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Urban Health Development

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  • 1. The Urban Health Intervention UGSPH Status Report on GEHIP for Ga East District Philip Adongo, PhD
  • 2. Outline of presentation 1) URBAN CHPS: • Milestones in setting up CHPS in Rural areas: Activity: Assessing the relevance of the CHPS process to an urban setting (Year 1) • Results: Clarification of how urban CHPS differs from Rural CHPS 2) THE LEADERSHIP COMPONENT OF HEALTH SYSTEMS STRENGTHENING • Leadership Programme: -- MPH health systems development component • District leadership development --Modular training component 3) PROGRESS WITH LAUNCHING THE BASELINE SURVEY IN GA EAST AND GA WEST
  • 3. Activity I: Preparation for Urban CHPS CHPS Programme Milestones Questions that we addressed: • Are the rural milestones relevant to the urban environment? • How are urban CHPS service operations different from rural operations? The milestones are: 1) Community engaged planning (Community Health Committee, zoning, mapping, etc) 2) Community entry (liaison with traditional and opinion leaders). Developing participatory implementation. 3) Community Health Compound development (construction, renovation, or rental) 4) Essential equipment procurement. 5) Nurse orientation to community work and posting to Community Health Compounds 6) Volunteer identification, recruitment, training and deployment
  • 4. Community Entry Strategy assessment for Urban CHPS Formative Research: 1. Focus Group Discussions (FGDs) 2. In-depth interviews with stakeholders and opinion leaders To seek views on – Health seeking behavior for child and maternal health – Health decision making at local level – Community conceptualization of Urban CHPS – Potential models of CHPS
  • 5. Milestone #1: CHPS Planning Urban versus Rural Model • Urban CHPS – Large populations (20,000-40,000) – Zoning is required and it is important exercise – Difficult to mobilize community to contribute – Nurses may need to concentrate on promotion activities • Rural CHPS – Small population (3000- 5000) – Zoning is easier – Easy to mobilize community to contribute – Curative aspects very important
  • 6. Milestone #1: Zoning of Ga East into CHPS areas All four Ga East sub-districts were “zoned” for CHPS including…. –Dome – Danfar – Madina – Abokobi
  • 7. Milestone #1: Selection of start up CHPS zones in Ga East Zones Area covered Estimated total population Estimated no. of chn 0-59m Estimated no. of household One Rabit, Auntie Mary, Ohenho etc. 23,282 4,191 1,219 Two Dome market, Dome Park, Grushie Town etc. 41,169 7412 966 Three CSC, GYM, Atomic, Atomic Ayigbe Town etc. 18,894 3400 729
  • 8. Milestone #2: Urban Community Entry Sensitization meetings with the SPH, Region and Districts • Discussions with regional health administration • The forum to has been created where GEHIP has been presented to the – School of Public, University of Ghana – All MHMTS, DHMTs – GA East – The Assemblies-Discussions with planning officers of Ga East (intervention area) and Ga West (comparison area)
  • 9. Milestone #3 Procurement of work space or clinic • Municipal Assembly providing storage space for equipment, but construction of a “Community Health Compound” may present a challenge • Partnership with private health providers to provide space • Municipal Assembly to providing space for the GEHIP field office in Ga East.
  • 10. Milestone #4: Essential equipment Health workers needs small Vehicles to conduct their activity
  • 11. Milestone #5 The Training of CHOs • TOT training completed in Mid September: • Training of CHOs started in October, 2010 – GEHIP is supporting the training of CHOs
  • 12. Milestone #5: CHO deployment The way forward for urban CHOs… • A non-residential service • Collaborate with private health institutions • We will learn from experience on in-service training for urban CHO. – Innovation in communication (ways to replace durbars) – May have to make modifications during our “Phase 2” implementation process
  • 13. Milestone #6 Volunteers – Volunteer identification, recruitment, training and deployment
  • 14. Milestone Rural CHPS Urban CHPS 1) Community - based Planning Situation analysis, initial outreach to chiefs, “zoning” of catchment areas. Block and neighborhood identification, clarification of geographic responsibility 2) Community entry • Building understanding with chiefs, elders, & opinion leaders. • Developing Community Health • Organizing CHC action • Developing durbars for health communication • Focus on identifying social networks (corresponding to ethnicity of settlers). • Outreach to formal authorities & politicians 3) Essential equipment Motorbikes & bicycles + clinical equipment for IMCI, EPI, FP/RH Low cost 3 or 4 wheel vehicles + clinical equipment for IMCI, EPI, FP/RH 4) Facility development Community volunteer construction of CHC or renovation of existing facility Arranging donation of secure space or renovation of donated space. No CHC 5) Nurse community engagement training & posting Training in community entry, liaison, and sustaining community participation Training in health education in the urban context 6) Volunteer identification, training, & deployment Community organizational focused Basic medicinal products distribution (Major role in health promotion: bednet promotion, condoms, ORS, etc.) Service focused volunteers with no curative services. (Limited role)
  • 15. Activity II Developing a Leadership Programme • Develop BPH/MPH Training that prepares leaders for District Health Management --Utilize GEHIP sites for MPH field practica in health systems development -- Two or three MPH students will be working on Urban CHPS in the Ga East Municipal • Develop field model to be used to strengthen both rural and urban CHPS through modular “peer” training in systems development
  • 16. The Problem: Existing training produces tiers of capable individuals, but not systems capacity building…. Community Health Officers Supervisors, Disease Control Officers, Nutrition, etc. Registered nurses, midwives District Directors & Health Management Team members
  • 17. The School is now contributing to Public Health Capacity Building at all levels of the system Community Health Officers Supervisors, Disease Control Officers, Nutrition, etc. Registered nurses, midwives District Directors & Health Management Team members A critical component: Bachelor of Public Health for supervisors, paramedics, nurses, etc.
  • 18. Pathways of the BPH course • Public Nursing • Disease control • Health promotion • Environmental health • Health information
  • 19. With GEHIP support, the UGSPH has formed a health systems development partnership with the GHS: Short public health system training modules on health systems development themes that require teamwork across levels Practical peer demonstration in GEHIP districts.
  • 20. With GEHIP support, the UGSPH has formed a health systems development partnership with the GHS for developing public health system modules that require teamwork across levels…
  • 21. What will GEHIP Add? Community Health Officers Supervisors, Disease Control Officers, Nutrition, etc. Registered nurses, midwives District Directors & Health Management Team members CHPS development Peer Leadership Training
  • 22. What will GEHIP Add? Community Health Officers Supervisors, Disease Control Officers, Nutrition, etc. Registered nurses, midwives District Directors & Health Management Team members GEHIP District Health Profiling & DiHPART implementation
  • 23. What will GEHIP Add? Community Health Officers Supervisors, Disease Control Officers, Nutrition, etc. Registered nurses, midwives District Directors & Health Management Team members Information for Decision- making
  • 24. MPH component of Leadership Training pretested in Ga East: • Participation in Ga-East Municipal Annual Review Meetings • Ga East Project (SPH & NOGUCHI) 14 MPH dissertations, all with health systems plus focus topics on .... – Health financing, planning – Nutrition – Oral health – Reproductive health, sexually transmitted diseases – Quality of care.
  • 25. Activity III. Preparations for the Baseline Study in Ga East • Draft questionnaire developed for Household surveys • Household surveys in Ga East & Ga South to obtain information on ….. – Household characteristics – Pregnancy history – Contraception – Antenatal care – Delivery & newborn care – Health seeking behaviours – Malaria & use of ITNs – HIV/AIDS & other STIs – Cost of health services
  • 26. Thank you very much