National Community Health Planning and Services (CHPS)

Policy

Theme: Accelerating attainment of Universal Health Coverage and bridging the

access inequity gap

WORKING DRAFT FOR VALIDATION

November 2014

FOREWORD BY HIS EXCELLENCY THE PRESIDENT
STATEMENT BY THE HON MINISTER OF HEALTH
Table of Contents

Abbreviations .................................................................................................................................. 5
1. National context ...................................................................................................................... 6
2. CHPS as a primary healthcare strategy ................................................................................... 8
3. Scaling-up CHPS: Where are we? .......................................................................................... 9
4. Implementation challenges ................................................................................................... 11
4. The CHPS Policy: definition and directives ......................................................................... 13
4.1 Definition of CHPS ........................................................................................................ 13
4.2 General principles .......................................................................................................... 13
4.3 Policy directives ............................................................................................................. 14
4.3.1 Policy directive 1: Duty of care and minimum package of services....................... 14
4.3.2 Policy directive 2: Human resources for CHPS ...................................................... 14
4.3.3 Policy directive 3: Infrastructure and equipment for CHPS ................................... 15
4.3.4 Policy directive 4: Financing ................................................................................. 16
4.3.5 Policy directive 5: Supervision, monitoring and evaluation ................................... 17
References ...................................................................................................................................... 18
Annex 1 Proposed incentives for CHOs and CHVs ..................................................................... 19
Annex 2 Basic equipment, tools, supplies, drugs for CHPS zones............................................... 21

 Abbreviations

CDS Community Decision System
CHFP Community Health and Family Planning Project
CHMC Community Health Management Committee
CHN Community Health Nurse
CHO Community Health Officer
CHPS Community-based Health Planning and Services
CHV Community Health Volunteer
CZ CHPS Zone
DDHS District Director of Health Services
DHMT District Health Management Team
EPI Expanded Programme of Immunization
GHS Ghana Health Service
MDG Millennium Development Goal
MMDA Metropolitan, Municipal, District Assembly
MoH Ministry of Health
OPD Out Patient Department
PMTCT Prevention of Mother to Child Transmission
PR Performance Review
SDHT Sub-District Health Team
SDMT Sub-District Management Team
SMM Senior Management Meeting
TBA Traditional Birth Attendant
UHC Universal Health Coverage
VHC Village Health Committee
1. National context

1. The Ghana Shared Growth and Development Agenda contain five Policy Objectives that are
relevant to the Ministry of Health. These are:

a. Bridge the equity gaps in access to health care and nutrition services and ensure
sustainable financing arrangements that protect the poor
b. Improve governance and strengthen efficiency and effectiveness in health service delivery
c. Improve access to quality maternal, neonatal, child and adolescent health services
d. Prevent and control the spread of communicable and non-communicable diseases and
promote healthy lifestyles
e. Expand access to and improve the quality of institutional care, including mental health
service delivery

2. Ghana's health system has over the years been premised on the basic healthcare model with a
network of health posts and dispensaries at the lowest level, linked to health centers, polyclinics
and hospitals. In 1977 Ghana adopted a strategy of service delivery at the community level using
Community Health Workers called Community Clinic Attendants and Traditional Birth Attendants.
This preceded the Alma Ata Declaration in 1978 of ‘Health for All by year 2000’ that focused on
Primary Health care (PHC).

3. The 1996 Health Sector Reform was launched with focus on health system development especially
at the district level. A Medium Term Health Strategy: Towards vision 2020 and the first of a series
of Five Year Program of Work and Common Management Arrangement were produced. The
conceptual framework for this reform has guided the health sector up to date and is shown in figure
1 below.

Figure 1 Conceptual Framework for the Five year medium term plans towards 2020
4. PHC was the bedrock of the first Medium Term Health Strategy and the Sector-wide Approach
leading to over 40% of the discretionary sector budget consistently being allocated to the district
and sub-district levels. Since then the Ghana health sector has continuously worked on strategies
for delivering care direct to communities. Over time CHPS has emerged as the main strategy for
doing this.

5. There has been significant reduction in child (under-5) mortality (111 per 1,000 live births in 2003
to 82 per 1,000 live births in 2011) and maternal mortality (740 per 100,000 live births in 1990 to
350 per 100,000 live births in 2010). The major driver for high under-five mortality is stagnation in
the reduction of neonatal mortality (32 per 1000 live births) and this is responsible for 40 percent of
under five deaths.

6. The proportion of OPD attendance by insured clients increased from 55.81% in 2010 to 82.11% in
20.11, OPD per capita increased from 0.98 in 2010 to 1.07 in 2011, with CHPS contributing
approximately 5% to the total OPD attendance countrywide. There has been a corresponding
progressive and significant increase in IGF from increasing attendance of insured clients at GHS
facilities. During 2011, attendance of insured clients at GHS facilities contributed to more than 80%
of their total IGF after suffering a dip in 2010 (72%) in comparison to 77.9% in 2009.

7. The safe motherhood indicators show fairly sustained ANC coverage over the three - year period
being reviewed that is, 92.1% (2009); 93.3% (2010) and 94.4% (2011). This has been in spite of
the proportion of clients achieving the 4+ visits, which has continued to decline from 88% (2009);
82.4%(2010) and 74.9% (2011). The national rate of skilled delivery has continued to improve from
45.6% (2009), 49.5% (2010) to 52.2% (2011).

8. With the national target at 90%, national performance in immunization, as measured by Penta-3
coverage, continued its decline for a second year running, dropped from 89.3%(2009) and 87.1%
(2010) to 85.8% (2011).

9. It estimated that up to 80% of illnesses could be prevented by the combination of improved

nutrition, adequate clean water supplies, education on personal hygiene, family planning,
vaccination services, treatment of common ailments and injuries. These are the main activities of
the Primary Health Care (PHC) System. However, there exists significant inequity in access to
health services between the rural and urban population. CHPS is a national strategy to improve
access and utilization and reduce inequities.
2. CHPS as a primary healthcare strategy

10. Ghana has been implementing the Community-based Health Planning and Services (CHPS)
program for 10 years. Considered one of the pragmatic strategies for achieving universal health
coverage of a basic package of essential primary health services, CHPS has gained
international recognition. Led by a Community Health Officer and supported by volunteers
drawn from the area of service, the CHPS strategy is a breakthrough in enhancing community
involvement and ownership of primary health care interventions towards achieving universal
health coverage (UHC).

11. CHPS began as a Community Health and Family Planning (CHFP) project based on lessons
learnt from Bangladesh (Phillips, 1988). The project was launched in Navrongo as an
operations research in 1994 piloted in three sub-districts. Four different models of delivering
community services were experimented to treat malaria, acute respiratory infections, diarrheal
disease and other childhood illness and providing family planning services and immunization
outreach. Each experiment location was referred to as a Cell with different configurations of
organisation of services as in figure 1 below.

Figure 1: Conceptual framework of Navrongo Community Health and Family Planning Project
Constant: Health Centres Traditional community not Traditional Community
in all cells upgraded mobilised Mobilised – entry, CHMC
equally formed and volunteers engaged
No nurses trained and Cell 4: Upgraded Health Cell 1:Upgraded Health Centre
deployed for home visits Centre with community mobilised
Nurses trained and Cell 2: Upgraded Health Cell 3: Upgraded Health Centre
deployed- residency, Centre with nurse trained and with communities mobilised and
with services available deployed in communities nurse trained and deployed
and home visits
Source: Adapted from Nazzar et al 1994

12. The option that proved most successful was Cell 3 which had three components - (i) a
compound where the CHNs lived and could be reached in emergency and a courtyard for
delivering ANC and services when required; (ii) volunteer assisted outreach program that
encouraged case tracing and referral, health education and confidential counselling and (iii) and
the Community Health Management Committees who oversee community mobilisation and
participation, service delivery and welfare of both the Community Health Nurse and the
Volunteers. Medical Assistants from the Health Centre provided support for community entry
and establishment, supervisory support and held zonal meetings to provide feedback on
implementation. With this option child mortality was reduced by 38% and total fertility was
reduced by one birth (Pence et al., 2001). It was also demonstrated that in the study area, the
case load increased eightfold, immunization and family planning coverage improved and fertility
and mortality rates declined (Debpuur et al., 2002).

13. In 1999, consensus was reached to adopt and scale up the Cell 3 model as a national strategy
to improve access, efficiency and quality of health care (Ghana Health Services, 2003). Fifteen
steps were developed to guide the implementation process. Community Health Nurses were
 provided further training and designated Community Health Officers (CHOs) as resident health
care providers in a CHPS zone. Zones were geographical coverage areas for community
services. The CHOs would provide reproductive, maternal and child health services, manage
diarrhoea, treat malaria, acute respiratory infections and childhood illness and provide
comprehensive family planning and childhood immunization outreach. The CHOs were
supported by volunteers whose roles involved educating the community on basic health issues
and serving mainly as agents of referral services and community social mobilization. These
services were mainly delivered through home visits. Treatment would be provided for those who
come to the CHOs at their residence. The model relied on communities and other stakeholders
to provide financial or in-kind resources for construction and provide oversight for service
delivery and welfare of the CHOs.

3. Scaling-up CHPS: Where are we?

14. In 2000 work began on scaling up the CHPS concept, but was initially limited by resource
constraints. The Ghana Macroeconomics and Health Initiative (GMHI, 2005) and the
opportunities presented by funding made available from the debt relief under the World Bank
Highly Indebted Poor Countries initiative provided impetus for scaling up. The backdrop to this
was worsening health status indicators, increasing cost of care and limited access to any kind of
health services. A twin track strategy was envisaged which was to remove both the financial and
geographical barrier to access to care. The national health insurance scheme was seen as the
social intervention to address the financial challenge and CHPS was to make basic services
available "close to client".

15. The GMHI focused attention on community health services emphasising the importance of the
entire district health system in PHC. The emphasised on construction of compounds as the
basis for scaling up CHPS diverted effort and attention from community mobilisation to CHPS
compound construction.

16. In line with the expected roll out of CHPS strategy, every CHPS zone was to have a CHPS
compound comprising CHO accommodation and a service delivery point. Patients who could
not be handled at this level were referred to a Health Centre, district hospital and regional
hospital in that order of upward referral. The gap between need and what is required across the
various categories of facilities were estimated as follows: 4475 Community Health Compounds,
346 additional Health Centres at the sub-district and 67 district hospitals. With the kind of health
systems outlined, each Region will need a referral hospital. It was estimated that realistically
only 300 of the CHPS facilities could be built in a year.

17. It was unclear what the prototype of the facility was to be. Nyonator and others (2005)
suggested that what was required was a simple facility, comprising ‘a room for the CHO living
area and a room for a community clinic. Experience over the years has shown that this standard
facility is not suitable for long term living and comfort of the CHO. In 2011 new designs were
suggested. The new design is a two bedroom, living room, kitchen and toilet and washroom
facilities for two person occupancy and a single room for consultation with a court yard.
18. The Ministry of Health since the revision of the CHPS Compound design in 2012 has funded the
construction and completion of 16 CHPS compounds with an additional 28 under construction
country wide.

19. Different development partners and District Assemblies have also supported the building of
CHPS compounds using different designs and standards at varying costs. In practice the sizes
vary from simple two-room structures to complex facilities the size of some health centers. The
varying specifications make it difficult to equip, maintain and manage these facilities.

20. Planning with communities, effective community entry and mobilisation, deploying the CHO
supported by volunteers to deliver services, and the acquisition the CHPS compound (may be
donated or constructed), and the provision of essential equipment and supplies are essential
components of the CHPS concept.

21. In 2008 a new terminology "functional" was defined and added to the demarcation of CHPS
zones. This definition stated: ‘where all the milestones have not been completed… but a
community health officer has been assigned and provides a defined package of services to the
catchment population, from house to house in the unit area’. In practice the definition was open
to different interpretations. It was then generally accepted that it is not mandatory to have a
purpose built CHPS compound in implementing CHPS (GHS, 2013).

22. The geographical demarcation for a CHPS zone was changed in 2010 from size of population or
Unit Committees to be conterminous with electoral areas. This reduced the number of CHPS
zones from 5280 to 2840. In 2013 and because of the increase in electoral areas the new figure
put out by the Ghana Health Service (GHS, 2014) is 5487. To date 1189 CHPS zones are
reported to be functional.

23. In 2003 the Ministry of Health set out to significantly increase the production of Community
Health Nurses for CHPS. It directed that all nursing training institutions should train this cadre.
New training schools were also opened. By 2008/2009 the CHN numbers started increasing
reaching over 6300 in 2010. Current estimates of staff in the system are almost 12,000 for only
CHNs (MoH, 2014b). Given the ratio between available CHPS zones and CHNs there appears
to be an over-production of this cadre.

Table 2: Trend in growth of CHNs

Staff Population
Category 2007 2008 2009 2010
Community Health Nurse (CHN) 3732 4502 6303 6343

24. The 2005 CHPS operational policy indicated that CHOs will be assisted by community health
volunteers who are supervised by Community Health Management Committees (CHMCs).
However the effort in developing volunteers (CHMC and Health Volunteers) has not been as
consistent as that in developing the CHO component of the strategy.
4. Implementation challenges

25. Implementation of CHPS is fraught with several policy and systems level challenges. Different
reviews point to a lack of clear policy direction, unclear definitions and an unending conceptual
debate. There were also issues in relation to effective leadership and technical direction.
Planning and budgeting for CHPS at the national, regional and district levels. Planning as a
process at the community level is also inadequate.

26. At the implementation level technical health and local government officers referred severally to
the confusion in directives received from the centre. Written guidelines were not adequately
disseminated, and were difficult to understand and implement. While local government and
district assemblies are willing to take on the challenge of scale up there is still no clarity in roles
and responsibilities. It is also unclear whether CHPS should be implemented in urban areas
given its origin as a strategy for reaching deprived rural areas.

27. The term ‘functional CHPS zone’ introduced further complication to the concept. Under the
functional CHPS zone concept compounds were no longer a mandatory requirement. Zones
were now ranked on a scale of fractional degrees of partial or incomplete depending on how
many of the six steps have been completed. Under the new definition it was difficult to
determine precisely what ‘functional’ meant (Awoonor-Williams et al., 2013; Baatiema et al.,
2013).

28. In rapid assessments in both the Western and Central Region about 77% of CHPS compounds
were found to be in a poor state of repair. Some districts have commissioned CHPs compounds
which have not as yet started operations after several years of commissioning. Most of the
compounds (about 60%) are partially equipped and without accommodation. Most CHOs also
complain of lack of operations running budget (MoH, 2014).

29. Service delivery was in a constant flux with ever changing definitions of the standard basic
package of interventions to be delivered in a CHPS zone (MoH, 1999, GHS, 2005, GHS, 2010
and GHS, 2013). New services are constantly layered onto existing ones with supervisors and
communities coming to expect an increasing variety and complexity of clinical services to be
delivered at the CHPS level. All disease specific programmes see the CHPS platform as an
opportunity to reach the communities with their programmes. There was also push for CHOs to
include deliveries in the CHPS portfolio of services. Lack of communication and engagement
has led to community members not understanding the distinction between community-based
health service and services at a higher level health facility (Tierozie, 2011). Communities expect
a facility to should deliver clinical care when required.

30. The current population reached with CHPS services is 5% (GHS, 2012). Considering
investment to output this might be considered low. This raises the question as to whether we
are optimally implementing the strategy and whether CHPS is value for money. Another issue
raised by this low coverage is to examine the methods and indicators for measuring CHPS
performance. CHOs are required to fill different forms for various programme specific activities.
The result is an overload in reporting requirements and little use of data.
31. The ratio of functional CHPS zone to CHN points to an over production of CHNs. Currently the
ratio is about 1:11. The initial assumption was to have one CHO per CHPS zone. It is now
considered to have at least two CHOs per zone. This presents logistic challenges in terms of
accommodation and amenities resulting in many CHNs not residing in CHPS zones. The CHN
training program was developed with no prospects of career progression while in service. Many
CHNs desire to continue their education, leading to dissatisfaction with the location and length
of their current placement. There is no policy on how long a CHN can remain in a deprived
community or incentives in place to reward those serving in deprived areas.

32. The selection, training and retention of volunteers have received the least attention in the CHPS
deployment framework. It is estimated that 55% of CHPS zones have no regularly trained active
volunteers working with CHOs on a regular basis (MoH, 2014). Volunteers provide a bridge for
the services between patients and the CHNs without affecting the national wage bill. The low
availability can be attributed to several factors. Different programs drawing on volunteer
services have led to volunteers implementing different uncoordinated services. There is no
policy on reward and incentives for these volunteers leading to volunteer fatigue and various
programs introducing cash incentives. This has distorted the volunteer system in several
communities resulting in some volunteers demanding cash for services. Some sub-districts are
waiting for funding to become available for hiring community members to perform volunteer
services (Awoonor-Williams et al., 2013, Seddoh et al 2014). There are proposals from the
Ministry of Health to retool existing volunteers and regularise the payment system by providing
some monetary payment.

33. Another issue that cut across all regions was Community Health Management Committees
(CHMCs). Though they were formed in most CHPS zones, members were inactive or not
trained in 65% of the CHPS zones (MoH, 2014). Community entry and appropriate community
mobilisation to support the CHPS programme were hardly done.

34. There are issues of inappropriate siting of CHPS compounds. In some instance land allocated
for CHPS are either in sacred groves, insanitary environments and not sensitive to the cultural
setting and taboos. There are also issues of security and availability of water and electricity.

35. Financing CHPS is not clear. Different development partners have funds for supporting the
development and scale up of CHPs but there is no coordination and harmonisation of the
various funds. The NHIA does not reimburse for CHPS services directly. Where services are
provided and qualify for NHIA reimbursement, the cost is claimed through the Health Centres as
part of the services provided by the Health Centre. Under capitation, individuals will prefer to
select health centres and hospitals as their preferred primary provider.
4. The CHPS Policy: definition and directives

4.1 Definition of CHPS

36. CHPS is a national mechanism to deliver essential community based health services involving
planning and service delivery with the communities. Its primary focus is communities in deprived
subdistricts and in general bringing health services close to the community.

The following constitute the components of CHPS implementation

a. A CHPS Zone refers to a demarcated geographical area of a 4 kilometre radius and between
4500-5000 persons or 750 households in densely populated areas and may be conterminous
with electoral areas where feasible
b. A CHPS Community is a town, part of a town or a group of villages or settlements grouped
together and designated as such by the district assembly as sub-units of a CHPS Zone. These
are mapped for ease of planning of itinerant services and assignment of CHOs and CHVs. A
CHPS Community in a densely populated area shall be approximately 1500 persons or 250
households.
c. A CHPS Compound refers to an approved structure consisting of a service delivery point and
accommodation complex both of which must be present
d. A Community Health Officer (CHO) is a trained and oriented Community Health Nurse working
in a CHPS zone and may be assigned to a Community within the zone
e. Community Health Volunteers (CHVs) are non-salaried community members identified and
trained persons supporting CHOs in a Community within the CHPS zone
f. Community Health Management Committees are community leaders drawn from the CHPS
Community with different competencies and responsibilities who volunteer to provide
community level guidance and mobilisation for the planning and delivery of health activities and
see to the welfare of CHOs in their community

37. The aim of this policy is to:

a. Attain the goal of reaching every community with a basic package of essential health
services towards attaining Universal Health Coverage and bridging the access inequity
gap 2020

4.2 General principles

38. The general principles guiding the development and implementation of CHPS are
a. Community participation, empowerment, ownership and volunteerism
b. Focus on community health needs to determine the package of CHPS services
c. Task shifting to achieve universal access
d. Communities as social and human capital for health system development and delivery
e. Health services delivered using systems approach.
4.3 Policy directives

39. The following policy directives shall apply and guide the implementation of this National CHPS
Policy. Implementation guidelines will be developed to provide more detailed information to
guide implementation.

4.3.1 Policy directive 1: Duty of care and minimum package of services

40. Package will include:

• Maternal and reproductive health ( emphasising FP, ANC+, providing relevant information
and motivating pregnant women to seek appropriate services including PMTCT and ANC,
and to deliver under trained health worker supervision) and ASRH)
• Child Health services (EPI, nutrition education and support and Growth monitoring and
promotion, Community Integrated Management of Childhood Illnesses
• Treatment of minor ailments, including fever control, first aid for cuts, burns and domestic
accidents, and referrals
• Health education, sanitation and counselling on healthy lifestyles and good nutrition
• Follow up on defaulters and discharged patients

41. Information and Surveillance: CHOs will keep records and report regularly according to standard
protocols. The reports will include vital events in the CHPS zone and prompt notification of
strange diseases or deaths and increased occurrence of known diseases such as diarrhoea,
neglected tropical diseases and jaundice.

42. Deliveries may not be performed by CHOs. They are expected to refer all delivery cases to a
higher level of care. Based on need, the District Director of Health Services may include
midwifery services in the package of services for a specific CHPS zone and post a qualified
resident midwife to the zone.

43. Where there is already a competent midwife operating in an accredited private maternity home
within the zone, such a facility shall be the referral point for the CHPS zone.

44. Any earmarked or project services to be implemented at the community level and directly
financed by any persons, institutions or development partners should be implemented on the
CHPS platform according the laid down

4.3.2 Policy directive 2: Human resources for CHPS

45. CHN is a professionally classified cadre by the Nurses and Midwives Council for persons
qualified and issued with the recognised specific license. A CHN who undergoes the prescribed
in-service training and orientation and posted as a staff in a CHPS zone is designated as a
CHO. There shall be established a CHO grading system for the purpose of providing career
progression.
 46. Any Community Health Nurse acquiring a professional nursing grade or a degree level
qualification shall migrate onto the new profession grade categories for their promotions. For
avoidance of doubt a CHN acquiring a professional qualification and licensed to practice in a
nursing profession above a CHN licensure shall move from the CHN category onto the new
qualification and license and progress from there. The professional may continue to serve at
the CHPS level where appropriate as in for example a CHN being designated a midwife.

47. There shall be at least three (3) CHOs to a CHPS zone who may serve for specified periods
depending on the level of deprivation and shall rotate out. No CHN shall however serve in the
same zone for more than four years.

48. An appropriate incentives scheme shall be developed and instituted to reward CHOs depending
on performance, duration of stay and category of deprivation of the CHPS zone. The incentive
scheme will recognise staff opting to serve in very deprived areas. See a proposed incentive
scheme in annex 1.

49. Community Health Volunteers shall continue to be an integral part of CHPS zone service
delivery. Each CHPS Community shall have at least two volunteers selected by the community
and trained by the sub-district health team. These will be the recognised volunteers for the
CHPS platform.

50. An appropriate incentives scheme shall be developed and instituted to reward Volunteers
depending on performance, duration of stay and category of deprivation of the CHPS zone. See
suggested incentive scheme in annex

4.3.3 Policy directive 3: Infrastructure and equipment for CHPS

51. A CHPS compound is a basic structure consisting of accommodation of CHOs and a service
delivery point which may also be referred to as a health post. To promote efficiency and cost
effectiveness in the construction, maintenance and management of CHPS compounds across
country, all CHPS compounds shall be standardised across the country using approved design
options. For the purpose of consistency in nomenclature, the complex of residence and health post
shall be referred to as a ‘CHPS Compound’.

52. Where a community has provided a temporary structure to serve as a CHPS compound, this
should be replaced in due course with the standard approved design

53. Where maternity services have been approved for a particular CHPS compound a separate
maternity facility co-located within the CHPS compound shall be constructed based on a
standard design approved by the Minister of Health
 54. A CHPS compound shall be equipped and furnished in accordance to the standard list defined
for the approved designs as attached in annex 2. CHPS compounds located in deprived areas
without power grid or safe water shall have solar power and boreholes as part of the standard
requirements

55. All on-going construction of CHPS compounds shall be completed with their planned design; or
modified to the new design where applicable except that the cost due to modifications shall not
be more than 15% of the suggested cost of construction of the new prototype. All CHPS
compounds not started shall comply with the approved prototype and constructed in line with
the principles set out in this policy

56. The establishment of CHPS zones and location of CHPS compounds shall be determined by
the District Assembly on the advice of the District Director of Health Services and consistent
with the District Strategic Health plan

57. The land for the construction of CHPS Compounds shall be provided by the host community as
a free hold with appropriate documentation sealed at the land title registry. The government on
receipt shall have a right to vest the land in a third party for the sole purpose of achieving the
objective of establishing a CHPS Compound.

58. In urban areas and around hospitals and health centres, the CHPS concept is applicable,
except that the services will be provided from an existing facility as the host facility. The
accommodation component may be provided to the CHOs if no accommodation already exists
for the CHOs

59. CHPS compound construction will be prioritised for rural and deprived areas

4.3.4 Policy directive 4: Financing

60. The primary responsibility for financing the scale up of CHPS rests with government.
Government shall allocate dedicated resources for the scaled up operations of the CHPS

61. Additional funds may be mobilized from the following sources:

a. 10% levy on salaries of the Executive and the Legislature already committed by the ruling
government
b. Allocation of the National Health Insurance Fund to the Ministry of Health
c. Development partner contributions including establishment of a common funding basket
d. Contributions from benefactors and philanthropists

62. All services delivered in CHPS compounds shall be delivered free of charge at the point of use.
All CHPS services on the NHIS benefit package shall be reimbursed. CHOs and their volunteers
will facilitate the registration of their populations onto the NHIS.
4.3.5 Policy directive 5: Supervision, monitoring and evaluation

63. The District Director of Health Services being the technical lead in the District and reporting to
the District Chief Executive and the district assembly shall have overall responsibility for guiding
service delivery in the CHPS zones in the district.

64. Direct supervision of CHOs shall be the responsibility of the Officer in charge of the health
centre in the sub-district. Where there is no public health centre, The District Director shall
delegate an appropriate officer to be responsible.

65. Medical officers in the District Hospital shall be assigned a number of sub-districts for which
they shall have mentoring and technical supervision responsibility and shall visit a CHPS zone
in their assigned sub-district at least once every quarter.

66. The District Chief Executive shall in collaboration with the District Director of Health Services
commission annual reviews of progress in CHPS implementation in the district and make the
report available to be discussed by the District Assembly. The report and recommendations of
the district assembly shall be made available to the Director General of the Health Service and
the Minister of Health by June of the reviewing year.
References
1. Ghana Health [Link] 2005; CHPS The Oerational Policy
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3. Ghana Health Service. December 2002; CHPS Initiative the Concepts and Plans for
Implementation
4. Ghana Health Service. December 2002; CHPS The Strategy for Bridging the Equity Gaps in
Access to Quality Health Services
5. Ministry of Health. November 1999; CHPS A Process for Effective Implementation of Primary
Health Care Program
6. Ghana Health Service/Japan International Cooperation Agency. June 2009; Guideline on
facilitative supervision in CHPS implementation
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Referral Procedure 2nd vesion
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Community-Based Health Planning and Services (CHPS)”
18. Philip Baba Adongo, James F Phillips, Moses Aikins, Doris Afua Arhin, Margaret Schmitt, Adanna
U Nwameme, Philip Teg-Nefaah Tabong and Fred N Binka. 2014. “Does the design and
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Services (CHPS)” Health Research Policy and Systems 2014, 12:16
19. CHeSS Ghana (2014): A conceptual pilot and evaluation for policy-STAR Ghana funded project
20. MoH 2013 CHPS Compounds Survey in the Eastern and Ashanti Region; Accra
21. MoH 2014 CHPS Compounds Survey in the Central and Western Region; Accra
Annex 1 Proposed incentives for CHOs and CHVs

Proposed Incentives for CHOs in deprived areas

Category 1st to 3rd Year 4th to 6th Year 7th to 9th Year
D eprived 15% salary top up per Automatic promotion to Automatic promotion to next
month with half year next grade; 20% salary top grade; 20% salary top up per
five working days rest up per month with half year month with half year five working
and recuperation paid five working days rest and days rest and recuperation paid
off days –standard recuperation paid off days off days –standard return bus
return bus fare paid –standard return bus fare fare paid by district assembly to
by district assembly to paid by district assembly to preferred destination in Ghana.
preferred destination preferred destination in Mandatory rotation out on
in Ghana Ghana. Mandatory rotation request of CHO
out on request of CHO
Most 30% salary top up per Automatic promotion to Automatic promotion to next
Deprived month with half year next grade; 30% salary top grade; 25% salary top up per
five working days rest up per month with half year month with half year five working
and recuperation paid five working days rest and days rest and recuperation paid
off days –standard recuperation paid off days off days –standard return bus
return bus fare paid –standard return bus fare fare paid by district assembly to
by district assembly to paid by district assembly to preferred destination in Ghana –
preferred destination preferred destination in automatic rotation out to a
in Ghana. Ghana. Guaranteed leave deprived or better endowed area.
with pay to health related In this case the conditions for the
degree program. new area shall apply at the
Mandatory rotation out on continuing incentive level if
request of CHO at anytime applicable at end of period.
Severely 40% salary top up per Automatic promotion to Not allowed – compulsory
Deprived month with bi-monthly next grade after second rotation out to better endowed
five working days rest year of service; 40% salary urban area and revert to standard
and recuperation paid top up per month plus, salary on new grade if acquired
off days – standard guaranteed paid new degree or automatic
return bus fare paid educational leave and fees promotion to next grade with two
by district assembly to paid to an approved health incremental point jump on salary
preferred destination degree after 3rd Year or scale for either
in Ghana- Mandatory guaranteed paid six
rotation out on months leave and move to
request of CHO after better endowed urban area
one year of choice after period.
Retain allocated motorbike
for personal use-
Mandatory rotation out on
request of CHO at anytime
 Proposed incentive system for volunteers
Up to one- 2nd and 3rd Year 4th and 5th Year 6th to 10th Year
year
Two pieces Retain allocated Three pieces of cloth from Retain allocated bicycle in 6th
of made in bicycle, two pieces of 4th year, 24” television in year, three pieces of cloth
Ghana cloths annually and 5th year, certified as trainer annually, 36” television in 8th
cloths certificate of service of volunteers year, combination fridge and
freezer in 10th year with
certificate of long service award
and rotated out
Annex 2 Basic equipment, tools, supplies, drugs for CHPS zones

For CHPS compound

Equipment
Resuscitation Kit: NeoNatalie
Salter Weighing Scale
Blood Pressure Apparatus
Bowl to receive placenta
Couch
Demonstration tray, family planning
Fetoscope
Forceps, dressing
Galipots
Screen or curtain
Refrigerator
Refrigerator thermometer
Adult weighing Scale
Vaccine carrier
Clock/watch with second hand
Logistics
Cup with 100ml/50ml mark for tasting ORS solution (ORT)
Bucket, container for 0.5% chlorine
Bucket, container for contaminated waste
Mackintosh sheet
Benches and chairs at waiting area
Tape measure
Weighing pant
Supplies
Information, Education and Communication materials
Methylated Spirit
Alcohol Hand Rub
Plastic apron
 Bandages / plaster
Chlorine solution or powder
Cotton swabs / gauze
Disposable syringes, 1 cc
Disposable syringes, 5 cc
Gloves, disposable
Gloves, sterile
Gloves, utility
Malaria Rapid Diagnostic Test
Scissors
Sheets, linen
Liquid soap
Thermometer
Waste containers: puncture proof for needles/syringes
Water, clean
Midwifery Kits – if approved
ITEM
Plastic sheet
Disposable gloves
Cord Ligatures (twine)
New Blade
Methylated spirit
Oxytocin
Soap (wrapped in Polybag)
Gauze Swabs
Cotton wool swabs
Polythene bag for waste
Plastic bowl (as galipot)
ORS
Thick Plastic bag (to wrap items)
FP job aid

Monitoring and Evaluation tools

Antenatal Care register
Child Health Record Book/weighing card
 Consulting Room register (OPD)
Daily log
Delivery Register
Drug register
Drug Bin cards
Family Planning register
Family planning client record books
Family planning monthly reporting format
Immunization register
IMNCI chart booklet
Maternal Health Record Book
MCH quartery reporting format
Monthly Morbidity Report forms
Post Natal Care Register
Refrigerator temperature sheet
School Health Registration Notebook
TT Cards
Vaccine logistics register
Medications
Albendazone
Amoxicillin
Artemether + lumefantrine
Artesunate + amodiaquine
Chloramphenicol eye ointment
Condoms
Cotrimoxazole
Depo-Provera (DMPA):
Distilled water
Ferrous folate
Gentian violet, 5%
Mebendazole tablet
Metronidazole
Misoprostol tablet
Multivitamin
 Noristerat, Norigest (NET-EN):
Norygnon:
Oral Rehydration Solution and Zinc tablet
Paracetamol
Sulfadoxine + Pyrimethamine
Tetanus Toxoid
Vitamin A

For Home Visit for CHO and CHW

(1) For CHO

Item Quantity
Back pack 1
Dressings (Bandage, Gauze swabs, Cotton Wool swabs, Plaster 5
1”&2”, Crip bandage, Vaseline Gauze etc.)
Raincoat 1
Cup & Spoon 2
Soap dish & Soap 1
Hand towels 6
Notebook 2
Pen & Pencil 2
Torch Light and batteries 1
Wellington Boots 1
Family Planning methods Samples & For sale
Oral Rehydration salts (ORS) Samples & For sale
Insecticide Treated Nets (ITNs) 1
Methylated Spirit/Glycerin (Alcohol Rub) 1
Penis Model 1
Health education 1 each
-Maternal Health Record Book
-Breastfeeding Care
-Complementary Feeding
-Malaria Prevention etc.
Brochures (Assorted) 1 each
Community Register NIL
Volunteer T-shirt (Lacoste) NIL
Plastic sheet 2 yards 1
First Aid items (Parafin, Mecurochrome, Activated charcoal, 1
Tape measure 1
Drugs – Anti-malarials
Artesunate Amodiaquine (various age groups) 5 each
Artemeter Lumifantrine (lonart, coaterm) 2
 Sulphadoxine Pyremethame (SP) 10
Paracetamol 2 sachet
Disposable gloves 2 pairs or more
Methylated spirit 1
Data Management tools Various in Plastic
wallet
Blood Pressure kit (digital) 1

(2) For CHV

Item Quantity
Knapsack 1
Plastic file 2
Community book 1
Data tools 4
Stationery 1
Plaster 1
Bandage 1
Cotton Wool swabs 5
Guaze swabs 5
Small notebook 1
Contraceptive methods 3
Anti malarials (Green leaf) 2
Plastic sheet 1
ORS 5
Scissors 1
Health education material 4
Gloves 1
Torch with Batteries 1
Wellington books 1
Plastic bowl ( as galipot) 2
Rain Coat 1