Ghana’s Community Health Planning and Services (CHPS) program provides an example of how community engagement activities can be integrated into all aspects of health reform plans. The program deploys trained nurses, called Community Health Officers (CHOs), as well as volunteers into communities to provide preventive, curative, and promotional health activities. In an effort to scale-up the CHPS program, the Ghana Health Services is constructing an implementation guide informed by implementation successes and failures since the initiation of the pilot program in 1994. Part of this guide includes a document on "15 Steps and Milestones for CHPS Implementation”. The 15 steps are grouped into six milestone achievements including:
The majority of the community engagement activities occur during “community entry”. Specifically, after planning and consultation with health workers, District Health Management Teams (DHMT) meet with community leaders to collaborate on implementation and sensitize the chief and elders to the program. Subsequently, community leaders and the DHMT hold community information meetings to delineate roles and address questions or concerns. A Community Health Management Committee is selected and approved by the community, and data are collected on the specific needs, demographics, and customs of the community. As CHOs and Community Health Volunteers are selected, they are introduced to and approved by the community in meetings. 1
However, evaluations during implementation between 2000 and 2003 found that the community-entry activities appeared to be a bottleneck to the implementation of CHPS. While 85% of districts had completed CHPS planning, only 30% had engaged in community entry.2 The authors suggested that this gap may be due to a lack of understanding about this core component of CHPS. In these areas where community engagement and participation had not been fully implemented, health outcomes were worse than anticipated under CHPS.10 Despite these implementation challenges, in places where CHPS has been successfully established, both the community and health workers encouraged its spread, qualitatively suggesting that these activities are widely appreciated by the community once implemented. Read more about CHPS in Ghana here.