urban health development

The Urban Health Intervention

UGSPH Status Report on GEHIP for Ga East District

Philip Adongo, PhD

Outline of presentation

1) URBAN CHPS:• Milestones in setting up CHPS in Rural areas:

Activity: Assessing the relevance of the CHPS process to an urban setting (Year 1)

• Results: Clarification of how urban CHPS differs from Rural CHPS

2) THE LEADERSHIP COMPONENT OF HEALTH SYSTEMS STRENGTHENING• Leadership Programme:

-- MPH health systems development component• District leadership development

--Modular training component

3) PROGRESS WITH LAUNCHING THE BASELINE SURVEY IN GA EAST AND GA WEST

Activity I: Preparation for Urban CHPSCHPS Programme Milestones

Questions that we addressed: • Are the rural milestones relevant to the urban environment? • How are urban CHPS service operations different from

rural operations?The milestones are:1) Community engaged planning (Community Health Committee, zoning, mapping, etc)2) Community entry (liaison with traditional and opinion leaders). Developing participatory implementation.3) Community Health Compound development (construction, renovation, or rental)4) Essential equipment procurement.5) Nurse orientation to community work and posting to Community Health Compounds6) Volunteer identification, recruitment, training and deployment

Community EntryStrategy assessment for Urban CHPS

Formative Research:1. Focus Group Discussions (FGDs)2. In-depth interviews with stakeholders and opinion

leadersTo seek views on– Health seeking behavior for child and maternal health– Health decision making at local level– Community conceptualization of Urban CHPS– Potential models of CHPS

Milestone #1:CHPS Planning

Urban versus Rural Model• Urban CHPS– Large populations

(20,000-40,000)– Zoning is required and it

is important exercise– Difficult to mobilize

community to contribute– Nurses may need to

concentrate on promotion activities

• Rural CHPS– Small population (3000-

5000)– Zoning is easier– Easy to mobilize

community to contribute– Curative aspects very

important

Milestone #1:Zoning of Ga East into CHPS areas

All four Ga East sub-districts were “zoned” for CHPS including….–Dome– Danfar– Madina– Abokobi

Milestone #1:Selection of start up CHPS zones in Ga East

Zones Area covered Estimated total population

Estimated no. of chn 0-59m

Estimated no. of household

One Rabit, Auntie Mary, Ohenho etc.

23,282 4,191 1,219

Two Dome market, Dome Park, Grushie Town etc.

41,169 7412 966

Three CSC, GYM, Atomic, Atomic Ayigbe Town etc.

18,894 3400 729

Total 83,345 15,003 2914

Milestone #2: Urban Community EntrySensitization meetings with the SPH, Region and Districts

• Discussions with regional health administration• The forum to has been created where GEHIP has been

presented to the – School of Public, University of Ghana– All MHMTS, DHMTs–GA East – The Assemblies-Discussions with planning officers of

Ga East (intervention area) and Ga West (comparison area)

Milestone #3 Procurement of work space or clinic

• Municipal Assembly providing storage space for equipment, but construction of a “Community Health Compound” may present a challenge

• Partnership with private health providers to provide space

• Municipal Assembly to providing space for the GEHIP field office in Ga East.

Milestone #4: Essential equipment

Health workers needs small Vehicles to conduct their activity

Milestone #5The Training of CHOs

• TOT training completed in Mid September:

• Training of CHOs started in October, 2010– GEHIP is supporting the training of CHOs

Milestone #5: CHO deploymentThe way forward for urban CHOs…

• A non-residential service• Collaborate with private health institutions

• We will learn from experience on in-service training for urban CHO.– Innovation in communication (ways to replace

durbars)– May have to make modifications during our

“Phase 2” implementation process

Milestone #6 Volunteers

– Volunteer identification, recruitment, training and deployment

Milestone Rural CHPS Urban CHPS1) Community -

based PlanningSituation analysis, initial outreach to chiefs, “zoning” of catchment areas.

Block and neighborhood identification, clarification of geographic responsibility

2) Community entry • Building understanding with chiefs, elders, & opinion leaders.

• Developing Community Health • Organizing CHC action• Developing durbars for health

communication

• Focus on identifying social networks (corresponding to ethnicity of settlers).

• Outreach to formal authorities & politicians

3) Essential equipment

Motorbikes & bicycles+ clinical equipment for IMCI, EPI, FP/RH

Low cost 3 or 4 wheel vehicles + clinical equipment for IMCI, EPI, FP/RH

4) Facility development

Community volunteer construction of CHC or renovation of existing facility

Arranging donation of secure space or renovation of donated space. No CHC

5) Nurse community engagement training & posting

Training in community entry, liaison, and sustaining community participation

Training in health education in the urban context

6) Volunteer identification, training, & deployment

Community organizational focused Basic medicinal products distribution (Major role in health promotion: bednet promotion, condoms, ORS, etc.)

Service focused volunteers with no curative services.

(Limited role)

Activity IIDeveloping a Leadership Programme

• Develop BPH/MPH Training that prepares leaders for District Health Management

--Utilize GEHIP sites for MPH field practica in health systems development

-- Two or three MPH students will be working on Urban CHPS in the Ga East Municipal

• Develop field model to be used to strengthen both rural and urban CHPS through modular “peer” training in systems development

The Problem:Existing training produces tiers of capable individuals,

but not systems capacity building….

Community Health Officers

Supervisors, Disease Control Officers, Nutrition, etc.

Registered nurses, midwives

District Directors & Health Management Team members

The School is now contributing to Public Health Capacity Building at all levels of the system





A critical component: Bachelor of Public Health for

supervisors, paramedics, nurses, etc.

Pathways of the BPH course

• Public Nursing• Disease control• Health promotion• Environmental health• Health information

With GEHIP support, the UGSPH has formed a health systems development partnership with the GHS:

Short public health system training modules on health systems development themes that require teamwork across levels

Practical peer demonstration in GEHIP districts.

With GEHIP support, the UGSPH has formed a health systems development

partnership with the GHS for developing public health system

modules that require teamwork across levels…

What will GEHIP Add?





CHPS development

Peer Leadership Training






GEHIP District Health Profiling &

DiHPART implementation






Information for Decision-making

MPH component of Leadership Training pretested in Ga East:

• Participation in Ga-East Municipal Annual Review Meetings

• Ga East Project (SPH & NOGUCHI) 14 MPH dissertations, all with health systems plus focus topics on ....– Health financing, planning– Nutrition– Oral health– Reproductive health, sexually transmitted diseases– Quality of care.

Activity III. Preparations for the Baseline Study in Ga East• Draft questionnaire developed for Household surveys• Household surveys in Ga East & Ga South to obtain

information on …..– Household characteristics– Pregnancy history– Contraception– Antenatal care– Delivery & newborn care– Health seeking behaviours– Malaria & use of ITNs– HIV/AIDS & other STIs– Cost of health services

Thank you very much

urban health development

Health & Medicine