Strategy for basic health services delivery at the district level: case study of Dangme West District (Ghana)

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For the last two decades or so two strategies of health care systems have competed for the attention of policy makers, practitioners and academicians alike. These strategies were: 1. Facility-based and curative-oriented often unintegrated strategy; and 2. Promotive, preventive, participatory and integrated approach to health. Although the first approach still persists in almost all countries there is a strong shift of policy towards the second one. This research tries to review the experience of Ghana with regard to these approaches in a case study of Dangme west district. It outlines the achievements and problems faced by the health care system and presents major findings and strategies with the view of achieving a maximum possible level of health by all the district population within this century. The research findings are based on primary data collected from field surveys and supplementary secondary data from various health and related institutions as well as informal discussions and personal observations. The analysis of these data reveals the following. i. Although the strategy of primary health care has been proposed as early as 1977 and much has been said about it the health care system of Ghana is still facility-based and curative-oriented. As a result the urban -rural disparities are pronounced. The case study revealed that the rural areas of Greater Accra Region are under-served while most of the health facilities and resources are concentrated in and around Accra and Tema. More than 70 per cent of health facilities and 89 per cent of health personnel are based in Accra and Tema. The district under study is worse than other districts in the region. It has only four governments owned health facilities; even these facilities are not up to standard. Most of them are deteriorating physically and. Under-supplied and poorly supervised. 2. The primary health care coverage in the study area is generally low. There is no consciously organised health education; malnutrition is rampant and is not given due consideration; water supply and sanitation services are woefully inadequate - only 37.2 per cent and 25 per cent of the population have access to reliable water and toilet facilities respectively, there is no sewerage system at all; family planning services are not common nor well—integrated in the health care system of the district; and Immunization coverage is as low as 63 per cent but it is more than 80 per cent in the region. Hence the prevention of locally endemic diseases is said to be in adequate as well as the treatment of common ailments due- to inadequacy of facilities and health personnel; and the provision of essential drugs is poor. 3. The present organisation of the District Health Management Team does riot allow the team to carry out integrated health programmes since it consists of only health personnel. This has created a great problem to coordinate activities and supervision. In addition, because of lack of logistic support the DHMT has been unable to perform the function it is supposed to do. 4. The training, deployment and supervision of community health workers arid traditional birth attendants have been weak. The drop-out rate has reached 42 per cent and 73 per cent respectively. 5. To a great extent the prevalent diseases in the district which posed serious health problems are environmental and water and sanitation related, which are preventable by appropriate health education, immunization and improvement in water and sanitation. 6. The district population will grow rapidly at an average growth rate of 3.5 per cent per annum. This leads to the doubling of the district population in twenty years. Therefore, a big gap between demand for and supply of health services .are discerned. 7. Currently, most of the population would have been devoid of any health service had it not been for traditional healers. But, unfortunately, traditional medicine has not received the support it deserves and has not been integrated into the health care system. The root causes of morbidity and mortality are poverty, ignorance and lack of safe water supply and sanitary services. In order to alleviate such problems and improve the health status of the people within the remaining years of this century strategies are proposed. These are: 1. Intensifying health education which can be achieved through introducing it in the school curriculum, in the non- formal education and in training programmes, in the mass media and by deploying trained community health workers in all communities. 2. Reorganising and strengthening the District Health Management Team; 3. Strengthening facility-based health services by rehabilitating existing facilities, construction of new ones and supplying the necessary resources; 4. Expanding maternal and child health care and family planning services; 5. Extending immunization programmes; 6. Improving water supply and sanitation services; 7. Nutrition improvement; 8. Improving management and supportive supervision; 9. Integrating traditional medicine in the health care system; 10. Implementing malarial control programme; and 11. Embarking on over all socio-economic development of the district.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirements for the award of the Degree of Master of Science in Development Planning and Management, 1991