Community Spirit

The most impressive thing I have seen over the year in Ghana has been the hard work of the community members for the benefit of their friends, family and peers. The most impressive program I have witnessed is called Community Case Management (CCM). The program is a Ghana Health Service program, with funding from UNICEF. It focuses on the biggest childhood killers in Ghana; 1. Malaria, 2. Diarrhoea and 3. Pneumonia. These are so common in children under 5 that this one intervention, if implemented universally, would reduce the number of under 5 deaths by 63%.

It is a program that is used in many countries, with the difference in Ghana being that the people running the program, assessing the children, going from house to house, being on call 24/7, and administering the treatment are all community volunteers. The community can nominate 2 people, who are then trained and equipped with educational cards, medications and reporting forms.

These volunteers are mostly women, which in the rural areas, means illiterate with no, or very little education. The volunteers diagnose and treat children using the skills taught to them in annual training sessions, a challenge in itself when you are trying to educate without the use of written tools. Role plays are a large part of the training, yet I never quite understand how the volunteers manage to remember the amount of information they do.

Volunteers attending training. Often with their own children. They are in charge of their supplies - in the white boxes, they carry these around on their heads, or if they are lucky, on a bicycle.

The main thing about the program, I have learnt, is that it increases the use of health services by poor children. Due to location, lack of services, lack of roads or transport or other factors, health facility-based services alone do not provide adequate access to treatment (in many countries, not just Ghana), and, not within the crucial window of 24 hours after onset of symptoms. So CCM brings the treatment to you.

It is affordable, treatment is cheap, and if you can’t afford even the recommended amount, it is given for free. Oral rehydration salts for diarrhoea costs a parent about 5c. Of which, 2c goes to the volunteer as ‘motivation’ – the only form of payment these hard working people receive. They are not officially identified as Ghana Health Service employees, and must keep other, sometimes multiple jobs to make ends meet.

The volunteers are given a large workload. Treating, screening and providing follow up care to the whole community. They must report to the closest health clinic once a month with the statistics of who and what they have treated, and re-stock their medication boxes. No transport is provided, these volunteers may have to walk kilometers, with no reward at the end. However how do you fill a report form when you cannot read or write? One health worker I met created a system to help him get reports from the volunteers. In a large jar put a grain of maize for every child 6-11 months treated for malaria. A grain of rice for every child 6-11 months treated for diarrhoea, and a grain of sorghum for every child 6-11 months treated for pneumonia. In a small jar do the same thing for children aged 12months – 5years. Genius.

It is innovations, cooperation and programs like these that makes this country so interesting. Yes, you get many volunteers who do not report, or health workers who demand written forms, but bit by bit Ghana is adapting its programs and building up its people to create something that will one day be a solid health system, built firmly on the strength of its amazing communities. This is dedicated to all the volunteers who give their time to the program, I am so proud of them, and continually hold them in such high esteem. I wish for them to be recognised and given employment entitlements, better status and the thanks that they deserve. 

Meet one of the volunteers - click here.