School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
Volta Regional Health Directorate, Ghana Health Service, Ho, Ghana.
BMC Health Serv Res. 2020 Sep 9;20(1):845. doi: 10.1186/s12913-020-05678-5.
To strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana's key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. We examined community utilisation and satisfaction with CHPS services in two System Learning Districts (SLDs) of the project.
This community-based descriptive study was conducted in the Nkwanta South Municipality and Central Tongu District of Ghana. Data were collected from 1008 adults and analysed using frequency, percentage, chi-square, and logistic regression models.
While the level of utilisation of CHPS services was 65.2%, satisfaction was 46.1%. Utilisation was 76.7% in Nkwanta South and 53.8% in Central Tongu. Satisfaction was also 55.2% in Nkwanta South and 37.1% in Central Tongu. Community members in Nkwanta South were more likely to utilise (AOR = 3.17, 95%CI = 3.98-9.76) and be satisfied (AOR = 2.77, 95%CI = 1.56-4.90) with CHPS services than those in Central Tongu. Females were more likely to utilise (AOR = 1.75, 95%CI = 1.27-2.39) but less likely to be satisfied [AOR = 0.47, 95%CI = 0.25-0.90] with CHPS services than males. Even though subscription to the National Health Insurance Scheme (NHIS) was just 46.3%, NHIS subscribers were more likely to utilise (AOR = 1.51, 95%CI = 1.22-2.03) and be satisfied (AOR = 1.45, 95%CI = 0.53-1.68) with CHPS services than non-subscribers.
Ghana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist. To accelerate progress towards the achievement of UHC with CHPS as the vehicle through which primary health care is delivered, there should be increased public education by the Ghana Health Service (GHS) on the CHPS concept to increase utilisation. Service quality should also be improved by the GHS and other stakeholders in Ghana's health industry to increase satisfaction with CHPS services. The GHS and the National Health Insurance Authority (NHIA) should also institute innovative strategies to increase subscription to the NHIS since it has implications for CHPS service utilisation and satisfaction.
为了加强加纳关键初级卫生保健提供战略——社区卫生规划和服务(CHPS)项目的实施,CHPS+项目于 2017 年启动。我们在该项目的两个系统学习区(SLD)中考察了社区对 CHPS 服务的利用和满意度。
这是一项基于社区的描述性研究,在加纳的 Nkwanta 南直辖市和中央 Tongu 区进行。从 1008 名成年人那里收集数据,并使用频率、百分比、卡方和逻辑回归模型进行分析。
CHPS 服务的利用率为 65.2%,满意度为 46.1%。Nkwanta 南的利用率为 76.7%,中央 Tongu 的利用率为 53.8%。Nkwanta 南的满意度为 55.2%,中央 Tongu 的满意度为 37.1%。与中央 Tongu 相比,Nkwanta 南的社区成员更有可能利用(AOR=3.17,95%CI=3.98-9.76)并对 CHPS 服务感到满意(AOR=2.77,95%CI=1.56-4.90)。女性更有可能利用(AOR=1.75,95%CI=1.27-2.39),但不太可能对 CHPS 服务感到满意 [AOR=0.47,95%CI=0.25-0.90],而男性则不太可能对 CHPS 服务感到满意。尽管全国健康保险计划(NHIS)的参保率仅为 46.3%,但参保者更有可能利用(AOR=1.51,95%CI=1.22-2.03)并对 CHPS 服务感到满意(AOR=1.45,95%CI=0.53-1.68),而非参保者。
如果 CHPS 服务的当前利用率和满意度持续下去,加纳可能无法在 2030 年实现全民健康覆盖(UHC)的目标。为了通过 CHPS 加速实现全民健康覆盖,作为提供初级卫生保健的手段,加纳卫生服务局(GHS)应该增加对 CHPS 概念的公众教育,以提高利用率。GHS 和加纳卫生行业的其他利益相关者还应提高服务质量,以提高对 CHPS 服务的满意度。GHS 和国家健康保险管理局(NHIA)还应制定创新战略,增加 NHIS 的参保率,因为这对 CHPS 服务的利用和满意度有影响。