Programme de bourses "Echanges Universitaires"

NGOs as Agents of Change in Health Development: The Agogo PHC Unit and CBS Volunteers

In trying to make health care more accessible to the worlds populations, the UN in conjunction with WHO and UNICEF introduced the health policy of Primary Health Care (PHC) in 1978.  PHC reflects the value of participation in improving health among the poor, especially in rural areas of developing countries following health programmes in the NGO sector, especially those by faith based organisations (FBOs). The main goal of PHC was to ensure health for all by the year 2000. An important mean through which this aim was to be achieved was by encouraging communities to play an active role in the provision of health by participating in decisions as well as in the implementation of programmes which affected them.  One way through which this aim was realised was through the use of community health workers (CHW); these are community members who are trained to provide basic health care in the communities in which they live. This system was introduced following the success of the Chinese bare foot doctors who were able to improve the health of the Chinese people using considerable less resources.

In the decades following Alma-Ata, PHC faced many difficulties especially the lack of resources due to the Structural Adjustment Programme (SAP). Health sector reforms which resulted from SAP led to a shift to selective PHC instead of the comprehensive PHC envisaged at Alma Ata.  The failure of the global community to achieve health for all by 2000 through PHC led to the inclusion of health goals in the Millennium Development Goals (MDGs). In order to achieve the MDGs by 2015 there is a call for the revitalisation of PHC and as such community participation and the role of CHWs in especially countries of the global south. In Africa this translated into the Ouagadougou Declaration which aims to reaffirmed the principles of the declaration of Alma-Ata in 1978.

The study seek to find out the role of the community-based surveillance (CBS) volunteer in the provision of health in the Agogo subdistrict in Ghana and to find out whether they are able to act as agents of change within their communities through their participation in the programmes of the Agogo PHC unit which is an FBO. The study focused mainly on the use of qualitative data gathered through interviews and observation.

The result of the study indicates that although under Ghana's Community-Based Health Planning System (CHPS), the establishment of the Community based surveillance (CBS) volunteer system in the Agogo subdistrict was to create a community system that will help define health problems through disease surveillance and the compilation of health statistics, due to shortage of human resources and for convenience, the PHC unit have added to the functions of the CBS volunteers, other roles; the mobilisation of community members for under fives clinics, health education on malaria and other diseases, screening for Buruli ulcer cases and helping in Buruli ulcer research, and also taking part in national immunisations. CBS volunteers are thus contributing to health development in their communities. However due to the lack of supervision and the non involvement of the larger communities in their choice the CBS volunteers are not performing these functions to the optimum. The participation of CBS volunteers has brought empowerment to only the individual CBS volunteers and not the larger community, as such the participation of the CBS volunteers in health activities in their communities has a limited potential in bringing large scale changes to their larger communities.

Map: Map of Ghana Indicating the Location of Ashanti-Akim North District
( Source: www.malariajournal.com)

Picture 1: Researcher in an interview with a community member at Serebuoso

Picture 2: Agogo High Street

Picture 3: Agogo Hospital, entrance

Picture 4: Out-reach team at work at Agogo Onyimso

Picture 5: Village of Serebuoso

Picture: Yakubu Ismaila

Contact

Yakubu Ismaila
33 Mittlere Strasse
CH-4056, Basel
E- mail y.ismaila@stud.unibas.ch, jakemaila@yahoo.com

Supervisor

Prof Dr Brigit Obrist
Institute of Social Anthropology
University of Basel
Münsterplatz 19
CH-4051, Basel
E- mail: brigit.obrist@unibas.ch

Swiss Tropical Institute
Department of Public Health
Socinstrasse 57, Postfach
CH-4002 Basel

Advisor

Prof Kodjo Senah, PhD
Sociology Department
University of Ghana
P. O. Box LG 65
Legon, Ghana
E-mail: kamesenah@yahoo.co.uk