regional Health Director told journalists at a three-day capacity building workshop that the focus of the CHPS compound was on households, since they were the primary producers of health care.

The workshop was organized by Ghana Essential Health Intervention Programme (GEHIP), in collaboration with the Navrongo Health Research Centre (NHRC), and sponsored by Doris Duke Charitable Organization.

The programme aims at experts in the health profession, notably researchers in Ghana and abroad, on how to engage with journalists and to brainstorm on how to disseminate health research findings to the people.

The challenge of health care delivery in the Upper East Region is quite enormous. With only one regional hospital, five district hospitals out of the nine districts, thirty-three health centers, forty-eight clinics and eight private hospitals serving a population of 1.1 million, of which 80% are still living below the poverty line, one could only understand the difficulties the inhabitants are going through in accessing a health facility.

However, with CHPS coming into force in 2006, the health needs of the local people, especially women and children in the Upper East Region has improved tremendously with supervised delivery, growing from 32% to 61% in three years.

The region now has 60% of health facilities at its disposal, thanks to the implementation of the CHPS compounds which now operates in 112 zones.

With this, the era of making referrals and riding on the back of donkeys, bicycles, and motor cycles is gradually fading out.

Vida Sigme, a 29-year old teacher, who was treated for malaria at the CHPS compound, told The Chronicle that the facility was the best thing to happen in the community, since it has come to solve their basic health needs.

"I have been going to Navrongo hospital and a nearby clinic at Wuru for health care service. But when this facility was opened to us in February this year, I have stopped going to those places. It has saved me some money and eliminated the risk in travelling those long distances, sometimes at midnight," a joyous looking Sigme mused.

Lambert Azuah, whose wife and other family members has been accessing the facility, told The Chronicle that the establishment of the facility in the Korania community was spot-on. According to him, it has saved his wife from walking a long distance of three miles to Wuru to access a health facility.

"Looking at the services being provided, I want the facility to be expanded to a hospital status, and I am prepared to contribute towards that," the 31-year old farmer stressed.

Basically, a community based facility, hand managing the compound was recruited in the community and this makes it unique from other health facilities in the country.

Hilda Allou, a 25-year old native of Nayagnia, who is under orientation at the Korania CHPS compound, narrated to The Chronicle how she and her colleagues go about their duties in the community on motorbikes.

According to her, they work till late in the evening to interact with community members who had returned from the farm.

Mabel Kanyomse, the midwife at the CHPS compound told The Chronicle how the health facility had saved the lives of women, who had to give birth while on their way to a hospital or home.

As at February 2012, the CHPS compound at Korania had recorded three successful birth deliveries.

According to her, though the people were patronizing the health facility, equipment at the center was not enough. Among the things she complained of were anti-natal delivery beds, sterilizer and sonikit.

So far, the entire catchment area of the Korania community has not been covered but Kanyomse believes her outfit would make a lot of progress by the end of the year.

"Most of the people go to farm during the day and return in the evening. So, we are able to cover about six to eight (8) compounds a day. The CHPS project is such that you have to visit every compound within your catchment area every three months and this is what makes it unique," Kanyomse explained.

By 2008, the Upper East Region, according to Dr. Awoonor-Williams, had achieved the Millennium Development Goals 4 (MDGs4), thus reducing by two thirds, between 1990 and 2012, the under-five mortality rate (women and children).

How CHPS operates

CHPS is a system where community health officers are engaged to live in compounds provided by the community or the assembly to provide basic health care to the people, while also making prompt referrals when necessary.

For the program to take off in the community, first a CHPS zone is demarcated where a compound is built to house the community and Health workers, while also attending to the health needs of the people.

This is done by mobilizing the community structures with volunteers working in partnership with the community to improve on health outcome. The community then engages a midwife and other health workers who volunteer to serve the community.

The health officers are then trained after which health care equipment and other auxiliary logistics (motorbikes to facilitate movement of the community health workers) are provided to commence their services in the community. The duration of service by the health officers are determined by the community.

The focus of this innovation is on home visitation. The community health officers go on an outreach program to educate the people on environmental sanitation, immunization, family planning, counseling, ante-natal care and treat other basic ailments such as malaria and diarrhea.

"Within CHPS implementation, there is a form of health insurance; trust. Sometimes, if a patient gets the services of the community health officer, for example, if the husband is not there, she could promise to pay for the service at a later date when the husband returns," Dr. Awoonor explained.

The cost of a CHPS compound, according to its initiators, is between GH¢10, 000 and GH¢12, 000 with the community's involvement.

Available statistics from the NRHC indicate that the CHPS compound reaches out to 85% of the population than the district (45%) and regional (15%) hospitals.

The Challenge

Despite the successful implementation of the CHPS compound, the community based health system faces a daunting task in the Upper East Region. Notwithstanding the lowest number of midwives in the public health institutions, with twenty seven (27) midwives in the region, according to the Regional Director of Health, are retiring from the service this year with only eleven (11) midwives readily to replace them.

Another major stumbling block is the taking over of the construction of the CHPS compound by the various Metropolitan, Municipal and District Assemblies (MMDAs). Their actions are said to have contributed to the increasing cost of establishing the compounds in areas needed the most.

"The Assemblies are now awarding contracts directly without the community involvement, and this increases the cost in establishing a CHPS compound to about GH¢45,000 and GH¢ 50,000.

"When the project started, the community will provide free labour; provide sand, land among many others. But gradually, it is shifting and this is a major challenge," the Regional Director of Health lamented.

Notwithstanding the increase in cost, the actions of the MMDAs are also eroding the spirit of patriotism and volunteerism in the communities. Disperse settlement pattern is also making home visiting tiresome for the community health officers.

The future

In spite of the challenges, the Upper East Region is targeting at having 187 CHPS compounds by the end of 2015, to put the region at a level of service delivery, which would be complimented by the district hospitals and centers.