One Million Community Health Workers

The One Million Community Health Workers (1mCHW) Campaign is pleased to present the Government of Ghana’s National Community Health Worker Program Operational Roadmap. The Campaign has worked closely with the Government of Ghana since April 2013 to develop a Roadmap for building a national community health worker cadre.

The Roadmap details the technical model of the Ghanaian community health worker (CHW) program including final services to be delivered, essential supplies package, training requirements, terms of references, and management structure.  Multiple departments of the Ministry of Health, Ghana Health Service (GHS), NGOs, academia, global funding agencies, and the private sector contributed input to the creation of this Roadmap.

The goal of the Ghanaian 1mCHW (GH1mCHW) Campaign is to strengthen Ghana’s community-based health delivery system by recruiting, training, equipping and deploying roughly 32,000 CHWs over a 10-year period (2014 – 2023). At the end of a three-phase implementation period, there will be an average of 1 CHW per 500 people (with some variation between urban and rural areas), who will provide community-based healthcare services in a supported manner. Operational and financial details can be found in the Roadmap.

The Roadmap development process kicked off in April 2013, when the Campaign Secretariat made a visit to Accra, Ghana at the request of the Government, to understand the current primary healthcare system and its needs. The Campaign found that Ghana already had a well-planned primary healthcare scheme, the Community-based Health Planning and Services (CHPS) program. CHPS employed community nurses, housed them in compounds that are located in the communities that they serve, and tasked them with visiting households to target and vulnerable populations – mainly children under the age of five and women within child-bearing age.

However, the CHPS program was inadequate to meet the needs of the communities. In reality, the nurses often found themselves confined to their compounds, operating like community clinics instead of using the compound as a base from which to conduct household visits. So the Government saw the Campaign as an opportunity to operationalize the intended design of the CHPS program by adopting the GH1mCHW Campaign.

The Ghanaian government went above and beyond to ensure that internal stakeholders were on board and ready to implement the CHW program by revising their Human Resources for Health Strategies and Implementation Plan 2013 to include the implementation of the CHW program. This move was not only a signal to internal stakeholders that Ghana has incorporated CHWs into the formal healthcare system, but also a call to action to the global health community for increased attention and support to Ghana as they undertake this historic nationwide scale-up process.

Finalization of this Roadmap brings an end to Phase 1 of the GH1mCHW process. After a year of close collaboration, the 1mCHW Campaign and the Government of Ghana have now initiated Phase 2 implementation planning, to strategize a timeline and work plan for rolling-out CHWs across Ghana’s 216 districts. Furthermore, Ghana is considering different growth strategies for key operational functions, developing vendor selection criteria for training and other functions to be outsourced, improving governance structures and re-assessing the allocation of decision-making authority across the existing decentralized health system, and inspecting the current monitoring and evaluation system.

Currently, the Ghanaian government has approximately 40% of the necessary funds to launch the CHW program within its current management and supervision budget. Pending additional funding, the Government will be ready to deploy the first batch of CHWs in the third quarter of 2014. Scale-up of the CHW program is urgent with regards to maintaining progress in Ghana’s Millennium Development Goal (MDG) achievements, before the 2015 deadline and beyond. It is also highly relevant to the post-2015 development agenda in the context of achieving Universal Health Coverage (UHC). By bringing basic health services to hard-to-reach Ghanaian communities, this formally recognized cadre of community health workers will strengthen Ghana’s overall health system, push towards reaching the MDGs by 2015 and help Ghana lay the foundation for UHC.

Visit our website for periodic updates on the progress of Ghana’s CHW scale-up process. To hear what Ghana’s Ministry of Health has to say about the process, check out their commentary on CHW scale up:

If you would like more information or have questions, please contact the Campaign’s Operations Advisor, Sharon Kim, at sjkim@ei.columbia.edu.