The experiment that launched CHPS began by reorienting existing workers to community health care and assigning trained paramedics to village resident locations. The cultural resources of chieftaincy, social networks, village gatherings, volunteerism, and community support were then mobilised. Since these dimensions can be mobilised independently, jointly, or not at all, a four-celled experiment was utilised to test the impact of mobilising community-based health care through traditional institutions with referral support and resident ambulatory care from Ministry of Health outreach nurses.

In 1994, a three-village pilot study was launched that combined social research with project implementation. Project organisers consulted with communities about activities and worked to tailor service delivery management to local needs and existing organisational resources. In 1996, a district-wide experimental programme with geographic zones corresponding to cells of the experimental design, each representing alternative intensive, low-cost, and comprehensive service delivery operations. A demographic surveillance system that monitored births, deaths, migration, and population relationships was used to test the impact of alternative strategies for community health services on fertility and mortality.

These studies resulted in the creation of CHPS, a process of sector-wide health system change and development that aims to provide accessible primary health care to Ghanian communities. The process involves a 15-step programme in participating districts:

Development Issues

Health.

Programme organisers noticed that, by the early 1990s, more than 70 percent of all Ghanaians lived over 8 kilometres from the nearest health care provider, a problem exacerbated by inadequate road and transportation facilities. Infant mortality rates in rural areas were double the rates prevailing in urban areas. The CHFP study found that mortality levels were high and that cultural traditions sustained high fertility. The economy in the study area was dominated by subsistence agriculture, literacy was low, and traditions of marriage, kinship, and family building emphasised the economic and security value of large families. Health decision-making was found to be strongly influenced by traditional beliefs and poverty.

As a result of the experiment, childhood immunisation coverage increased from 30 to 83% and contraceptive use increased from 3 to 20% in the area where the nurse works in the context of active community support. Infant mortality rates declined from 141 to 96 per 1000 live births. The fertility rate declined by almost one birth per woman.

The first CHPS programme was launched in Nkwanta District. Click here for a programme description. Over the 1998 - 2000 period, 71 districts out of the 110 districts in Ghana started the CHPS programme.