Contribution of DSS to Promoting g Health for All in Ghana Cornelius Debpuur Navrongo Health Research Centre Ghana
Introduction • Access to basic health care recognized as a human right right • Various efforts to promote access to basic health care for all • Progress has been made in improving access to health care, but more remains to be done – Persistent inequity Persistent inequity – Inability of poor to prevent ill health despite availability of effective technology • Research utilizing DSS platform has contributed Research utilizing DSS platform has contributed significantly to improved access to health care
Objective Objective • Using the example of Navrongo, demonstrate how DSS-based research has contributed to improved health care in Ghana improved health care in Ghana • Provide an example of Navrongo DSS-based research being adopted in the national effort to improve access to basic health care i t b i h lth � In Ghana, DSS-based health research has brought the nation at least one district closer to g achieving health for all
Demographic surveillance system Demographic surveillance system • A critical research tool that involves: – Continuous monitoring of a geographically defined population – Monitoring of vital events (births, deaths and migrations) at regular intervals – Other events of interest monitored at defined intervals e.g. immunization • DSS platform widely employed by field research stations in the research stations in the developing world
The Navrongo Story The Navrongo Story • DSS as the bedrock of NHRC research activities • Vitamin A Supplementation Trial initiated basic DSS i DSS in the Kassena-Nankana District th K N k Di t i t • Expanded and full scale DSS initiated in 1993 • The DSS platform has facilitated research Th DSS l tf h f ilit t d h activities in Navrongo that have contributed to improved health care in Ghana p
NDSS and health care in Ghana NDSS and health care in Ghana • Generating evidence of what works in promoting health care • Building local capacity for research and health • Building local capacity for research and health delivery • Direct investment in health and development of catchment populations • Facilitating development of evidence-based health programs and policies programs and policies
Generation of evidence • Development and Testing of health technologies – Vitamin A Supplementation Trial Vitamin A Supplementation Trial • Vitamin supplementation reduces child mortality by 20% – Insecticide treated bednet trial Insecticide treated bednet trial • Use of ITN reduces child mortality by 17% • Evaluation of health delivery strategies – Navrongo Community Health and Family Planning project • Possible to restructure health care delivery at community level • Doing so improves access and promotes health
Capacity Building Capacity Building • Health research capacity Health research capacity – Academic training of scientific staff (over 10 PhD and numerous MSc/MA) – INDEPTH Leadership program INDEPTH Leadership program – Capacity to conduct research of varied designs • Capacity for health care delivery – Field training for public health trainees – Field training for health managers – Field training for health workers
Promoting the health of study community • Study participants as beneficiaries – Participation in research enhances access to health care • Benefits to local population B fit t l l l ti – Scale up of successful interventions – Impact on behavior of local community – Economic impact of research on local community
Facilitating Evidence-based Programs and Policies • Demonstration of what works – Effective health technologies – Effective strategies for health care delivery – Effective strategies for health care delivery • Dissemination and advocacy – Using evidence to engage policy makers
The Navrongo Community Health and Family Planning Project • Community Health and Family Planning (CHFP) Project, a Community Health and Family Planning (CHFP) Project, a quasi-experimental design, launched in 1994 in Kassena- Nankana District, Upper East Region by the NHRC • • The CHFP assessed whether convenient community The CHFP assessed whether convenient community health and Family Planning services can reduce fertility and mortality in a rural population • The CHFP had four treatment cells: – Three of the cells had a new basic primary health-care and FP program in addition to the standard clinic-based services provided by the Ministry of Health (MOH) – The fourth cell had only the basic standard services and was used as the comparison area for y p the project.
CHFP Experim ental Cells Mobilizing traditional community organization organization No Yes Mobilizing No Comparison Zurugelu only Ministry of (4) (1) Health Nurse Zurugelu plus outreach outreach nurse outreach Yes only (2) (3)
Role of DSS in CHFP Role of DSS in CHFP • Monitoring and Evaluation – Provided demographic information on the district – Provided comparable fertility and mortality over time for all cells p y y – Provided platform for design and implementation of surveys to monitor trends fertility-related behaviors – Provided platform for design of management information system to guide activities of nurses activities of nurses
CHFP Impact CHFP Impact • Increased service coverage • Increased service coverage – One Community Health Officer attend to many people a day than a health centre • Impact on mortality – Reduction in child mortality by 40% in most intensive cell • Fertility impact – Reduction in fertility by one birth in most intensive cell y y � CHFP demonstrated the feasibility and desirable impact of restructuring health care delivery in rural Ghana
NAVRONGO COMMUNITY HEALTH AND FAMILY PLANNING PROJECT AND FAMILY PLANNING PROJECT • Test the fertility and mortality impact y y p of restructuring health service delivery at the community level • Increased service coverage • Reduction in fertility by one birth f • Reduction in child mortality by 40% y y
From Research to National Policy From Research to National Policy • Core elements of the most intensive cell of the • Core elements of the most intensive cell of the CHFP adopted by Ghana Health Service – Reorientation and relocation of community health nurses – M bili Mobilization of community resources for health care delivery ti f it f h lth d li • Community-based Health Planning and Services as the national strategy to promote access to gy p basic health care in Ghana
Summary Summary • NHRC’s mission is to conduct research on critical NHRC s mission is to conduct research on critical health problems in Ghana so as to inform policy • DSS platform as a critical resource in achieving thi this mission i i • Research activities of NHRC contributed in several ways to improved health care in Ghana several ways to improved health care in Ghana • There is reason for optimism that ongoing studies would further contribute to making health f for all a reality in Ghana ll lit i Gh
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