The Village Health Committee (VHC) System as a Tool in Community Participation for Promoting Rural Health - a Study of Selected Districts in Ashanti Region, Ghana

The study analyses the Village Health Committee (VHC) system as a tool in community participation for promoting rural health in Ghana. Since 1978, after the Alma Ata Declaration in former Russia, the P1-IC concept has seen as a medical approach to bring about Health For All by year 2000 and community participation was accepted as a key strategy for achieving this objective which has been embraced by most governments. In Ghana, there have been several attempts at involving communities in health care. The Danfa, and Brong Ahafo Rural Integrated Development Programme (BARIDEP) pilot projects and the Community Clinic Attendant /Community Health Worker concept are examples of such attempts. The high attrition rate (75%) of the Community Clinic Attendants made the MOH to shift its policy to the formation of the VHC system in 1989 which was envisaged by the MOH as the main vehicle for promoting community participation in health in rural areas. The VHCs were supposed to be responsible for promoting health development in their respective communities by carrying out preventive health (public health) activities. Unfortunately, after almost a decade of the implementation of the VHC concept in most districts, preventable and communicable diseases continue to form the bulk of diseases reported at the health facilities, new ones arc emerging and even old ones re-surging especially in the rural communities. Besides, there is considerably more emphasis on curative care than preventive care or public hea1th. The question that arises is whether the MOH is actually committed to the implementation of the system. The principal concern of the study, therefore, was to investigate the policy establishing the VHC system in dealing with the health problems of the rural communities and how the concept could be used as a vehicle for achieving HFA 2000, which is the goal of PHC. Specific areas of interest in the study include a review of health policies and the policy establishing the VT-IC system; factors affecting the performance of the VHCs; as well as the adequacy of support given by the MOH and finally, the acceptance of the concept by the communities. Due to the wide scope of the study in terms of spatial coverage, a cross-sectional approach was adopted by using three districts (Ejisu - Juaben, Afigya - Sekyere and Asante Akim North) in Ashanti region for the survey and the findings generalised for the country. The research was conducted by collecting primary and secondary data. In all, the three actors — health worker, VHCs and community opinion leaders- were targeted. Quota sampling technique was applied to interview 17 health workers while purposive sampling was used to select 25 VHCs and three members of each VHC, interviewed. Focus group discussions were also held with the community opinion leaders. The study observed that: • In spite of several attempts at promoting preventive health through community participation curative health receives the bulk of the health budget (65 - 75 percent) contributing to the incidence of preventable and communicable diseases. The VHCs do not play any major role in the management and planning process of the health system since they are not included in the DHMTs and the SDHTs. • The activities of the VHCs facilitate the work of the health workers especially the environmental and MCH staff. The VI-IC activities have also created awareness in public health issues such as village sanitation and domestic hygiene and have received the communities’ appreciation and acceptance. • The MOH has not been committed enough in the provision of service support such as training, logistics, incentives and regular supervision to make the system work effectively. In addition, the MOH has not educated the communities in the activities of the VHCs, for them to become fully involved in the system. This has resulted in the lack of co-operation of some of the community members. Consequently, HFA 2000 appears to be a mirage unless efforts are re-doubled to intensif’ communities’ involvement in health. This calls for integrated policy interventions, which include: • The provision of service support such as logistics, training, and incentives for VHCs by MOH; • Education and involvement of the community in the entire decision-making process in health; • Provision of an enabling environment by health managers/policy makers and by soliciting support from the private sector; and • Collaboration of MOH with other sectors, agencies and departments to ensure integrated development. The successful implementation of the above proposed interventions would depend on the determined efforts and commitment by all actors, especially the MOH to make health promotion a reality.

Source: KNUST