James Duah, MBChB, MPH, EMBA, Deputy Executive Director of the Christian Health Association of Ghana (CHAG) shares lessons learned and successes from CHAG's efforts to partner with the Ministry of Health, other faith groups, and community groups to deliver maternal and mental health services at the CCIH 2018 Annual Conference.

1. Working with Policymakers, Service
Providers and Different Faiths in
Providing Maternal and Mental Health
Services: The Case of CHAG
James Duah, MBChB, MPH, EMBA
Deputy Executive Director, CHAG
CCIH 32ND Annual Conference: Power of Partnership: Working Together
to Serve the Kingdom
July 13 – 15, 2018 | Johns Hopkins University | Baltimore, MD

2. Outline
• Introduction
• Partnership & Interventions – MCH &
Mental Health
• Results
• Take home message

3. Introduction
CHAG is the 2nd largest provider of health
services in Ghana with 331 facilities in 10
regions and 188 districts

5. Introduction
cont’d
• Maternal and Mental Health are
two important components of
health care in Ghana
• Whereas one is more
prioritized, the other is not

6. Maternal
Health:
“100 days
free of
maternal
mortality
campaign”
MDG target not achieved
Maternal mortality rate (MMR)
319/100,000 LB (2015)
Institutional MMR in CHAG
was 167/100,000 LB in 2015
MMR > 200/100,000 LB in
some institutions
Causes of maternal mortality is
not the same in all institutions
– contexts vary

7. Region
Total Maternal Deaths by Year Total maternal
deaths
2014 2015 2016 2017
Ashanti 139 168 129 162 598
Brong Ahafo 95 87 77 70 329
Central 65 67 95 77 304
Eastern 117 107 97 106 427
Greater Accra 204 208 197 196 805
Northern 66 92 133 121 412
Upper East 45 30 37 46 158
Upper West 31 30 25 26 112
Volta 86 62 71 62 281
Western 93 75 94 82 344
Total 941 926 955 948 3,770

8. Partnerships maternal health;
where do we begin?
1) Institutional – affirmations, acknowledging
unity in diversity (1 Cor 12:12)
2) Policy level – advocacy, visibility
3) Service providers
4) Community

9. Partnership – Service providers
Mentorship programme
• Make skill and knowledge
available to underserved
areas
• OBGYN selected from
CMIs and Teaching
Hospitals
• Each mentor assigned 4-6
facilities to mentor to
reduce maternal mortality

10. Partnership with
Community-TBAs

11. Partnership with the community

12. Special Partnership Initiatives
Collaborative / networking
o Zoning of the CHAG network into 4
o Each Zone has 15-20 hospitals and a team of mentors
o Each facility has a team of 5
o Teams come together in zones to develop charter for maternal mortality
o Zones meet every 100 days to review progress made on their charter

13. Results
• 1st 100 days – 83.3% of facilities did not
record maternal mortality
• 2nd 100 days – 80.1% of facilities did not
record maternal mortality
• Massive support from the community

14. Results

15. Key indicator % change Comment
Maternal mortality 24.8% improved Reduced from 145 (in 2015)
to 109 per 100,000 LB (in
2016)
Supervised delivery 24.0% improved From 110,228 (2015) to
136,669 deliveries (in 2016)
Still birth rate 4.8% improved 21 to 20 per 1000 LB
Neonatal mortality 100% worsened 6.5 – 13 per 1,000 LB
Results cont’d

16. Mental Health
• 98% gap in access to mental health
services
• 18 psychiatrists serving 28 million
Ghanaians
• Services available in 3 psychiatric
institutions in Southern Ghana
• Stigma and discrimination against
mentally ill persons still rife

17. CHAG’s Mental Health
Programme
Objectives
1) Improve access to care and treatment
2) Reduce stigma and discrimination
towards
3) Reintegrate persons treatment from
mental illness
Aim: Improve the lives of people living

18. Partnerships for MH
Services delivery
• Policy / legislation
• Training
• Service providers
• Communities
• Religious / traditional healers & Muslims
• Schools
• Youth groups
• Parliament / legislature

19. Partnership at policy
level & legislature
CHAG engages:
1) Parliament
2) MOH
3) MOF
4) NGOs and other
stakeholders
on the need to pass LI to back
the MH Act (846)

20. Partnerships for
Funding
• Government funds < 3% of health
budget
• Mental health service not on the
NHIS benefits package
• DFID major funder
• Critical questions
1) Who funds service after DFID
withdrawal?
2) What should facilities do to cater
Mentally ill persons?

21. Training
• Psychiatry not attractive to
doctors and nurses
• CHAG trains mid-level staff in
partnership with:
1) College of Health &
Wellbeing
2) Psychiatric hospitals
3) Teaching hospitals
4) NGO – BasicNeeds

22. Partnership with
Service providers
• Few institutions provide care
• Churches and prayer camps
are the first port of call in
many communities
• Chaining and other human
right abuses occur in some
communities
Partner with managers to
Integrate MH in their continuum of care
Engagement of fetish priests

23. Partnership with service providers
cont’d

24. Partnership with service
providers cont’d
• Prayer camp managers
• Muslim Clerics

25. Partnership with
communities

26. Partnership with
schools

27. These packs of
“wee” were found
in one school.
Costs < $0.5 per
pack

28. Results
• Higher demand for mental health care
• Increased OPD attendance (14,328 new clients & 16,044 reviews in 2017)
• About 180 CHAG facilities have integrated MH in their continuum of care
• 49 CPOs, 111 CMHOs trained to support care
• Green light given to pass LI
• Referrals from prayer camps, churches and mosques to CHAG facilities

29. Conclusion?

30. Take home
message
Take leadership role and let people believe in
your message
Be on the table (visibility)
Acknowledging that CHAs and governments
are members of one body – complementary
in our work (1 Cor 12:12)
Affirmations – “they themselves are makers of
themselves” – James Allen

31. Thank you