Within Ghana, there’s an average of 1 doctor and 10 nurses per ten thousand people, most of which are located in more urbanized areas (WHO, 2011). Community health care services are essential to treat minor ailments, make referrals, provide education, and counsel on family planning (Ministry of Health, 1999). In order to better serve the 48% of the population living in rural settings, Ghana has developed Community Based Health Planning and Services (Ministry of Health, 1999). This has been instrumental in an effort to reduce national poverty (Nyonator et al., 2005). It does so by “mobilizing social traditions for consensus building, leadership, and decision-making” (Nyantor et al., 2005). The objectives are to deliver equitable, comprehensive and cost effective care (Ministry of Health, 1999). The main barrier to providing adequate care is the immense volume of people which must be seen on a daily basis. Mamprobi, one of the clinics, is responsible to serve a population base of close to four hundred thousand people with twenty one thousand expected pregnancies each year. They simply don’t have the capacity to do so. In this reflection, I will discuss the benefits of community health care as it pertains to rural communities, school settings and maternal health.
The importance of this initiative can only be truly appreciated when immersed in community health care – as the culture is diverse and rich throughout Ghana. While shadowing a community nurse Adjoa from Apemanim who travels to 4 neighbouring villages often by foot to give immunizations, counsel mothers and monitor the growth of newborns by weighing them from a cocoa tree, it’s apparent to see the therapeutic relationship she has built with mothers who can relate to one another. Community health takes devotion and dedication as positive results require a comprehensive needs assessment to determine how to go about promoting health through long-term initiatives. Since culture and hierarchy are highly valued, prior to performing home visits in a Muslim community, as a sign of respect, we were to greet the chief of the village in his home. Because not everyone can afford transportation to clinics, the nurses also do mobile programs, mainly monitoring and counselling pregnant mothers within their homes.
While doing child head-to-toe assessments and personal hygiene teaching in a government school, in one visit, we found children with ear infections, undescended testicles, respiratory tract infections, umbilical hernias and dental carries. It’s likely that these children wouldn’t have sought medical attention until the problem was severe, as I’ve seen time and time again in the hospital setting. Once referrals are made, this allows health care professionals in tertiary settings more time to manage and treat serious cases, while minor ailments can be treated in the community (Ministry of Health, 1999).
Ghana’s focus on maternal health is apparent as 78% of women attend 4 or more antenatal visits where women are screened and managed for underlying conditions, complications, and counselled on positive health behaviours (Lincetto et al., 2001). This program has not only reduced barriers for women to access care, but through lifestyle modifications promotes lasting health beyond the period of pregnancy (Lincetto et al., 2001). Being directly involved in these visits has allowed me the opportunity to monitor women for pregnancy related complications like gestational diabetes, and eclampsia.
Every morning is started with a prayer song eloquently chanted by the women who possess unity in their voices and rhythm in their movements. The antenatal portion of the clinic sees up to two hundred patients per day. Each day they reach a different target population, for example Wednesdays are for primiparous women (who are bearing their first child) which I’ve observed is generally is associated with the younger population. We have seen expecting mothers as young as 15. At this stage in life, it’s hard enough to care for yourself, let alone another person. The nurses provide non-judgmental care and patients are counselled on how to maintain their health and prepare both physically and emotionally to give birth. Although some women have a university level education, the majority are illiterate street vendors, hairdressers or seamstresses. With an average fertility rate of 4, and a contraceptive usage rate of only 24%, primary health care in rural settings serves as a means to reach a greater distribution of the pregnant population, those who likely would not be served by trained professionals otherwise (WHO, 2011).
Working in the community setting has enabled me the opportunity to see a different form of health care within Ghana something which in my opinion is being well executed, considering the resources available. The nurses here are accepting of diverse cultures, and respectful when providing care. For example, when counselling mothers on nutrition, the nurses will take into consideration their religion. I have always been a strong promoter of preventative health care and this experience has made me realize how important it is, especially for a country with a shortage of health care facilities and professionals. From this, I will incorporate in my practice an increased understanding for cultural diversity and how to respectfully provide knowledge-based care despite challenges like language barriers.
Lincetto et al. (2001). Antenatal care. In opportunities for Africa’s newborns.(pp. 51-62)
Ministry of Health Ghana (1999) a Community-Based health planning and services. In a process for effective implementation of primary health care programmes. (pp. 1-37). Have into health research center: Ghana
Nyonator et al. (2005). The Ghana community-based health planning and services initiative for scaling up service delivery innovation. In health policy and planning (pp. 1-10): Oxford university press
World Health Organization (2011). Ghana: health profile. In Ghana statistics. Retrieved March 30, 2014.