NATIONAL IMPLEMENTATION GUIDELINES

Community-Based Health Planning and Services

(CHPS)
National Implementation Guidelines

SEPTEMBER 2016

This guidee is made possiible by the generous support ofo the Americaan people throuugh the United States
Agency foor Internationall Development (USAID) under the terms off the Cooperative Agreement AID-OAA-A-
14-00028. The contents are a the responssibility of the M
Maternal and Child
C Survival P
Program and do
d not
necessarilyy reflect the vieews of USAID
D or the United States Government.

Additionall technical suppport provided by

b Japan Internnational Coopeeration Agencyy JICA and Finnancial
Support from the World Bank and Koreea Internationaal Cooperation Agency KOIC CA

SEPTEMBER 2016
Table of Contents
Table of Contents ........................................................................................................... i
Abbreviations ............................................................................................................... iv
Acknowledgments ..................................................................................................... viii
Chapter One: Introduction........................................................................................... 1
Background ............................................................................................................................... 1
CHPS Policy Directives .............................................................................................................. 2
Chapter Two: CHPS Implementation........................................................................... 3
Introduction ............................................................................................................................... 4
Definition of Key Terms ............................................................................................................. 4
Roles and Responsibilities......................................................................................................... 5
15 CHPS Implementation Steps............................................................................................... 7
Basic Package of Services..................................................................................................... 17
Chapter Three: Establishing and Managing a Referral System .............................. 29
Introduction ............................................................................................................................. 29
General Principles for Referrals ............................................................................................. 29
Chapter Four: Community Engagement .................................................................. 36
Introduction ............................................................................................................................. 36
Community Entry..................................................................................................................... 36
Community Consultation ....................................................................................................... 36
Community Needs Assessment............................................................................................. 37
Community Mobilisation ........................................................................................................ 37
Community Decision System (CDS) in CHPS ....................................................................... 37
Key Players in CDS .................................................................................................................. 38
CHAP ........................................................................................................................................ 38
Stakeholders’ Responsibilities in CHAP ................................................................................. 39
Organising Community Durbars ........................................................................................... 40
Organising Community Meetings ......................................................................................... 41
Chapter Five: Management Responsibilities ........................................................... 42
Introduction ............................................................................................................................. 42
National Level.......................................................................................................................... 42
Regional Level ......................................................................................................................... 42
District Level ............................................................................................................................. 42
The Sub-District Level .............................................................................................................. 44
Community Level .................................................................................................................... 44
Chapter Six: Resource Management ....................................................................... 45

i Community-Based Health Planning and Services: Implementation Guidelines

 Introduction ............................................................................................................................. 45
Human Resource Management........................................................................................... 46
Financial Management ......................................................................................................... 48
Infrastructure Management .................................................................................................. 52
Chapter Seven: Supervision ....................................................................................... 62
Introduction ............................................................................................................................. 62
Concept of Facilitative Supervision...................................................................................... 62
Chapter Eight: Performance ...................................................................................... 67
Introduction ............................................................................................................................. 67
M&E of CHPS Implementation .............................................................................................. 67
Reviews and Awards (DA, Peer Reviews, Regional, National) ......................................... 74
Appendix A: Community Profile ................................................................................ 76
Appendix B: Service Interventions for CHOs ............................................................ 77
Appendix C: Conducting a Situation Analysis......................................................... 78
Service Coverage ................................................................................................................... 78
Resource Status ....................................................................................................................... 79
CHNs and Level of Work ........................................................................................................ 80
Output of the Situation Analysis ............................................................................................ 81
Appendix D: PSs from Sub-district to CHPS zone Levels and Assessment Tools
(Refer to PS booklet for PSs for other higher levels) ................................................. 82
Performance Standard and Criteria for Supervision .......................................................... 82
Facilitative Supervision Checklist .............................................................................. 87
Level: Sub-District → CHPS Zone ........................................................................................... 87
Summary Sheet of FSV by SDHT to CHPS .................................................................. 99
Appendix E: CHPS Roll-Out Assessment Tool ......................................................... 100
Appendix F: Equipment, Tools, Supplies, Drugs for CHPS Zones ........................... 101
Appendix G: CHAP ................................................................................................... 105
What Are CHAPs? ................................................................................................................. 105
Functions of CHAPs ............................................................................................................... 105
Preparation and Support ..................................................................................................... 105
Description of the Components of the CHAP Format ..................................................... 106
Appendix H: Roles and Responsibilities of the GHS Headquarters Divisions ...... 110
Appendix I: Standard Design for CHPS Compound .............................................. 113
CHPD Compound (Apartment 2)....................................................................................... 113
CHPD Compound (Apartment 3)....................................................................................... 124
Appendix J: Referral Forms ...................................................................................... 125
ii Community-Based Health Planning and Services: Implementation Guidelines
 GHS Health Facility Referral Form (updated and reprinted in 2013) ............................. 125
GHS Health Facility Referral Feedback Form .................................................................... 128
Appendix K: M&E of CHPS Implementation for the Districts.................................. 131
Form 1—Community ............................................................................................................. 131
Appendix L: List of Feasible Actions Taken by MMDAs ......................................... 135
1. Community Level .............................................................................................................. 135
2. CHPS Level ......................................................................................................................... 136
3. SDHT Level .......................................................................................................................... 137
4. Hospital Level .................................................................................................................... 138
5. Referral ............................................................................................................................... 140
6. Other................................................................................................................................... 141
Resources .................................................................................................................. 143

iii Community-Based Health Planning and Services: Implementation Guidelines

Abbreviations
ANC Antenatal Care
ARI Acute Respiratory Infection
BF Breastfeeding
BP Blood Pressure
CBSV Community-Based Surveillance Volunteer
CDS Community Decision System
CETS Community Emergency Transport System
CHAP Community Health Action Plan
CHMC Community Health Management Committee
CHN Community Health Nurse
CHO Community Health Officer
CHPS Community-Based Health Planning and Services
CHV Community Health Volunteer
CMAM Community Management of Acute Malnutrition
CWC Child Welfare Clinic
DA District Assembly
DCE District Chief Executive
DDHS District Director of Health Services
DHD District Health Directorate
DHIMS2 District Health Information Management System
DHMT District Health Management Team
DHSP District Health Service Profile
EMD Estate Management Department
EN Enrolled Nurse
EPI Expanded Programme on Immunization
FHD Family Health Division
FP Family Planning
FSV Facilitative Supervision
GHC Ghana Cedi
GHS Ghana Health Service
HASS Health Administration and Support Services
HC Health Centre
IEC Information, Education, and Communication
ICD Institutional Care Division
IGF Internally Generated Funds
iv Community-Based Health Planning and Services: Implementation Guidelines
IMCI Integrated Management of Childhood Illness
IMNCI Integrated Management of Neonatal and Childhood Illness
IPO Immediate Postpartum Observation
ITN Insecticide-Treated Net
IYCF Infant and Young Child Feeding
JICA Japan International Cooperation Agency
M&E Monitoring and Evaluation
MCH Maternal and Child Health
MMDA Metropolitan, Municipal, and District Assembly
MNDA Maternal and Neonatal Death Audit
MNH Maternal and Newborn Health
MOH Ministry of Health
MP Member of Parliament
N/A Not Applicable
NGO Non-Governmental Organisation
NHIA National Health Insurance Authority
NHIS National Health Insurance Scheme
NTD Neglected Tropical Diseases
OPD Outpatient Department
OPV Oral Polio Vaccine
PFM Public Financial Management
PHC Primary Health Care
PLA Participatory Learning Approach
PMTCT Prevention of Mother-to-Child Transmission
PNC Postnatal Care
PPMED Policy, Planning, Monitoring and Evaluation Division
PR Performance Review
PS Performance Standard
RDHS Regional Director of Health Services
RHD Regional Health Directorate
RHMT Regional Health Management Team
SDHT Sub-District Health Team
STI Sexually Transmitted Infection
TBA Traditional Birth Attendant

v Community-Based Health Planning and Services: Implementation Guidelines

Foreword
The Community-Based Health Planning and Services (CHPS) initiative as a strategy to
deliver primary health care services at the community level is a key health system reform for
the Ghana Health Service (GHS). The levels of health care provision have been clearly
defined and articulated in the GHS and Teaching Hospitals ACT, 1996 (ACT 525).

Over the years, the predominant notion of health service delivery has largely been facility-
vi Community-Based Health Planning and Services: Implementation Guidelines
based. As such, GHS have concentrated on improving both volume and quality of service
delivery at the Hospitals and Health Centres. We have invested in constructing health facilities
since independence, hoping that the presence of these facilities will make the population
healthier. However, Ghana’s outpatient department (OPD) attendance has plateaued and
maternal mortality and child mortality and morbidity remain high. For a very long time, there
has been little or no community participation in health decision-making.

If the health sector is to achieve the health-related Sustainable Development Goals in Ghana,
then there is the need to accelerate the paradigm shift in health service provision with the
CHPS strategy. The CHPS strategy, if implemented faithfully according to this National CHPS
Implementation Guidelines of the Ministry of Health/Ghana Health Service, provides us with a
vehicle to deliver primary health care services at the community level by engaging the
community members themselves in taking decisions concerning their own health. The primary
producers of health are the individuals within households - especially mothers.

The goal and vision of the Ghana Health Service is that every member of the household
remains healthy with unlimited access to primary health care services for all ages everywhere
and at all times. An enabling environment to provide referral services and backstopping will
facilitate the delivery of continuum of care.

I am confident that in harmonizing and standardizing the collective efforts of all stakeholders
in scaling up CHPS implementation in this country, we will be steadily cruising towards
providing all people living in Ghana with universal access to quality primary health care
services by 2030.

Dr. Ebenezer Appiah-Denkyira

Director General
Ghana Health Service
September 2016

vii Community-Based Health Planning and Services: Implementation Guidelines

Acknowledgments
The National CHPS Implementation Guidelines was developed as a result of the
collaboration between Ministry of Health, Ghana Health Service, JICA, USAID, Maternal
and Child Survival Project–USAID, and System for Health Ghana-USAID and ably led by
Dr. Koku Awoonor-Williams, Director Policy Planning, Monitoring, and Evaluation Ghana
Health Service (GHS). Through this collaboration, resource persons in various fields relevant
to the development of the guidelines worked as Technical Working Group to develop this
National CHPS Implementation Guidelines. In no special order these Technical Working
Group members are:
1. Dr. Koku Awoonor-Williams, Director, PPMED/GHS, Accra
2. Dr. Samuel Kaba, Director, ICD/GHS, Accra
3. Dr. Anthony Ofosu, Deputy Director, M&E, PPMED/GHS, Accra
4. Charles Adjei Acquah , Deputy Director, Policy, PPMED/GHS, Accra
5. Joe Dodoo, Policy Analyst, Ministry of Health, Accra
6. Martin Ankomah, Deputy Director, HASS, GHS, Accra
7. Dr. K. Boateng Boakye, Public Health Specialist, PPMED/GHS, Accra
8. Tei Djangmah, DDHS, Atiwa District, Eastern Region, GHS
9. Mustapha A. Hamid, Deputy Director, Finance Division, GHS, Accra
10. Basilia Saalia, DDHS, Wa West District, UWR
11. Nana Kwame Quandahor, Ag. Deputy Director, Planning, PPMED/GHS, Accra
12. Stephen Duku, Health Economist, PPMED/GHS, Accra
13. Veronica Apetorgbor, Principal Nursing Officer, PPMED/GHS, Accra
14. Isaac Akumah, Administrator, PPMED/GHS, Accra
15. Zacchi Sabogu, Senior Technical Specialist, Maternal and Child Survival Project
16. Robert Alirigia , Senior Technical Specialist, Maternal and Child Survival Project
17. Tsunenori Kofi Aoki, Policy Advisor, PPMED/GHS/JICA, Accra
18. Chantelle Allen, Country Director, Maternal and Child Survival Project
19. Stephen Darko, Chief Biostatistician Officer, HRD, GHS, Accra
20. Joyce Ablordeppey, Senior Technical Advisor, Systems for Health, Accra
21. Joel Abekuliya, Senior Health Information Officer, FHD, GHS, Accra
22. Augustina Nartey, Regional CHPS Coordinator, Eastern region GHS, Koforidua
23. Vivian Ofori Dankwah, Program Officer, FHD, GHS, Accra
24. Juliana Pwamang, Health Activity Manager, USAID, Ghana

The writing team would also like to acknowledge the support and rich contribution of Dr.
Ebenezer Appiah-Denkyira, Director General of Ghana Health Services, Dr Erasmus
Agongo, former Director PPMED/GHS, Tomoya Yoshida, then Policy Advisor
PPMED/GHS/JICA, and Dr. Koshie Nazzar, then Consultant, PPPMED/GHS/JICA in
facilitating the development of this document.

viii Community-Based Health Planning and Services: Implementation Guidelines

Chapter One: Introduction
The Ghana Health Service (GHS), as mandated by Act 525 of 1996, is to provide and
prudently manage comprehensive and accessible quality health services with emphasis on
Primary Health Care in accordance with approved National Policies. In pursuit of this
mandate, the GHS has over the years implemented a number of initiatives including CHPS to
significantly reduce health inequalities and to promote equity of access to health by removing
geographic barriers at the community level.

The CHPS strategy involves mobilisation of community leadership, decision-making

systems, and resources in a defined catchment area, the placement of reoriented frontline
health staff known as Community Health Officers (CHOs) with logistics support, and
community volunteer systems to provide services according to the principles of primary
health care (PHC).

CHPS as a strategy must be used as a unified platform to deliver all health services at the
community level and must be based on the Health Family Concept.

Background
In 1977, Ghana adopted a strategy of service delivery at the community level using
Community Health Workers (called Community Clinic Attendants) and Traditional Birth
Attendants (TBAs). This preceded the Alma Ata Declaration in 1978 of “Health for All by
year 2000” that focused on PHC.

CHPS began as a community health and family planning project based on lessons learnt from
Bangladesh (Phillips, 1988) and was piloted in Navrongo as operations research in 1994.
CHPS became a breakthrough in enhancing community involvement and ownership of PHC
interventions towards achieving Universal Health Coverage. In 1999, consensus was reached
to adopt and scale up the CHPS initiative as a national strategy to improve access, efficiency,
and quality of health care (Ghana Health Service, 2003).

Fifteen steps were developed to guide the implementation process. Community health nurses
(CHNs) were provided further training and were designated CHOs as resident health care
providers in geographical coverage areas known as CHPS zones. The CHOs:
 Provided reproductive, maternal, and child health services;
 Managed diarrhoea;
 Treated malaria, acute respiratory infections (ARIs), and childhood illness; and
 Provided comprehensive family planning (FP) and childhood immunisation outreach.

The CHOs were supported by volunteers whose roles involved educating the community on
basic health issues and serving mainly as agents of referral services and community social
mobilisation, generally delivering these services through home visits. Treatment was
provided for those who visited the CHOs at their residence compound. The CHPS model
relied on communities and other stakeholders to provide financial or in-kind resources for
construction and provide oversight for service delivery and welfare of the CHOs.

In 2000, work began on scaling up the CHPS strategy, but was initially limited by resource
constraints. The Ghana Macroeconomics and Health Initiative (GMHI, 2005) and the
opportunities presented by funding made available from the debt relief under the World Bank

1 Community-Based Health Planning and Services: Implementation Guidelines

Highly Indebted Poor Countries initiative provided impetus for scaling up. The backdrop to
this was worsening health status indicators, increasing cost of care, and limited access to any
kind of health services. A twin-track strategy was envisaged which was to remove both the
financial and geographical barriers of access to care. The National Health Insurance Scheme
(NHIS) was seen as the social intervention to address the financial barrier and CHPS was to
address the geographical barrier by making basic services available “close to client”.

Ghana has been implementing the CHPS programme at national scale for the past 10 years.
Implementation of CHPS is fraught with several policy and systems-level challenges.
Different reviews point to a lack of clear policy direction, unclear definitions, and an
unending conceptual debate. There are also issues in relation to effective leadership and
technical direction. Planning and budgeting for CHPS at the national, regional, district, and
community levels has been inadequate. The CHPS Policy was therefore revised and launched
in March 2016 to address the implementation challenges.

This CHPS National Implementation Guidelines has been developed to translate the policy
into guidelines to serve as a vehicle to deliver PHC services at the community level based on
known evidence and proven strategies. It outlines the community-level systems and the
enabling environment needed to provide referral services and backstopping that will facilitate
the delivery of care along the continuum from household to CHPS compound.

CHPS Policy Directives

The CHPS policy directives cover five areas as follows:
 Duty of care and minimum package: defines the core package of services to be
provided within the CHPS zone by the CHO and Community Health Volunteer
(CHV). The package focuses predominantly on maternal and child health (MCH) and
nutrition services. Coordination and linkages with private health facilities in the
CHPS zone is emphasised.
 Human resources for CHPS: clarifies who a CHO is and determines the CHO-to-
population ratio. It directs that a system for career progression be developed and
incentive schemes instituted. It also identifies the essential role of the CHVs.
 Infrastructure and equipment for CHPS: defines standards for a CHPS compound
and the accompanying list of equipment and furnishings, and directs that all CHPS
compound construction shall comply with MOH standard design. Guidance for
completing ongoing projects is provided. Establishment of CHPS zones and location
of CHPS compounds shall be determined by District Assembly (DA) and all land for
construction shall be documented and sealed at the Land Title Registry. Rural and
underserved areas shall be prioritised for CHPS construction and guidance is provided
for urban CHPS.
 Financing: Directs that all services delivered in a CHPS compound shall be free and
assigns government the primary responsibility for financing.

2 Community-Based Health Planning and Services: Implementation Guidelines

  Supervision, monitoring, and evaluation: The main policy provides for the
hierarchy of supervision, monitoring, and evaluation. It indicates that the Officer in
charge of the sub-district shall supervise the work of the CHO, with technical support
from the District Health Management Team (DHMT).

General Principles for CHPS Implementation

The general principles guiding the development and implementation of CHPS are:
 Community participation, empowerment, ownership, gender considerations, and
volunteerism
 Focus on community health needs to determine the package of CHPS services
 Task shifting to achieve universal access
 Communities as social and human capital for health system development and delivery
 Health services delivered using a system approach
 CHO as a leader and community mobiliser

Purpose of the CHPS National Implementation Guidelines

This Implementation Guidelines seeks to provide direction on the implementation of the
essential elements of CHPS to ultimately:
 Improve equity in access to basic health services,
 Improve efficiency and responsiveness to community health needs,
 Strengthen inter-sectoral collaboration and community engagement systems, and
 Empower households to support PHC.

Chapter Two: CHPS Implementation

3 Community-Based Health Planning and Services: Implementation Guidelines
Introduction
Implementation of the CHPS strategy contributes towards health sector efforts to achieve
Universal Health Coverage by establishing a District Health System comprising three service
delivery levels - community (CHPS zone) level, sub-district (health centre) level, and district
(hospital) level - with strong referral components between levels. Universal Health Coverage
can be achieved through careful planning based on adequate knowledge of the disease
patterns and services within the sub-district. Implementation is focused on providing access
to, and promoting utilisation of, PHC while actively engaging the community to participate.

This chapter describes a detailed approach to CHPS implementation by defining key terms,
specifying roles and responsibilities of CHOs and Volunteers, articulating the 15 steps of
CHPS implementation, and describing the basic package of services to be provided.

Definition of Key Terms

CHPS
The National CHPS Policy (March 2016) defines CHPS as “a national strategy to deliver
essential community- based health services involving planning and service delivery with the
communities”. Its primary focus is communities in deprived sub-districts and in general
bringing health services close to the community. The policy determined that the following
constitute the components for CHPS implementation:
 CHPS Zone: A demarcated geographical area of up to 5,000 persons or 750
households in densely populated areas and may be conterminous with electoral areas
where feasible.
 Functional CHPS Zones: A functional CHPS zone can be either completed or
uncompleted. The functionality of a CHPS zone does not necessarily depend on the
presence of a compound, though a CHPS Compound is highly desirable in a zone
where there is no health centre or hospital, particularly in an underserved or “oversea
area”.
 Completed Functional CHPS Zone: A completed functional CHPS zone is one
in which all the milestones have been completed and the CHO actually resides in
the community (in a CHPS compound) and provides a basic package of services
to the catchment population.
 Uncompleted Functional CHPS Zone: An uncompleted functional CHPS zone
is a CHPS zone where:
— The community entry process is completed and community members are
sensitised and are fully engaged;
— The CHMC has been formed and introduced to the community through a
durbar (formal community gathering) and is actively involved in health
planning and service delivery design;
— A CHO has been deployed to the defined zone after being introduced to the
community through durbar or meeting with key stakeholders;
— Volunteers have been selected from the community, introduced to the
community through durbar, and trained for service delivery;
— A community profile (see Appendix A) is in place;

4 Community-Based Health Planning and Services: Implementation Guidelines

 — Health service delivery is targeted at households and families, particularly
through home visits;
— The CHPS zone is in the District Health Information Management System
(DHIMS2) database as an organisational unit and data on activities are entered
monthly*;
— The Community Health Compound (newly constructed, rented, hired, or
refurbished) and some of the needed equipment are not yet ready.
 Where a functional CHPS zone does not have a CHPS compound, the CHPS zone
shall have at least an operating point of reference such as office working space.
 CHPS Compound: An approved structure consisting of a service delivery point and
CHO residential accommodation complex, both of which must be present.
 Community Health Officer (CHO): A trained and oriented (in CHPS) Health Staff
working in a CHPS zone. The CHO may be assigned to live in a community within
the zone.
 Community Health Volunteers (CHVs): Non-salaried community members
identified and trained to support CHOs in a community within the CHPS zone.
 Community Health Management Committee (CHMC): A group of community
leaders with different competencies and responsibilities drawn from the communities
within the CHPS zone. CHMC members volunteer to provide community-level
guidance and mobilisation for the planning and delivery of health activities and to see
to the welfare of CHOs in their communities.

Roles and Responsibilities

This section outlines the roles and responsibilities of the CHOs, CHMC, and CHVs in a
CHPS zone.

CHO
The CHO is a trained health worker oriented in CHPS and placed in a CHPS zone to work
with communities to achieve the objectives of providing basic PHC. Their roles are
summarised in Box 1. CHO, like District Director of Health Services (DDHS) or Sub-District
Head, is a position requiring a worker with technical skills as well as community mobilisation
skills but not a professional grade. The CHO in a CHPS zone is a member of the SDHT
responsible for carrying out basic health services. The CHO in the community shall perform
three main tasks:

*In the event that a facility such as a health centre or a district hospital falls within a CHPS zone and has a CHO
assigned, data generated by the CHO working from that facility as operating point of reference shall be separately
reported in the DHIMS2 database.

5 Community-Based Health Planning and Services: Implementation Guidelines

1. As a health service provider Box 1: Roles of the CHO
(see more details in Appendix • Engage the CHMC to manage community health
B and Table 2) service;
 Sexual and reproductive • Initiate process for and develop community profile in
collaboration with CHMC and CHVs;
health: FP, antenatal care
• Act as change agent for community health-seeking
(ANC), PMTCT/early behaviour;
infant diagnosis, skilled • Engage community stakeholders for dialogue on CHPS;
delivery, postnatal care, • Carry out community advocacy and diplomacy for
adolescent sexual and CHPS;
reproductive health • Deliver home-specific and home-relevant health
services (prevention, promotion, and minor ailment
 Child health: expanded treatment);
programme on • Treat minor ailments at the CHPS compound and refer
immunization (EPI), more severe cases to higher care level;
community integrated • Supervise supportive cadres and volunteers in
management of neonatal technical community health service delivery;
and childhood illnesses • Deliver school health services (prevention, promotion,
and minor ailment treatment) with the support of the
 Growth monitoring sub-district;
programme • Manage and account for resources (financial and
logistical) at the CHPS compound;
 Disease surveillance and
• Work closely with and report to the Sub-District Health
control Team.
 Treatment of minor
ailments
 Health education and counselling for healthy lifestyles and good nutrition
 Household visits (house-to-house and home visits)
 Understanding community needs and communicating these needs to the sub-district to
enable the DHMT to plan a more effective and relevant service delivery intervention
 Community Mental health
 Care of the aged
2. As a leader
 Establish and sustain good interpersonal relationships
 Work with community leaders and CHMC members
 Participate and lead national health activities in the communities
 Conduct meetings with key social groups
 Participate in CHMC meetings, health durbars, and special health education sessions
3. As a manager
 Managing resources (logistics, money, equipment)
 Supervising CHVs and TBAs
 Participating in sub-district/district activities
 Record-keeping and reporting

6 Community-Based Health Planning and Services: Implementation Guidelines

CHMC and CHVs
Box 2: Roles of the CHMC
For successful CHPS implementation, • Liaise between traditional leaders and
selection, approval and training of CHMCs health authorities;
and CHVs are key. In selecting the CHMCs • Carry out community advocacy and
and CHVs, both sexes shall be well diplomacy for CHPS;
represented. • Develop Community Health Action Plans
(CHAPs);
• Mobilize and sensitize the community for
CHMC health action;
The CHMCs are volunteers, made up of • Collaborate with the CHO and support the
CHPS service delivery;
dedicated, respected, and willing leaders
• Engage and administratively supervise the
(both men and women), who supervise the CHV to support CHPS service delivery;
health system at the community level and • Mobilize resources for CHPS service delivery;
also administratively supervise the CHVs. • Organize community health meetings
These are opinion leaders from the various (durbars) and provide feedback to
development bodies in the constituent communities on health issues with the
communities that come together to form the support of the CHO;
CHPS zone. They report directly to the chief • Settle disputes between CHOs, CHVs, and
the community;
and are accountable to the community
• Assist in the maintenance of the CHPS
members. Their roles are explained in Box compound.
2. • Establish Community Emergency Transport
System (CETS)

CHVs
The CHO shall be assisted by the CHVs. Box 3: Roles of the CHV
The volunteers are publicly identified, • Mobilize and sensitize the community to take
vetted, and approved for community service action to manage health in the community;
through a community durbar. The selected • Collaborate with the CHO and support CHPS
service delivery;
volunteers are then trained by the
• Visit, assess, and advise on environmental
DHMT/SDHT/CHO and presented publicly factors in the home that can affect health;
at another durbar where the tasks the CHVs
• Assist the CHO in home visits, outreach
may and may not carry out are explained to services, and work at the CHPS compound;
all community members. Volunteers are • Conduct home visits for health education
then commissioned for community work to and follow-up of defaulters;
assist the CHO. They are administratively • Carry out disease surveillance and report on
supervised by the CHMC while the CHO disease and health events;
supervises their technical performance. • Liaise between CHO and community
Their roles are explained in Box 3. members on health status of community;
• Support in the organization of community
durbars and disseminate health information;
15 CHPS Implementation Steps • Provide first aid and treatment of minor
ailments in hard-to-reach areas (which Shall
The implementation of the CHPS strategy be context specific), and refer cases to the
demands systematic and joint planning and CHO;
execution by the DHMT, the SDHT, and the • Assist in compiling and updating a
community leadership as well as the community register and profile;
citizenry at large. Table 1 outlines the step- • Refer serious cases to the CHO or notify the
CHO and refer to a higher level.
by-step activity sequence and the milestone
that each series of steps will achieve. In
practice, GHS shall carry out steps as needed, and not necessarily in order, to improve the
implementation process. Below are further details on each step.

7 Community-Based Health Planning and Services: Implementation Guidelines

Table 1: Summary of 15 steps and milestones for CHPS implementation
Milestone
Step Key Task Activities Responsible Output
Achieved
• Situation analysis and problem identification at the DHMT • Compiled situation analysis of
level available resources and
The DHMT (DDHS programme requirements
• Consultation with District Assembly (DA): the District Chief and public
One Plan Executive (DCE) and the Social Services Sub-Committee • Detailed report showing the list of
health nurses/ Detailed plan
• Zoning of communities in the district demarcated CHPS zones
midwives) created
prioritised by year of
• District CHPS Scale-up Plan
implementation
Two Consult and raise • Consultation and sensitisation of health workers • Health workers accept CHPS
DHMT
awareness of CHPS strategy
Three • Identify contact persons e.g. assembly member Community entry
The DHMT (DDHS conducted
Dialogue with • Meet with the community’s leadership • Chief and elders of the
and public
community • Sensitise the chief and his elders highlighting key support communities making up the zone
health
leadership areas from the chief and community (e.g. community sensitised
nurses/midwives)
durbar, workspace, land)

• Community information durbars

• Participation by all communities making up the zone
Organise community • Address questions and concerns of community members Community
Four • Informed community created
information durbar • Site selection and approval leaders/DHMT
• Roles and responsibilities of stakeholders including
community members

• Assess, counsel, and select staff who are interested in

community work
Select and train staff
Five • Train/orient selected staff as CHOs DHMT/SDHT • Certification of CHOs
as CHOs
• Discuss with each CHO the zone where she/he Shall be
assigned

• Selection of CHMC members based on the criteria

outlined in the section “Step 6: Select, Approve, and • CHMC members confirmed, and
Community
Select, approve, and Orient CHMC” in this guideline have signed a social
Six leadership, SDHT,
orient CHMC commitment contract during the
• Durbar for approval of CHMC DHMT
durbar
• Orientation of CHMC
Compile community • Compilation of community profile: information on DHMT; SDHT; • Community profile brief and
Seven
profile geographic and demographic characteristics, CHMC members; register established

8 Community-Based Health Planning and Services: Implementation Guidelines

 Milestone
Step Key Task Activities Responsible Output
Achieved
settlement patterns, existing human habitation, and DA; community
health features and facilities leadership
• Read any available literature about the communities
making the zone especially where the compound Shall
be sited
• Ask individuals in the community about the history, norms,
taboos, sacred places, occupations, etc.
• Conduct a transect walk to identify important landmarks
including schools, churches, mosque, chief palace,
market, etc.
• Inform the opinion leaders on the necessity and time
needed to register community members
• Register community members by community and by
household
• Summarise the results to obtain population by
community, number of households by community, etc.

• Procurement (construction, renovation, hiring, renting, or

rehabilitation) of Community Health Compound for CHO Community
Construct/ residence • Community Health Compound Health
Eight operationalise CHMC
• Refer to the boxes 26, 27 and 28 in the “Community constructed Compound
compound
Participation in the Planning . . .” section of this guideline operationalised
for further details

• Provide sufficient supplies, medicines, equipment, Essential

• Logistics stocking and
Nine Provide CHPS logistics furniture, and transport to CHPS zone for service provision DHMT equipment
Management System Established
supplied
• Organise community information durbar to formally Community
Organise durbar to launch CHPS in the community • Community awareness,
leaders
Ten launch activities of understanding and support for CHO posted
• Formal introduction of CHOs to the community at the supported by
the CHPS zone CHPS and the CHOs
durbar DHMT/DA

• Selection of CHVs (refer to “Step 11: Select CHVs” section

Eleven Select CHVs CHMC, SDHT • CHVs’ acceptance of status
of these guidelines for selection criteria)

Approve CHV • Host durbar to finalise the selection and gain approval of
Twelve CHMC, SDHT • Community approval obtained CHVs deployed
selection CHVs from community and community leadership

• Training of CHVs based on the training content spelt out

Thirteen Train CHVs DHMT, SDHT • Certification of CHVs
in section “Step 13: Train CHVs”

9 Community-Based Health Planning and Services: Implementation Guidelines

 Milestone
Step Key Task Activities Responsible Output
Achieved
Procure logistics, • Mobilisation of logistics and equipping the volunteers • Logistics management system
Fourteen equipment, and DHMT, SDHT
established
volunteer supplies
• Launch the CHPS zone
Launch the CHPS Chiefs, CHMC, • CHPS zone launched and
Fifteen • Introduce CHMC, CHVs, and CHO during the durbar
zone and SDHT services provided
• Introduce security guard for the compound, etc.

10 Community-Based Health Planning and Services: Implementation Guidelines

Practical Implementation of the 15 Steps
This section outlines the key steps that are useful in developing a micro plan to create a
CHPS zone from the list of demarcated CHPS zones. A partnership micro plan developed in
collaboration with the DDHS and DCE and captured in the District Medium-Term Plan has
proved to be most successful (Awoonor, 2015).

Step 1: Planning and Demarcating a CHPS Zone

Conducting Situational Analysis
The essential or key step in implementing
CHPS for all districts is conducting a Box 4: What is a situation analysis?
situational analysis of service delivery and This is the process by which the DHMT carries out
a critical examination of its operations in the
coverage as well as an appraisal of the status
delivery of primary health care services to the
of CHPS implementation in the sub-district people of the district with the view of:
(See Appendix C for further details). This is • Assessing the DHMT’s capabilities,
the stage where health managers reflect on • Identifying the challenges, and
the performance of the health sector, use the • Developing a new and more relevant
information to design the CHPS programme, program of action.
select demarcated electoral areas for priority By this process, the DHMT constitutes itself into a
intervention with CHPS, consult and special review team made up of the DDHS, the
medical superintendent in charge of the district
sensitise health workers, and dialogue with hospital, the public health nurse, the disease
community leaders and the DA for their control officer, the medical assistant, and the
inputs into the design (For a brief sub-district heads.
description, see Box 4).

CHPS zones shall be aligned to the electoral Box 5: CHO-to-Population calculations

areas. The number of CHOs and CHPS and assumptions
zones in an electoral area shall be calculated Home visits = 8 homes a day
based on the recommended CHO-to- Working 5 days a week, but performing home
Population ratio of 1:1,440. The calculation visits at 50% of working time ~ 3 days a week
is based on the assumption that a CHO uses 4 weeks a month (8 x 3 x 4 = 96 homes)
50% of days in the week for home visits to 10 months a year = 960 homes
households and the average size of a
household is six people (See more detail in To be able to make four visits to each home in a
Box 5). If the electoral area has more people year = 960 / 4 = 240 homes per CHO
than one CHPS zone can serve, the electoral Average # of people per home = 6 x 240 =
area can be demarcated into multiple CHPS 1,440 persons per CHO
zones. However, based on the local context
and available resources, this CHO-to-Population ratio could vary upon consultation with
DDHS and RDHS.

Within existing resource constraints, the focus in establishing CHPS shall be prioritised for
the most underserved communities in both rural and urban areas in districts before the
eventual roll-out to cover 100% of the population of sub-district/municipal/metropolitan
areas.

Planning to Create a CHPS Zone

Once the list of demarcated CHPS zones in the district is agreed on by all stakeholders
including health team, DA, chiefs, etc., it then becomes a working document for the District
Director of Health Services to use for lobbying and advocating for resources to increase
geographical access. Agreed demarcated CHPS zones, like sub-districts, shall not be changed

Community-Based Health Planning and Services: Implementation Guidelines 11

arbitrarily without any compelling reasons for change. Where a demarcated zone is perceived
to be big by population size or surface area, it will be better to assign more CHOs to the zone
than to re-demarcate the zone. The list of agreed demarcated CHPS zones for a district shall
therefore remain constant and shall be prioritised by zone and year for implementation. The
plan for making these demarcated CHPS zones functional over a period of years shall be
developed by the DDHS and shared with the DCE and other stakeholders.

While there are several other successful approaches to planning to create a CHPS zone, one
approach that has worked well is the DDHS-DCE partnership approach. The DDHS, DCE,
and other development partners shall consider a number of these zones in the medium-term
development plans and budget for these zones appropriately. This shall be an annual affair,
especially in the most underserved districts in the country. Intermittent political interference
must be considered and tolerated at this stage. A detailed implementation plan shall be
developed specifically for the zone. This plan shall include community entry and sensitisation
durbars; siting or workspace selection; assigning a CHO; provision of essential medical
equipment, logistics, and other working materials; compound construction depending on the
situation; etc.

Step 2: Consult and Raise Awareness of CHPS

Once the preparatory work is concluded between the DHMT and DA or any other
development partner, the SDHT is briefed on the level of preparation for that particular zone.
The awareness creation meeting shall highlight staffing of the zone, community entry and
registration, logistics support, and the roles and responsibilities of SDHT, DHMT, DA,
community and other stakeholders.

Step 3: Dialogue with Community Leadership in the Zone

The dialogue meeting between the DHMT/SDHT and the chiefs shall discuss the following:
 The distribution of health facilities and health workers in the district
 The weaknesses in the health delivery system and the problems of access
 The role of chiefs, elders, and key stakeholders and their people in improving access
to health delivery
 The community health programme/CHPS concept
 Other areas include:
 Formation of CHMCs as an advisory body
 Operation of CHV system—selection of volunteers and their supervision
 Construction of CHPS compounds
 Safety and security of the CHPS compound and health workers
 Identifying and using other community structures—opinion leaders, youth groups,
etc.—to facilitate CHPS programme activities

Refer to Chapter Four for how to organise a community durbar.

Community-Based Health Planning and Services: Implementation Guidelines 12

Step 4: Organise a Community Information Durbar with Communities in the
CHPS Zone
The community information durbar is a durbar organised for all the participating
communities and their members. The following are highlighted during the durbar:
 The roles of chiefs, elders, and key stakeholders and their people in improving access
to health delivery
 The community health programme/CHPS concept
Other areas include:
 Formation of CHMCs
 Operation of CHV system—selection of volunteers and their supervision
 Construction of CHPS compounds
 Safety and security of the CHPS compound and health workers
 Identifying and using other community structures—opinion leaders, youth groups,
etc.—to facilitate CHPS programme activities

Step 5: Select and Train Staff as CHOs

Health staff such as CHNs, midwives,
Box 6: Must-do Modules in CHO Training
and enrolled nurses (ENs) are selected
from all the districts in the region based Manual Volume 1
on the need of each district and the  Current Health Status and CHPS Concept
availability of resources for the training.  Managing CHO activities
The training consists of 6 days of theory  Home Visiting for Health Activities
on the Volumes 1, 2, & 3 of the CHO  Supporting Community Health Volunteers
Training Manual (including “must-do”  Behaviour Change Communication
modules) and other special lectures plus  Working with Communities (including use of
PLA tools and CHAP
4 days of field work. The field work
covers the following:  Resource Management

Day 1
 Interaction with CHO and volunteers
 Transect walk to identify key landmarks in the community, e.g., market,
church/mosque, chief palace, water source, schools

Day 2
 Home visits

Day 3
 School health

Community-Based Health Planning and Services: Implementation Guidelines 13

Day 4
 Organise a community durbar and give feedback

A preparatory meeting is organised prior to the main training to:

 Review modules, case studies, pre- and post-test, and programme
 Share roles and responsibilities
 Organise learning aids and other materials
 Discuss field work arrangements

The modules, training duration, and field work shall be revised after CHPS training is
implemented as part of CHN education curricula nationwide.

Step 6: Select, Approve, and Orient CHMC

The CHMC, made up of dedicated, respected, and willing leaders (both men and women),
shall supervise the health system at the community level and also administratively supervise
the CHVs. These are opinion leaders from the various development bodies in the
communities that constitute the CHPS zone. CHMC members report directly to the chief and
are accountable to the community members. After the identification and selection of the
CHMC members by the community members with the facilitation of the community
leadership (chiefs, queen mothers, elders, assembly members, opinion leaders, etc.), the
CHMC members undergo orientation by the DHMT/SDHT. This prepares them to play lead
roles in effectively mobilising the communities for participation in CHPS implementation.

CHMC Composition
CHMCs shall be gender balanced and include the following:
 A representative from each village within the zone
 A generally recognised and respected women’s leader
 A generally recognised and respected male personality/opinion leader in the
community
 A representative of the Unit Committee/Area Council
 The assembly member of the area
 A representative of the Paramount Chief
 Any other personality the community deems necessary

Step 7: Compile Community Profile and Delineate CHO Work

The SDHT and the staff assigned to the zone shall develop a community profile and define
the initial scope of work of the CHO and share this with the District Health Administration.
The scope of work and available resources shall include whether the assigned staff will be
resident or not, work 5 days or less in the zone, and the type of logistics required. The profile
(Appendix A) includes, but is not limited to, the following:

Community-Based Health Planning and Services: Implementation Guidelines 14

  Names of communities making up the zone and the proposed name of the CHPS zone
 Map of the zone showing important landmarks in the zone
 Major economic activities of the zone
 Social services and amenities in the zone
 Estimated population by gender, service target groups, etc.

Step 8: Construct/Operationalise Compound

When planning for the construction of a new CHPS compound, the DHMT shall plan an
initial meeting with all the community leaders residing in the CHPS zone. This is often done
during the dialogue meeting with the chief and elders and, subsequently, during the
community sensitisation durbar.

Ensure that the site selected is in the proper area for the intended use:
 The site shall be checked for possible constraints to its use: size, topography,
drainage, soil conditions, natural features and limitations, catchment area to be served,
social acceptability, convenience to the community and the CHOs, etc.
 The site shall be free from dangers of flooding and pollution of any kind, including
air, noise, water, and land pollution. Refer to the “Infrastructure Management” section
of this guideline on how to properly acquire land titles.

Step 9: Provide CHPS Logistics

Some equipment and supplies are needed to ensure productivity. For example:
 Motorbikes for CHOs and bicycles for volunteers
 Relevant registers and reporting formats
 Medical and non-medical consumables
 Home visiting bags with contents
 Medical equipment and other comfort items
 CHPS compound (Service delivery area and residential accommodation for CHO)

Step 10: Launch the CHPS Programme at Durbar

This durbar is used to sensitise the community members of the key activities that shall be
carried out in preparation for the actual launching or commissioning of the CHPS compound.
Some of these activities include:
 Introduction of the CHO to the communities as the provider of PHC
 Community registration and developing a community profile
 Volunteer selection and orientation

Community-Based Health Planning and Services: Implementation Guidelines 15

Step 11: Select CHVs
The selection criteria for a CHV shall include community trust, volunteer spirit, dedication,
honesty, and willingness to stay permanently or long term within the community. The CHV
shall also be able to relate to people in the community to make the CHV’s work easier. A
CHV is a person who can be trusted to maintain confidentiality when this is needed to
support health services delivery activities in that community. Both men and women shall be
chosen for this important role, and there shall be a CHV representative from each community
within the zone. In practice, however, existing volunteers or a mixture of new and old
volunteers are normally considered.

Factors to Consider in the Selection of CHVs

The CHV must be:
 Literate (ability to read and write)
 Committed to work
 Available on a regular basis to help the CHO in the organisation of health activities in
his or her catchment community
 A person with no recent history of long-term or seasonal migration from the village
 Active and energetic
 Resident in the community
 Experienced with prior volunteer work
 A credible role model, with a reputation as being selfless
 Trustworthy and well‐received within the community
 Supportive of reproductive rights, FP, and open discussion
 Effective social mobiliser
 Able to communicate effectively
 Ready to work under supervision of community leaders and health staff
 Community development oriented

Step 12: Approve CHV Selection

CHVs shall be selected and approved by the community during a community durbar. The
durbar is organised by the District Assembly and the communities forming the CHPS zone
with the facilitation of the District Health Management Team (DHMT) and the respective
Sub-District Health Teams (SDHTs). Prior to the training of the CHVs, a durbar is held to
seek the communities’ approval for the selected CHV members.

Step 13: Train CHVs

The selected CHVs shall be trained by the DHMT/SDHT and the CHO and commissioned to
work directly with the CHO. CHVs are provided with a minimum of 3 days’ training in
community health mobilisation, health promotion, basic records keeping, logistics
management, and reporting.

Community-Based Health Planning and Services: Implementation Guidelines 16

Step 14: Procure Logistics, Equipment, and Volunteers’ Supplies
The following logistics shall be provided as a minimum to all CHPS zones to make them
fully functional:
Service Delivery Logistics
 Cold chain equipment
 Service delivery consumables
 Working gear
 Communication equipment—two-way radio or mobile phones etc.
 Personal digital assistants for data collection

Mobility Logistics
 Motorcycle for the CHO
 Bicycles for the CHVs in each community within the zone
Where necessary, the following:
 Tricycles
 Tiller Ambulance
 Tractor Ambulance
 Motorboat

Comfort Logistics
 Accommodation: It can be new, or rented and renovated
 Consumer durables: Bed, Furniture, TV, Radio Set, Kitchen ware, etc.

For a detailed list of equipment and logistics see Appendix F

Step 15: Launch the CHPS Zone

Organise a grand durbar of chiefs, opinion leaders, community members, health workers,
DA, and other decentralised departments to launch the zone. The durbar shall highlight the
following:
 Community participation and ownership
 Scope of services
 Introduction of staff, volunteers, etc.

Basic Package of Services

CHPS provides a platform for provision of integrated primary health care to communities.
The provision of these services is carried out jointly by the CHO and CHV and supported by
the CHMC. The package includes community linkage and outreach services; basic clinical
services; and management of activities, logistics, and services. Table 2 outlines the various
components of the CHPS basic package of services. Refer to Appendix D for the detailed
compendium of performance standards (PSs) for Sub-district and CHPS zone levels [For PSs
for region to district and district to sub-district refer to the Performance Standard Manual].
This section covers the basic package of services that are rendered in a CHPS zone. The

Community-Based Health Planning and Services: Implementation Guidelines 17

service package shall be implemented based on the staff mix, availability of equipment, and
service delivery space and shall be developed by each zone to reflect the health needs of the
community.

Table 2: CHPS basic package of services

1. Provided by CHO
1.1 Community linkage and Key tasks
outreach services
1 Health promotion and Organise health education and promotion through
education durbars and home visits; conduct community walkabout,
record and report.
2 Disease surveillance Identify diseases requiring prompt reporting, investigate
outbreaks, do surveillance, report according to protocol.
3 Home visits i. Routine House to house visit: Day to day service delivery
visits to households and individuals in their homes.

ii. Special/Targeted: Designate special clients; prepare

and conduct home visits. Trace defaulters, follow up
patients referred by hospital after discharge, and advise
and support clients with non-communicable diseases like
diabetes and hypertension. Document and report on
these activities.
4 School health Prepare activities, conduct health education and
physical examinations, inspect environment, brief school
authorities on findings, and write report.
5 Outreach activities Prepare and conduct outreach activities; document and
report.
6 Managing CHVs Organise meetings, revise CHAPs, and submit reports.
7 Working with the CHMC Conduct meetings, write community profiles, draw map
of community, and give technical assistance.
1.2 Basic clinical services Key tasks
A1. Child health
8 Immunisation Education, administration and management of vaccines,
recording and reporting.
9 Breastfeeding (BF), growth Education, BF support, weighing babies and children,
monitoring, and nutrition recording, identifying malnourished children, education
on prevention of malnutrition.
10 Acute care of infants and History taking; initial assessment; physical examination;
children (Integrated identification, classification, and management (jaundice,
Management of Neonatal diarrhoea, ARI, fever, measles, ear infection); recording;
and Childhood Illness referral if needed.
[IMNCI])
A2. Reproductive health
11 Family planning Counselling on all methods, education on preferred
method, administration of method (i.e. condoms,
combined oral contractive, injectable, implants), and
referral for other or permanent methods.
12 HIV/AIDS and sexually Education, condom use, physical examination, preparing
transmitted infections (STIs) client and using rapid diagnostic test, giving feedback,
appropriate management, and referring where
necessary.
13 ANC History taking, identification and management of
anaemia, malaria in pregnancy, syphilis in pregnancy,
implementation of PMTCT activities, counselling pregnant
women based on findings, and teaching danger signs in
pregnancy.

Community-Based Health Planning and Services: Implementation Guidelines 18

 14 Safe emergency delivery and Immediately assess mother, prepare for delivery, monitor
newborn resuscitation labour, deliver baby, resuscitate if baby is not breathing
well, and conduct active management of the third stage
of labour.
15 Postnatal care (PNC) and Conduct immediate PNC to mother and baby, educate
essential newborn care family on PNC, assess baby and mother at 6 weeks.
A3. Other clinical services
16 Infection prevention Manage supplies; decontaminate, clean, sterilise, and
store instruments appropriately. Dispose of waste properly.
17 Communicable diseases (HIV, Recognise signs and symptoms, refer, follow up, conduct
malaria, TB) home visits for TB. Perform HIV rapid test. Perform malaria
rapid test and treat.
18 Non-communicable and Recognise signs and symptoms, refer, follow up, conduct
chronic diseases home visits.
(hypertension, diabetes)
19 Neglected tropical diseases Recognise signs and symptoms, refer, follow up, conduct
(NTDs) home visits.
20 Adolescent health Adolescent-friendly health services, counselling (e.g. FP,
STIs and HIVs, nutrition), provision of services, referral as
needed, follow-up and home visits.
21 Mental health Assess and diagnose clients, give appropriate care, and
treat if possible.
22 Minor ailments Assess, diagnose, give appropriate treatment.
23 First aid and home Identify signs and symptoms; diagnose and manage
emergencies shock, snake bite, poisoning, convulsion and seizures,
burns, sprains and strains, fractures and dislocations, and
epistaxis; and wound dressing.
24 Caring for the Aged Home visit to the aged to provide education on care and
nutrition.
1.3 Resource management Key tasks
25 Planning Plan activities monthly and implement them.
26 Logistics management Request supplies, manage them, manage vaccines well,
and keep CHPS compound clean.
27 Financial management Keep value books, receive completed books, procure
utilised books, and receive cash revenues and bank them
daily. Collect cheques and bank them; manage petty
cash.
28 National Health Insurance Record and submit NHIS claims.
Agency (NHIA)
29 Data collection, reporting, Collect and record all data; analyse, interpret, and use
analysis, and use for decision-making. Ensure that data is entered
separately into the DHIMS2 for that particular CHPS zone.
2. Provided by CHVs
30 Disease prevention and Report any suspected epidemic-prone disease
environmental sanitation immediately to the CHO; educate community members
on proper environmental sanitation practices in their
communities.
31 Home visiting Prepare, conduct, and end visits appropriately.
32 Home management of minor Identify and manage fevers, diarrhoea at home.
ailments (integrated
community case
management)
33 Community outreach Participate, give health education, promote BF, family
planning, and wearing and removal of condoms. Equip
oneself with home visiting bag.

Community-Based Health Planning and Services: Implementation Guidelines 19

 3. Provided by CHMC
35 Governance, membership, Ensure community recognises CHPS and community
and operation members know their responsibilities, write down minutes
during meetings, support health education activities, and
resolve conflicts.
36 Selection and supervision of Supervise CHVs and provide motivation for CHVs.
CHVs
37 Welfare of CHO (include Care for CHOs and ensure security for CHOs.
Security)
38 Facility maintenance Manage waste well and create community ambulance
system.
39 Resource mobilisation and Keeps CHPS compound clean; records contributions
management made by others and all financial transactions.

Continuous Delivery of Services

Over the past decade, the CHPS strategy aimed at improving geographical access to health
services has gained both national and international attention. The resources made available in
the expansion and establishment of health training institutions, construction of CHPS
compounds by DA and other partners, provision of medical equipment, and capacity building
of frontline service providers requires that quality essential basic health services are delivered
to all beneficiary communities at all times. Once the 15 steps have been implemented, the
emphasis is on continuous delivery of services as outlined in the basic package to maximise
the huge investment from government and development partners.

A well-functioning CHPS zone that stands the test of time shall have the following
characteristics;
 A well –functioning supervision system
 A well-organised team of health workforce (CHO and Volunteers)
 Continuous quality health services
 A good health financing system
 Good leadership and governance
 Team approach to service delivery

1. A Well-Functioning Supervision System

One of the biggest challenges in scaling up of CHPS implementation is supervision. These
guidelines have a chapter on supervision, however, the following key components must be
addressed:
 Standardisation of methods and procedures
 Standardisation of tools and formats
 Effective feedback and utilisation of supervision results
 Conduct of supervision in a facilitative manner that addresses system weaknesses

A CHPS Roll-Out Assessment Tool is provided in Appendices E and K as a guide for use by
health teams to monitor and supervise CHPS implementation at all levels.

The team shall also be empowered to use data for decision-making, e.g. improving first
trimester registration if that is found to be low.

Community-Based Health Planning and Services: Implementation Guidelines 20

2. A Well-Organised Team of Health Workforce (CHO and Volunteers)
CHOs and volunteers shall be well trained and provided with the requisite materials and
logistics to work. CHOs shall be responsive, fair, and efficient to achieve the best health
outcomes possible, given available resources and circumstances:
 Well trained using the standard materials
 Provided with the needed resources to conduct all home visits and outreaches
 Encouraged to design health solutions that meet the needs of the communities they
serve

It is imperative to assess the skills of CHOs from time to time to give them refresher training
on the job or as in-service. Such trainings shall be well planned and executed. Onsite
coaching and mentoring sessions shall also be organised for CHOs using available
technologies. A well-organised team shall also facilitate learning and in turn provide a
practicum site for other trainees.

3. Continuous Quality Health Services

CHPS zones are required to provide 24-hour service throughout the week. The services they
deliver shall be effective, safe, quality personal and community health interventions to meet
client needs at the right time and in the right place, with minimum waste of resources. A
well-functioning health system ensures equitable access to essential medical products,
vaccines, and technologies of assured quality, safety, efficacy and cost-effectiveness, as well
as their scientifically sound and cost-effective use.

4. A Good Health Financing System

Financing CHPS shall come from different sources such as Government of Ghana,
Community members, Donor Agencies, District Assemblies, Internal Generated Fund,
Community-based Organizations and Civil Society Organizations. Where services are
provided and qualified for NHIA reimbursement, the cost is claimed through the health
centres drawing from the accounts of the CHPS zone. Under capitation, individuals shall tend
to select health centres and hospitals as their preferred primary provider. The SDHT and
DHMT shall ensure that all services delivered in CHPS compounds are delivered free of
charge at the point of use. All CHPS services on the NHIS benefit package shall be
reimbursed. CHOs and CHVs shall facilitate the registration of their populations onto the
NHIS. All functional CHPS zones with compounds shall be assisted by the District Health
Directorate (DHD) to get NHIS accreditation to improve access to affordable basic health
services.

5. Leadership and Governance

The CHO is a service provider, a manager, and a leader. The CHO technical skills training
and other refresher trainings enhance the service provision skills of the CHOs. Good
leadership and governance requires that the CHO:
 Identifies with the people, live with the people, and work with the people
 Lobbies and advocates for the establishment of community structures such as CHAPs,
Community Emergency Transport System (CETS), etc.
 Organises durbars and promotes community participation at all times
 Organises and chairs meetings with volunteers and other groups
Community-Based Health Planning and Services: Implementation Guidelines 21
  Gives feedback to community members

6. Team Approach to Service Delivery

The new CHPS policy outlines that CHPS zones shall be staffed with up to three CHOs. In
reality, these three staff members are usually a mix of ENs, CHNs, and midwives. In this
multi-disciplinary team, it is important that an in-charge of the CHPS team is specified by the
DHMT/SDHT. There shall be both flexibility and teamwork while rendering daily services
and the responsibilities must be clearly outlined and delegated (see Table 3).

Table 3: Basic package of services and responsible persons

Basic Package
CHN Enrolled Nurse Midwife
of Services
Community • Health promotion/ Support CHN when • Maternal Health care,
Linkage and education necessary: promotion/education
Outreach • Disease Surveillance • Outreach Activities
Services • Home visits
• Home Visits
• School health • Management of
minor ailments
• Outreach Activities
• Managing CHVs
• Working with the
CHMC
Basic Clinical Services
Child Health • Immunisation • Acute care on Infant • BF, Growth
• BF, Growth and Children (IMNCI) Monitoring, and
Monitoring, and Nutrition
Nutrition • Acute care on Infant
and Children (IMNCI)
Reproductive • FP • STI management • FP
Health • HIV/AIDS and STIs • HIV/AIDS
If there is no midwife: • ANC
• ANC • Delivery and
• Safe Emergency Newborn
Delivery and resuscitation
Newborn • PNC and essential
Resuscitation newborn care
• PNC and Essential
Newborn Care
Other Clinical • Infection Prevention • Infection Prevention • Infection Prevention
Services • Communicable • Non-communicable • Adolescent Health
Diseases (HIV, and Chronic Diseases
Malaria, TB, Cholera) (Hypertension,
• NTDs Diabetes)
• Adolescent Health • Minor Ailments
• Mental Health • First Aid and Home
Emergencies
• Care for the aged

Community-Based Health Planning and Services: Implementation Guidelines 22

 Basic Package
CHN Enrolled Nurse Midwife
of Services
Management of • Planning • Planning • Planning
Activities, • Logistics • Logistics • Logistics
Services, and Management Management Management
Logistics
• Financial • Financial • Financial
Management Management Management
• HR management • NHIA • HR management
• NHIA • Data collection, • NHIA
• Data collection, reporting, analysis, • Data collection,
reporting, analysis, and use reporting, analysis,
and use and use

Implementing CHPS in Urban Settings

It is a common claim that residents of urban areas have greater access to health facilities and
better health outcomes than rural counterparts. In Ghana, however, such assumptions fail to
consider the rapidly growing proportion of urban populations residing in rapidly growing
slums and shantytowns in informal settlements. Such areas have poorer socioeconomic
conditions than many of the most underprivileged rural areas. Moreover, it has become
difficult for urban health systems to accommodate these rapidly growing populations. For this
reason, unlike the rural population, where CHPS coverage is expanding, vast areas of
Ghana’s urban population live in neighbourhoods that have no access to basic PHC facilities.
Geographic proximity is deceptive. Because public transportation is expensive, deficient, or
lacking altogether, the urban poor are often isolated from health care of any kind.

Urban Features that Affect Urban CHPS Implementation

 Informal settlements are rapidly expanding, and oftentimes have poor sanitation, poor
ventilation, and over‐crowding.
 Access to urban health facilities is often lacking; urban transport is expensive.

 Unhealthy urban lifestyle choices including consuming junk food and the lack of
exercise.
 Dual burden of disease challenge and sustained risk of rural disease burden among
children of the very poor: the urban poor experience diseases that affect rural people
as well as those that affect urban people.
 High prevalence of non‐communicable diseases such as hypertension, diabetes, and
cancer.
 High prevalence of HIV and STIs.
 High rates of unmet need for FP.
 Families direct all their time to economic survival, hence volunteerism is very weak.
 Populations are mobile, hence tracking people in need of health care is difficult.
 Housing is very expensive, hence getting a community-donated Community Health
Compound for the CHPS is difficult.
In view of the uniqueness of the urban settlement, CHPS implementation milestones could be
modified to suit the urban context.
Community-Based Planning
Situation analysis is important for clarifying “zones” in terms of block and neighbourhood
identification, and the CHO residence and service location shall be well clarified. Rural

Community-Based Health Planning and Services: Implementation Guidelines 23

patterns of doorstep rounds of outreach do not work because few urban residents remain
home during regular work hours. Clarification of geographic responsibility of CHO and
identification of opinion leaders and political networks can be challenging in the urban
setting.

Community Entry
Focus on identifying social networks (corresponding to ethnicity of settlers). Focus on
outreach to formal authorities and politicians. Traditional leaders may exist but have limited
authority, therefore, identification of trade and market networks is essential. The CHO needs
to do detailed community assessment of the availability of the community members. A
detailed assessment will inform the CHO’s ability to draw an activity plan that will be
suitable to meet the needs of the various target groups within the catchment.

Essential Equipment
Due to the urban terrain, motorbikes are inappropriate: Low-cost 3- or 4-wheel vehicles are
more appropriate. Augment clinical equipment for Integrated Management of Childhood
Illness (IMCI), EPI, and (FP)/RH with equipment for monitoring chronic diseases
(particularly diabetes and high blood pressure [BP]). GHS and municipal authorities shall
facilitate the acquisition of essential equipment. Refer to Appendix F for a detailed list of
equipment.

Facility Development
Arrangements shall be made for donation of secure living space or renovation of donated
space. (It is difficult to build CHPS compounds in urban areas due to the high cost of land
and the absence of donation mechanisms.) Dealing with space challenges requires
coordination with urban government, churches, or non-governmental organisations (NGOs).
The CHO might not reside in the community in a compound, but may reside in his or her own
rented apartment and commute to the community every day.

Nurse Recruitment, Training, and Service Provision

Urban nurses shall focus on adolescent and adult health needs in addition to chronic disease
and sanitation. Midwifery is less important for the urban nurse, since there are a lot of health
facilities offering the same services. IMCI and FP training shall be augmented with training
for preventing and treating prevalent non-communicable diseases and chronic illness. The
doorstep model which is central to rural CHPS implementation is inappropriate for urban
CHPS. Home visits during the week-days and during the daytime might also not be fruitful,
hence weekend and evening visits could be better. FP services shall focus on the long term
rather than the short term.

Volunteer Identification, Training, and Development

Service-focused volunteers with no provision of curative services (more limited role) take the
place of CHVs in urban CHPS implementation. Link volunteerism to urban institutions that
engage in activities that are compatible with adding health components: Private pharmacies,
faith‐based organisations, political organisations, trade associations, etc. Urban volunteers
shall be given some stipend since there is greater opportunity cost for their involvement.

CHO Work Itinerary

Itinerary for CHOs shall include the following:

Community-Based Health Planning and Services: Implementation Guidelines 24
 1. Modes of Delivery
1. House to house and Home visits
2. Home visits for follow up clients /patients
3. Health durbars
4. Social Groups’ meetings/ health education
5. Outreach service delivery
6. Static service delivery

2. Attending activities at sub-district & District

3. Other travels
4. Annual Leave

Home visits can be routine house to house or targeted/special activities for CHOs. All staff
shall undertake home visits to realize the aim of CHPS in bringing health care close to
individuals and households in their homes. The Table 4 is a checklist for home visits for
CHOs to help him/her provide a life course approach of service delivery at the CHPS zones.

Table 4 Checklist for Home Visits by CHO

Done

Cohort Type of intervention Yes No Remarks

Neonate/ Infant Newborn/Infant care -Essential newborn

care/Cord care/ Early initiation of
breastfeeding
Exclusive BF up to 6 months

Kangaroo mother care (KMC)

Nutrition – IYCF/GMP/CMAM

Neonate/ Infant C-IMNCI & referral of serious cases

Disease surveillance & control - malaria

prevention, including sleeping under ITNs/
Paediatric diagnosis and ART/Education on
prevention

Pregnant women Focus Ante Natal Care(FANC)-Pregnancy

monitoring/Education on
nutrition/Micronutrients (iron, folate)/Birth
preparation/IPT/HCT/Maternal ART
Skilled attendance at delivery

EmONC

PNC

Children under – Vaccination

five years
Nutrition- GMP/ vit A supplementation/CMAM

Disease Control - Deworming 2yrs -

5yrs/Education on prevention & treatment of
fevers, diarrhea & ARI/Malaria/

Community-Based Health Planning and Services: Implementation Guidelines 25

 Done

Cohort Type of intervention Yes No Remarks

Adolescents ASRH including Family planning/Education

against teenage/early pregnancy

Education on preventable diseases (HIV/STIs,

malaria, )& NCDs (obesity, drug abuse,)

School children School health activities ( based existing

guidelines)

WIFA FP (short term methods (pill, male & female

condoms, injectables, etc) and implant
insertion & removal

Household nutrition /iodated salt consumption

General Population

Discharged Follow up of discharged patients & DOTS (e.g

Patients children, TB, leprosy, hypertension, epilepsy,
diabetes, malnourished children etc,
Regenerative health & nutrition/Household
Iodated salt consumption

Mass Drug Administration (yaws, filiariasis,

schistosomiasis, intestinal worms)
General Population
Disease surveillance & control - Investigation &
reporting on rumours/unusual events/ (malaria,
HIV/STIs, TB, NTDs, diseases for
eradication/elimination & NCDs (hypertension,
diabetes, SCD, asthma,)

The Aged Home visits to the Aged to provide education

on care & nutrition

The Health Family Forum/Meeting

The District, Sub-district or CHPS zone Health Family Forum is a meeting of all key
stakeholders to discuss public health and clinical care issues of common interest to facilitate
the delivery of health service seamlessly. The objectives are:
 To improve linkage between clinical care and public health
 To improve the referral system
 To strengthen the sub-district system
 To strengthen the CHPS strategy
 To transfer knowledge and experience between centre and periphery of the district
health system
 To decrease preventable deaths in the district
 To decrease delays in health delivery in the district
 To improve teamwork and perception of teamwork by subordinates
Community-Based Health Planning and Services: Implementation Guidelines 26
Strategies:
 Meeting shall be organised as follows at various levels of the district health system
o At the District level- by the hospital Medical Superintendent quarterly in
consultation with the District Director of Health Services (DDHs). Key
participants include Heads/Unit heads of public and private health facilities
including. CHPS zones and CHAG, District Coordinating Officer, District
Planning Officer, CSOs including NGOs, Prominent traditional leaders,
o At the Sub-district level-by Sub-district Head monthly in consultation with the
DDHS and SDHT. Participants include Heads / Unit heads of public and
private health facilities including CHPS zones and CHAG, Prominent
Traditional Leaders, Assemblymen and women, CBS, CSOs, NGOs
o At the CHPS zone level- by the CHO in charge of CHPS zone monthly in
consultation with the Sub-district Head. Participants include,
Traditional/Opinion Leaders, Assemblyman and woman, CBS, CSOs, NGOs,
leaders of social groups
There shall be exchange of telephone numbers of key participants of these meetings to
facilitate referrals from one level to the other in the district health system.
 Minutes of meetings shall be documented
 Reports of meetings shall be submitted by Medical Superintendents to the Regional
Health Directorates; by the Sub-district Heads to District Health Directorates; and by
CHOs to Sub-District Heads respectively.
 The DHMT and the Hospital Management Team at the District level, Sub-District
Head and SDHT at the sub-district level and CHO in charge at the CHPS zone level
respectively shall provide leadership for the overall success of the various level
meetings. The DDHS shall provide oversight responsibility for the success of the
Health Family forums in the District.

Implementation steps include:

1. Letters for meeting shall be sent at least a week prior to the meeting.
2. Dates of meetings shall be synchronised with district/sub-district/CHPS zone calendar of
activities.
3. The sitting arrangement is circular to create an atmosphere of friendship and family.
4. Meetings shall be held in the District Hospital, Health Centre and CHPS
compounds/delivery points
5. Discussions shall include, but are not limited to, the following:
 Referrals among health facilities
 Surveillance in the district
 Clarifications of diagnoses, case definitions, and treatment modalities
 Sub-district/CHPS zones feedback of clients’ experience in the health facilities
and CHPS zones
 Improvement of pre-referral preparation of clients before clients leave the sub-
district facilities and CHPS zones

Community-Based Health Planning and Services: Implementation Guidelines 27

6. Refreshments shall be provided by hospital and health centres and travel and
transportation funded by the sub-district facilities.

The following conditions are required for the successful implementation of Health Family
Forums:
 Willingness of leadership of various levels of the District Health System to work
together and to lead.
 Availability of problem-solving skills in the team.
 Availability of moderation skills at the meeting to keep the blame game to a
minimum.
 Clinical visits to the sub-district by the Medical Superintendent and the Medical
Superintendent’s team improve the quality of the meeting.
 Regional Director of Health Services (RDHS) and other Heads of the District Health
System demand for reports formalises the procedure and imposes responsibility for
success.
 DDHS/SDH willingness to coordinate the linkage during the interval between
meetings is critical to success.
 Management of teamwork between the district hospital and DHD, the SDH and
DDHS, and between CHO in-charge and SDH is important for the sustainability of
the meetings.
 Needs assessment shall be done in critical areas like leadership, team building, etc.

Community-Based Health Planning and Services: Implementation Guidelines 28

Chapter Three: Establishing and Managing a
Referral System
Introduction
Effective referral requires proper judgement
guided by checklists, protocols, and Box 7: Role of Facilities
guidelines; skilled personnel; clear • Referring facility Shall:
communication; and timely transport to − Have clear judgement on health status
of patient
ensure that a patient receives optimal care at
− Complete referral form
each level of the health system according to
− Document the reason for the referral in
the patient’s need, vulnerability, and disease a register
severity. The roles of referring and receiving − Advise patient to go to receiving facility
facilities as spelt out in Box 7. − Activate emergency transport
arrangements for the patient if so
required
General Principles for Referrals − Inform receiving facility ahead of arrival
CHPS is a crucial gate-keeper system within of patient
the referral system when the CHO in every • Receiving facility Shall:
community is the preferred PHC provider. − Prioritize referred patient
Other levels of health care delivery above − Retain referral form
the CHPS zones are health centres, − Register referred patient
polyclinics, and district, municipal, regional, − Have clear judgement on health status
tertiary, and specialised hospitals. of patient
− Provide feedback on referred case to
referring facility
The referral system in the CHPS zones shall
be in line with the MOH referral policy and
guidelines.
 The National Referral Policy and Guidelines shall be available in all the CHPS zones.
 Two-way referral system shall be implemented in all facilities. In this regard, referrals
can be from CHPS to a health centre—or in special cases to a higher or specialist
facility—and vice versa.

Community-Based Health Planning and Services: Implementation Guidelines 29

 Figure 1. Referral pathway and procedure within the region

 The DDHS shall prepare and make available in all CHPS zones in the district, a
directory of facilities and services provided. This shall be annually updated.
 Registers shall be maintained for monitoring and evaluation of internal and external
referrals in all health facilities.

Establishing a Referral System

In each CHPS zone, an appropriate referral system shall be established by the District
Assembly and the community, with initiation through health education and technical input
from GHS, for clients needing a higher level of care (see Table 5). The referral system is
meant to ensure that there is a continuum of care from household level to CHPS compound,
from CHPS compound to health centre, and from health centre to district hospital. The
referral process at the referring facility shall follow the GHS referral procedure (see Figure
1). Logistics needed for a good referral system include referral forms, a referral register, and
a referral feedback file.

Community-Based Health Planning and Services: Implementation Guidelines 30

Table 5: Interventions for developing a well‐functioning emergency referral system
Requirements for an Level of
Emergency Referral Potential Activities this Could Involve the Health
System System
Referral strategy
informed by the
1.1: Conduct a situational analysis of your district. This can District,
assessment of
include gathering information on other referral schemes Sub‐district,
population needs and
that may exist in the district. CHPS zone
health systems
capabilities
2.1: Utilise data collected during district‐led routine
monitoring of community- and sub‐district-level facilities to
Adequately resourced Sub‐district,
resolve any deficiencies identified (relevant to referral)
referral centre CHPS zone
and ensure the facilities’ basic readiness for emergency
management.
3:1: Hold a meeting with regional, district, and sub‐district
Region,
Active collaboration stakeholders to review implementation strategy and reach
District,
between referral levels consensus on an implementation plan.
Sub‐district,
and across sectors 3:2 Conduct qualitative appraisal to assess community
CHPS zone
stakeholder reactions to the emergency referral system.
4:1: Develop and test an emergency communication
Formalised system to facilitate effective referral and transportation
District,
communication and services.
Sub‐district,
transport 4:2: Strategically deploy and test vehicles for emergency
CHPS zone
arrangements transportation services at the community and sub‐district
levels.
5:1: Develop a protocol (or refine an existing one) as
needed for the referral programme. Create a database for
routine data entry and analysis.
Setting‐specific District,
5:2: Conduct trainings for referral personnel on equipment
protocols for referrer Sub‐district,
and protocols.
and receiver CHPS zone
5:3: Develop the capacity of community members to
recognise signs of an emergency and the importance of
seeking care.
6:1: Train district and sub‐district supervisors to oversee
referral programme activities in their localities and provide
routine monitoring and supervision to intervention sites. Region,
Supervision and 6:2: Hold quarterly review meetings with regional-, district-, District,
accountability and sub‐district-level supervisory staff to review preliminary Sub‐district,
results and discuss any challenges that may arise. CHPS zone
6:3: Seek feedback from users of the emergency referral
service at the community level.
7.1: Hold meetings with local DA members, elders, and District,
Affordable service
other community leaders to discuss localised solutions to Sub‐district,
costs
addressing the costs for transportation. CHPS zone
8:1: Refine existing data collection tools and develop new
instruments as needed to collect data for monitoring the District,
Capacity to monitor
referral scheme. Sub‐district,
effectiveness
8:2: Conduct routine monitoring and evaluation of referral CHPS zone
programme.
Region,
9.1: Orient policy makers and district leaders to emergency
District,
Policy support referral strategies.
Sub‐district,
9.2: Communicate lessons learnt to wider community.
CHPS zone

Community-Based Health Planning and Services: Implementation Guidelines 31

General Medical Conditions Requiring Referral
 Bleeding that will not stop
 Breathing problems (difficulty breathing, shortness of breath, not breathing)
 Choking
 Convulsions or seizures
 Coughing up or vomiting blood
 Severe diarrhoea and/or vomiting with dehydration
 Fainting or loss of consciousness
 Change in mental status (such as unusual behaviour, confusion, di fficulty in arous
suicidal feelings)
 Severe anaemia
 Severe hypertension
 Severe, sudden abdominal pain
 Severe, sudden dizziness, blurred vision, severe headache
 Snake bite or bee sting with a reaction
 Poisoning
 Head or spine injury
 Accidents such as road traffic accident with serious injury, extensive burns or smoke
inhalation, near drowning, or deep cuts
 Others (Any other condition not manageable at CHPS level)

Maternal Health–Related Conditions Requiring Referral

Pregnant Women
1. Bleeding during pregnancy
2. Severe sudden dizziness, blurred vision
3. Severe headache
4. Convulsions/fits
5. Swelling over body, hands, and face
6. Absence of foetal movements
7. High fever during pregnancy or after delivery
8. Trauma during pregnancy
9. All medical conditions in pregnancy such as:
 High BP in pregnancy
 Diabetes mellitus
 Urinary tract infection
 Offensive vaginal discharge

Community-Based Health Planning and Services: Implementation Guidelines 32

10. Persistent vomiting
11. Preterm labour
12. Abnormal presentations (breech, arm, cord prolapse, cord around neck, etc.)
13. Prolonged labour
14. Excessive bleeding during delivery or after delivery
15. Retained placenta
16. Bursting of water bag without labour pains

Newly Born Baby

1. Breathing problems/difficulty
2. Skin infection
3. Cord infection
4. Lethargy
5. Jaundice
6. High/low temperature

Communication during Patient Care and Transportation

Where possible, referrals must have prior communication (telephone, radiophone, email, fax,
etc.) to the receiving facility, providing patient details as stated in the national referral policy.
The CHO should write down and display telephone directories of all the receiving facilities
near communications equipment for easy communication during emergencies.

Medico-Legal Issues
 All requests for medico-legal examinations (e.g., rape, assault) must be accompanied
by an official request from the police and other relevant authorities.
 Medico-legal requests not within the capability of the CHO shall immediately be
referred to the appropriate level.

Circumstances under which CHOs may refer a Client to a Higher Level

To ensure an effective gate-keeping system, CHOs shall refer cases that are beyond their
ability to manage to the health centre for further management after having completed a
referral form (Appendix J). After the cases are managed, the health centre shall inform the
CHO about the type of care given to the client; this will inform the type of follow-up care
given when the client is treated and discharged to the community. Therefore, as part of the
referral process, there shall be regular communication between the referral facility and the
receiving facility.

The client could be referred straight to the district hospital, polyclinic, or regional hospital
under the following circumstances:
 When the distance from the CHPS zone to the other, higher-level service delivery
point is shorter than to the health centre
 When the road network to the other, higher-level service delivery facilities is better
than that to the health centre
Community-Based Health Planning and Services: Implementation Guidelines 33
  When the condition, to the discretion of the CHO, is beyond the management of the
health centre, e.g. a child who is very anaemic and would need blood transfusion,
which might not be available at the health centre level

Community-Managed Referral System

A community-managed referral system is a community-led and community-managed
mechanism for referral and transportation of clients seeking care. This mechanism is usually
linked to formal health services such as CHPS or health centres or hospitals and focuses on
providing transportation in cases of emergency referral. In these guidelines, the Community
Emergency Transport System (CETS) will be described, although there are other examples of
community-managed referral systems in Ghana.

CETS
CETS is the pre-arrangement and payment by community members for transport services to a
health facility for emergency cases and urgent referrals. CETS is set up by community
members with leadership from the CHMC and technical guidance from the CHO as part of
their CHAP implementation strategy (see Box 8). It has a constitution that specifies its
membership, executives and their roles and term of office, fixed-amount contributions/mode
of funding and other income-generating activities, bank accounts, the CETS’s management,
etc. Community members are encouraged to contribute money or find any appropriate means
of raising funds into a common fund. Vehicles and drivers are identified in the community to
be used as community ambulances. Fixed rates are agreed with transport owners as
reimbursement for the use of vehicles and emergency phone numbers of the drivers are
distributed among the community members and the CHOs. Drivers are responsible for taking
referrals and transporting clients with emergency needs to the nearest point of referral.

Implementation Process
Box 8: Establishing CETS
• CHO shall brief community leaders, CHMC members, CHVs, and other opinion leaders on the
importance of CETS.
• The concept shall be shared with the whole community during a community durbar on CHAPs.
• An action plan shall be drafted explaining how to implement CETS if it is accepted by the CHMC
and CHO.
• A simple constitution, which is a requirement for opening bank accounts, Shall be developed by
the CHMC and CHO with support from the Sub-District Head.
• An executive body shall be selected to manage CETS implementation (chairperson, secretary,
treasurer, organizer, and a trustee).
• Agree on source of funding or fixed-amount contributions by all members.
• Open bank accounts with the chairperson and treasurer as signatories.
• Identify transport and negotiate with private owners including National Ambulance Service.
• Clarify communication channels in case of emergency, including telephone directory with
assigned person who can be contacted.
• Announcement of the CETS service to the community members.
• Report on CETS as part of CHAPs.
• CETS funds are treated as loans to beneficiary members.
• Manage/sustain CETS through regular contributions, repayment of loans, and income-generating
activity like annual farming by members where the farm proceeds are used to supplement their
contributions. Transparency and good remarks from beneficiaries are also helpful in sustaining
the system.

Community-Based Health Planning and Services: Implementation Guidelines 34

Roles/Responsibilities of the CETS Drivers
Prior to the notification of an emergency, there are several crucial responsibilities for
the volunteer driver, including:
 The drivers shall maintain roadworthiness of vehicles and carry out regular
maintenance. Keep the vehicle adequately fuelled (it should never go below half a
tank).
 Maintain the external appearance of the vehicle (ensure it is clean and not damaged).
 Maintain cleanliness of the vehicle.
 Be familiar with road networks, shortcuts, and the layout of communities.
 Stay informed of changes in road conditions and areas inaccessible; proactively come
up with potential solutions for inaccessible areas.
 Become familiar with the various communities being served.

Upon notification of emergency, it is expected that the driver shall:

 Follow communications protocols.
 Provide estimated time to reach the CHPS zones (via phone).
 Get to the site immediately.

Upon arrival at site of emergency, it is expected that the driver shall:

 Assist in transporting patient into ambulance/car.
 If required, support accompanying health worker in emergency management.

While in transit, it is expected that the driver shall:

 Follow road safety and traffic rules.
 Remain calm and alert. Listen for any instructions from accompanying health worker.
 Be able to quickly change routes if there is a change in receiving facility.
 Troubleshoot for any unanticipated inaccessible roads.

Upon arrival at receiving facility, it is expected that the driver shall:

 Assist receiving worker with lifting/moving patient out of vehicle (if needed).
 Stand by until accompanying health worker has completed his/her onsite
responsibilities if possible.
 Send, or if applicable transport, accompanying health worker back to referring facility.

Community-Based Health Planning and Services: Implementation Guidelines 35

Chapter Four: Community Engagement
Introduction
Community engagement in CHPS is the process by which health workers engage community
leadership and individuals to build ongoing, permanent relationships for the purpose of
applying a collective vision in the implementation of CHPS for the benefit of the community.
Sustaining CHPS operations continuously over time requires continuous community
engagement, dialogue, and diplomacy to be pursued by DHMT, SDHT, District Assembly,
stakeholders, and other partners. This chapter is intended to guide health workers to harness
community resources for CHPS implementation.

Community Entry
Box 9: Community Entry Process
Community entry is the process of • Form a community entry team
combining principles and techniques to • Learn about the community
mobilise communities and get them to • Identify contact persons
participate in and take ownership of health • Meet with the community’s leadership
care delivery activities. It is the first step in − Let community leaders and people
community engagement, and involves know you and your mission in the
recognising the community leaders, community
structure, people and applying appropriate − Seek approval and support for CHPS’s
strategies in interacting with them. The first activities and become conversant with
the customs and traditions of the
contact programme staff have with the people
community usually leaves an impression that
• Conduct meetings with the community
influences subsequent interactions. The
• Conduct community needs assessment
community entry process is outlined in Box
9.

Community Consultation Box 10: Community Consultation Process

Community consultation with community • Identify the leadership and recognize their
leadership and people engenders ownership positions and roles
and sustains community health care in • Meet them upfront to let them understand
CHPS. Consultation and consensus-building your message, purpose, mission, and vision
with traditional leadership shall be • Organize several meetings to convey
message
organised along the levels of hierarchy with
• Work with them to organize community
respect to the traditional authority system in durbars to present your message to the
the area (see Box 10). wider community
• Follow the community protocols

Meetings between the DHMT/SDHT and the chiefs shall focus discussions on the following:
 The patterns of health care delivery in the district/sub-district. (The District Health
Service Profile, which describes the nature of the district – major economic activities,
disease burden, availability of health facilities, etc. – and the 5-year health
development plan, is presented.)
 The weaknesses in the health delivery system and the problems of access.
 The roles of chiefs, elders, and key stakeholders and their people in improving access
to health delivery.

Community-Based Health Planning and Services: Implementation Guidelines 36

  The CHPS process. Box 11: Key areas for consensus-building in
CHPS
 Consensus-building on the roles of • Formation of CHMCs
the chiefs and their people. (Key • Operation of CHV system—selection of
areas specified in Box 11.) volunteers and their supervision
• Construction/Maintenance of CHPS
compounds
• Safety and security of the CHPS compound
and health workers
Community Needs Assessment • Organization of communal labour
Community needs assessment is a process of • Fund raising to support CHPS activities
finding out and prioritising the local • Identifying and using other community
problems of a community, identifying the structures—opinion leaders, youth groups,
environmental and socio-cultural factors etc.—to facilitate CHPS programme
activities
influencing such problems, and discovering
resources available in the community to
solve the problems. It establishes the essential foundation for vital planning, and identifies the
strengths and resources available in the
community to meet the needs of children, Box 12: Community Needs Assessment Process
youth, and families. • Collect information and organize discussion
on health needs with community members
Box 12 outlines the community needs
• Discuss and analyse community health issues
assessment process. with community members, SDHT, and other
health workers
• Hold meetings with chiefs, leaders, and
social groups, e.g. Mothers club

Community Mobilisation • Use information to develop CHAPs with

community members
Community mobilisation is a process by • Implement CHAPs and evaluate
which communities are motivated to bring
together human, material, or financial
resources to take action to improve their
state of development and well-being.

It involves activities that are planned, carried out, evaluated by community members or with
the support of others in a participatory manner, and sustained to achieve the community’s
developmental goals. The steps in community mobilisation are detailed in
Box 13.
Community Decision System Box 13: Steps in Community Mobilization
(CDS) in CHPS • Identify stakeholders
The CDS is a community-based health • Meet with stakeholders to discuss health
issues
information system that is designed to offer
• Identify resource strength of each
specific information about an individual stakeholder
community’s health status to its members at • Share roles and responsibilities for all
a gathering or durbar. In CDS, community stakeholders
members gather and use information about • Develop a community mobilization plan
their health problems to facilitate decision- which includes agreed-upon contributions
making, planning interventions, acting from stakeholders with timelines

together, and monitoring to improve their • Follow up on the pledged resources from
stakeholders
own health situations. Details of the process
• Mobilize all resources
of community decision-making are outlined
in Box 14.

Community-Based Health Planning and Services: Implementation Guidelines 37

Key Players in CDS Box 14: CDS Process
 All members of the community • Design community bulletin
board/screen/wall (see Figure 1)
 CHMC • Design pictorial indicator cards (cards on
health issues)
 Other community health providers e.g.
• Formation of Community Health Team
herbalists, TBAs, chemists, Wanzams
• Data collection by the Community Health
(circumcisers) Team
 An Okyeame/Linguist or MC • Organize community durbar to return
information to the community
 CHVs • Present the information in a clearly
understandable form (numbers,
 CHOs percentages, etc., using the cards)
• Facilitate discussions and analysis of
The findings from the CDS, when completed information
at a durbar, give rise to the drawing of a • Use the information to make decisions and
CHAP. take action
• Prepare CHAPs
• Implement planned activities
• Monitor, supervise and evaluate the action
plan

CHAP

A CHAP (See Appendix G) is a community

roadmap summarised in a format that
indicates what community members want to
achieve within a specified period with a view
to improving their health conditions.

CHAP is developed by community members

with GHS staff such as CHO, SDHT, and
DHMT providing the necessary support. The
CHAP is implemented by community
members. It is reviewed and updated on a
regular basis by community members and the
CHO to make room for new activities after the
achievement of current targets on the plan.

Community-Based Health Planning and Services: Implementation Guidelines 38

 Box 15: CHAP Implementation Action Plan
The rationale for CHAP is to promote • Assess needs of community using PLA tools
community involvement, develop • Hold meetings to sensitize communities on
ownership, and help set a vision for the CHAP
CHPS zone. It serves as a monitoring and • Hold a series of durbars involving all the
evaluation tool for the CHPS community members
implementation and can attract donors and • When communities embrace the CDS ideas
philanthropists to the community. and findings, enumerate challenging issues
and prioritize them for CHAP
• Community draws CHAP facilitated by
In CHPS implementation, CHAP highlights health worker/CHO and an active
the “P” component of CHPS which is community member
“Planning”. Generally, CHAP can be used • Display CHAP on local wall for reference by
to establish a common fund for health all members involved in its implementation
issues, e.g. CETS, or increase/improve low- • Health worker/CHO/CHMC/CHVs to follow
performing areas, e.g. to increase ANC up with persons responsible for activities
specified
registrants or supervised delivery. Also,
CHAP can be applied to CHPS-related
issues such as construction of extra space for CHPS (emergency delivery room), gardening,
water fetching, and security guard.

See CHAP implementation process in Box 15.

Stakeholders’ Responsibilities in CHAP

District Level
The DHMT shall provide guidance and supportive supervision to the sub-district and CHPS
zone to facilitate the CHAP process.

Sub-District Level
The SDHT;
 Meet the CHO, review and discuss:
o CHPS data
o Service delivery (e.g. most common illnesses)
o Common issues (e.g. late first ANC visit)
 Identify issues to discuss with the community (e.g. emergency transportation)
 Support the CHO to prepare a presentation to the community
 The sub-district shall support facilitation of this meeting

CHPS Zone Level

The CHOs;
 Organise the durbar—set date and time with CHMC
 Invite District Assembly
 Work with CHMC to notify the Chiefs, opinion leaders, etc., of the date and time
 Inform the community what is needed (e.g. venue, beat the gong-gong, chairs)

Community-Based Health Planning and Services: Implementation Guidelines 39

At the Meeting
The CHOs;
 Make a presentation on key issues, data findings/challenges
 Facilitate the action planning process with the community
 Note the actions, persons responsible, and deadlines for each action in a CHAP
 Document the CHAP

Community Level
The CHMC;
 Supports the hosting of the meeting
 Ensures full participation especially opinion leaders and key influential persons (e.g.
teachers, pastors, herbalists, chemists, Imam, women’s groups, youth groups, welfare
groups, Unit Committee Representative, assembly members)
 Identifies an Okyeame/Linguist to facilitate the meeting
 Participates fully in the meeting
 Responsible to implement tasks assigned (e.g., tasks could be assigned to Unit
Committee)
 Supports CHAP implementation

Organising Community Durbars

Durbars are formal community gatherings for discussing issues concerning the community to
give information and build consensus on issues of importance to the community. The steps in
organising durbars are listed below:

Planning the durbar:

1. Determine the topic and set objectives
2. Conduct community entry
3. Contact community leaders
4. Brief leaders on the objectives of the durbar
5. Draw programme and assign responsibilities with community leaders
6. Arrange venue, date, and time in consultation with community leaders, taking into
consideration convenient time for participants
7. Discuss with community leaders how durbar Shall be announced, e.g. by gong-gong
beating
8. Ensure that announcement of the durbar is carried out in good time
9. If there is cancellation of the durbar, ensure that is announced in good time

Community-Based Health Planning and Services: Implementation Guidelines 40

At the Durbar
1. The health team shall be punctual to the durbar
2. Ensure that community leaders are present
3. Ensure participation of men, women, and marginalised groups
4. Inform and educate community members on the objectives of the durbar
5. Allow everybody to participate in the discussions
6. Ensure that one person talks at a time
7. Give a summary of the issues discussed and the decisions taken

Post-durbar activities:
1. Discuss outcome with community leaders
2. Write report
3. Conduct any follow-up activities

Organising Community Meetings

Steps in Organising a Meeting
1. Establish rapport
2. Outline your mission to community members
3. Ask community members for their support
4. Ensure the message is clear and devoid of unnecessary jargon
5. Encourage questions
6. Encourage effective dialogue through the use of two-way communication skills
7. Create an enabling environment for effective interpersonal relationships

Meeting Process
 Introduce self, greet in a relaxed atmosphere
 Build rapport
 Encourage and direct discussion and involve minorities
 Write minutes
 Ensure action areas are clear to all
 Agree on follow-up issues
 Summarise and evaluate the session to see if objectives have been met

Community-Based Health Planning and Services: Implementation Guidelines 41

Chapter Five: Management Responsibilities
Introduction
The organisational layout of the health sector in Ghana is a five-tier service delivery system
from the national level to the community level forming the frontline. Management
arrangements at the various levels are as described below.

National Level
The Ministry of Health (MOH) shall provide policy direction clarifying the CHPS concept,
mobilise resources, and build partnerships and inter-sectoral collaboration for the
implementation of CHPS across the country. It shall also coordinate monitoring and
evaluation.

GHS Headquarters, shall mobilise resources and provide implementation guidelines,

technical guidance, coordination, support, supervision, monitoring and evaluation, and
oversight function for CHPS implementation. The Director General is accountable for overall
success of CHPS implementation. The Divisional Directors and Programme Managers are
responsible for mainstreaming their programme areas into the CHPS implementation
framework.

The roles and responsibilities to promote and implement the CHPS policy and strategy by
each division of GHS at the national level are in Appendix H. Each division shall report
progress of CHPS in respect of the division’s mandate at Senior Managers and Performance
Review Meetings.

Regional Level
The RDHS shall advocate for Box 16: Roles of Regional Health Management Team (RHMT)
CHPS to create a better RHMT Members shall:
understanding and buy-in of 1. Plan and coordinate CHPS implementation in the region
the concept by the Regional 2. Carry out advocacy for CHPS
Coordinating Council, local 3. Mobilise resources for CHPS implementation
and foreign NGOs, and 4. Provide training and technical support to Districts
corporate bodies. She or he 5. Monitor, supervise and evaluate the implementation of
CHPS in the region
shall also mobilise external
resources to assist
communities willing to implement CHPS (see Box 16).

The RDHS is accountable for CHPS implementation in the region and may delegate
coordination of CHPS to an appropriate RHMT member, who shall coordinate, support,
supervise, monitor, and report on CHPS implementation in the districts on behalf of the
RDHS. The designated RHMT member shall also provide technical support to the districts
for effective implementation. She or he shall be oriented to perform the duties delegated.

District Level
The district is the apex service delivery point of PHC organisation and management in
Ghana. The district hospital provides support to the sub-district in various activities such as
referrals, emergencies, and trainings. Within the district, health services are organised in a

Community-Based Health Planning and Services: Implementation Guidelines 42

three-tiered hierarchy with the district level (level C) at the top, the sub-district level (level B)
in the middle, and the community level (level A) at the bottom (see Figure 2).

Figure 2: District health system

District level District Health Committee

District Health District hospital Hospital
Management Team Advisory
Hospital Management Boards
(DHMT) Team

patient referral supervision patient referral

Sub-District Level
Sub-District
Health centres in Health centres in
Health Teams
(SDHT)
... Sub-district Sub-district
...
patient referral patient referral patient referral

supervision supervision supervision

Community CHPS -1 CHPS -2 CHPS-3 CHPS -4

zones with zones with zones with zones with
community community community community
Community support support support support
Health
Committees ... systems systems systems systems
...
Source: Community-Based Health Planning and Services (CHPS). The Operational Policy GHS Policy Document
No. 20, pg. 18. 2005.

The District Health Management Team (DHMT)

The DHMT serves as the decision-making, Box 17: Roles of District Health Management
Team (DHMT)
programme development, and coordinating DHMT Members shall:
body for health services within the district. • Engage the community for dialogue on
The DHMT supports the SDHTs for CHPS CHPS with advocacy and diplomacy;
implementation and scale-up within the • Support overall CHPS programme
district. The DDHS directs the CHPS implementation in the district;
implementation process. The DDHS does • Provide guidance and technical assistance
this with the support of the DHMT (Roles of to SDHTs;
DHMT -see Box 17). • Plan and budget for CHPS programme
activities;
• Serve as liaison and organize meetings
The DDHS is accountable for between DHMT and SDHT;
implementation of CHPS in the district and • Provide essential medical supplies to SDHT;
may delegate coordination of CHPS to an • Provide supportive supervision for SDHT CHPS
appropriate member of the DHMT, who implementation activities;
shall coordinate, support, supervise, • Train the SDHT and CHOs in CHPS
monitor, and report on CHPS implementation activities; and
implementation in the sub-districts on behalf • Manage data generated by CHOs and
of the DDHS. The designated DHMT CHVs and provide feedback to SDHT.
member shall also provide technical support

Community-Based Health Planning and Services: Implementation Guidelines 43

to the sub-districts for effective CHPS implementation across the district. He or she shall be
oriented to perform the duties delegated.
The DDHS is responsible for overall
Box 18: Roles of SDHTs
management of the CHPS strategy, SDHT members shall:
providing guidance, assistance, planning and • Engage community for dialogue on CHPS
budgeting for district health service delivery with advocacy and diplomacy
activities. However, the Sub-District Head • Consult communities to set up new CHPS
has the delegated responsibility to zones
implement CHPS services in the CHPS • Explain the CHPS concept to stakeholders
zones in his/her particular sub-district. • Sensitize and mobilize the community for
CHPS
• Supervise all CHPS zones within the sub-
The Sub-District Level district catchment area
• Organize monthly zonal meetings for CHOs
The SDHT supervises CHOs and links them and other stakeholders to share best
to district-level officers. The SDHT plans practices and experiences and learn from
and budgets programme activities in its each other
CHPS zones. It manages the flow of • Manage logistics for service delivery
essential medicines and FP supplies between • Budget for CHO service delivery as well as
the DHMT and CHO/CHMCs. The CHMC general activities within the individual CHPS
zones
then distributes needed resources to the
• Collate and analyse service delivery data
CHVs to complete actual delivery. from all CHOs, CHVs, and CHMCs
• Write reports to DHMT and provide feedback
(Refer to Box 18 for the roles of SDHTs). to CHPS zones

Community Level
Box 19: Roles of the Community Leadership
CHPS service delivery targets individuals, • The community leadership shall be
families, and groups within the community responsible for the welfare of the CHOs and
for primary healthcare services. The assist in the selection of the CHMC and
community has a critical role in ensuring CHVs.
that the CHPS zone operates effectively and • They shall assist in the organization of
community health durbars and CHMC
efficiently.
meetings.
• They shall assist the CHOs, CHVs, and CHMC
(Refer to Box 19 for the roles of the in the preparation of the CHAP.
community leadership).

Roles of Metropolitan, Municipal, Box 20: Roles of the MMDA

• Assist communities that cannot provide
District Assemblies (MMDA) and CHPS compounds to construct and maintain
Community CHPS compounds
• Provide utility services such as safe water
MMDAs and electricity to the compound

The MMDAs have key roles to play in the • Assist in providing security to the CHPS
compound and the CHO
implementation of CHPS (Box 20) and their
• Support to maintain the volunteer system
level of participation would depend on how
• Mobilize other resources to support CHPS
effectively the DDHS can engage with them. activities
Through this engagement, CHPS • Monitor the CHPS implementation in the
implementation roll-out can be accelerated district
in the district. To facilitate the active • Sponsor staff for training
involvement of the local government and
simplify the engagement process, CHPS zones have been redefined to be coterminous with
the electoral areas whenever possible. In this way, the assembly members can lobby the

Community-Based Health Planning and Services: Implementation Guidelines 44

District Assemblies on behalf of their communities to place health on their development
agenda.
Members of Parliament (MPs)
MPs represent constituencies within the
Box 21: Roles of Members of Parliament
districts and are the links between the • Construction and renting of CHPS
national parliament and the DA. They compounds
advocate for the needs of the electorates in • Equipping CHPS compounds
parliament. MPs’ common fund for health is • Funds for training
used to undertake activities in the area of • Provision of sanitation facilities for
health. community members
• Provision of incentives for CHOs and CHVs
(Refer to Box 21 for roles of MPs) • Any other health needs of the CHPS zone

Traditional Authority
Traditional authorities have the power and
Box 22: Roles of the Traditional Authority
authority based on customs and traditions to • Mobilize community members for the
make legitimate decisions in their traditional formation of the CHMC;
area of jurisdiction. • Manage and resolve conflict within the
community;
(Refer to Box 22 for roles of Traditional • Sit on various committees as advisors;
Authority). • Release land for development and resolve
land disputes;
• Serve as knowledgeable people for
Unit Committees consultation on affairs concerning the
community.
Each electoral area has one Unit Committee
with five members, all elected. A unit is
normally a settlement or a group of settlements with a population of between 500 and 1,000
in the rural areas, and a higher population (1,500) for the urban areas. Unit Committees,
being in close touch with the people, play the important roles of education, organisation of
communal labour, revenue-raising for and ensuring environmental cleanliness, registration of
births and deaths, and implementation and monitoring of self-help projects, among others.
They work in close collaboration with the assembly members. Given their official role within
the local government structure, they can form the nucleus of the CHMC for the CHPS zone.

Other District Development Partners

Development organisations have become essential partners in local level development. They
marshal support for social and health development projects. They provide support for CHPS
Community Health Compound construction and implementation activities.

Identifying the development partners, NGOs, CBOs, etc in the district and CHPS zones and
effectively collaborating with them can enhance CHPS implementation and scale up in the
district.

Chapter Six: Resource Management

Introduction

Community-Based Health Planning and Services: Implementation Guidelines 45

Different resources are required at different stages for the effective and efficient
implementation of CHPS. CHPS implementation requires human, financial, and logistical
resources. A combination of these resources is necessary for effective functioning of CHPS.
This chapter therefore provides in-depth understanding of how these resources can be
managed for the successful implementation of CHPS across the country.

Human Resource Management

This section covers the establishment of a CHN grading system, CHO staff requirements in a
CHPS zone, preparation for deployment of CHOs, internship for CHOs, and the duration of
stay of CHOs in a CHPS zone as well as their incentive package. CHVs’ requirements, their
training, and incentive package in a CHPS zone are also covered.

Establishment of CHN Grading System

The Human Resource Directorate (HRD) of the GHS shall take immediate steps to establish a
CHN grading system within the GHS for the purpose of providing career progression towards
a certificate, diploma, or any higher class of the CHN cadre. Any CHN acquiring a
professional nursing grade or a degree-level qualification shall migrate onto the new
promotional grade categories. The HRD shall also develop schemes and conditions of service
that shall make the CHN category attractive.

CHO Requirement
A CHPS zone of population up to 5,000 or 750 households shall have up to three CHOs of
appropriate staff mix based on types of services needed and staff availability. Where
population density is high, as in urban or peri-urban areas, and the geographical area is small,
additional CHOs may be added to a CHPS zone without necessarily establishing additional
zones. A higher level of training shall not preclude the person from becoming a CHO.

Preparation for Deployment of CHOs

There are currently enough CHNs and other health workers trained within the GHS for CHPS
implementation. However, the majority are not deployed into the CHPS zones.
The challenge now is how to deploy these human resources into the communities to provide
PHC using the CHPS strategy. To meet this challenge, GHS shall do the following:
 Re-orient all staff at management levels (national to sub-district) to the vital role of
the CHPS strategy in the delivery of PHC services in Ghana through a series of
workshops and study tours of exemplary good and promising CHPS zones
 Create awareness and understanding of the CHPS concept and how to implement and
sustain the dialogue on CHPS among the current pool of DDHSs, decision makers,
and all health workers
 Mobilise and engage District Assemblies of the Local Government, Chiefs, and
Elders to appreciate the concept and the benefits of the CHPS service delivery
strategy
 Re-orient trained CHOs on community service delivery
 Systematically deploy CHOs into mobilised and sensitised communities to implement
service delivery with the CHPS strategy
 Monitor and evaluate CHPS roll-out strategy

Community-Based Health Planning and Services: Implementation Guidelines 46

Internship of Trainees of Health Training Institutions
 The Heads of Training Institutions whose training of graduants does not include the
CHO Training Curriculum shall in collaboration with RDHS ensure that their trainees
before graduation undergo a 2-week refresher course on the contents of The CHO
Training Manual Volumes 1, 2 & 3. Thereafter, they shall undergo a mandatory 3-
month structured attachment to a completed CHPS zone of reputed good practice † to
understudy a senior CHO before they complete their programmes. The newly
recruited CHOs shall be oriented for 5 days by RHMT/DHMT before they are posted
to work in CHPS zones. The orientation shall be based on the must-do-modules in
CHO Training Manual Volume 1 with emphasis on field practice both in the CHPS
compound for clinical experience and in outreach and home visits for public health
experience in the CHPS zone.
 In the event that CHO Training Curriculum is fully mainstreamed in the school
curricula of CHN and other Health Worker Training Schools i.e. the CHO Training
Manual Volumes 1, 2,& 3 as part of the training and mandatory 3-month structured
internship completed, the newly recruited CHOs shall be oriented for 5 days by
RHMT/DHMT before they are posted to work in CHPS zones. The orientation shall
be based on the must-do-modules in CHO Training Manual Volume 1 with emphasis
on field practice both in the CHPS compound for clinical experience and in outreach
and home visits for public health experience in the CHPS zone.

Duration of CHO Stay in a Community

The CHO shall remain and work in a community for not less than 3 years after which he/she
shall be eligible for transfer. The CHO in his/her last year shall impart his/her experience and
skills in the field by coaching and mentoring newly recruited CHNs/CHOs and trainees.

Team Approach to Service Delivery and Headship of CHPS Zones

The new CHPS policy outlines that CHPS zones shall be staffed with up to 3 CHOs. In
reality, these three staff members are usually a mix of ENs, CHNs, and midwives. In this
multi-disciplinary team, it is important that one person be selected by the DHMT/SDHT as
the leader of the CHPS team, who must be well oriented in CHPS. There should be both
flexibility and teamwork while rendering daily services and the responsibilities must be
clearly outlined and delegated.

Incentives for CHOs

The Human Resource Directorate of GHS, in collaboration with key stakeholders, shall
develop and institute an appropriate incentive scheme to reward CHOs depending on
performance, duration of stay, and category of deprivation of the CHPS zone. The incentive
scheme shall recognise staff opting to serve in deprived areas.

Volunteers for CHPS Zone

Volunteers shall continue to be an integral part of each CHPS zone’s service delivery. There
are two types of volunteers for CHPS. They are CHVs and members of the CHMC.

†Where a CHO has had a minimum of 3 years’ working experience in the community and has a well-rehearsed and
satisfactory set of service delivery routines in the CHPS zone.

Community-Based Health Planning and Services: Implementation Guidelines 47

Volunteer Requirement
Each CHPS zone shall have at least two CHVs selected by the community. CHVs shall be
provided with a one (1) week orientation in community health mobilisation, with particular
emphasis on FP, RH, diagnose & management of minor ailments. The initial training shall be
done using a manual for training CHPS zone CHVs. However the Youth Employment
Agency (YEA) Community Health Worker (CHW) program aimed at supporting CHPS
implementation shall undergo 6 weeks training to work under the supervision of the CHO in
the CHPS zone.

In-service or refresher training is very important to keep the CHVs abreast with their
responsibilities. These training sessions shall be organised by the DHDs in collaboration with
the various sub-districts and regional teams. The CHMCs shall also be trained by DHDs in
collaboration with the various sub-districts using the manual for Training Community Health
Management Committee to enable the CHMC to facilitate the work of the CHO. This will
enable CHMC members to understand the concept of CHPS and the roles they are expected
to play in its implementation.

Maintaining Volunteer Engagement and Motivation

Sustaining volunteerism in health service delivery requires efforts from all health
stakeholders—including the volunteers themselves and community members—and
collaboration between the health directorates at all levels, the District Assembly, and
community leadership. Another way to sustain volunteerism is to ensure community
ownership from the beginning and for DHMTs/SDHTs to be at the centre of interactions to
enhance loyalty by volunteers and community members.

CHVs’ incentives shall reflect the context: workload, opportunity costs, and the environment
in which they work. Consistent incentives, whether for salary, allowances, or per diem
payments, can help encourage accountability, commitment, motivation, and in many cases,
can facilitate an uninterrupted provision of health services.

Non-financial incentives shall be included as essential components of any community health

programme, including paid and volunteer programmes. Such incentives, including regular
training, supervision, public recognition, and opportunities for advancement and professional
development, improve the capacity of CHVs and ensure high-quality service provision.
SDHTs shall make budgetary allocations for provision of appropriate logistics, including
raincoats, wellington boots, torch light, ID cards, and certificates for CHVs. ID cards and
certificates are important because they differentiate CHVs from their community peers,
indicating that the CHVs hold a special role in their communities and Shall be acknowledged
for their hard work. The community, together with the DHMT, shall put together a
package/token as a way of motivating the volunteers. Another important motivation for
volunteers are frequent visits by DHMT members or Regional Health staff to supervise their
work and help resolve their challenges. Awards can also be given to reward deserving
volunteers and to encourage other volunteers to continue their hard work.

The Policy, Planning, Monitoring and Evaluation Division (PPME) of GHS shall harmonise
incentives, trainings, reporting, and supervision among national programmes and donors
supporting CHV programmes to reduce duplicative costs, improve capacity and use of
services, and limit frustration related to inconsistent incentives.

Financial Management

Community-Based Health Planning and Services: Implementation Guidelines 48

Resources in the form of money, salaries, infrastructure, equipment, and medical supplies are
required for service delivery and other operations such as home visits, treatment of minor
ailments, outreaches, CHMC meetings, community health durbars, and maintenance of
buildings, equipment, and motorbikes. The CHO in charge of the CHPS zone shall manage
funds sent to the zone and report appropriately to the Sub-District Head.

Sources of Funds
Sources of funds for PHC at the CHPS zone shall come from:
 Government of Ghana
 Community members
 Donor agencies
 Community-based organisations
 District Assemblies
 Civil society organisations
 Internally generated funds

MOH and the GHS shall lead the advocacy for mobilising resources for infrastructure, major
equipment, and funds for preventive health care for the effective implementation of CHPS.
GHS shall work closely with stakeholders to coordinate, leverage, and make efficient use of
available pools of resources for CHPS implementation.

Financial management at the community level by the CHO shall be in line with standard
public financial management (PFM) procedures adopted by the Government of Ghana. PFM
covers the following areas: planning and budgeting, budget execution, accounting, reporting,
procurement and supplies management, and auditing (internal and external audit). The
volume of activities under these areas varies with the value and scale of operations. As such,
this guideline covers relevant aspects of the PFM process which are in tune with the scale of
operations at the CHPS level.

Community-Based Health Planning and Services: Implementation Guidelines 49

Work Plans and Budgets
CHPS zones shall prepare annual work plans and budgets for the ensuing year and submit to
the sub-district to be ultimately included in the consolidated sub-district budget. The work
plans and budgets must be prepared in line with budgeting guidelines communicated to the
sub-district. The work plans and budgets shall cover the following activities: management of
minor ailments, quarterly review meetings, supervision of volunteers, community durbars,
maintenance (building, equipment, and motorbikes), outreaches/growth promotion, home
visits, and school health and community mobilisation. The work plans and budgets take into
consideration potential local resources from the DA, clients, community members, and other
stakeholders. The capacity of CHOs must be developed to promote the production of sound
and attainable plans and budgets. These budgets shall form part of the sub-district annual
approved budget.

Budget Execution
The budget shall be executed in line with the quarterly action plans submitted. Such action
plans must conform to the approved work plans and budgets.

The CHO in-charge of the CHPS zone shall make monthly requests for funds to the Sub-
District Head to execute the action plans. Timelines for submitting returns to retire previous
imprest releases shall be strictly followed.

Bank Accounts
Bank accounts shall be opened by the District/Sub-District in the name of the CHPS zone.
Such accounts shall be used to manage the funds of the CHPS zones by way of receipts and
disbursements or releases to the zones for their operational activities. Two bank accounts—an
internally generated funds (IGF) services account and an IGF medicines account—shall be
opened for each CHPS zone.

Where the sub-district is endowed with a good complement of staff including an Accountant,
the signatories to the CHPS accounts shall be the Sub-District Head, the CHO, and the Sub-
District Accountant. However, where there is no Accountant at the sub-district, then the
DDHS, the District Accountant, and the CHO shall be signatories to the accounts. The
District/Sub-District Accountant shall keep custody of the value books pertaining to the
account, including cheque books, and shall conduct all bank transactions pertaining to the
account on behalf of the CHPS zone.

Financial Transactions
Funds released from the district/sub-district to the CHPS zones for operations shall be treated
as imprest to the CHPS zone. These operations include management of minor ailments,
quarterly review meetings, supervision of volunteers, community durbars, outreaches/growth
promotion, home visits, school health and community mobilisation. Imprest shall be retired
within set timelines where such timelines exist for specific activities. Generally, these
timelines shall not exceed one month. IGF received for service at the CHPS zone shall be
lodged into the relevant CHPS account for utilisation by the CHPS zone. IGF shall be used to
replenish medicines, non-medical consumables, and other operations for service delivery.
The capacity of the CHOs shall be built to enhance their compliance with and understanding
of basic accounting and the maintenance of basic account records.

Community-Based Health Planning and Services: Implementation Guidelines 50

To execute a transaction (either imprest recoupment or other transactions), the following
basic procedure shall be followed:
 Request from the CHO through the Sub-District Head to the District Director of
Health Services or request from the CHO to the Sub-District Head for approval where
the sub-district has an Accountant
 Approval by the District Director or the Sub-District Head, as the case may be
 Accountant prepares voucher with relevant documentation
 Voucher is approved by the District Director of Health Services/Sub-District Head, as
the case may be
 Cheque is written by the Accountant

Cheque is signed by:

o The District Director of Health Services and Accountant and the CHO or
o The Sub-District Head and Accountant and the CHO where the sub-district
has an Accountant
 Payment is then effected by the Accountant either to a supplier or to the recipient
 CHO shall manage the imprest as explained above

Recording and Accounting

The CHPS zones shall keep basic books of account for imprest received from the sub-district.
This shall include a petty cash book or an analysis cash book to track the imprest. The CHPS
zone shall also keep proper records and custody of relevant supporting documents on
transactions to facilitate the retirements. Supporting documents may include honour
certificates (where appropriate) and relevant receipts. Accounts officers at the sub-district
shall support the CHPS zone to ensure the latter adheres to these guidelines.

Basic records on revenue from service shall also be kept to track and account for revenues
and expenditures of the CHPS zones. Such records shall include basic expenditure and
revenue ledgers to capture cash as well as deferred payment revenues (national health
insurance). In instances where cash is received for services, such amounts shall be paid in
gross into the relevant bank account or sent to the sub-district/district, as the case may be, on
a weekly basis at most. Expenditures shall not be made out of cash receipts. Accounts
officers at the sub-district shall support the CHPS zones to ensure the latter adheres to these
guidelines.

Financial Reporting
On a monthly basis, the CHPS zones shall summarise the transactions for the month and
submit to the sub-district for compilation to the district. Accounts officers at the sub-district
shall support the CHPS zones to ensure the latter adheres to these guidelines. Details of the
procedures covering these guidelines can be obtained from the Accounting Treasury and
Financial Rules and Instructions.

Community-Based Health Planning and Services: Implementation Guidelines 51

Logistics Management
“Logistics”, as used in this document, refers to the basic tools required for effective
operations at the CHPS zones. Such tools shall usually include vaccines, vaccine carriers,
commodities, registers, fuel, and many other apparatuses required for effective service
delivery at the CHPS zones.

Logistic Requirements
The annual CHPS work plans and budgets shall capture the needed logistics for the
management of minor ailments, quarterly review meetings, supervision of volunteers,
community durbars, outreaches/growth promotion, home visits, and school health and
community mobilisation. Adequate supply of logistics shall be provided to enable the CHPS
zone to execute their quarterly action plans. Such action plans must conform to the approved
work plans.

The CHO in charge of the CHPS zone shall make requests for logistics to the Sub-District
Head to facilitate service delivery as and when necessary. Logistics shall be properly
received into store, properly stored under good and secure conditions, and issued
appropriately for utilisation on service operations. Equipment and motor bikes shall be
regularly maintained and stored according to standard guidelines for the maintenance and
storage of same.

Recording of Logistics
The CHPS zones shall keep basic records to take account of all logistics. Such records shall
enable the tracking of the logistics from requisition through receipt to utilisation or disposal.
For assets, an assets register shall be kept to capture and track all assets in the CHPS zone.

Reporting on Logistics
On an annual basis, the CHPS zones shall prepare a report on logistics and assets and submit
to the sub-district. Details of the procedures covering these guidelines can be obtained from
the Accounting Treasury and Financial Rules and Instructions and other relevant policy
documents.

Logistics Audit
Audit operations shall be carried out periodically in line with audit guidelines of both the
Internal Audit Division of the GHS or the Ghana Audit Service to provide assurance to
relevant stakeholders and higher-level managers of the effective use of resources at CHPS
zones.

Infrastructure Management
Infrastructure as used in this guideline refers to the CHPS compound. CHPS compounds play
a critical role in CHPS implementation by serving as a residence for the CHOs and also as a
service delivery point from which CHOs reach out to the community and from which
community members can also obtain early diagnosis and treatment of common ailments and
timely referral of serious cases. Each level of GHS has a role to play in the planning, design,
construction, and management of CHPS compounds.

Community-Based Health Planning and Services: Implementation Guidelines 52

National Level
Design and Construction of CHPS
Box 23: The Estate Management Department
Compounds (EMD) of GHS shall:
A national standard design for CHPS • Promote the use of the approved standard
compounds has been approved by MOH. The design and monitor and ensure that all new
construction of CHPS compounds across the
aim of the standard design is to establish country conforms to the requirements of the
standards and specifications for CHPS approved prototype
compounds. It is also to provide the basis for • Monitor and ensure accessibility compliance
determining not only the cost of constructing for persons with disabilities
CHPS compounds, but the quality of • Develop cost regimes for the approved
construction as well. CHPS compound design options.
• Lay out design for CHPS compounds with
 The approved standard design for a cost estimates.
CHPS compound is provided in • Provide technical support and advice to
Appendix I. GHS and other institutions for construction of
CHPS compounds and procurement
 The MOH shall, in collaboration with procedures that are consistent with National
GHS, revise the design from time to Procurement Law.
time to reflect the changing needs of • Facilitate the development of annual
service delivery. budget and capital plans for CHPS
infrastructure.
 All new construction of CHPS • Build and update a comprehensive facility
compounds shall be done in database on CHPS compounds as part of
accordance with the approved standard the national facility health inventory.
designs of MOH and requirements of • Build and update a comprehensive
database on all civil work on CHPS
the Estate Management Department compounds in the regions.
(EMD) of GHS (refer to Box 23 for
• Monitor and provide updates on progress
the roles of EMD). and status of all GHS civil work/contracts on
CHPS compounds as well as CHPS
 The construction shall also be in compounds being constructed for GHS by
accordance with the relevant national other organisations.
and local government laws. • Create and update case files with site plans,
land title documents, building permits, and
 In the case of ongoing construction of building designs for each CHPS compound
CHPS compounds, they shall be across the country. This shall help create a
completed with their planned design or land inventory database for CHPS
modified to the new design, except compounds and also help identify the status
of the ownership of the land as well as the
that the cost due to the modifications size of the land on which each CHPS
shall not be more than 15% of the compound is built.
suggested cost of construction of the • Ensure the standard design for CHPS
new prototype. compound meets the specific needs of both
sexes
 Where a community has provided a
temporary structure to serve as the CHPS compound, this shall be replaced in due
course with the standard approved design.
 Where maternity services have been approved for a particular CHPS compound, a
separate maternity facility co-located within the CHPS compound shall be constructed
based on the approved standard design.

Community-Based Health Planning and Services: Implementation Guidelines 53

Regional Level
The RHDs shall monitor and ensure that the construction of new CHPS compounds in their
regions conform to the requirements of the approved standard design. The roles of the Estate
Unit of RHD are as shown in Box 24.

District and Sub-District Levels

Box 24: The Estate Unit of RHD shall:
Planning for Construction of New • Provide technical support and advice in the
CHPS Compound construction of CHPS compounds in the
region
The DHMT shall:
• Build and update a comprehensive
 In collaboration with the District database on existing CHPS compounds and
Assembly, develop a master physical all civil work on CHPS infrastructure in the
region
development plan and a prioritised list
• Collect and update geographical
for CHPS compounds as part of the coordinates for mapping purposes
District Health Strategic Development • Monitor and provide updates on progress
Plan. The plan and list shall be based on and status of all GHS civil works/contracts on
needs assessment, engagement with CHPS compounds as well as CHPS
community leaders, and broad compounds being constructed for GHS by
other organisations in the region
consensus-building with all stakeholders
• Create and update land case files with site
including the MP. plans, land title documents, building permits,
 Plan an initial meeting to discuss and building designs for each CHPS
compound in the region
construction of a new CHPS compound
with all the community leaders residing Box 25
in the CHPS zone. This is done during • As a condition for the construction of the
CHPS compound, the DHMT in collaboration
the dialogue meeting with the chief and with the District Assembly shall ensure that all
elders and, subsequently, during the issues with acquisition of the land for the
community sensitisation durbar. compound are resolved before actual
construction work begins.
 Ensure that land for the construction of • The land shall have proper ownership title
the CHPS compound is properly and shall be litigation free. (Unsolved
acquired and the site selected is in the problems of ownership can constrain full
proper area for the intended use. The utilization of the site and therefore sites with
ownership problems shall not be used.)
location of the CHPS compound shall be
• The DHMT shall actively collaborate with the
such that it should be readily accessible District Assembly to facilitate the smooth
to the community. acquisition of the land including processing
and obtaining legal title (site plan, land title
documents, and building permits).
 Obtain the approved standard designs • The land documents shall include site plans,
from the RHD or EMD (GHS land title documents, designs, and building
Headquarters) and monitor and ensure permits.
that the construction of • The site Shall be checked for possible
CHPS compounds conforms to the constraints to its use: size, topography,
drainage, soil conditions, natural features
requirements of the approved standard and limitations, catchment area to be
designs. served, social acceptability, convenience to
the community and the CHOs, etc.
 Obtain relevant building permits and • The site Shall be free from dangers of
approval from the appropriate flooding as well as pollution of any kind,
departments in the assemblies, as • Including air, noise, water, and land
pollution.
required.

Community-Based Health Planning and Services: Implementation Guidelines 54

Land Acquisition for Construction of CHPS Compounds
 Acquiring land for construction of the CHPS compound and protecting land
boundaries from future encroachment shall be taken more seriously by all
stakeholders.
 The land for the construction of CHPS compounds shall be provided by the host
community as a freehold with appropriate documentation sealed at the land title
registry.
 The government, on receipt of the land, shall have a right to vest in a third party for
the sole purpose of achieving the objective of establishing a CHPS compound.

(Refer to Box 25 for the roles of the DHMT on CHPS compound construction).

Transfer of Ownership of CHPS Compounds

Where a CHPS compound is constructed by a private individual or organisation as their
contribution to the health of the community, the ownership of the structure shall be
transferred with proper documentation to the GHS. The Regional or District Estate Unit and
representatives from the RHD, DHMT, SDHT, District Assembly, and the community shall
be actively involved in the transfer of the ownership of the structure.

CHPS Facility Database at the District

The DHMT shall build and update comprehensive health facility data on existing CHPS
compounds as well as all ongoing civil work on CHPS compounds in the district.
Community Participation in the Planning and Construction of CHPS
Compounds
The DHMT and SDHT shall collaborate and dialogue actively with the community on the
planning and construction of the CHPS compound. This will help to get the broader
community fully involved in the construction of the CHPS compound

(Refer to Boxes 26, 27 and 28 on the DHMT roles in involving the communities in planning
and construction of CHPS compounds).

Box 26
The DHMT and SDHT shall:
• Hold a durbar with the community to inform them of the work that is going to happen and allow
them to discuss and express their concerns.
• Present the design and cost of the construction and its appropriateness to the community
members during the durbar.
• Harness the potential of the communities to support the construction of the CHPS compound.
The community can directly support the construction of the CHPS compound in several ways,
including the following:
− Provision of land
− Provision of materials
− Human resources (communal labour, contractor, labourers to the contractor, etc.)
− Funding (payment of cash for land, labour, materials, etc.)
− Voices for political advocacy

Community-Based Health Planning and Services: Implementation Guidelines 55

 Box 27
To also maintain the trust and relationship with the community, the DHMT/SDHT shall:
• Involve the community leaders in the site meetings. Hold periodic meetings (durbars) with the
broader community members to present progress on the work and allow the committee
members to discuss any problem areas.
• Organise periodic site visits for the community members to show them the rationale behind
doing a piece of work a certain way, or discuss ways in which the infrastructure can be altered
to suit technical and user criteria.

The use of local people either as labourers, supervisors, technicians, or monitors can cut
project cost as well as present an excellent opportunity to allow the local communities to
physically participate in the construction of the CHPS compound. The local people may not
have high levels of technical knowledge, but they have knowledge of the local area and the
problems they face.

Box 28
To increase community responsibility and participation, the DHMT/SDHT shall:
• Make use of local contractors (petty contractors) in the construction of the CHPS compounds.
• Where local people do not have the requisite skills, they can be employed as unskilled labour to
support contractors from outside the community.

Maintenance of CHPS Compounds

“Maintenance” here refers to work undertaken in order to restore premises, buildings,
facilities, and their contents to a good state of repair and efficient working order and to an
agreed acceptable standard. The presence and strong role of the DA, NGOs, churches,
traditional leaders, and community-based organisations at the community level offer
immense opportunities which the DHMT/SDHT and the staff of CHPS compounds can
exploit to facilitate the maintenance activities at the CHPS compound (see Box 29).

Box 29
The DHMT/SDHT shall:
• Put in place an effective maintenance programme to prevent untimely breakdown of buildings
and equipment. The CHPS compound building and equipment shall be kept in a state of good
repair.
• Monitor and ensure proper cleaning and upkeep of the CHPS compounds. This shall focus on
maintaining a healthy and aesthetic environment for the personnel, clients, and the community.
• Put in place security measures to ensure adequate physical security and safeguarding of assets,
including protection of patients and staff from assault or loss of property.
• Forge active collaborative links with other relevant stakeholders such as the Department of
Environmental Health, Department of Community Development, the Community and Water
Sanitation, and MP to facilitate the implementation of maintenance activities at the CHPS
compound.
• Set imprest specifically for the preventive maintenance and also show commitment by releasing
all approved funds for preventive maintenance at the CHPS compound.
• Ensure the District Estate Officer/Manager periodically visits the CHPS compounds to undertake
monitoring and facilitative supervision of preventive maintenance activities at the facilities.
• Make use of local artisans (masons, carpenters, painters, plumbers, etc.) in carrying out
maintenance activities at the CHPS compound.

Maintenance and repairs of CHPS facilities shall be taken into account in the construction of
CHPS compounds. Technology shall be chosen taking into account local capacities for

Community-Based Health Planning and Services: Implementation Guidelines 56

maintenance and repair. Maintenance and repairs of CHPS facilities including equipment,
water supplies, and health-care-waste facilities shall be planned and adequately budgeted for.
The role of CHOs working with the CHMC is as shown in Box 30.

Box 30
The staff of the CHPS compounds, through the CHMC, shall:
• Collaborate and dialogue actively with the communities on the maintenance and development
at the CHPS compound.
• Establish good relationships and have regular interaction with the community leaders, churches,
and other organizations as a means of whipping up their interest in supporting maintenance
activities at the CHPS compound and providing equipment and other logistics to support service
delivery. Support can be in the form of periodic communal labour for maintenance of the
grounds, donation of cleaning materials, painting of the building, clean-up exercises, etc.

Documentation on Planned Preventive Maintenance (PPM) Activities

CHPS compounds shall have records on the maintenance work performed, date, materials
used, names of artisans who carried out the maintenance, and reasons the maintenance or
repairs were done. This helps in decisions as to whether to continue to repair or replace the
items with new ones as well as whether to continue to buy the same materials for the repairs.

Asset Register
Assets include such items as medical
Box 31
equipment, office equipment, The District Estate Officer/Manager shall provide
maintenance equipment, technical support to the CHOs to maintain an
telecommunications equipment, updated asset register for all assets of the CHPS
compound.
kitchenware, furniture and fittings, and
residential items. The responsibility of
the District Estate Officer/Manager is
stated in Box 31.

Comfort Logistics
The DHMT shall ensure that accommodation (new, rented, or renovated) and consumer
durables such as beds, furniture, TV, radio, and kitchenware are provided as comfort logistics
at the CHPS compounds.

In urban areas where CHPS activities may be provided from an existing facility, such as a
health centre or hospital, accommodation may be provided to the CHOs if no accommodation
already exists for the CHOs.

Utilities
The DHMT shall ensure that electricity, water, and a communication system are available at
the CHPS compounds. If the facility is not connected to the national grid, generators or solar
panels shall be provided to provide power. Radio communication lines shall be established
where there is no communication system.

Community-Based Health Planning and Services: Implementation Guidelines 57

Water, Sanitation, and Hygiene
Water, sanitation, and hygiene are critical in the provision of basic healthcare at the CHPS
compounds. The lack of these basic services has the potential to cause infections and diseases
in clients, staff, and the community as a whole. Adequate water, sanitation, and hygiene
services shall therefore be provided at the CHPS compound to prevent or minimise the risk of
infections and water-borne diseases in staff, clients, and the community. The compounds
shall have indoor plumbing for water supply, with sinks and taps at all workstations and flush
toilets available to staff and patients. The facilities are expected to be well maintained and
clean at all times to ensure healthcare-transmitted infections are totally controlled or
contained. See Boxes 32–35.

Box 32: Water

• The CHPS compound shall use the approved public water supply system whenever available. If
not, boreholes with water pumps shall be provided and the water must be potable and
adequate in amount.
• The water must meet the water quality standards for Ghana as described in the Ghana
Standards Authority (GSA) Water Quality Standards.
• Water must be available within treatment rooms and at workstations.
• Delivery rooms must be supplied with water.
• Rain harvesting systems shall be incorporated in the roofing of the CHPS compound.

Box 33: Sanitation

• Toilet must be on-site
• Separate toilets Shall be provided for staff and patients
• Toilets must be accessible to all categories of users including males, females, children, and
people living with disabilities
• The toilet area Shall provide privacy during use, especially for women
• Toilets Shall be regularly maintained and clean to ensure there is a hygienic environment in and
around the toilet at all times
• The management of excreta and disposal of sludge/wastewater Shall be done in a manner
prescribed by the relevant local authority and/or Shall not pollute the environment

Box 34: Hygiene

• Hygiene promotion shall be carried out by DHMT and SDHT at all times for the staff at the CHPS
compounds, with a focus on infection control, hand washing, and correct use of toilet facilities
• Water points with soap or alcohol-based hand rub shall be provided in all treatment areas,
waiting rooms, and near toilets for clients and staff
• Where water storage is provided, the containers shall be kept clean and hygienic at all times
• Provision shall be made for proper and hygienic disposal of different categories of waste

Box 35: Waste Disposal

• Liquid, solid, and other waste (infectious and hazardous wastes including sharps) shall be
disposed of in accordance with GHS Guidelines on Health Waste Management and Infection
Prevention and Control (IPC)
• Staff at the CHPS Compounds shall be encouraged to practice source separation of wastes
• Special containers shall be provided for sharps
• Where incinerators are provided, operations Shall be carried out in accordance with the design
and operational specifications
• All efforts shall be made to avoid the release of pollutants from incinerators into the atmosphere
as these can create health complications when inhaled

Community-Based Health Planning and Services: Implementation Guidelines 58

Fire Safety
In line with fire safety regulations, the DHMT shall ensure that:
 Fire extinguishers are installed and are easily visible and accessible in strategic areas
of the CHPS compounds in the district
 Fire risk assessment is periodically carried out in the CHPS compounds in the district
and actions taken to implement recommendation of the assessment
 The CHOs are periodically trained in fire safety procedures

Signage
 There shall be adequate directional signs to CHPS compounds
 The signs and labels shall be visible, clear, and appropriately sited

Equipment Management
The availability of the requisite equipment in its required numbers and working condition
plays an important role in CHPS implementation. Such equipment may include, but is not
limited to, delivery sets, BP apparatus, thermometers, weighing scales, and vacuum
extractors.

Equipment List for CHPS

The list of necessary equipment required for service delivery by the CHO and CHV is in
Appendix F.

Equipment Inventory
 Equipment inventory shall be maintained by CHOs for all equipment in their care at
the CHPS compounds.
 All relevant information about the equipment must be entered, including date of
receipt, name of equipment, manufacturer, serial number, its location, and records of
repair and maintenance.
 The DHD shall, as part of their monitoring to the CHPS compound, check to ensure
that equipment inventories are maintained by the CHOs.

Planned Preventive Maintenance of Equipment

Planned preventive maintenance is regular,
repetitive work done to keep equipment in Box 36
• The CHOs shall undertake routine planned
good working order and to optimise its preventive maintenance of equipment in
efficiency and accuracy. This activity involves their care.
regular, routine cleaning, lubricating, testing, • Technical repairs, which are the
calibrating, and adjusting; checking for wear responsibility of the equipment
and tear; and eventually replacing components technicians, shall be scheduled on a
periodic basis.
to avoid breakdown. Roles of various
• The SDHT shall liaise with DHD to ensure
stakeholders are stated in Box 36. that the equipment technicians visit the
CHPS compounds to undertake technical
repairs of equipment.

Community-Based Health Planning and Services: Implementation Guidelines 59

Equipment User Training
It is important that the users (CHOs) are trained on the safe and proper use and maintenance
of equipment given to them. The sub-district shall therefore liaise with DHD to organise
periodic user training of equipment to CHOs at the CHPS zones.

Transport Management
An effective and reliable means of transport is very critical for the work of the CHO and
therefore very important in CHPS implementation.

Type of Transport Box 37

The means of transport outlined in Box 37 shall be • Motorbikes for the CHOs
provided as a minimum requirement to all CHPS • Bicycles for the CHVs in each community
zones to make them mobile and fully operational. within the zone
• Where necessary, tricycles, tiller
ambulances, motorboats, and tractor
The acquisition, use, maintenance, and repairs of ambulances shall be provided
motorbikes and other transport for CHPS activities
shall be done in accordance with GHS Transport
Policy and Operational Guidelines.
The specification for procurement of motorbikes
shall take into account the varying needs of the
riders, particularly with regard to gender
considerations.

Operating Motorbikes
 The DHD shall ensure motorbike riders at the CHPS zones have the knowledge, skills,
and training necessary to operate a motorbike safely, or are closely supervised until they
are assessed as competent.
 The DHD shall liaise with RHD to
Box 38
provide riders with the training and Motorbike riders shall:
supervision they need to operate the • Conduct a pre-operation check before riding
bikes safely. • Wear a helmet at all times the bike is being
ridden
 The DHD shall provide safety
information relevant to motorbike use to • Ensure the bike is in reliable working condition
by undertaking routine cleaning and
GHS staff before allowing them to lubricating, conducting regular maintenance
operate GHS motorbikes. checks, and taking remedial action where
shortcomings are found
 The Sub-District shall ensure fuel is
• Put security measures in place to control
provided at all times to facilitate access to the bike and keys when the
movement of CHOs to the communities motorbike is not in use
for outreach services.
 Responsibilities of the motorbike riders
are in Box 38.

Community-Based Health Planning and Services: Implementation Guidelines 60

Records on Transport
 All relevant information about the motorbikes including date of receipt, registration
number, make, manufacture date, and records of repair and maintenance must be
maintained by CHOs.

Use of Personal Motorbikes for Official Duties

 CHOs may use their personal motorbikes to undertake CHPS activities including
outreach services.
 CHOs who use their motorbikes for official work shall be reimbursed for fuel and
maintenance. However, this must be authorised by the Sub-District Head or
Designated Officer.
 The fuel use shall be refunded according to the prevailing government rate or the rate
established by GHS.

Community-Based Health Planning and Services: Implementation Guidelines 61

Chapter Seven: Supervision
Introduction
Supervision is a mainstreamed integral component of program management. This chapter
describes the concept of facilitative supervision (FSV); structure to be put in place to support
FSV; areas, performance standard, and tools for FSV; and steps in conducting FSV.

Concept of Facilitative Supervision

Facilitative supervision (FSV) is a system of management whereby supervisors at all levels in
an institution focus on the needs of the staff they oversee. This approach emphasises
monitoring, joint problem-solving, and two-way communication to strengthen the learning
process between the supervisor and those being supervised.

The overall objective of FSV is improvement of DHMT performance. The specific objectives
are to:
 Find out challenges of DHMT performance.
 Strengthen problem-solving capacity at all levels.
 Assess training needs to improve service delivery through coaching on the job.
 Document issues to be reflected on in the next planning phase.
 Discuss policy directives on new ways of doing things.
 Supply logistics where applicable.

Structure
Flow
FSV shall be established at all levels of service delivery (RHMT, DHMT, SDHT, CHPS) in
each region as a routine process of managing health service delivery. The flow of FSV is
shown in Figure 3.

Community-Based Health Planning and Services: Implementation Guidelines 62

Figure 3: Flow of FSV

Abbreviations: D-Internal, district-level internal; RHA, Regional Health Administration; R-Internal, regional-level
internal.

Frequency
FSV shall be conducted at appropriate times as described in Figure 3.
 Monthly: CHO to CHMC members/CHVs, sub-district to CHPS zone
 Quarterly: District to sub-district, region to district, internal FSV at district with
technical supervisory team, and internal FSV at region
 When needed: Technical FSV from district and region

Team Composition
FSV team shall be formed at each level by the Head (Sub-District Head, DDHS, RDHS)
comprising an appropriate mix of staff.
 At RHD level, each FSV team shall be led by Deputy Directors (public health/
reproductive and child health, clinical care, and support services).
 At DHD level, an FSV team shall consist of at least three officers from public health,
clinical care, and support services.
 At CHPS level, at least one person (Midwife or Physician Assistant) shall conduct
FSV.
 A technical supervisory team shall be constituted as necessary for each level.

Community-Based Health Planning and Services: Implementation Guidelines 63

Areas, Performance Standards (PSs), and Tools
Areas
FSV shall cover performance of various service-management areas:
 Managerial areas (facility condition and infrastructure, data management, staff
management, equipment and assets management, financial management, supply
management)
 Quality improvement of workplace
 Service Delivery (infection prevention and control; maternal, neonatal, and child
health; disease control/surveillance; health promotion)
 Referral and feedback
 Monitoring and supervision systems

PSs
FSV shall be conducted based on the performance standards on all the areas mentioned
above. PSs shall be developed at each of the levels to reflect key services to be provided to
each level. Models of PSs at sub-district and CHPS zone levels are presented in Appendix D.
[Refer to PS booklet for PSs for other higher levels] PS is used as a basis for developing the
FSV tools, as shown in Figure 4.

Figure 4: Performance standard and tools sheet

Tools
FSV shall be conducted by using standardised tools (sheets) and the guidelines on scoring.
The tools (sheets) are structured in three parts, as shown in Table 5.

Community-Based Health Planning and Services: Implementation Guidelines 64

Table 5: Structure of FSV tools (sheets)
• Location
• Date
• Duration
Part 1: Basic information • Name of supervisee
• Supervisors
• Issues to be followed up based on the result of the previous
supervision

• Managerial areas
• Quality improvement of workplace
Part 2: Main tool • Service delivery
• Referral and feedback
• Monitoring and FSV

• Challenges found
• Follow-up issues (actions to be taken)
Part 3: Summary
• Timeframe
• Name and signature of supervisor and supervisee

Implementation Steps
In conducting FSV, the following four steps shall be implemented.

1. Planning
 Collect and analyse information (e.g. number of SDHTs/CHPS zones responsible,
travel times, convenient day in a month, seasonal factors at site, availability of
transport and fuel).
 Include supervisory plan in annual/monthly calendar.
 Share the plan with to supervisee to prepare for the visit and to give necessary
support.

2. Preparation
 Prepare logistics (supplies, transport, etc.)
 Confirm the appointment.
 Review documents.
 Organise preparatory meeting for team members.
 Review the previous FSV report.
 Examine the problems and actions to be taken in the previous FSV.
 Check the status of programme implementation.
 Check supplies to be delivered and identify priority areas.
 Follow up the problems identified in the previous FSV.
 Identify performance that was not satisfactory in the previous FSV.

Community-Based Health Planning and Services: Implementation Guidelines 65

3. Implementation
 Greet and explain the purpose of visit.
 Monitor DHMT/SDHT performance/CHPS implementation by using FSV tool.
 Check if the problems found during the previous visit were solved.
 Assess performance of various service-management areas.
 Conduct on-the-job training.
 Observe if DHMT/SDHT/CHO staff applies correct technique in his/her work.
 Train and update DHMT/SDHT/CHO staff’s skills through practice if necessary.
 Provide feedback.
 Discuss with DHMT/SDHT/CHO staff. (Give constructive and objective feedback.
Summarise and emphasise important points. Give enough time to
DHMT/SDHT/CHO staff to respond.)
 Summarise the findings in summary sheet. (Findings shall be short and clear.
Prioritise findings. Use information to identify problems. Discuss and take decisions
together.)
 Give verbal feedback if it is urgent and the case needs quick support. Give feedback
in written form that can be kept as a record and shared with others.

FSV conducted by Supervision Team shall to be:

 Balanced: give and take, mutual questioning, sharing of ideas and information, not
one-sided.
 Concrete: focus on objective aspects of performance.
 Respectful: use behaviours that convey that the other person is a valued and fully
accepted counterpart.

Feedback given from supervision team must be:

 Immediate and direct
 Appropriate to the situation and in the right cultural context
 Politely given
 Constructive and non-judgmental

4. Follow-Up
 Organise and interpret data.
 Include follow-up activities in the action plan (e.g., technical visits to
DHMT/SDHT/CHO staff, frequent communication with DHMT/SDHT/CHO staff,
support to resolve conflicts between DHMT and SDHT/CHO staff or community).
Communicate with higher levels for support if necessary.
 Take actions based on the plan.

Community-Based Health Planning and Services: Implementation Guidelines 66

Chapter Eight: Performance
Introduction
This chapter looks at the monitoring and evaluation (M&E) of CHPS implementation within
the larger context of the M&E that guides the implementation of GHS programme of work.
The M&E for CHPS implementation focuses on the progress and effectiveness of the
implementation.

M&E of CHPS Implementation

M&E forms an integral component of programme management. They help to ensure that
programmes are implemented as planned and allow assessment of achievement of the results
desired.

Monitoring is the day-to-day follow-up of activities to measure progress and ensure that
activities are occurring according to plan and are on schedule. M&E shall occur at all levels
(and at multiple stages of a programme).

The goals of monitoring are to:

1. Track and provide feedback on the progress of activities
2. Identify challenges and problems with implementation
3. Take corrective action and make modifications as and when necessary

Monitoring of CHPS implementation involves using various approaches to monitor how

districts have implemented CHPS using the resources available to them.

Evaluation deals with strategic issues such as project effectiveness, efficiency, and relevance
in the light of specified objectives, as well as project impact and sustainability. It is designed
specifically to attribute changes to an intervention, although total attribution is extremely
difficult to achieve. Importantly, it also aims at systematic learning from experience and the
usage of learnt lessons to improve current activities and promote better planning for future
activities. Evaluation of CHPS implementation shall be done periodically as part of the
overall evaluation of health sector medium-term development plans. Evaluation of CHPS
implementation can also be done as part of national review of CHPS implementation.

The CHPS Implementation Guidelines spells out 15 steps and six milestones that guide the
establishment of CHPS. Compliance with these guidelines shall be monitored and
documented to indicate progress and status of the implementation of these steps and
milestones. M&E of the progress and status of CHPS implementation shall take place at all
levels as mentioned, namely: community, sub-district, district, regional, and national. The
tool for conducting the M&E is shown in Appendix K and supplemented by Appendix E.

PSs from sub – districts to CHPS zone levels and assessment tools are shown in Appendix D
and actions that can be borne by the MMDAs to facilitate implementation are shown in
Appendix L.

Community-Based Health Planning and Services: Implementation Guidelines 67

Key Roles and Responsibilities
Regions
All regions are expected to provide quarterly updates on their CHPS implementation through
the DHIMS2. All regions are to ensure that all districts in their region have completed the
quarterly CHPS reporting form in the DHIMS2. Regions shall conduct CHPS verification
twice each year to authenticate the data on CHPS that districts have reported in the DHIMS2.

All regions shall produce half-year and annual health service performance reports; these
reports shall include sections on CHPS implementation. The region shall, in this section of
the reports, provide details of the extent to which the 15 CHPS implementation steps have
been completed for each CHPS zone (this can be an appendix to the reports). The reports
shall also include the performance of the districts against the targets for CHPS roll-out and
CHPS’s contribution to service delivery.

Districts
All districts are required to report quarterly on the status of CHPS implementation in their
districts using the DHIMS2. Districts are to ensure that the CHPS quarterly reports in
DHIMS2 are completed before the 15th of the month after the quarter closes (e.g. the First
Quarter report shall be entered into DHIMS2 before 15 April).

The district shall analyse and interpret CHPS data in the DHIMS2 and the progress reports
from the sub-districts. These shall form the basis for all planning, monitoring, and decision-
making processes to guide CHPS implementation.

Districts shall provide the regions with quarterly reports on the processes and status of
completion of the 15 steps for each CHPS zone in their district. To be able to submit this
report, all districts shall keep a database of all CHPS zones in both manual and electronic
formats, showing the level of completion of the 15 implementation steps for each of the
CHPS zones (See Appendix E). This shall be updated quarterly by the district.

All districts shall produce half-year and annual health service performance reports, each
including a section on CHPS implementation. The district shall in this section of the half-year
and annual reports provide details of the extent to which the 15 CHPS implementation steps
have been completed for each CHPS zone (Appendix E). They shall also show the
performance of the districts against the targets for CHPS roll-out.

Sub-Districts
Sub-districts shall provide monthly reports on CHPS implementation in their sub-districts to
the district. This report shall include progress made in coverage, the extent of completion of
the 15 implementation steps for each CHPS zone, and the work performance of each CHO
working in the sub-district. The sub-district shall keep a database, either manual or electronic,
showing the progress of each zone in each of the 15 implementing steps. Service performance
from each functional CHPS zone shall be reported to the sub-district or entered directly into
the DHIMS2 after verification, if the CHO has access to the internet and has been trained on
the DHIMS2.

The sub-district shall organise monthly data validation meetings of all CHOs working in the
sub-district to validate the summary forms. At these meetings, the CHOs shall bring their
service registers along for sample verification to be conducted to ensure that the data
Community-Based Health Planning and Services: Implementation Guidelines 68
recorded on the summary forms are the same as those in the registers. These meetings shall
also provide an avenue for capacity building in data management for the CHOs. Officers
from the district level can be occasionally invited to join these meetings. Reports on these
data validation meetings shall be submitted to the district.

The sub-district shall analyse the service data and use it to monitor the performance of the
sub-district. Standardised tools shall be used by the sub-districts to assess the performance of
each CHO in their sub-district (see Appendix D). The sub-district shall use feedback, peer
review, and other mechanisms to improve overall CHO performance.

CHPS
All functional CHPS zones shall keep standard registers for all the services that they are
offering. These registers shall include the consulting room register, the maternal health
register, the child health register, the FP register, the school health register, and the home visit
register. At the end of every month, CHOs shall prepare monthly summary reports on service
performance using the appropriate monthly summary reporting forms and send these reports
to the sub-district or enter the data directly in the DHIMS2 if they have access to the internet.
Data from CHPS shall not be added to that of the health centre in the sub-district and reported
under the health centre. CHPS data shall be reported on their own.

A newly posted CHO shall be trained on the standard operating procedures for health
information management. She or he shall be provided with all the necessary registers and
summary forms after the training. Once this is done, the CHO shall report on services
delivered in his/her zone and this information shall be entered directly into the DHIMS2 by
the sub-district or by the district in the name of the CHPS zone.

CHVs
The CHVs shall report on their activities monthly to the CHO using the standard Community
Volunteers reporting form. All suspected epidemic-prone disease shall be reported
immediately to the CHO.

E-Tracker: Freeing Up More Time for the CHO to Offer Service

The Ghana Essential Health Interventions Programme conducted a study of CHOs’ use
of work time. The study found that CHOs spend many hours each month on collating data
from the various service registers for reporting. To effectively address this issue and provide
more time for the CHO to offer direct service, as well as to improve the quality of health
service data, the e-tracker was developed.

The DHIMS2 e-tracker enables the facilities at the CHPS level to collect, manage, and
analyse transactional, case-based data records on a web-based system using tablets, phones,
or laptops. The e-tracker allows the CHO to store information about individuals and track
these persons over time using a flexible set of identifiers (see Figure 5). The tracker allows
the CHO to configure SMS reminders, track missed appointments, and generate visit
schedules. The CHO can create monthly service reports as well as dynamic reports based on
cases and generate on-the-fly statistical reports.

It is envisaged that all CHOs will be using the e-tracker to collect and manage patient data for
both service delivery and reporting. The e-tracker shall facilitate the follow-up of defaulters.
Analysis of each client’s status in the continuum of care shall be facilitated by the e-tracker.

Community-Based Health Planning and Services: Implementation Guidelines 69

Figure 5: Name-based information-tracking process

Indicators for Monitoring CHPS Performance and Their Source

The data on establishing the CHPS zone and scaling up CHPS implementation shall be
captured at district level on the “District CHPS Quarterly Monitoring Form” in DHIMS2.
From this quarterly report, FSV visit reports, and CHPS verification visit reports, the status of
the roll-out of CHPS in the district, as well as the implementation of the 15 steps in each
CHPS zone, can be monitored. Service performance of the CHPS zone can be monitored
through the various service-reporting forms in the DHIMS2.

The quarterly CHPS report shall be completed in the DHIMS2 by all districts (see Table 6). It
provides a summary of the status of the processes of setting up CHPS in the districts.

Table 6. Quarterly CHPS report in DHIMS2

No. Data Element Definition
1 Number of Electoral Areas Number of electoral areas in the district.
Total Number of Communities in Total number of communities in district.
2
District
Number of Communities Served by Number of communities served by GHS facilities and
3
GHS outreaches in the district.
Number of Communities Served by Number of communities whose health needs are
4
Other Partners served by other partners.
6 Number of Outreach Sites Number of outreach sites in the district.
7 Number of Demarcated CHPS Zones Number of demarcated CHPS zones in the district.
Number of completed CHPS zones in the district (a
completed CHPS zone is defined as one in which “all
the milestones have been completed and the CHO
8 Number of Completed CHPS Zones
actually resides in the community (in a CHPS
compound) and provides a basic package of services
to the catchment population”).
Number of CHPS compounds (each of which consists
of a residence for CHOs and clinic in any form) at the
9 Number of CHPS Compounds
end of the quarter, including compounds newly
constructed during the quarter.
Number of functional CHPS zones which have basic
equipment necessary for CHOs to provide basic
service. Equipment includes:
• Cold chain equipment
• Service delivery equipment and consumables
Number of Functional CHPS Zones
10 • Working gear (wellington boots, raincoat, torch
with Equipment
light, etc.)
• Communication equipment (two-way radio or
mobile phones, etc.)
• Personal Digital Assistants (PDAs) for data
collection

Community-Based Health Planning and Services: Implementation Guidelines 70

 No. Data Element Definition
• Motorcycle for the CHO
• Bicycles for the CHVs in each community within the
zone
Population covered by completed and functional
11 Population Covered by CHPS CHPS zones (Total population of communities within
the completed and functional CHPS zones).
Number of functional CHPS zones (not counting
completed CHPS zones) in the district. A functional
CHPS zone shall be commissioned when:
1. The community entry process is completed and
community members are fully engaged;
2. The CHMCs are formed and actively involved in
health planning and service delivery design;
3. A CHO is deployed to the defined zone;
4. CHVs are selected from the community and
trained for service delivery;
5. A community profile (see Appendix A) is in place;
12 Number of Functional CHPS Zones 6. Health service delivery is targeted at households
and families;
7. The CHO has developed a schedule of home visits
that covers all homes in the catchment area and
is implementing regular home visits on schedule;
8. Identifiable service delivery data from the CHPS
zone as an organizational unit are reported and
are available in the health information
management system; and
9. The Community Health Compound (newly
constructed, rented, hired, or refurbished) and the
needed equipment are not yet ready.
Number of trained CHOs who are assigned to CHPS
13 Number of Trained CHOs
zones in the district.
Number of Active CHMCs with
Number of active CHMCs which held their last
14 Meeting Held At Least Once in the
meeting within the last 6 months.
Last 6 Months
15 Number of Active CHVs Number of active CHVs in the district.
Number of Functional CHPS Zones
16 with CHAP
Number of functional CHPS zones which have a CHAP.
Number of Zones planned to Be Number of CHPS zones which are planned to be
17 Made Functional for the Year functional in the year.
Number of Zones Planned to Be Number of CHPS zones which are planned to be
18 Made Functional for the Quarter functional in the quarter.
Number of CHPS Compounds
Number of CHPS compounds which are planned to
19 Planned to Be Constructed in the
be constructed in the quarter.
Quarter
New Functional CHPS Zones during Number of CHPS zones which became functional in
20 the Quarter the quarter.
Number of CHPS Compounds Number of CHPS compounds newly constructed
21 Constructed in the Quarter during the quarter.
Number of Home Visits Done in the Total number of home visits done by all CHOs during
22 Quarter the quarter.
Number of Durbars in the Quarter Number of durbars related to CHPS activities held in
23 the quarter.
Number of Meetings with Social Number of meetings with social groups such as
24
Groups in the Quarter women's group or youth group in the quarter.
Number of Volunteers Trained in Number of CHVs trained in surveillance (Community-
25
Surveillance Based Surveillance Volunteers or CBSVs) in the district.
Number of Volunteers Trained in Number of CHVs trained in malaria control activities.
26 Malaria
Number of Volunteers Trained in Number of CHVs trained in child health activities
27 Child Health (IMNCI).
Number of Volunteers Trained in FP Number of CHVs trained in FP commodity distribution.
28 Distribution

Community-Based Health Planning and Services: Implementation Guidelines 71

 No. Data Element Definition
29 Number of Trained TBAs Number of trained TBAs.
30 TBA Deliveries Number of deliveries conducted by TBAs.
31 TBA Postnatal Number of postnatal clients seen by TBAs.
32 TBA Antenatal Number of antenatal clients seen by TBAs.

To monitor the inputs, processes, outputs, outcomes, and impacts of CHPS implementation, the
minimum set of indicators outlined in Table 7 shall be monitored at the levels indicated.

Table 7: Minimum set of indicators

Indicator Metrics Data source Level
Input
Percentage of Total number of districts with -CHPS roll- Regional Annual Regional
districts with -CHPS out plan / Total number of districts in the and Half-year National
roll-out plan region reports
Percentage of Number of functional zones with officially DHIMS2—CHPS Sub-district
functional zones constructed compounds / Total number quarterly District
with compounds of functional CHPS zones reporting form Region
National
Percentage of Number of functional zones with District Annual Sub-district
functional CHPS temporary or rented compounds / Total Reports District
zones with number of functional CHPS zones Region
temporary National
compounds
Percentage of Number of functional zones with basic DHIMS2 CHPS Sub-district
functional zones CHPS equipment / Total number of quarterly report District
with basic CHPS functional CHPS zones Region
equipment National
CHO per Equity index = CHO per population ratio DHIMS2 Human District
population ratio of the worst sub-district / CHO per resource Region
(equity index) population ratio of the best district quarterly form
Proportion of CHNs Number of CHNs trained on CHPS / Total DHIMS2—CHPS Sub-district
trained on CHPS number of CHNs in the district Quarterly Report District
module Region
National
Proportion of Number of volunteers trained on CHPS / DHIMS2—CHPS Sub-district
trained community Total number of volunteers Quarterly Report District
volunteers Region
National
Process
Proportion of Number of durbars held for the period / DHIMS2 CHPS zone
scheduled Total number of scheduled community Sub-district CHPS Sub-district
community durbars durbars for the period narrative reports District
organised
Proportion of Number of home visits held for the period DHIMS2 CHPS zone
scheduled home / Total number of scheduled visits for the Sub-district CHPS Sub-district
visits held period narrative reports District
Proportion of Number of district health family meetings District Quarterly District
scheduled district held / Total number of scheduled district Health service Region
health family family meetings performance National
meetings held report
Proportion of Number of meetings held with identified Monthly CHPS CHPS zone
scheduled social social groups / Total number of reports Sub-district
group meetings scheduled social group meetings Monthly sub- District
held district reports
Quarterly district
reports
Output

Community-Based Health Planning and Services: Implementation Guidelines 72

 Indicator Metrics Data source Level
Proportion of Number of pregnant women reached Sub-district CHPS CHPS zone
pregnant women per expected pregnancies narrative reports Sub-district
reached on home E-tracker District
visits
Proportion of Number of neonates visited per Sub-district CHPS CHPS zone
neonates reached expected live births narrative reports Sub-district
on home visits E-tracker District
Proportion of Number of children under 5 years visited Sub-district CHPS CHPS zone
children under 5 per total number of children under 5 narrative reports Sub-district
years old reached E-tracker District
on home visits
Outcome
Proportion of Total number of functional CHPS zones / DHIMS2—CHPS Sub-district
functional CHPS Total number of demarcated zones Quarterly Report District
zones Region
National
Proportion of zones Total number of functional zones with DHIMS2—CHPS Sub-district
with CHAP CHAP / Total number of functional zones Quarterly Report District
Region
National
Proportion of Total number of CHMCs trained / Total District Quarterly Sub-district
trained CHMC number of CHMCs CHPS report District
Region
National
Proportion of active Total number of CHMCs which held DHIMS2—CHPS Sub-district
CHMC for the meetings with minutes in the last Quarterly Report District
period 6 months / Total number of CHMCs Region
National
Percentage of Total population covered by CHPS / Total DHIMS2—CHPS Sub-district
population population at level of monitoring Quarterly Report District
covered by Region
functional CHPS National
zones
Percentage of Total ANC clients seen by CHPS / Total DHIMS2—Form A Sub-district
CHPS contribution ANC clients seen for the level (Midwifery form) District
to ANC disaggregated Region
by type of National
facility
Percentage CHPS Total number of early PNC clients seen by DHIMS2—Form A Sub-district
contribution to CHPS / Total PNC clients for the level (Midwifery form) District
early PNC (within 48 disaggregated Region
hours) by type of National
facility
Percentage Total number of children under 1 year DHIMS2—EPI Sub-district
contribution of receiving Penta 3 through CHPS / Total disaggregated District
CHPS to Penta 3 number of Penta 3 immunisations by type of Region
immunisation administered facility National
Percentage Total number of FP acceptors seen at DHIMS2—Form B Sub-district
contribution of CHPS level / Total number of FP disaggregated District
CHPS to FP acceptors by type of Region
acceptors facility National
Percentage Total number of deliveries conducted at DHIMS2—Form A Sub-district
contribution of CHPS level / Total number of deliveries (Midwifery form) District
CHPS to skilled disaggregated Region
delivery by type of National
facility

Community-Based Health Planning and Services: Implementation Guidelines 73

Reviews and Awards (DA, Peer Reviews, Regional, National)
The M&E framework of the Health Sector Medium-Term Development Plan 2014–2017 has
CHPS implementation as one of the important indicators. The number of functional CHPS
zones is one of the indicators used to monitor the strategy of strengthening the district and
sub-district health systems as the bedrock of the national PHC strategy.

Reporting on progress of CHPS implementation shall therefore be one of the critical

components of all annual and half-year reviews of service performance held at the district,
region, and national levels.

The national level, as part of its monitoring reporting responsibilities, is supposed to report to
the MOH on the number of functional CHPS zones in the reporting year.

The DDHS, being the technical lead in the district and reporting to the District Chief
Executive and the DA, shall have overall responsibility for guiding service delivery in the
CHPS zones in the district. The District Director shall, in the review of the district’s service
performance, include the extent to which the district’s CHPS roll-out plan has been executed.

The District Chief Executive shall, in collaboration with the DDHS, commission annual
reviews of progress in CHPS implementation in the district and make the report available to
be discussed by the DA. The report and recommendations of the DA shall be made available
to the RDHS of the region, the Director General of the GHS, and the Minister of Health by
June of the reviewing year.

Improving CHOs’ performance over time is very important. Feedback on performance, peer
reviews, and performance-based rewards can be used to facilitate this improvement.
Rewards, like being allowed study leave out of turn, shall be used by districts to facilitate
improved performance of CHOs. Each district and region, working with its stakeholders,
shall look at innovative and sustainable ways of motivating and rewarding CHOs working in
the CHPS zones.

Communities and District Assemblies offering support for CHPS implementation can be
publicly recognised, including with citations from the DHDs and RHD at Annual Review
meetings.

Community-Based Health Planning and Services: Implementation Guidelines 74

Appendices

Community-Based Health Planning and Services: Implementation Guidelines 75

Appendix A: Community Profile
A typical community profile shall present the following:
 Name of sub-district
 Names of zones
 Name of the community
 Names of villages making up the community - cluster
 Physical characteristics - topography and vegetation
 Population of each village - male/female/adults/children (a community register shall
be compiled)
 Main customs and beliefs of the people
 Predominant religious groups and organisations
 Economic activities - sources of income
 Economic facilities - markets etc.
 Communication - road networks, transportation etc.
 Water facilities
 Sanitation facilities
 Housing - nature of houses and pattern of housing
 Educational facilities - schools etc.
 Health facilities - hospitals, clinics, chemist shops etc. and
 Disease pattern:
 Most common causes of ill health,
 Most frequently diagnosed diseases, and
 Special and unusual health problems.
 Sickness and health behaviour:
 Who do people see for health when sick?
 What do people do to prevent illness and stay healthy?
 What role do traditional healers and TBAs play in health services delivery?

Community-Based Health Planning and Services: Implementation Guidelines 76

Appendix B: Service Interventions for CHOs
Target Service interventions
Neonate/infant • Newborn/Infant care—Essential newborn care/Cord care/Early initiation of BF
• Exclusive BF up to 6 months
• Kangaroo mother care
• Nutrition—infant and young child feeding (IYCF)/growth monitoring and
promotion (GMP)/Community Management of Acute Malnutrition (CMAM)
• Community Integrated Management of Newborn and Childhood Illness (C-
IMNCI) and referral of serious cases
• Disease surveillance and control—malaria prevention, including sleeping
under insecticide-treated nets (ITNs)/Paediatric diagnosis and antiretroviral
therapy/Education on prevention
Pregnant • Focused antenatal care (FANC)—Pregnancy monitoring/Education on
women nutrition/Micronutrients (iron, folate)/Birth preparation/intermittent preventive
treatment (IPT)/HIV counselling and testing/Maternal antiretroviral therapy
• Skilled attendance at delivery
• Emergency Obstetric and Neonatal Care (EmONC)
• PNC
Children under 5 • Vaccination
years old • Nutrition—GMP/vitamin A supplementation/CMAM
• Disease Control—Deworming 2yrs–5yrs/Education on prevention and
treatment of fevers, diarrhoea and ARI/Malaria

Adolescents • adolescent sexual and reproductive health including FP/Education against

teenage/early pregnancy
• Education on preventable diseases (HIV/STIs, malaria) and non-
communicable diseases (obesity, drug abuse)

School children/ • School health activities (based existing guidelines) FP (short term methods (pill,
women of fertile male and female condoms, injectables, etc.) and Jadelle insertion and
age removal
• Household nutrition/iodated salt consumption
Discharged • Follow-up of discharged patients and directly observed therapy short course
patients (e.g. children, TB, leprosy, hypertension, epilepsy, diabetes, malnourished
children)

General • Regenerative health and nutrition/Household iodate salt consumption

population • Mass Drug Administration (yaws, filariasis, schistosomiasis, intestinal worms)
• Disease surveillance and control - Investigation and reporting on
rumours/unusual events/malaria, HIV/STIs, TB, NTDs, diseases for
eradication/elimination and non-communicable diseases (hypertension,
diabetes, sickle cell disease, asthma)

The aged • Home visits to the aged to provide education on care and nutrition

Community-Based Health Planning and Services: Implementation Guidelines 77

Appendix C: Conducting a Situation Analysis
This is the process by which the DHMT carries out a critical examination of its operations in
the delivery of PHC services to the people of the district with the view of:
 Assessing its capabilities
 Identifying the challenges, and
 Developing a new and more relevant program of action.

By this process the DHMT constitutes itself into a special review team made up of the
DDHS, the medical superintendent in charge of the district hospital, the public health nurse,
the disease control officer, the nutrition officer, the medical assistant and the sub-district
heads. The following areas are assessed in conducting the situational analysis:

Service Coverage
Objectives
 Identification of areas of low coverage of services
 Identification of areas of low patronage of services

In assessing service coverage the DHMT examines the existing service map of the district or
creates one where it is not available. This map shall indicate
 The sub-districts and the main communities
 The existing service delivery points, and
 The types of services offered.

The district health service map shall therefore reveal the pattern of service coverage in the
district and provide response to the following key questions:
 Which areas of the district are receiving better coverage of services?
 Why?
 In which areas of the district are services being poorly patronised?
 Why?
 Which services are receiving better patronage?
 Why?
 Which services are being poorly patronised?
 Why?
 How can service coverage and service quality be improved with the existing resources
and plan for more resources later?

Community-Based Health Planning and Services: Implementation Guidelines 78

Resource Status
Objectives
 Identify the existing service delivery structures
 Identify the sources of funding for implementing CHPS

An examination of the available resources for service delivery is necessary. In this exercise
the DHMT takes account of the existing service delivery structures in the district. These shall
include the number of hospitals, clinics, health centres and outreach points etc., their capacity
and state of functionality. The resource survey shall provide answers to the following key
questions:
 To what extent are the existing service structures being used to maximise service
delivery to community members?
 What can we do to improve upon the level of functionality of these structures?

Table C1 may be adopted:

Table C1: Status of facilities

Type of State of Functionality
Sub-district Number
Facility 0–25% 26–50% 51–75% 76–100%

Sources and levels of funding and equipment for various services and structures shall also be
identified. The identification of the sources of funding shall provide answers to the following
key questions:
 How much money would be available to support CHPS from the various funding
organisations?
 Which particular components of the CHPS implementation programme are the
various organisations interested in?

Table C2 would be useful:

Table C2: Sources of funding

Targeted
Estimated Type of
Organisation Component of
Amount of Money Equipment
CHPS
Govt. of Ghana funds/financial
encumbrances
Internally generated funds (IGF)
Donor funds
DA
Communities
NGOs

Community-Based Health Planning and Services: Implementation Guidelines 79

 Others

CHNs and Level of Work

Objectives
 Identify the pattern of distribution of CHNs in the district
 Identify the level of performance of CHNs – whether underutilised or not

The DHMT shall conduct a work analysis of the performance of the CHNs in particular to
identify the following:
 Number of public health nurses in the district;
 Number of CHNs in the district;
 Number of CHNs in the sub-district;
 Number of patients seen by the CHNs at each of the identified service points in a
month;
 Nurse-patient ratio i.e. average number of patients seen by each CHN is a week, a
month etc.

Tables C3 and C4 will be used to facilitate the CHN Work Analysis:

Table C3: Availability of health worker

Category Of Staff Number In District Total Number Required
Public Health Nurse
CHN
Medical Assistant
Health Assistant (Clinical)
Others

Table C4: CHN-to-patient ratio

Expected Number of Patients to Number of Patients Seen by A
Category of Service Point
Be Seen by CHN CHN per Month

This work analysis will provide answers to the following key questions:
 Are the CHNs performing to their fullest capacity?
 If not, why?
 Are the community members making full use of the available facilities?
 If not, why?
 Could the available staff of health workers provide PHC services using the CHPS
strategy?

Community-Based Health Planning and Services: Implementation Guidelines 80

Output of the Situation Analysis
Two outputs will result from carrying out the situation analysis of the district health service
system:

Draft District Health Service Profile

The first is the District Health Service Profile (DHSP), which shall reveal the merits and
inadequacies in PHC delivery in the district as well as the sub-districts. The DHSP will
indicate the following:
 The most patronised services according to sub-districts;
 The most patronised service points according to sub-districts, indicating communities
in which they are located;
 The less patronised services in each sub-district;
 The less patronised service points in each sub-district indicating communities in
which they are located;
 Communities with little or no access to services;
 Distribution of service providers according to sub-districts;
 Distribution of services;
 Distribution of service facilities;
 Existing sources of funding and their assessment;
 Other possible sources of funding; etc.

Draft Health Action Plan

The DHSP shall guide the DHMT to start developing the District Health Service Action Plan
for implementing CHPS. This initial plan will reveal:
 Pattern of redistribution of service providers, particularly CHNs and their supervisors,
to meet the requirements for CHPS;
 Pattern of reorganisation of services to meet the requirements of CHPS; and
 Timelines on CHPS implementation activities in the district.

Community-Based Health Planning and Services: Implementation Guidelines 81

Appendix D: PSs from Sub-district to CHPS zone Levels and Assessment Tools (Refer to PS
booklet for PSs for other higher levels)
Performance Standard and Criteria for Supervision
(Revised in May 2016)
I. Managerial Areas Code
I-I Data management
All health related records (ANC Register, Birth and Emergency 1 Standard directory of filling is available and updated. 1
plan, Maternal Health Record, Postnatal Register, Child Health
2 All sections, columns and cells of registers/reports are completed and up to date. 2
1 Records, Referral Records, Midwives Returns, Home Visit Book,
Child Welfare Clinic [CWC] Book, Health Promotion Activity
3 Community registers are updated monthly and community profile updated annually. 3
Report, etc.) are kept according to standard.
I-II Financial management
Financial Management is conducted according to standard Internally Generated Fund is recorded according to standard operations guidelines
1 1 4
operations guidelines. and cash is banked or sent to the SDHT (daily, weekly, monthly).
I-III Activities schedule and meetings
1 Meetings are organised monthly with CHVs and the Minutes are available and current. 5
1 Regular meetings are organised.
2 Quarterly CHMC meetings are organised and minutes are available. 6
1 Daily Attendance register is available and current 7
2 Action plans and information sharing with SDHT and CHVs
2 Monthly work plan of CHPS zone is available, implemented and monitored 8
I-IV Supply management
All health commodities as specified in the guideline are stocked above the re-order
1 9
level.
2 Monthly stock check is conducted. 10
All commodities are kept in good condition, organised and issued according to “first-to-
1 Standard Inventory management is conducted at facility. 3 11
expire, first-out”.
All unserviceable commodities are stored separately or excess stock is in process of
4 12
being returned.
5 Health commodities are ordered and issued according to the established guideline. 13
I-V Transport, equipment, estates and facility
1 Motorbikes are maintained. 1 Monthly motorbikes servicing is conducted. 14
2 All equipment and assets are stored and maintained according 1 Assets register is available and updated. (Equipment part of assets) 15

82 Community-Based Health Planning and Services: Implementation Guidelines

 I. Managerial Areas Code
to standard 2 All the equipment in use and in store is functional. 16
All items (e.g., stationeries) are set in order, and the stock items are categorised in
3 17
appropriate sections/areas.
4 All assets and equipment are embossed according to standard or guideline. 18
Cold chain equipment, fridge is monitored with a thermometer and the temperature
5 19
recorded on the daily monitoring sheet
1 The rooms are well organised for the purpose. Cleanliness and privacy are maintained. 20
Facility and its surroundings are well maintained and in good Surrounding of the facility is kept clean, well lit, water source and disposal pit are
3 2 21
condition. functioning.
3 Mobile network is available. 97

II. Quality Improvement of Workplace

II-I Preventive maintenance
Non-functioning equipment are separated and stored in designated place for disposal or
1 22
repair.
All equipment and assets are stored and maintained according
1 Necessary manuals and instructions accompanied with equipment are filed or displayed
to guidelines. 2 23
near equipment for easy access and reference.
3 Regular maintenance of equipment is conducted. 24
II-II Infection prevention and control
1 Implementation of routine cleaning of the facility is conducted according to schedule. 29
2 Soap, alcohol rub and water are readily available at each procedure room. 25
3 Hand-washing is done before and after every procedure according to protocol. 26
1 Universal standard precautions are followed in the facility.
4 Personal Protective Materials are readily available for use (such as "disposable Glove"). 27
Re-Usable Personal Protective Materials (e.g., utility gloves, plastic apron, wellington
5 28
boots, and mackintosh) are maintained, cleaned and stored according to protocol
Relevant disinfectants (Chlorine/Chlorhexidine solution) are available and properly
1 30
labelled.
2 Medical equipment is disinfected and readily available for use. Medical instruments/equipment are processed and maintained for safe use according to
2 31
guideline(decontamination and cleaning)
3 Medical equipment are stored according to guideline to avoid possible contamination. 32
Waste from facility is managed according to standard precaution Labelled waste containers for different type of waste are available at where the services
3 1 33
guidelines. are provided.

83 Community-Based Health Planning and Services: Implementation Guidelines

II. Quality Improvement of Workplace
2 All medical waste is disposed according to the set guideline or procedure. 34
3 No hazardous items are exposed in the facility. 35
II-III Emergency preparedness
Minimum set of equipment are available and ready for emergency (including at least
The facility is prepared for receiving delivery and emergency 1 36
1 two sterile delivery kits.)
cases.
2 Essential emergency procedures/protocols are displayed for easy access and reference. 37

III. Service Delivery

III-I MNH and child health
Guideline and Protocol are available at the service delivery Guideline and protocol/charts are placed on the wall at the appropriate places for
1 point and accessible to all staff.
1
reference in performing procedures.
38

1 FP commodities are available and above re-order level. 39

2 FP is provided according to policy guidelines.
2 FP is given as specified in the guideline. 40
3 Adolescent health services are provided. 1 Adolescent health corner is available and records of services provided. 90
Commodities for focused ANC are available. (Iron/folate tablets, TT vaccine, SP
1 41
package).
4 Focused ANC is provided according to policy guidelines.
2 ANC is given as specified in the guideline. 42
3 PMTCT services are provided according to policy guidelines. 43
Minimum quantity of emergency drugs and supplies are available in the facility, ready for
1 44
Delivery and emergency services are provided according to use (oxytocin, antibiotics).
5
policy guidelines. Intrapartum, postpartum and newborn care is given as specified in the
2 98
protocol.
Commodities for postnatal care are available (Iron/folate tablets, vaccines, Vitamin A
1 45
6 Postnatal care is provided according to policy guidelines. etc.).
2 Postnatal care is given as specified in the guideline. 46

Quality is maintained in the report on RCH services (FP, ANC, 1 Reporting of FP, ANC, Delivery and Postnatal is done at specified interval correctly. 47
7
Delivery and PNC) 2 Used registers/reports are kept at a section in the stores. 48
1 EPI is conducted and recorded. 99
There is an updated graph showing coverage of various antigens (Bacillus Calmette–
8 EPI is conducted according to policy guidelines. Guérin, Oral Polio Vaccine [OPV1-3], Penta 1-3, Pneumococcal conjugate vaccine
2 49
[PCV1-3], Rotavirus [Rota 1-2], measles [MLS 1-2], yellow fever, Tetanus Toxoid, etc.)
clearly displayed.

84 Community-Based Health Planning and Services: Implementation Guidelines

 III. Service Delivery
3 Dropout rate is calculated correctly and updated chart displayed. 50
4 There is a chart showing wastage of various antigens. 51
9 School health services are conducted according to guidelines. 1 School health services are conducted according to schedule. 52
CWC (growth monitoring and promotion) is conducted monthly and entries done
10 CWC (growth monitoring) is conducted properly 1 53
correctly.
List of the structured training experience of each staff on MNH is
11 1 List of the structured training experience of each staff on MNH is recorded and updated. 54
recorded and updated.
1 Nutrition activities are correctly reported. 94
2 Nutrition registers including CMAM and IYCF are available and updated. 95
12 Nutrition activities are conducted recorded
3 Support visits on nutrition activities including growth monitoring are conducted. 96
4 There updated graphs/charts showing nutrition status of children. 55
III-II Disease control/surveillance
1 There is updated graph showing cases/vital events and diseases under surveillance. 100
Surveillance is conducted according to guidelines and reports 2 All CBSVs are supervised monthly and reports submitted 56
1
submitted timely
There are spot maps showing areas in the CHPS zones where diseases of public health
3 57
importance occur.
III-III Health promotion
1 FP promotion is carried out. 58
2 Promotion of early ANC, skilled delivery and PNC is carried out. 59
1 Reproductive health promotion is conducted.
The number of population reached with health promotion is recorded by sex and age
3 60
group.
IEC materials are available in the facility (such as ANC, skilled delivery, PNC etc. flip
Information, education, and communication (IEC) materials are 1 61
2 charts etc.)
available and in use.
2 IEC materials are used to carry out health promotion activities. 62
3 Health promotion is conducted. 1 Health promotion sessions are conducted during the last month. 63
III-IV Community participation
1 Regular home visits for ANC, PNC are carried out by the CHOs, or CHV. 64
1 Regular home visits are carried out.
2 Defaulter tracing is conducted (evidence of defaulter tracing) 65
Community members with the support of the CHO develop CHAPs and it is regularly
Community’s health activities are implemented with support of 1 66
2 monitored, reviewed and updated.
CHOs.
2 CHO support communities to implement CETS and ensure its monitoring and operation. 67

85 Community-Based Health Planning and Services: Implementation Guidelines

 III. Service Delivery
1 Durbars and meetings are organised quarterly 68
Meetings with community-based volunteers (Community-Based Agent, CBSVs, TBA, etc.)
2 69
3 Communities are sensitised. are conducted monthly (quarterly).
Visit to other health partners (the traditional healers, chemical sellers or private midwives)
3 70
are conducted monthly.
4 Community supports maintenance of CHPS compound 1 Community support CHO/CHN in water fetching, cleaning, security and other activities. 85

IV. Referral and Feedback

1 At least 10 sets of GHS referral forms are available. 71
2 Entries in the referral register are completed including feedback received. 72
1 Availability of standard referral tools and treatment guidelines.
Current National Treatment Guideline is available and accessible at the area where
3 73
consultation is done.
1 No. of referral cases sent in last 3 months is recorded. 78
2 Referral system is functioning.
2 No. of feedbacks received in last 3 months is recorded. 79
1 Documented evidence of referral sent (pink form) remain in the GHS referral booklet. 74
3 Records are kept properly.
2 Received feedback forms are kept in each patient folder or a feedback file. 75
Transport is available (National Ambulance, CETS or other available means of
1 76
4 Support system for referral is established. transport mode).
2 Telephone directory is accessible to all staff, displayed and regularly updated. 77

V. Monitoring and Supervision System (FSV)

1 FSV from CHO to CHV is conducted. 1 Monthly CHVs-supervision is conducted. 80
1 Copies of supervisory reports are submitted to SDHT. 81
2 All the monitoring sheets are submitted to SDHT. Findings of supervision is implemented from SDHT to CHO and from CHO to CHV that the
2 82
CHO is responsible.
The report and documents of CHMC and CHV level are submitted
3 1 Monitoring reports of CHVs by CHO are submitted timely. 83
to CHO on time.
4 CHO participates in CHPS Review Meeting. 1 CHOs participate in the quarterly CHPS Review Meeting (conducted by DHMT). 84

86 Community-Based Health Planning and Services: Implementation Guidelines

Facilitative Supervision Checklist
Level: Sub-District → CHPS Zone

Basic Information (Interview with CHO)

District: Sub-district:
Name of CHPS Zone:
Date (DD/MM/YY) and Time: / / Start: ____ End:_____
No. of communities (catchment areas): No. of CHMC members:
No. of active/registered CHVs:__/__

Status of CHO/CHN/others
CHO/
Supervisee
CHN/ Name Tel. no. Email
(tick)
others

Supervisors
Name Job title Organisation Tel no.

Issues to be followed up based on the result of the previous supervision

Community-Based Health Planning and Services: Implementation Guidelines 87

I. Managerial areas
I-I. Facility condition and infrastructure
Means of Goo
No. Check Items Fair Poor Remarks
Verification d
Are the rooms well organised and Observation at
1
cleaned? room
Is surrounding of the facility kept Observe
2
clean? surroundings
Is water supply regular and Interview
3 secure? (Pipe borne, bore hole
and well)
Is electricity available? Interview/Obse
4
rvation
Are lights functioning? Observation at
5
room/Interview
6 Is mobile network available? Interview

I-II. Data management

Means of
No. Check Items Good Fair Poor Remarks
Verification
Is current standard directory of Standard
7
filing updated? directory
Is community register updated Community
8
monthly? registers
Is community profile updated and Community
9
current? profile
Check the availability and completeness of the reports on the list below
No. Reports/Records Good Fair Poor Remarks
10 Monthly Midwife Returns
11 Monthly Family Planning Returns
12 Monthly Child Health Returns
13 Monthly CBSV reports
14 Monthly Revenue Returns
15 Monthly Drug Returns
16 EPI Record
17 Monthly Nutrition Returns

I-III. Financial management

Means of
No. Check Items Good Fair Poor Remarks
Verification
18 Is internally generated fund Revenue
recorded appropriately? collection
book,
Notional
Revenue
Budget
Ledger (NHI),
summary
cash book

Community-Based Health Planning and Services: Implementation Guidelines 88

 Means of
No. Check Items Good Fair Poor Remarks
Verification
19 Is General Counterfoil Receipt GCR/Controll
(GCR) Book available and used? er and
Accountant
General
Department
(CAGD),
Approved
receipt book
of MOH,
value book
stock register
20 Are claims of NHIS compiled daily? Daily claims
forms,
Notional
Revenue
Budget
Ledger
(NHIS),
revenue
returns
Is revenue sent to the SDHT? Duplicate
Pay-in-Slip,
passbook,
Notional
Revenue
Budget
Ledger
21
(NHIS), cash
analysis
book,
revenue
returns
(software),
GCR

I-IV. Activities schedule, meetings, and training

Means of
No. Check Items Good Fair Poor Remarks
Verification
Daily
Is Daily Attendance register
22 Attendance
available and current?
Register
Is monthly work plan of CHPS zone Monthly work
23
available and current? plan
Are meetings organised monthly Interview,
24 with CHVs and meeting minutes Minutes with
available and current? CHV
Training
Does CHO have a logbook and in
25 logbook,
use?
interview

Community-Based Health Planning and Services: Implementation Guidelines 89

Tick the training experienced on each staff below.
Life
CHO/ Fresher Refresher Refresher Refresher
Name Saving
CHN CHO (1)a (2)b (3)c
Skills

a Refresher (1) = CHO Refresher Training (1) ANC/Delivery/PNC

b Refresher (2) = CHO Refresher Training (2) Community-Based MNH
c Refresher (3)= CHO Refresher Training (3) Community Mobilisation/FSV

I-V. Equipment and assets management

Means of
No. Check Items Good Fair Poor Remarks
Verification
26 Is Assets register available and Assets
updated? register/Store
ledger book
27 Are assets labelled? Check labels
28 Are all equipment in use Assets
functional? register/Store
ledger
book/Obsv.
Eqpts
29 Are non-functioning Observation at
equipment separated for storeroom,
sending to repair? Unserviceable
store ledger
30 Are manuals and instruction Place of
filed or displayed in keeping user’s
designated area? manuals and
instructions
31 Is regular maintenance of Maintenance
equipment (e.g. Refrigerator, schedule,
Solar system) conducted? Interview with
CHO
32 Is monthly motorbikes Interview,
servicing conducted? maintenance
schedule and
register

Community-Based Health Planning and Services: Implementation Guidelines 90

I-VI. Supply management
Means of
No. Check Items Good Fair Poor Remarks
Verification
33 Are health commodities Requisition, Issue and
requested and issued by Receipt Voucher,
standard forms? Requisition form book

34 Does each drug have a bin Bin cards

card?
35 Are all health commodities Bin cards, Drug
stocked above the re- returns
order level?
36 Are commodities kept in Storage condition
good condition (No at dispensary/store
sunlight, heat, moisture,
dust, insect or animal)?
37 Are commodities aligned Cross-check
on shelves by labels between labels on
indicating where the drug the shelves and
belongs? drugs
38 Are commodities Check 2-3 drugs
organised according to aligned
first-to-expire, first-out?
39 Are unserviceable stock Observation at
stored separately to be storeroom,
returned? unserviceable store
register
40 Are office supplies Observation at
(stationery) set in order by storeroom
category?
41 Are copies of Maternal Stock of the booklet
Health Records Booklet at store/service
stocked? point
42 Are copies of Child Health Stock of the booklet
Records Booklet (CWC at store/service
Book) stocked? point
43 Are used Registers/reports Storeroom
kept in the stores?

Community-Based Health Planning and Services: Implementation Guidelines 91

II. Quality improvement of workplace
II-I. Infection prevention and control
Means of
No. Check Items Good Fair Poor Remarks
Verification
44 Is routine cleaning of the Interview with
facility conducted? staff, Schedule
of cleaning
45 Are soap, alcohol rub and Observation at
water or Veronica buckets service points
available for hand-washing at
service points?
46 Are Personal Protective Observation at
Equipment available with OPD and store
appropriate stock (Disposable room
glove, Mask)?
47 Are Re-Usable Personal Observation at
Protective Materials (e.g., room
utility gloves, plastic apron and
mackintosh) maintained
cleanly?
48 Are relevant disinfectants Expiry dates,
(Chlorine/Chlorhexidine) strengths on
available and labelled? labels
49 Is medical equipment Interview with
processed and maintained for CHO
safe use (Sterilisation)?
50 Are medical equipment stored Observe
appropriately to avoid equipment
contamination? storage
51 Are labelled waste containers Observe waste
for different type of waste containers
available? (Label, Place),
Safety box
52 Are no hazardous items Observe Facility
(sharps, contaminated
materials, flammables, harmful
chemicals) exposed in the
facility?
53 Are disposal pits for general Observe
medical wastes available? disposal pit
54 Is placenta disposal pit Observe
available and in use? placenta
disposal pit
55 Are medical wastes disposed Interview with
appropriately (incinerator, staff/Observe
waste disposal pit, or landfill)?

Community-Based Health Planning and Services: Implementation Guidelines 92

III. Service delivery
III-I. MNH and child health
A. FP
Means of
No. Check Items Good Fair Poor Remarks
Verification
56 Is Family Planning FP Not updated
Guideline/Protocol Guidelines/Protocol
available?
57 Are FP commodities Check all FP
(Condoms, Pills, Injection, commodities
Implant, and IUD) available
in stock?
58 Is Family Planning register Family Planning
available and correctly register
completed?
59 Is the record of FP service Check 1-2 FP Client
correctly completed on the Card
FP Client Card?
60 Is Family Planning flipchart Observe if clients
used for counselling? are available.
GHS Family
Planning flipcharts
on the desk

B. Adolescent health
Means of
No. Check Items Good Fair Poor Remarks
Verification
61 Is adolescent health corner Observe the
available? corner
62 Is there an adolescent health Sub-district
profile for the sub-district? profile
63 Is adolescent health service Adolescent
record updated? health service
record
64 Is there an adolescent health Action plan
action plan for the sub-district?

C. ANC and PMTCT

Means of
No. Check Items Good Fair Poor Remarks
Verification
65 Are Guides for Maternal and Observation at
Newborn Care Part 1 and Part maternity
2 available? service point
66 Is National Safe Motherhood Observation at N/A
Service Protocol available? maternity
service point
67 Is the record of ANC services ANC register
correctly completed on the
ANC register?
68 Is the birth preparedness plan Maternal Health N/A
completed on the Maternal Record Booklet
Health Record Booklet? ( If pregnant
women
available)

Community-Based Health Planning and Services: Implementation Guidelines 93

 Means of
No. Check Items Good Fair Poor Remarks
Verification
69 Is the record of ANC service Maternal Health N/A
correctly completed on the Record Booklet
Maternal Health Record ( If pregnant
Booklet? women
available)
70 Are commodities for focused Check
ANC available? Iron/folate,
Multivitamin, TD,
SP
71 Are PMTCT commodities PMTCT
available (HIV test, Syphilis commodities
test)?
72 Is the record of PMTCT services PMTCT register
correctly completed on the
register?
73 Is client’s privacy ensured Observation at
(Screen, Door closed or room
Partition) in the room?

E. Emergency delivery
Means of
No. Check Items Good Fair Poor Remarks
Verification
77 Are minimum quantity of Check Oxytocin,
emergency drugs and supplies IV fluid, Antibiotics
available in the facility?
78 Are minimum set of equipment See condition of
available and ready for use? two sterilised
delivery kits
79 Is partograph used to monitor Used partographs Fill in the number
women in labour? of sample 10 of labour cases
Fill in the number of cases cases on Delivery monitored using
Register of the last partograph
monitored with partograph at
quarter among recent
“Remarks” 10 cases:
(____/ 10 )
80 Is partograph used correctly? Used partographs Fill in the number
of sample 10 of labour cases
cases on Delivery using
Register of the last partograph
quarter correctly among
recent 10 cases:
(____/ 10 )
81 Is Immediate Postpartum Used IPO sheet of
Observation (IPO) sheet used recent 10 cases of
sample 10 cases Fill in the number
to monitor mother and baby
on Delivery of labour cases
after delivery for 10 times in 6 monitored using
Register of the last
hours? (quarterly for 1 hour, quarter IPO sheet
half hourly for 1 hour and among recent
hourly for 4 hours) 10 cases:
Fill in the number of cases (____/ 10 )
monitored with partograph at
“Remarks”

Community-Based Health Planning and Services: Implementation Guidelines 94

F. Child health (CWC, EPI)
Means of
No. Check Items Good Fair Poor Remarks
Verification
82 Are the CWC services correctly CWC Register
recorded on the CWC (Check two
Registers? different age
group registers)
83 Are the CWC services If children
recorded on the Child Health available, see the
Record Booklet? booklet (CWC
booklet)
84 Is the refrigerator monitored Temperature
and temperature recorded on monitoring sheet
the daily monitoring sheet?
85 Is EPI protocol displayed? Observe Service
corner
86 Are there updated graphs Charts of
showing coverage of various coverage of eight
antigens (BCG, OPV, Penta, antigens
PCV, Rota, MLS, YF, TD)
displayed?
87 Are dropout rates (OPV, Penta, Dropout rate
PCV, Rota, MLS) calculated chart (normally
correctly and updated chart same charts the
above)
displayed?
88 Are No. of vaccinations and EPI returns
No. of opened vials reported
monthly?
89 Is there a chart showing Vaccine wastage
wastage of various antigens? chart

90 Are school health services Child health

conducted according to the returns
schedule?

G. Nutrition
Means of
No. Check Items Good Fair Poor Remarks
Verification
91 Are nutrition registers including CMAM and IYCF
CMAM and IYCF available registers
and updated?
92 Are support visits to volunteers Monitoring reports
on nutrition activities
conducted?
93 Are there updated Graphs/charts of
graphs/charts showing: listed indicators
• Prevalence of underweight
among children 0 to 59
• Vitamin A coverage
• Low birth weight
prevalence
• CMAM discharge rates
(cure, defaulter, died)
• CMAM treatment
coverage
• Pregnant/lactating mothers
(children 0–23 months)

Community-Based Health Planning and Services: Implementation Guidelines 95

 Means of
No. Check Items Good Fair Poor Remarks
Verification
counselled
• IYCF support groups formed
• IYCF support groups
facilitated

III-II. Disease control/surveillance

Means of
No. Check Items Good Fair Poor Remarks
Verification
94 Are there updated graphs Graph of
showing cases/vital events surveillance
and diseases under
surveillance?
95 Are all CBSVs supervised CBSV
monthly? Supervisory
report
96 Are CBSV reports submitted on CBSV report
time by CHO to SDHT?
97 Are there spot maps showing Spot map
areas in the CHPS zones where
diseases occur?

III-III. Health promotion

Means of
No. Check Items Good Fair Poor Remarks
Verification
98 Is family planning health FP returns,
promotion carried out? Health
promotion
activity report
99 Is promotion of early ANC, Health
skilled delivery and PNC promotion
carried out? activity report
100 Is the number of population Health
reached from health promotion
promotion recorded by sex? activity report
101 Are IEC materials for Observation in
reproductive and child health the facility
available such as flip charts,
leaflets?
102 What do you use during health Interview
promotion activities?
103 Were health promotion Reports of
sessions conducted during the home visits,
last month? school health
education and
promotion,
Health
promotion
activity report

III-IV. Community participation

Means of
No. Check Items Good Fair Poor Remarks
Verification
104 Are regular home visits for Home Visit Book

Community-Based Health Planning and Services: Implementation Guidelines 96

 Means of
No. Check Items Good Fair Poor Remarks
Verification
ANC, PNC carried out by the
CHO/CHV?
105 Is defaulter tracing Defaulters record
conducted?
106 Have community members CHAP
developed CHAP with the
support of the CHO?
107 Is CHAP regularly monitored, CHAP monitoring
reviewed and updated? report
108 Are CETS established in the Interview/Report/
CHPS zone? Telephone
directory
109 Does CHO support and CETS meeting
monitor communities to minutes (Check
implement CETS? CHO’s name)
110 Are Durbars organised Meeting reports
quarterly?
111 Are quarterly CHMC CHMC meeting
meetings organised and minutes
minutes available?
112 Are visits to other health Visit record/Home
partners (e.g. traditional visit book
healers) conducted
regularly?
113 Is security man for CHPS Interview with
compound provided and CHO
supported by communities?
114 Do communities support in Interview with
water fetching for CHO
CHO/CHN?
115 Do communities support in Interview with
cleaning/weeding at CHPS CHO/Observe
compound?
116 Do communities support Interview with
CHPS for other activities (e.g. CHO
health campaign)?

IV. Referral and feedback

Means of
No. Check Items Good Fair Poor Remarks
Verification
117 Are at least 10 sets of GHS Referral booklet
referral forms available?
118 Are entries in the referral Referral register
register completed including
feedback received?
119 Is current National Treatment National
Guideline available at the treatment
consultation area? guideline

120 No. of referral cases sent in last Referral register No.

3 months
121 No. of feedbacks received in Referral register No.
last 3 months
122 Are Essential Emergency Essential
procedures/protocols Emergence

Community-Based Health Planning and Services: Implementation Guidelines 97

 Means of
No. Check Items Good Fair Poor Remarks
Verification
displayed for easy access and procedures/proto
reference? cols at service
points
123 Does documented evidence Referral booklet
of referral sent (pink form)
remain in the GHS referral
booklet?
124 Are received feedback forms Patient
kept in each patient folder or folders/feedback
a feedback file? file

125 Is transport available (National Interview

Ambulance, CETS or other
mode)?
126 Is telephone directory Telephone
accessible to all staff, directory
displayed and updated?

V. Monitoring and supervision system (FSV)

Means of
No. Check Items Good Fair Poor Remarks
Verification
127 Is monthly CHVs-supervision Monthly CHV-
conducted? supervision
report
128 Are copies of supervision Copies of
reports submitted to SDHT? submitted
reports at SDHT
129 Are findings of supervision Interview with
implemented from CHO to CHO/CHV
CHV?
130 Do CHOs participate in the Intervi9ew with
quarterly FSV Review Meeting CHO
conducted by DHMT?

Community-Based Health Planning and Services: Implementation Guidelines 98

Summary Sheet of FSV by SDHT to CHPS
Name of CHPS: Date:
Implementation
Name of Person
Q# Issues identified Action Level Timeframe Remarks
Responsible
(CHPS/SDHT)

Name(s) and signature(s) of supervisor(s):

Name(s) and signature(s) of supervisee(s):

99 Community-Based Health Planning and Services: Implementation Guidelines

Appendix E: CHPS Roll-Out Assessment Tool
Done
Step Milestone Detailed Tasks Responsible Institution/Official Comment
Yes No
Situation analysis and problem identification at the level of the
DHMT
The DHMT (DDHS and public health
One Detailed plan Consultation with DA—the DCE and the Social Services Sub-
nurses/midwives)
created Committee
Selection of communities
Two Consultation and sensitisation of health workers DHMT
Three Community Dialogue with community leadership: DA, area council, Unit
The DHMT (DDHS and public health
entry Committee members, social groups responsible for the
nurses/midwives)
conducted communities, chiefs, leaders, women’s groups, etc.
Four Community information durbars Community leaders/DHMT
Five Selection and training/orientation of CHOs DHMT/SDHT
Six Selection and orientation of CHMC members Community leadership, SDHT, DHMT
Compilation of community profile: information on geographic
DHMT; SDHT; CHMC members, DA;
Seven and demographic characteristics, settlement patterns, existing
community leadership
human habitation, and health features and facilities
Community Procurement (construction, renovation, hiring, renting, or
Health rehabilitation) of Community Health Compound for CHO
Eight CHMC
Compound residence
operationalised
Essential Mobilisation of logistics
Nine equipment DHMT
supplied
Launching of CHO programme—community information Community leaders supported by
Ten CHO posted
durbar DHMT/DA
Eleven Selection of CHVs CHMC, SDHT
Twelve Approval of CHVs at a durbar CHMC, SDHT
CHVs
Thirteen Training of CHVs DHMT, SDHT
deployed
Fourteen Mobilisation of logistics and equipping the CHVs DHMT, SDHT
Fifteen Durbar to launch CHPS programme Chiefs, CHMC, SDHT

100 Community-Based Health Planning and Services: Implementation Guidelines

 Appendix F: Equipment, Tools, Supplies, Drugs for
CHPS Zones
Category Description Quantity Needed
1 General Sphygmomanometer 2
2 General Stethoscope 2
3 General Weighing Scale (adult) 2
4 General Height Scale (adult) 2
5 General Weighing Scale (baby, flat type) 2
6 General Height Scale (baby) 2
7 General Measuring tape 2
8 General Thermometer digital 2
9 General Wall Clock 2
10 General Examination couch 1
11 General Snellen’s chart 1
12 General Nurse scissors (5 1/2”) 1
13 General Apron, vinyl 1
14 General Kidney dish (L, M, S) 1
15 General Gallipot (L, M, S) 1
16 General Instrument tray with cover (M, S) 1
17 General Sterilizing drum (Medium) 2
18 General Boiling Sterilizing case with lid 1
19 Outreach Pedal waste bin 3
20 Outreach Home visiting bag 1
21 Outreach Weighing scale (hanging type for baby) 1
22 Dressing Dressing instrument set 1
23 ANC Foetal stethoscope 1
24 ANC Vaginal speculum cusco (medium) 1
25 ANC Examination bed for obstetrics 1
26 Delivery Delivery instrument set 1
27 Delivery Ambubag (for adult & infant) 1
28 Medical furniture Consultation desk & chair 1
29 Medical furniture Chair for patient 1
30 Medical furniture Medical cupboard 1

31 Medical furniture Veronika bucket (small 1

32 Medical furniture Veronika bucket (large) 1
33 EPI Refrigerator for vaccine 1
34 Transport Motorbike 1

101 Community-Based Health Planning and Services: Implementation Guidelines

 For Home Visit for CHO and CHV
(1) For CHO

NO. ITEM Quantity

1 Back pack 1
2 Dressings (Bandage, Gauze swabs, Cotton Wool swabs, Plaster 1”&2”, 5
Crip bandage, Vaseline Gauze etc.)
3 Raincoat 1
4 Cup & Spoon 2
5 Soap dish & Soap 1
6 Hand towels 6
7 Notebook 2
8 Pen & Pencil 2
9 Torch Light and batteries 1
10 Wellington Boots 1
11 Family Planning methods Samples & For sale
12 Oral Rehydration salts (ORS) Samples & For sale
13 Insecticide Treated Nets (ITNs) 1
14 Methylated Spirit/Glycerin (Alcohol Rub) 1
15 Penis Model 1
16 Health education 1 each
-Maternal Health Record Book
-Breastfeeding Care
-Complementary Feeding
-Malaria Prevention etc.
17 Brochures (Assorted) 1 each
18 Community Register 1
19 Volunteer T-shirt (Lacoste) 2
20 Plastic sheet 2 yards 1
21 First Aid items (Parafin, Mecurochrome, Activated charcoal, ) * 1
22 Tape measure 1
23 Drugs – Anti-malarials
24 Artesunate Amodiaquine (various age groups)* 5 each
25 Artemeter Lumifantrine (lonart, coaterm)* 2
26 Sulphadoxine Pyremethame (SP)* 10
27 Paracetamol 2 sachet
28 Disposable gloves 2 pairs or more
29 Methylated spirit 1
30 Data Management tools Various in Plastic wallet
31 Blood Pressure kit (digital) 1
Midwifery Kit
32 Plastic sheets 1 (2 Yards)
33 Disposable gloves 2 pairs
34 Cord Ligatures (twine) 2 pairs
35 New Blade 2
36 Methylated spirit 1 100ml.
37 Oxytocin 4
38 Soap (wrapped in Polybag) 1
39 Gauze Swabs 5 packs
40 Cotton wool swabs 5 packs
41 Polythene bag for waste 2 (1 for placenta)
42 ORS 1
Community-Based Health Planning and Services: Implementation Guidelines 102
 (2) For CHV

NO. ITEM Quantity

1 Knapsack 1
2 Plastic file 2
3 Community book 1
4 Data tools 4
5 Stationery 1
6 Plaster 1
7 Bandage 1
8 Ekrobewu 1
9 Cotton Wool swabs 5
10 Guaze swabs 5
11 Small notebook 1
12 Contraceptive methods 3
13 Anti malarials (Green leaf) 2
14 Plastic sheet 1
15 ORS 5
16 Scissors 1
17 Health education material 4
18 Gloves 1
19 Torch with Batteries 1
20 Wellington books 1
21 Plastic bowl ( as galipot) 2
22 Rain Coat 1

Kit Quantity
Domiciliary midwifery kit: plastic sheet, plastic apron, blade, cord ligatures, 2 kits/sets
tablet of Misoprostol, cotton wool/gauze swabs, gloves, soap
Sterile delivery set: sterile gauze/cotton wool, artery forceps, disposable Kits/sets
gloves, umbilical clamp/sterile string, scissors, sponge holding forceps (2)
Medications To be determined by CHO
Albendazole
Amoxicillin
Artemether + lumefantrine
Artesunate + amodiaquine
Chloramphenicol eye ointment
Condoms
Cotrimoxazole
Depo-Provera (DMPA):
Distilled water
Ferrous folate
Gentian violet, 5%
Mebendazole tablet
Metronidazole
Misoprostol tablet

Community-Based Health Planning and Services: Implementation Guidelines 103

 Multivitamin
Noristerat, Norigest (NET-EN)
Norygnon:
Oral Rehydration Solution and Zinc tablet
Oxytocin, 10 units
Paracetamol
Sulfadoxine + Pyrimethamine
Tetanus Toxoid
Vitamin A

Community-Based Health Planning and Services: Implementation Guidelines 104

Appendix G: CHAP
What Are CHAPs?
CHAPs stands for community health action plans. They are community road maps
summarised in a certain format, and indicate what community members want to achieve
within a specified period with a view to improving their health conditions. CHAPs are
developed by community members with GHS staff members such as CHO, SDHT and
DHMT, providing the necessary backstopping. The CHAPs are implemented by community
members. They are reviewed and updated on a regular basis by community members and the
CHO to make room for new activities after the achievement of current targets on the plan.

Functions of CHAPs
 CHAPs stimulate community interest and sustain enthusiasm in health promotion
through the people’s participation in designing activities, and monitoring progress
against set targets.
 CHAPs bring about full community involvement through its participatory
development process. As a result, it promotes community ownership in community
health activities.
 CHAPs serve as M&E tools for the community members as well as the stakeholders
outside the communities.
 CHAPs attract donors and philanthropists who are interested in supporting similar
initiatives when they are publicly displayed.

Preparation and Support

Engagement of the community takes commitment, preparation and support from all levels
starting from DHMT and including SDHT and CHPS Zone. Responsibilities include the
following:

District Level:
 Articulate a commitment to community engagement and participation in health
 Meet with SDHT to map electoral areas
 Zone district into sub-districts
 Sub-district further demarcated into CHPS zones (aligning with electoral areas)
 Ensure all communities covered by CHPS zones
 Clearly describe population dynamics (e.g. total population, children under 5 years,
children under 1 year, expected pregnancies, and women of fertile age) in district,
sub-district, CHPS zones and communities (e.g., number of households)

Community-Based Health Planning and Services: Implementation Guidelines 105

Sub-District Level:
 Meet the CHO
 Review and discuss CHPS data
 Service delivery (e.g., most common illnesses)
 Common issues (e.g. late first ANC visit)
 Identify issues to discuss with the community (e.g. emergency transportation)
 Support the CHO to prepare a presentation to the community
 In future the sub-district could support the CHO financially to facilitate this meeting

CHPS Zone and CHO:

 Call a durbar—set date and time with CHMC
 Invite District Assembly
 CHMC notifies the Chiefs and opinion leaders of the date and time
 Inform the community what is needed (e.g. venue, beat the gong-gong, chairs)
 At the meeting:
 Makes a presentation to the community meeting on key issues, data challenges
 Leads the action planning process with the community
 Notes the actions, persons responsible and deadlines for each action in a CHAP
 CHAP is documented

Community Level:
 Supports the hosting of the meeting
 Ensures full participation especially opinion leaders and key influential participants
(e.g. teachers, pastors, herbalists, chemist, imam, women’s groups, youth groups,
welfare groups, Unit Committee Representative, assembly member)
 ‘Okyeame’ is identified to facilitate the meeting
 Participates fully in the meeting
 Responsible to implement tasks assigned (e.g., tasks could be assigned to Unit
Committee)
 Support action plan implementation

Description of the Components of the CHAP Format

The following headings constitute the components of the CHAP format.
 CHPS zone: This refers to the CHPS zone, which implement targets in the CHAP.
 Implementing CHPS community: The community or communities within the zone
responsible for carrying out the planned activities.

Community-Based Health Planning and Services: Implementation Guidelines 106

  Facilitator: The person who guides the CHAP’s development process; in other words,
the person who leads the community members in the drawing-up of the CHAP e.g.
civil society organization (NGO) or Ms Gloria (CHO).
 Date: This is the date on which the action plan was developed.
 Target: This originates from the issues/problems prioritised by all
groups/communities. You can convert/rephrase the original issues/problems into what
refers to the results earmarked to be accomplished within a specified period e.g.,
“Poor access road to CHPS compound (issues/problems)”. This is
converted/reworded into “Access road to CHPS compound is improved (Target)”.
 Overall timeframe: The total amount of time needed to accomplish the targeted
activities.
 Main activities: They originate from the actions prioritised by all
groups/communities. These are the key tasks to carry out in order to achieve the
target. For one target, you should set several activities which are rephrased/re-
developed based on the original actions.
 Schedule: This indicates when each activity is carried out for the target. In CHPS
implementation, CHAPs are expected to be updated every three months. Therefore,
the schedule for activities in the next three month is described.
 Resources required: These are the logistics/materials needed to carry out the
activities. Items will be described as clearly as possible. For example, “GHC
(Ghanaian cedi) 150.00” will be mentioned instead of a less-precise description such
as “money”. For example, 15 note pads, 10 buckets of stone, GHC 5.00 for
transportation fee.
 Persons in Charge: They are the community members selected to lead the whole
community in working to achieve a particular target. Writing the names of community
members against a task, makes him/her feel recognised and motivated to work hard.
 Indicators: They are the milestones or sign post that tell community members whether
or not they are on track and progressing towards achieving their planned activities.
Ideally, evidence as a means of verifying shall also be described, e.g., number of
participants (minutes of meeting).
 Remarks: They are statements about the status of planned activities. That is whether
the activity is accomplished, ongoing, or stopped. It shall also have reasons assigned
for such actions if possible.

Community-Based Health Planning and Services: Implementation Guidelines 107

108 Community-Based Health Planning and Services: Implementation Guidelines
109 Community-Based Health Planning and Services: Implementation Guidelines
Appendix H: Roles and Responsibilities of the GHS
Headquarters Divisions
Division Roles and Responsibilities Activities
Office of the • Ensuring that the CHPS • Provide direction and oversee the implementation
Director zones contribute of the CHPS strategy
General significantly to • Advocate for inter-sectoral collaboration and
(ODG) reducing morbidity support for the CHPS implementation
and mortality
• Mobilise resources to support the CHPS
implementation
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Institute an award system for good performance
PPME • Policy development • Review and disseminate CHPS policy
and review • Develop and disseminate CHPS implementation
• CHPS strategic and guidelines
operational planning • Prioritise CHPS in planning guidelines
• CHPS implementation • Develop and disseminate indicators for assessing
monitoring CHPS level performance in respect of the Division's
mandate
• Monitor CHPS implementation and information
system and report on CHPS contribution to
attainment of GHS objectives
Public Health • Mainstreaming • Mainstream public health programmes planning
Division (PH) community-level and implementation into CHPS
public health activities • Develop appropriate guidelines and build CHPS
into CHPS zones capacity in public health service delivery
(equipment, guidelines, training, etc.)
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Monitor community-level public health activities
and report on CHPS contribution to attainment of
public health targets and objectives
Intuitional • Mainstreaming • Mainstream development of planning of
Care Division Community-level management of emergencies and minor
(ICD) clinical services into ailments/injuries, quality assurance and referral
CHPS system (training, equipment, etc.) into CHPS
• Develop appropriate material and build capacity
of CHPS zones in management of minor ailments
and referrals (equipment, training, guidelines etc.)
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Monitor CHPS implementation of clinical services
and contribute to institutional care objectives and
targets

Community-Based Health Planning and Services: Implementation Guidelines 110

 Division Roles and Responsibilities Activities
Family Health • Mainstreaming • Mainstream MCH programmes planning and
Division (FHD) community-level MCH implementation into CHPS
activities into CHPS • Develop appropriate guidelines and build CHPS
zones capacity in MCH service delivery (equipment,
guidelines, training, etc.)
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Monitor community-level MCH activities and report
on CHPS contribution to attainment of MCH targets
and objectives
Human • Human resource • Liaise with Health Training Institutions in the training
Resources planning for CHPS of CHNs, midwives for deployment as CHOs
Development zones • Plan and coordinate the equitable deployment of
Division • Management of CHOs CHOs and CHNs, midwives to CHPS zones
(HRDD)
• Coordination of In- • Liaise with other institutions that train other health
service training of professionals to factor in their training the principles
CHOs, CHMCs and and strategy of CHPS
CHVs. • Work with other divisions to develop structured in-
service training programme for CHOs, CHMCs, and
CHVs
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Monitor staff deployment and management in
CHPS zones and report on staff performance
Health • Provision and • Plan for infrastructural, transport and equipment
Administratio coordination of needs for CHPS zones
n Support infrastructure, • Develop appropriate guidelines and build CHPS
Service transport and zones capacity in maintenance of estate, transport
(HASS) equipment support and equipment (equipment, guidelines, training,
systems for CHPS etc.)
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Coordinate the management and monitor the
infrastructural development, transport and
equipment provision in CHPS zones
Supplies, • Ensuring availability of • Plan for CHPS level capacity and commodities
Stores and the requisite needs
Drug medicines and • Develop and disseminate indicators for assessing
Managemen medical commodities CHPS level performance in respect of the Divisions
t (SSDM) without stock-outs in mandate
CHPS zones
• Coordinate, monitor and report on logistics
management in CHPS zones
Finance • Ensuring sound • Factor in CHPS in the Division's planning
Division (FD) financial • Develop and disseminate financial management
management in CHPS guidelines for CHPS zones
zones
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Monitor and report on financial management in
CHPS zones

Community-Based Health Planning and Services: Implementation Guidelines 111

 Division Roles and Responsibilities Activities
Internal Audit • Ensure accountability • Factor in CHPS in the Division's planning
Division (IAD) for resources provided • Develop and disseminate simple accountability
to CHPS zones guidelines for CHPS zones
• Develop and disseminate indicators for assessing
CHPS level performance in respect of
accountability for resources
• Monitor and report on accountability for resources
in CHPS zones
Research • Ensuring that strategies • Investigate the effectiveness and efficiency of the
and adopted at CHPS strategies employed in CHPS zones
Development zones are evidence • Periodically conduct or support the conduct of
Division based impact evaluation of the CHPS strategy
• Develop and disseminate indicators for assessing
CHPS level performance in respect of the Divisions
mandate
• Explore for new innovations for improving the
effectiveness and efficiency of community-level
health programmes

Community-Based Health Planning and Services: Implementation Guidelines 112

 •

Appendix I: Standard Design for CHPS Compound

CHPD Compound (Apartment 2)

Community-Based Health Planning and Services: Implementation Guidelines 113

Community-Based Health Planning and Services: Implementation Guidelines 114
Community-Based Health Planning and Services: Implementation Guidelines 115
Community-Based Health Planning and Services: Implementation Guidelines 116
Community-Based Health Planning and Services: Implementation Guidelines 117
Community-Based Health Planning and Services: Implementation Guidelines 118
Community-Based Health Planning and Services: Implementation Guidelines 119
Community-Based Health Planning and Services: Implementation Guidelines 120
Community-Based Health Planning and Services: Implementation Guidelines 121
Community-Based Health Planning and Services: Implementation Guidelines 122
Community-Based Health Planning and Services: Implementation Guidelines 123
CHPD Compound (Apartment 3)

Community-Based Health Planning and Services: Implementation Guidelines 124

Appendix J: Referral Forms

GHS Health Facility Referral Form (updated and reprinted in 2013)

Instructions for Use
1. The referral form can be used for clinical or diagnostic services referrals.
2. The instructions below are to assist in completing the form and referring clients
appropriately.
3. The form comes in three-fold (original, duplicate and triplicate), with each sheet in
different colour.
 Each set of three sheets has one unique serial number. When the client is referred, the
triplicate is to be retained in the referring facility and the client takes the duplicate and
original to the referred facility (i.e. the facility to which the client is referred).
 The duplicate is kept by the referred facility.
 The original is clipped to the client NHIS bill as evidence that the client was referred.
 Where the client’s condition requires feedback, a separate feedback form must be
filled and returned to the referring facility.
 Please complete form legibly.
 Where necessary, staple extra plain sheet to referral form to provide additional
information.

Form developed by the Institutional Care Division

Community-Based Health Planning and Services: Implementation Guidelines 125

GHS Health Facility Referral Form

Patient reg. no. _____________________________ Serial no. (Pre-printed)

Day Month Year

Health Facility Information

Name and address of referring health facility:

Name and address of health facility referred to:

Time referred: Time of departure (if emergency):

Patient/Client Information
Surname: Other name(s):

Sex Date of birth Insurance status

Male Uninsured

Female Day Month Year Insured

Age ID no.___________
Name and address of contact person/relative:

Telephone no. of contact person:

Patient/Client Clinical Details

Presenting complaint(s)

Examination findings

Temperature: Pulse: Respiratory rate: BP: Weight:

Results of investigations carried out

Community-Based Health Planning and Services: Implementation Guidelines 126

 Diagnosis/es

Medical management/treatment given

Reason for referral and comment for next level

Name of officer referring:

Position:

Signature: Date:

Contact(s) of officer referring:

Community-Based Health Planning and Services: Implementation Guidelines 127

GHS Health Facility Referral Feedback Form
Instructions for Use
1. The referral feedback form can be used for providing feedback on patients whose
conditions and clinical management require sharing between the facilities concerned for
continuity and improving quality of care.
2. The instructions below are to assist in completing the form:
 The form comes in two-fold (original and duplicate) with each sheet in different
colour.
 Each set of two sheets has one unique serial number. The duplicate is to be retained in
the facility and the original copy submitted to the health facility which referred the
client (i.e. the facility where the client came from).
 Please complete form legibly.
 Where necessary, staple extra plain sheet to feedback form to provide additional
information.

Form developed by the Institutional Care Division

Community-Based Health Planning and Services: Implementation Guidelines 128

GHS Health Facility Referral Feedback Form

Patient reg. no. _____________________________ Serial no. (Pre-printed)

Day Month Year

Kindly fill this form in duplicate and return a copy to the facility which referred this client.

Health Facility Information

Name and address of health facility providing feedback:

Name and address of health facility to which feedback is being sent:

Name and position of clinician who received client:

Patient/Client Information
Surname: Other name(s):

Sex Date of birth Insurance status

Male Uninsured

Female Day Month Year Age Insured

ID no.___________
Name and address of contact person/relative:

Telephone no. of contact person:

Date of referral Date of arrival at referred Diagnosis on referral
facility ________________________________
________________________________

Day Month Year Day Month Year

Final diagnosis

Medical
management/treatment given
(please write how patient was
managed)

Outcome (please tick) Discharged

Died Day Month Year

Day Month Year

If client is being referred back to another facility on discharge, please provide advice for further
management and any other recommendations. Use extra sheet if need be.

Community-Based Health Planning and Services: Implementation Guidelines 129

 Next review date (where
applicable):

Name of officer providing feedback:

Position:

Signature: Date:

Contact(s) of officer providing feedback:

Community-Based Health Planning and Services: Implementation Guidelines 130

Appendix K: M&E of CHPS Implementation for the Districts
Form 1—Community
Name of Name of
Name of SD Served by No. of CHMCs No. of CHV CETS Population
CHPS Zone Communities
Number of active 0: No CETS has started
0: Directly served by CHMC Number of Active 1: CETS is not
Name given List all
SDHT (Active CHMC = CHV functioning in the last
to the CHPS communities No of population
1:Served by CHPS attended meeting at (Active CHV = reports quarter
zone under the zone
zone least once in the last 6 to CHO monthly) 2: CET is functioning in
months) the last quarter
Bamahu Bamahu Dagaabayiri 1 6 1 1 618
Bamahu Bamahu Kongpaala 1 4 1 1 404
Bamahu Bamahu Yarihiyiri 1 4 1 1 676
Bamahu Boli Boli 1 12 3 1 2,583
Bamahu Piisi Piisi 1 8 4 0 1,983

131 Community-Based Health Planning and Services: Implementation Guidelines

Form 2—CHPS Resources
CHPS Enhancement Data

Functional CHPS zones

CHPS with health staff

Population Covered
by CHPS with health

Population covered
by functional CHPS
Service Delivery h
Total No. of Staff
No. of Midwives
Electoral Area

Construction f
Mother SDHT

Compound e
No. of CHOs

No. of CHNs

and service
Equipment g
Coverage d

Sponsor of
No. of ENs

Remarks
CHMCs j

CHVs k
CHPS c

CHAP i

staff
No.

Refer to staff list and

Criteria Same as coverage
count the number.
12 Bamahu Bamahu Boli 2356 1 1 1 1 4 1 DA 1 2 1 0 8 1 1 2356 2356 Newly
Added

c If demarcated CHPS zones are added, add another row at the end of the group of the same mother SDHT. Mention in the remarks in the last column “newly added”.
d Currently population of the
e Please enter the following numbers: 0 = no compound, 1 = compound constructed, 2 = under construction.

f Please enter the following: DA = District Assembly; JICA = grants or donor name; or other name as applicable.

g Refer to the list of essential equipment: 0 = no equipment; 1 = partially equipped; and 2 = fully equipped.

h Please enter the following: 0 = No service delivery; 1 = partial (CHO based SDHT); 2 = fully (CHO works in compound)

i Please enter the following: 0 = No CHAP started; 1 = CHAP is not updated in the last quarter; 2 = CHAP is updated in the last quarter

j The CHMC has conducted a meeting in the last six months. Please enter the following: 0 = no; 1 = yes.

k No. of CHVs who reports to the CHO monthly.

132 Community-Based Health Planning and Services: Implementation Guidelines

133 Community-Based Health Planning and Services: Implementation Guidelines
Form 3—Technical Staff Available
Title
Name of Health Background of
Mother Sub-District CHPS (CHO, CHN, EN, Mobile No. Email Address
Workers CHO
Midwife)
Bamahu Bamahu

Yaa CHO CHN

Bamahu Boli Mensah CHO EN

Anne CHN CHN

Mary Midwife CHN

134 Community-Based Health Planning and Services: Implementation Guidelines

Appendix L: List of Feasible Actions Taken by MMDAs
1. Community Level
No. Category No. Sub-category Indicators Source of information
Provide required technical skills to implement CHAP
activities that are construction-related in CHPS zones such # of CHPS zones receiving technical skills MMDAs Annual Accounts
1-1-1.
as drawing plans, appropriate locations and supervision of from MMDAs to implement CHAP MMDAs Activity Report
construction work
Bear the cost of relevant materials to implement CHAP # of CHPS zones which received
1-1-2. activities that relate to construction and maintenance e.g. materials from MMDAs to implement MMDAs Annual Accounts
zinc and wood for roofing, etc. CHAP
Support CHAP
1-1
implementation # of community durbar organised by
1-1-3. Organise community durbar on health issues MMDAs Activity report
MMDAs
# of advocacy sessions by MMDAs that
Advocate involvement of community members in
1-1-4. target community members to involve MMDAs Activity report
implementing CHAP activities
them in CHAP activities
Provide the cost and material for durbar and/or meeting # of CHPS zones which received MMDAs Stores Receipt
1-1-5.
to develop CHAP such as stationary, snack, etc. material from MMDAs to develop CHAP Voucher/Facility Assets Register
# of CHPS zones receiving money from MMDAs Stores Receipt
1-2-1. Give initial money to create CETS
MMDAs to start CETS Voucher/Assets Register
# of CHPS zones getting tricycles by
1-2-2. Support communities to procure tricycles MMDAs Annual Accounts
Support CETS MMDAs support
1-2
creation
# of communities that have used
MMDAs to set aside one vehicle as emergency transport
MMDAs emergency vehicle for CETS
1-2-3. for CETS to communities that cannot get and make funds CETS Records at the CHPS zones
purposes and # of cases supported by
available to fuel such emergency transport
MMDA on fuel cost
# of CHVs/CHMCs enrolled into NHIS
1-3-1. Pay registration fees to CHVs/CHMCs to enrol into NHIS MMDAs Annual Accounts
with fees from MMDAs
# of CHMC sponsored for CHMC training
1-3-2. Provide funds for CHMC training MMDAs Annual Accounts
by MMDAs
Motivate # of volunteers sponsored for training by
1-3 1-3-3. Provide funds and support for CBSVs MMDAs Annual Accounts
CHVs/CHMCs MMDAs
Pay fees to renew membership status of CHV/CHMC in # of CHVs/CHMCs NHIS renewed by
1-3-4. MMDAs Annual Accounts
NHIS MMDAs
# of CHVs receiving allowance from
1-3-5. Provide funds as allowance for CHVs MMDAs Annual Accounts
MMDAs

135 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
# of CHVs who receive bicycles
1-3-6. Purchase bicycles for CHVs MMDAs Stores Receipt Voucher
purchased by MMDAs
Provide funds to purchase Identification cards for # of CHVs/CHMCs who receive
1-3-7. MMDAs Annual Accounts
CHVs/CHMCs identification card
Organise food demonstration to raise awareness on # of community supported for garbage
1-4-1. MMDAs Activity Report
appropriate complementary feeding practices collection by MMDAs

Support # of community-based surveillance

1-4-2. Carry out community-based surveillance activities MMDAs Activity Report
1-4 community supported by MMDAs
health activity # of maternal auditing and mortality
1-4-3. Carry out maternal auditing and mortality durbars MMDAs Activity Report
durbars supported by MMDAs
1-4-4. Procure ITNs to reduce malaria # of ITNs procured by MMDAs MMDAs Activity Report

2. CHPS Level
No. Category No. Sub-category Indicators Source of information
# of CHN sponsored for fresher training by
2-1-1. Provide fund for CHO fresher training MMDAs Annual Accounts
MMDAs
Support
capacity # of CHO sponsored for refresher trainings
2-1 2-1-2. Provide funds for CHO refresher training MMDAs Annual Accounts
building of by MMDAs
CHOs
# of students sponsored for CHN training MMDAs Stores Receipt Voucher/
2-1-3. Sponsor eligible local indigenes into CHN training school
school by MMDAs Assets Register
# of new compounds constructed by
Support 2-2-1. Construct new CHPS Compounds MMDAs Contracts Register
MMDAs
2-2 compound
construction # of new compounds furnished By MMDAs Stores Receipt Voucher/
2-2-2. Furnishing of new compounds
MMDAs Facility Assets Register
# of CHPS zones supplied with cold
MMDAs Stores Receipt Voucher/
2-3-1. Purchase cold chain equipment for CHPS zones chains
Assets Register
purchased by MMDAs
# of CHPS zones with motorbikes MMDAs Stores Receipt Voucher/
Support with 2-3-2. Procure motorbike for CHPS zones
provided by MMDAs Facility Assets Register
2-3 logistics to
CHPS zones Purchase communication equipment - two-way radio or # of CHPS zones with communication MMDAs Stores Receipt Voucher/
2-3-3.
mobile Phone for CHPS zones equipment provided by MMDAs Facility Assets Register
2-3-4. Construct toilet facilities for CHOs and visitors # of toilets constructed by MMDAs MMDAs Contracts Register
2-3-5. Support comfort logistics for CHO and CHN # of CHPS zones with the items provided MMDAs Stores Receipt Voucher/

136 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
(bed, furniture, kitchen ware, TV, radio, etc.) by MMDAs Facility Assets Register
Construct outreach activity points in communities far from # of new outreach activity points
2-3-6. MMDAs Contracts Register
CHPS compounds constructed by MMDAs
# of compounds with electricity provided
Support with 2-4-1. Provide electricity at CHPS compounds by MMDAs utilities extension records
utilities at the MMDAs
2-4
CHPS # of compounds with boreholes provided
compound 2-4-2. Provide water (borehole) by MMDAs Contracts Register
MMDAs
# of CHPS zones with security paid for by
2-5-1. Pay allowance to the security at the CHPS compound MMDAs Annual Accounts
Security for the MMDAs
2-5
compound # of CHPS compounds with fence built by
2-5-2. Build security fence around CHPS compounds MMDAs Contracts Register
MMDAs
# of advocacy sessions organised by
Organise food demonstration to raise awareness on
2-6-1. MMDAs to involve community members MMDAs Activity report
Maintenance appropriate complementary feeding practices
in maintenance
2-6 of existing
compounds # of compounds maintained using
Purchase materials and pay labour cost for maintenance
2-6-2. materials purchased and labour cost MMDAs Stores Receipt Voucher
of CHPS compounds
paid by MMDAs

3. SDHT Level
No. Category No. Sub-category Indicators Source of information
# of CHNs/ENs/midwives sponsored by
3-1-1. Sponsor candidates for CHN/ENs/midwives for training MMDAs Annual Accounts
MMDAs
Support build Support midwives/CHN with transportation and # of midwives/CHNs supported with
the 3-1-2. MMDAs Annual Accounts
accommodation cost for attending training sessions transport cost to attend training sessions
3-1 capacity of
staff of the Sponsor eligible local indigenes into midwifery training # of students sponsored for Midwifery MMDAs Stores Receipt
3-1-3.
facility school training school by MMDAs Voucher/Assets Register
# of midwives receiving motivation
3-1-4. Provide motivational package to midwives MMDAs Annual Accounts
package from MMDAs

Strengthen MMDAs Stores Receipt

3-2-1. Attend MNDA reviews sessions # of MNDA reviews attended by MMDAs
maternal and Voucher/Facility Assets Register
3-2
neonatal death MMDAs Stores Receipt
audit (MNDA) 3-2-2. Sponsor MNDA review sessions # of MNDA reviews sponsored by MMDAs
Voucher/Assets Register

137 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
# of times venue has been provided for
3-2-3. Provide venue for MNDA reviews MNDA review report
MNDA reviews
3-3-1. Construct a new health centre # of H/Cs constructed by MMDAs MMDAs Contracts Register
Construct health centres’ (HCs') facilities
(e.g. resting place for newly delivered mothers and
3-3-2. # of facilities constructed by MMDAs MMDAs Contracts Register
children, children's ward, theatre block, medical
laboratory, male/female wards, maternity block)
# of Apartments for staff at HC
3-3-3. Construct and furnish staff accommodation at the HCs MMDAs Contracts Register
constructed and furnished by MMDAs
# of HCs using generator provided by MMDAs Stores Receipt
3-3-4. Provide generator for HCs, fuel and maintenance
MMDAs Voucher/Facility Assets Register
MMDAs Stores Receipt
Provide telephone line and pay for the monthly fees or # of HCs with telephone line or given
Support facility 3-3-5. Voucher/Facility Assets
3-3 give some monthly credits for telephone call credits for phone by MMDAs
improvement Register/actual telephone line
# of HCs with placenta pits and safe
Construct placenta pit and safe disposal
3-3-6. (covered or fenced) waste disposal by Actual pits/waste disposal pit
(covered/fenced) for medical/common wastes
MMDAs
# of HCs with water supply maintained by
3-3-7. Maintain water supply (borehole, tap water etc.) MMDAs Annual Accounts
MMDAs
Help HCs to create woman and baby friendly delivery
# of HCs helped by MMDAs to provide
3-3-8. room and ANC/PNC rooms (to keep privacy such as MMDAs Contracts Register
means to protect privacy for women
curtain, screen)
Organise food demonstration to raise awareness on # of HCs receiving maintenance and
3-3-9. MMDAs Annual Accounts
appropriate complementary feeding practices renovation sponsored by MMDAs
Support running Provide a person for cleaning the HC and pay the # of HCs using cleaners hired and their
3-4 3-4-1. MMDAs Annual Accounts
of the HC remuneration for such a person, if none remunerations paid by MMDAs
# of HCs provided with motorcycles,
3-5-1. Provide motorcycles, helmets and maintain them helmets and MMDAs Annual Accounts
maintained by MMDAs
Transport for
3-5 # of HCs provided with fuel for official
SDHT 3-5-2. Provide fuel for motorcycles for official trips MMDAs Annual Accounts
trips
# of midwives in the receiving motivation
3-5-3. Pay allowance for midwives in the district as motivation MMDAs Annual Accounts
allowance by MMDA

4. Hospital Level
No. Category No. Sub-category Indicators Source of information

138 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information

Support Amount of funds provided MMDAs to fuel

4-1-1. Bear the cost fuelling the ambulance MMDAs Annual Accounts
effective ambulance
4-1
operation of # of times ambulance has been
ambulance 4-1-2. Maintain ambulance MMDAs Annual Accounts
maintained by MMDAs
# of hospitals with IEC materials for MCH
4-2-1. Procure IEC materials for MCH classes MMDAs Annual Accounts
Strengthen classes provided by MMDAs
4-2
MCH classes # of advocacy sessions conducted by
4-2-2. Advocacy for increased participation in MCH classes MMDAs activity Report
MMDAs
Sponsor the training of nurses/midwives working at the MMDAs Stores Receipt
4-3-1. # of nurses sponsored by MMDAs
hospital Voucher/Facility Assets Register
Pay for refresher training for nurses/midwives to update # of nurses sponsored for refresher MMDAs Stores Receipt
4-3-2.
Support them with current skills trainings Voucher/Assets Register
4-3 capacity # of hospital staff supported for the
building of staff 4-3-3. Pay transport for the staff going for the training transport in order to attend training by MMDAs Annual Accounts
MMDAs
# of doctors receiving motivation
4-3-4. Pay motivation allowance to doctors MMDAs Annual Accounts
allowance from MMDAs
# of hospitals whose water supply are
4-4-1. Maintain water supply system MMDAs Annual Accounts
maintained by MMDAs
Maintain power supply or give a generator, if necessary # of hospitals supported by MMDAs for
4-4-2. MMDAs Annual Accounts
(give fuel and maintenance if to provide a generator) the power supply
List of work supported by MMDAs per
4-4-3. Help general repair/maintenance of facility MMDAs Annual Accounts
hospital
Construct waiting homes for pregnant women and # of constructed waiting homes at
4-4-4. MMDAs Contracts Register
families hospital
Support the
4-4 running of the Help to create woman and baby friendly delivery room
# of HCs helped by MMDAs to provide
facility 4-4-5. and ANC/PNC rooms (to keep privacy such as curtain, MMDAs Contracts Register
means to protect privacy for women
screen)
# of operating theatres constructed at
4-4-6. Construct operating theatre at the district hospital MMDAs Contracts Register
the district hospital by MMDA
# of casualty ward constructed at the
4-4-7. Construct casualty ward at the district hospital MMDAs Contracts Register
district hospital by MMDA
# of nutrition block constructed and a
Organise food demonstration to raise awareness on
4-4-8. rehabilitated centre worked on by MMDAs Contracts Register
appropriate complementary feeding practices
MMDA

139 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
# of Doctor bungalow constructed by
4-4-9. Construct bungalow for a doctor in the district MMDAs Contracts Register
MMDA
# of A fence wall constructed around the
4-4-10. Construct fence wall for district hospital MMDAs Contracts Register
district hospital MMDA

5. Referral
No. Category No. Sub-category Indicators Source of information
# of apartments for staff provided by Physical inspection of
5-1-1. Provide accommodation for ambulance staff
MMDAs accommodation
# of apartments for ambulance staff MMDAs Stores Receipt
5-1-2. Furnish the accommodation of ambulance staff
furnished by MMDAs Voucher/Assets Register

Strengthen Office space available for ambulance

5-1-3. Provide office space for ambulance services Direct inspection of office space
national services
5-1
ambulance # of times office space is maintained MMDAs Stores Receipt
operations 5-1-4. Bear the cost of maintenance of the office space
using MMDAs funds Voucher/Facility Assets Register
Available office furniture provided by MMDAs Stores Receipt
5-1-5. Provide furniture for office space
MMDAs Voucher/Assets Register
Cost of ambulance maintenance paid
5-1-6. Bear the cost of maintaining ambulance MMDAs Annual Accounts
for by MMDAs
Alternative # of private car owners with agreement
5-2-1. Make agreement with private car owners Signed agreement
emergency to provide emergency transport services
transport to
5-2
back Availability of maximum rates to operate Statement of maximum rate of
ambulance 5-2-2. Set maximum fares for emergency transport services
emergency transport emergency transport
service
# of referral review sessions attended by
5-3-1. Attend referral reviews sessions Referral Review Report
MMDAs
Strengthen
# of referral review sessions sponsored by
5-3 referral 5-3-2. Pay for the cost referral review sessions MMDAs Financial Report
MMDAs
reviews
# of referral review sessions held with
5-3-3. Provide venue for referral review session Referral Review Report
venue provided by MMDAs

Improvement of Construct new road/bridge around health facilities where # health facilities with new roads/bridges
5-4-1. MMDAs Annual Accounts
5-4 access there are none constructed to facilitate referral
between 5-4-2. Repair the damaged road/bridges around health facilities # of Health facilities with repair of MMDAs Annual Accounts

140 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
community and roads/bridges damaged
hospitals/SDHTs
Arrange hospital ambulances (Vehicle, Regular # of times the hospital ambulance is
for referral 5-4-3. MMDAs Annual Accounts
maintenance cost, Fuel) maintained or fuelled
Organise food demonstration to raise awareness on # and location of mast built to enhance Document with telephone
5-4-4.
appropriate complementary feeding practices effective communication companies

6. Other
No. Category No. Sub-category Indicators Source of information
6-1-1. Renovate and refurbish DHMT office # of DHMT office rehabilitated by MMDA MMDAs Contracts Register
# of DHMT officer's accommodation
6-1 DHMT 6-1-2. Renovate and refurbish DHMT staff accommodation MMDAs Contracts Register
rehabilitated by MMDA
6-1-3. Award for hard working and retired staffs # of DHMT officer awarded by MMDA MMDAs Activity Report
# of borehole drilled and mechanised at MMDAs Stores Receipt
6-2-1. Drill and mechanise a borehole at training school
training school by MMDA Voucher/Facility Assets Register
Training school
(schools for MMDAs Stores Receipt
6-2-2. Furnish training school # of school furnished by MMDA
CHN, Voucher/Assets Register
6-2
midwifery, or # of Student hostel constructed by
medical 6-2-3. Construct students' hostel MMDAs Contracts Register
MMDA
assistant)
Amount of funds provided MMDAs to
6-2-4. Provision of teaching/learning materials and equipment MMDAs Annual Accounts
purchase materials
# of semidetached quarters rehabilitated
6-3-1. Rehabilitate semidetached quarters for junior staff MMDAs Contracts Register
by MMDA
6-3 Junior staff
# of junior staff quarters constructed by
6-3-2. Construct junior staff quarters MMDAs Contracts Register
MMDA
6-4-1. Support district response initiative on malaria prevention Amount of funds provided MMDA MMDAs Annual Accounts
6-4-2. Support district response initiative on HIV/AIDS Amount of funds provided MMDA MMDAs Annual Accounts
6-4-3. Support kangaroo mother care programme Amount of funds provided MMDA MMDAs Annual Accounts
Campaign 6-4-4. Support blood donation campaign Amount of funds provided MMDA MMDAs Annual Accounts
6-4
support
6-4-5. Support exclusive BF campaign Amount of funds provided MMDA MMDAs Annual Accounts
Support food demonstration to raise awareness on
6-4-6. Amount of funds provided MMDA MMDAs Annual Accounts
appropriate complementary feeding practices
6-4-7. Support National Immunisation Day programmes # of National Immunisation Day MMDAs Activity Report

141 Community-Based Health Planning and Services: Implementation Guidelines

 No. Category No. Sub-category Indicators Source of information
programmes organised by MMDA
# of cerebrospinal meningitis
6-4-8. Support cerebrospinal meningitis programmes MMDAs Activity Report
programmes organised by MMDA
# of malnourish people provided with
6-5-1 Provide food supplementation MMDAs Activity Report
food supplementation
6-5 Food support
# of centres constructed by MMDA for
6-5-2 Construct supplementary feeding centres MMDAs Activity Report
feeding

142 Community-Based Health Planning and Services: Implementation Guidelines

Resources
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