An evaluation of community health care service in Ghana: A case of the Community-Based Health and Planning Service (CHPS) compound in Ghana

Abstract

Background: Ghana implemented the Community-based Health Planning Services (CHPS) as a primary healthcare initiative designed to provide essential health services to underserved rural communities in Ghana. To date there is paucity of evidence on the effectiveness of the CHPS initiative in Ghana. In addition to the limited evidence on the initiative’s effectiveness, there is also limited understanding on the determinants of the positioning of the CHPS compounds in Ghana. Such knowledge is critical to inform the initiative’s continuous operation and improvement. The general aim of the study is to evaluate the effectiveness and implementation of primary health service centres in Ghana, to inform policy making and enhance health service delivery through optimised location, positioning, and operational efficiency, along the CHPS Zones. Methods: A review of 39 studies identified knowledge gaps on CHPS's effectiveness and influencing factors. An Interrupted Time Series Analysis (ITSA) assessed CHPS effectiveness using metrics such as Family Planning (FP) visits, Antenatal Care (ANC) visits, Maternal Deliveries, and Outpatient Department (OPD) attendance. Secondary data from the Ghana Health Service supported these analyses. Three Logistic Regression models examined factors determining CHPS positioning, and a Generalized Linear Model assessed disease outbreak distances relative to CHPS facilities across 216 districts. Additionally, a Discrete Event Simulation modelled CHPS operations to suggest service delivery improvements. Results: The ITSA indicated significant improvements in maternal and child health outcomes, particularly maternal deliveries and ANC visits, since 2016. However, OPD visit effectiveness requires further strengthening. Analysis showed that out of 117 districts, 68 had at least one CHPS facility within 8 km, but 83 did not meet the mandated threshold. Districts with no CHPS facilities were 12% more likely to be closer to disease outbreaks. Districts with 6-11 CHPS facilities were farther from disease outbreaks, while those with over 11 facilities were closer to outbreaks. Simulation results revealed lengthy wait times as a major challenge, suggesting an increase in staff and assessment rooms to boost efficiency. Conclusions: The study revealed that districts with CHPS facilities were more distanced from disease hotspots compared to those without such facilities, underscoring the pivotal role of primary healthcare in disease prevention and control. Additionally, the simulation of CHPS operations highlighted significant issues related to lengthy wait times, which can adversely affect healthcare demand and utilization. The findings advocate for interventions to streamline patient flow and improve service delivery efficiency, emphasizing the importance of staff training and flexible staffing schedules. The implications for policy are many-fold. Firstly, there is a clear need for a strategic and equitable expansion of CHPS facilities across Ghana, prioritizing underserved, and remote districts. Policymakers should consider a strategic increase in the number of CHPS facilities to ensure they are adequately staffed, equipped, and integrated into the community’s already existing healthcare system. Moreover, continuous monitoring and assessment of these facilities are essential to maintain their effectiveness and adapt to evolving healthcare needs.