Birim North District expands access to health care, saves lives

USAID is supporting the Ministry of Health and Ghana Health Service’s country-wide Community-based Health Planning and Services (CHPS) initiative in the Birim North District. The CHPS program has resulted in a remarkable increase in people’s access to health care and is ultimately saving lives.

Birim North is one of the most deprived districts in Ghana’s Eastern Region. Prior to the introduction of the CHPS initiative in 1999, the district had 14 health care facilities for over 128,000 people. The facilities were far apart and therefore most people had to travel over 15 km to the nearest facility. The roads were and are still very poor, making most communities inaccessible in the rainy season. Telecommunication facilities were also inadequate. In such a situation, complications in child delivery ended in loss of lives because the mothers could not reach the nearest facility in time. In 1999, four maternal deaths were
recorded in one of the six sub-districts alone. People without medical expertise also took advantage of the situation to peddle drugs and treat the sick, resulting in mishandling of illnesses.

To get health care to the people, USAID supported the training and deployment of ten community health officers (CHOs) in the remote parts of the district. Communities selected their own volunteers to be trained to assist the CHOs and to help mobilize community members to participate in health activities. Traditional birth attendants (TBAs) were also trained to work closely with the CHOs and to ensure safe delivery. At the district level, the Health Management Team comprised of the director and heads of health centers, disease control and nutrition in the district, were also trained to enable them to effectively supervise and strengthen the performance of the CHOs and the volunteers. USAID also installed a radio communication system to facilitate prompt referral of the sick.

Today, the CHO lives with and provides the basic health care needs of people in three to five nearby communities. The CHO works with the community volunteers to provide door-to-door health care. As a result, unqualified peddlers no longer sell drugs, and people are able to get the healthcare they need. The Birim North District, which had the second highest number of Guinea worm cases among the 15 districts in the region in 1999, registered zero cases in 2003. In addition, all TB patients have fully adhered to taking their prescribed treatments and the number of mothers who sought the assistance of CHOs and TBAs in child delivery rose from 2,792 to 3,094 between 2001 and 2003.

Another remarkable achievement of the initiative is that no maternal deaths have occurred in the district since 2001. In complicated deliveries, the CHOs use the USAID-funded communication system to contact the health center at New Abirem, the district capital, for assistance.

“The communication system is helping us to save mothers and infants’ lives. When TBAs are having problems with deliveries, the CHOs use the system to call us and we in turn dispatch a vehicle to the village to convey the mother to the health center here at New Abirem”, Tei Djangmah, the District Director of Health Services said.

The communication system has also enhanced the day-to-day health care activities in the district. The health workers use it to share experiences and ideas, and it assists the supervisors in supporting and advising CHOs on which drugs to use in treating specific cases reported to them, and how to administer them.

The increased access to health care for the people of Birim North District has encouraged community health nurses’ training institutions in southern part of the country to send their students to the district for practical training in the CHPS program.