Assessment of the level of community participation in health care delivery in Ketu District

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A successful health care delivery under Primary Health care needs individual and Community self- reliance and active involvement of people living together in some form of social organisation and cohesion in planning, operation and control of primary health care using local, national and other resources. Great importance is accorded to community participation in health. Due to the scarce resources at their disposal, and the large number of potential benefits attributed to participation processes, including better addressing of community needs through more locally adopted organisational processes and improvement in health outcomes many governments around the world have adopted policies and programmes of community participation as part of their strategy to implement primary health care services in accordance with its principles as declared by the WHO (1978) at its Alma - Ata conference. In Ghana, attempts have been made at involving the communities in as early as the late seventies. According to Asbuo Dam (1993) the involvement of the communities in the provision of essential health care led to the solution of several health problems at the local level. Community participation varies in level from community to community due to several factors affecting it from the side of both the providers as well as the beneficiary communities of health programmes. The primary concern of the study therefore was to assess the prevailing level of community participation in health care delivery programmes and factors affecting it in Ketu District of the Volta Region. The study covered non-professional components or primary health care — construction of infrastructure for clinic and health centres, latrines, rural water supply and garbage covering the period from January 1997 to August 2000. Specific areas of interest in the study include determining the extent of involvement of communities in the identification of their heath needs; the influence of leadership on community participation; the effect of community organisation on the involvement of community in health care delivery; assess the commitment of communities to resources mobilisation for health care activities; the involvement of communities in the management of health projects and to establish a framework for future assessments and recommend appropriate guidelines for soliciting and sustaining community participation in health care delivery. In order to answer the study questions a qualitative descriptive study design was chosen. Face validation method was applied to check the validity of the collected data. The study population consisted of two MOH staffs in decision making position in each of the selected health facilities - one from each sub-district selected at random. Five communities were selected at random from the catchment area of the selected health facilities. Ten respondents were purposively selected from the community to answer questionnaire. These were chiefs, assembly members, unit committee members, opinion leaders, etc. Focus group discussions were held involving 8-12 people including both men and women. It was found out that the level of community participation in health and health related programmes in Ketu district was rather low. This is not to say that there were no communities with high level of community participation. Strong leadership was fundamental in the high level of community participation in some communities. Weak leadership was responsible for low level community participation even though such communities were endowed with all the resources which could be used for development of health related projects. A framework was established as a basis for measurement of future levels of participation in health care delivery. Recommendations were made for the improvement of community participation. The recommendations included stepping up health education involvement of communities in planning and execution of health programmes, training of MOH staff in communication skills among others.
A Thesis Submitted to the Board of Post Graduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfilment of the requirements for the award of the Msc Degree in Health Services Planning and Management, 2001