Planning improved health services for district development: (case study of West Gonja District in Ghana)

At an international conference on Primary Health Care held in Alma-Ata, U.S.S.R. in 1978 a declaration urged all governments to formulate national health policies, strategies and plans of action to launch and sustain Primary Health Care as part of a comprehensive health system and in coordination with other sectors. It also called for urgent and effective national and international action to develop and implement health systems based on Primary Health Care throughout the world, but particularly in developing countries. This is because the W.H.O. has estimated that about a tenth of time for productive work is lost through disease disabilities. Despite these efforts little improvements seem to have been made in improving the health status of the vast majority of the population who live in the rural areas in most developing countries like Ghana Thus morbidity and mortality levels main unchanged, over the years and still very high as compared to acceptable standards. Among some of the reasons for this state of affairs are the facts that comprehensive planning for health services at the local (district) Level is either a myth or not well organised if carried out at all. The general organisation of health services and resources in most developing countries like Ghana, reflects historical developments rather than current needs, There are therefore many deficiencies in the organisation of health delivery services at the local level in these countries, it is therefore alleged that health services in these countries are administered but not planned. Besides, the fact that health programmes normally originate from the national level to the local Levels, attention is unduly focused in most instances on incidence of diseases, absence of health and related facilities as well as shortage of medical staff. But little attention has been paid to the planning and management of health service programmes themselves at the local level. Emphasis has been on ad-hoc and often belated attempts when epidemics break out, even though in the case of Ghana a health planning unit was instituted some two decades ago. The study therefore sets out to explore the many problems associated, with the management and organisation of health services delivery in rural 4istriots in Ghana, with special reference to West Gonja District. The study thus aimed at taking a comprehensive inventory of the various health delivery systems, their problems and potentials at the district level with the view to coming out with proposals to improve the management and organisation of health services. In order to achieve the research aims, field surveys were conducted to solicit primary data from various health and related institutions and from a sample of the communities in the district using interview guides. Library research was also carried out. The study revealed that:- 1. Parasitic and infectious diseases are the main causes of morbidity and mortality and these can be easily ameliorated by ensuring adequate re source to public health programmes and develop men of infrastructure in the fields of water supplies and housing as well as proper waste disposal systems. 2. There is lack of proper planning, management and evaluation of health services at the district level. 3. The district suffers from poor transportation system and this has caused the low coverage and utilisation of health services. Only about 13 per cent of the district’s population is within the effective service delivery zone of health services. 4. Intersectoral and departmental coordination was grossly lacking, thus leading to duplication of functions and waste of resources; 5. Potential local/community resources have not been effectively exploited to improved health services delivery; for example the availability of water resources, but little has been done to improve its quality for domestic use. 6. Primary Health Care programmes (which are poorly organised) and traditional medical practices have not been integrated into institutional health care, as envisaged; 7. There is lack of logistic and other support services for the various health delivery systems; 8. There is also inadequate supporting research programmes to improve pon health services delivery at this level. 9. Population growth in the district is very high (estimated to be 4.2%. per annum), thus if measures are not taken to redress current problems, there will be tremendous stress on existing services in the district as a result of increasing health needs of the population; 10. Most health facilities in the various health institutions have broken down. The foregoing problems have resulted in a situation where health programmes in the district seem not to have offered suitable solutions to the health care problems of the communities, resulting in cases like low immunization coverage, little family planning services, negligence of nutritional, child and mother care programmes and environmental sanitation programmes. The effects have been high incidence of diseases, high mortality rates and virtual stagnation in the physical quality of life of the people in the district. Recommendations were therefore made on the basis of systematic analyses of health care programmes at the district level with the view to enhancing: i. The prevention of children contracting easily preventable diseases and dying from them, ii. Adequate and accessible curative care for common ailments; iii. Building of a healthier environment through appropriate sanitation measures; iv. Forging an integrated health care delivery system at the district level, and v Community participation in health services delivery. The recommendations included: 1, The setting up of health planning unit at the district level, creation of health data bank under the planning unit and the formulation of a District Health Plan based on local needs and within the broad national health policy framework; 2. Reorganisation of the District Health Management Team to broaden its membership an scope of activities to encompass all health related programmes and to be in line with guidelines laid down by Ministry of Health. 3. Embarking on community health education programmes and the initiation and encouragement of community involvement in health programmes. 4 Establishing level “B” centres in identified locations in the district from where health services could be rendered to the hinterlands to redress the present gross spatial inequalities in the distribution of health facilities. 5. The integration of the various health delivery systems at the district level through interdepartmental and intersectoral co-operation, especially between the various health institutions, the District Health Management Team and the various health related agencies. 6. Training of more health personnel including selected traditional healers and the provision of incentives to health workers at the district level. 7. Rehabilitation of health facilities and the provision of logistic support to the institutions to facilitate the execution of their programmes. 8. Rehabilitation and construction of a network of roads to the remote parts of the district, especially the “overseas” areas to make these areas accessible to health care services. 9. Finally, the improvement in the economic base of the district by adopting suitable incentive and extension packages that will help boost production and increase income levels. This will help eliminate most of the poverty linked health problems of the district. It is hoped that one of the most effective means of achieving “Health for ALL by year 2000” in most developing countries like Ghana is by making the delivery of health services efficient through proper planning and management of health service programmes at the district level.

Source: KNUST