Enhancing primary healthcare delivery at the district level: a case study of the Bibiani Anhwiaso-Bekwai District

The health of an individual is very important to the person in particular and the nation as a whole. This has prompted several governments to offer the best health delivery to its citizens. Ghana like many other developing countries has been shifting from the colonially influenced and urban-based curative system to the pro-poor preventive health delivery system. The Alma-Ata conference ushered in the Primary Healthcare system, which has been adopted by Ghana as one of her key strategies of achieving quality healthcare for her people. This approach tries to bring healthcare as close as possible to where people live and work. Several governments since independence have put in place measures and strategies to ensure that the aim of the Primary Healthcare (PHC) delivery system is achieved. The health system has been decentralized in line with the governments decentralization policy; the Districts have been further broken down into sub-districts, while more health facilities in the rural areas have been put in place ; several community health workers have been posted to these facilities ; numerous training programmes have been organized for members of District Health Management Teams (DHMT) among other activities, with the aim of ensuring that healthcare gets to the remotest community as possible. In the Bibiani-Anhwiaso-Bekwai District, just as in other rural districts, people continue to troop to the district hospital from the villages for curative services instead of making use of the health facilities in their areas. In the light of this situation, this study set out to investigate how the PHC system is being implemented at the district level and also find out how best this healthcare system can be improved. A case study approach was adopted to investigate the problem. The process of the research started with a background introduction and a problem statement. Objectives of the research was then derived from the research problem while various literature was reviewed to have a clear insight into the Primary Healthcare system and also guide in the design of the data collection instruments to suit the research. Questionnaires were administered on health personnel in the communities, while structured interviews were administered on opinion leaders and members of the communities to solicit data on the level of their participation in the health delivery system and factors that determine the kind of healthcare they seek among others. An institutional survey was also conducted among key members of the DHMT and the District Assembly Officials who also have some influence on healthcare delivery in the district. Results of the study revealed that the core members of the DHMT in the district had the full complement of staff and also meet regularly to plan, monitor and review all health activities in the district. However, collaboration with the extended members of the DHMT which included officials from other departments which are not directly related to health was seen to be very weak. Even though there was limited health facilities to cater for all the communities in the district, health personnel to manage these facilities were limited, as those posted to the sub district health facilities hardly stay for long. The study further revealed that a new approach to the PHC which was fully community-based, known as the Community-based Heath Planning and Services(CHPS), was catching up with the people, yet the pace of implementation was extremely slow. Also the level of community involvement which is key to the success of Primary Healthcare was low as a result of the peoples’ limited knowledge of their roles in its implementation. From the above findings the study made some recommendations including; ensuring a strong collaboration between the District Assembly and the District Health Management Teams (DHMT) on one side and the DHMT and other decentralized departments on the other. District Assemblies were also to sponsor trainees in health institutions so that on completion of their courses they would be posted to the district to serve the deprived communities. An intensive awareness creation for community members should be undertaken to enable members to know their roles in the implementation of the PHC. These recommendations among others were seen to be the means to enhance primary healthcare delivery at the district level which will also go a long way to promote quality health in general.

Source: KNUST