Ghana’s Community Health Officers and Community Health Volunteers

Ghana established the Community-Based Health Planning and Services (CHPS) policy in 1999. CHPS which outlines two different cohorts of CHWs. The first cohort is comprised of full-time, paid Community Health Officers (CHOs) who provide reproductive health, minor health treatment, and health education, among other services. The second cohort of CHWs, Community Health Volunteers (CHVs), are part-time, unpaid volunteers that assist the CHOs with service delivery and community mobilization. Studies have highlighted the positive impact of the CHPS policy on maternal health, but not on a country-wide scale.

Background
Ghana’s national Community-Based Health Planning and Services (CHPS) policy was adopted in 1999 and implemented in 2000. CHPS operations represent a response to early evidence emerging from the Navrongo Community Health and Family Planning Project in northern Ghana (1996-2003) showing that community- based primary health care improved childhood survival and reproductive health care. Two community health worker cadres were established in 1999: (1) the Community Health Officer (CHO), a full-time, government employee who resides and works in the community he/she serves and (2) the Community Health Volunteer (CHV), a part-time unpaid worker who supports the CHO. In early 2016 the government introduced a third cadre called Community Health Workers (CHWs) who were temporary employees of the National Youth Employment Agency. After a new government was elected in late 2016, the program stopped.

Implementation
CHOs deliver health services to a population of approximately 5,000 people in a demarcated area of a district known as a CHPS Zone. The community selects at least two CHVs to work with each CHO. There are now 2,523 trained CHOs operating across 5,062 functional CHPS Zones with an active community health committee. In addition, there are 19,411 active CHVs who support the CHOs.

Roles/responsibilities
CHOs provide maternal and reproductive health services, neonatal and child health services, treatment of minor ailments, health education, and referrals, many at the level of the household. CHVs support the CHO with service delivery tasks and community mobilization, and they assist community members in their homes.

Training
CHOs first obtain training as a Community Health Nurse (CHN), receiving two years of training at an accredited Community Health Nursing Training School. Upon graduation, many CHNs receive two additional weeks of training, mainly on community engagement and mobilization, and complete an internship in order to become a CHO. CHVs receive five days of training.

Supervision
CHOs are supervised monthly by public health nurses, physician assistants, and Sub-district CHPS Coordinators. CHOs supervise CHVs monthly. Community Health Management Committees also supervise the work of the CHVs.

Incentives and remuneration
CHOs are full-time salaried employees of the Ministry of Health. The starting monthly salary is around 800 Ghana cedis (about US$ 140). Additional incentives for CHOs include extra paid leave days and the opportunity to advance their education with paid educational leave. CHVs are part-time health agents and do not receive remuneration. Incentives given to CHVs include T-shirts, transport per diem, and, on occasion, bicycles.

Impact
The CHPS model combines resident CHO health services with CHV mobilization. Several studies have demonstrated the impact of CHPS on maternal health. However, no countrywide, large-scale impact evaluations have been conducted on the CHPS program.

Author Affiliations

• George Mwinnyaa is a PhD Student, Johns Hopkins University Bloomberg School of Public Health.
• Tanya C. Jones is a Dean’s Research Fellow, Dartmouth College.
• Patricia Antwi
• Elizabeth Chan is a JD Candidate, University of Toronto Faculty of Law.
• James F. Phillips is at the Mailman School of Public Health, Columbia University.
• John Koku Awoonor-Williams works at the Ghana Health Service.

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