Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

Figures & data

Figure 1. The WHO UHC cube: towards universal coverage

Table 1. Estimates of key indicators of CHPS service coverage by study regions

Population characteristic	Study regions		Ghana
	Volta region	Northern region
Projected 2016 populations	2,434,212	2,858,793	28,308,301
Demarcated CHPS zones	649	430	6,548
Functional Zones	408	291	4,400
Percent of demarcated zones that are functional	62.9	67.7	67.2
Maternal Mortality Ratio^a	706	531	319
Skilled Delivery (%)	66.3	36.4	73.7
Neonatal Death Rates^b	30	24	29
Under Five Mortality Rate^c	61	111	60
Contraceptive Prevalence Rate^d	29.5	10.8	77.2
C-section Rate^e	8.8	2.7	12.8

^aDeaths to women during pregnancy and 42 days following delivery per 100,000 live births (2010–2015).

^bRates calculated as the number of deaths within 28 days of delivery per 1,000 live births.

^cRates calculated as the number of deaths between birth and 5 years of age per 1,000 live births.

^dPercent of surgical deliveries.

^ePercent of women aged 15–49 who are currently using any modern method of contraception.

Sources [5,38,47,48].

Table 2. Numbers of focus group participants by SLD, type of participant and type of background characteristics of participants

Type of focus group participant	Northern region SLD		Volta region SLD
	Gushiegu	Kumbungu	Nkwanta South	Central Tongu
Fathers	16	16	18	13
Mothers	16	16	21	15
Young boys	16	16	16	15
Young girls	14	16	14	16
Leaders	17	19	21	16
Total	115	116	122	97
Focus group participant characteristics:
Educational attainment
No education	44%	41%	61%	7%
Some education	56%	59%	39%	93%
Household religion:
Christian	0%	0%	46%	91%
Muslim	95%	100%	3%	0%
Animist	1%	0%	27%	9%
Non-response/no religion	4%	0%	24%	0%
Total	100%	100%	100%	100%

Figure 2. Community perceptions of improving the contribution of CHPS to achieve UHC

Table 3. Perceptions of CHPS in communities with functioning services versus communities lacking resident CHPS nursing services with associated policy implications

Type of community comment	Communities with functional CHPS services	Communities lacking resident nurse provided CHPS services	Examples of possible policy implications
Type A Comments: Population Covered
CHPS reduces delays in accessing care	Noted by most participants	Noted by most participants	Use as a communication theme during CHPS promotional activities.
CHPS improves infant and child health and survival	Noted by all participants	Noted by most participants	Develop CHPS links with grassroots political system
CHPS contributes to adolescent reproductive health	Noted by some participants	Noted by some participants	Develop a comprehensive adolescent health policy and strategy for CHPS
CHPS health workers serve as role models for community youth	Not mentioned	Noted by a few participants	Develop means for youth to volunteer or lead CHPS ‘durbars’
Access to care is still restricted by geographical remoteness	Not mentioned	Noted by some participants	Sustain current policies of expanding CHPS coverage
Type B comments: service provision
Capacity to prevent maternal morbidity and mortality	Referral services are mentioned Facility-based delivery is promoted	Not mentioned	Review midwifery training for CHO; expand deployment of midwives to CHPS facilities
Promotion of ANC and facility delivery	Noted by some participants	Noted by some participants	Support logistics requirements of perinatal care
Health education promotes family planning adoption and spacing	Noted by some adult women participants	Noted by some adult women participants	Expand family planning outreach to men
Essential drugs are often out of stock	Noted by most participants	Noted by most participants	Urgent need for logistics and supply review and reform
Emergency referral services are lacking	Noted by some participants	Not mentioned	Strengthen operational links between service providers
Lack of confidence in technical competence of CHPS health workers	Not mentioned	Noted by few participants	Enhance technical skills of CHOs and referral systems
Negative attitudes of health workers	Noted by some participants	Noted by some participants	Launch in-service training on improving service quality and client satisfaction.
Type C comments: financial protection
Offsets costs of travel for care	Noted by some participants	Noted by a few participants	Use as a communication theme during CHPS promotional activities.
Primary health care is often unaffordable	Noted by most participants	Noted by most participants	Extend NHIS reimbursement to all elements of CHPS services

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Data availability statement

By agreement among partners to the CHPS+ initiative, de-identified qualitative data are available to institutions seeking access by written request to the Corresponding Author of this publication. Requests should clarify the purpose of research and should specify relevant ethical review for the proposed research. Data acquired by this process are for scholarly purposes only and may not be sold or independently distributed.