CHORUS research will be conducted in two urban cities of the Greater Accra region of Ghana: Ashaiman and Madina.
The poor in both these areas often live within slum settlements. As these are informal, they are deprived of government support. The structure and locations of the settlements make access difficult for health providers which limits the ability of the residents to engage with healthcare providers effectively. The two cities selected have similar urban characteristics, however they have certain contextual factors to inform the issues faced and proposed solutions.
Since the pilot in 1994, Ghana has been adopted the Community-based Health Planning and Services (CHPS) programme to achieve primary health care, which was scaled up nationally in 2000. CHPS posts fully trained Community Health Officers (CHOs) to communities to deliver health services for the community members. The programme has been successful in helping rural communities meet health needs, which has led to a need to adapt the concept for the urban setting. The urban poor communities in Ghana continue to have worse health indices than their rural counterparts, experiencing the double burden of NCDs and CDs, in addition to the health effects of overcrowding.
The CHPS programme faces different challenges in the urban setting, including the different community structures and densely populated nature of urban settings, understanding, confidence in and awareness of the CHPS programme and health services, logistical challenges, and the plurality of providers. The CHORUS research programme will look at how to link communities, local government and health workers to provide and support health programmes and services at the household and community level in urban areas, and address the challenges of operating CHPS in the different urban settings.
Ashaiman is within one of the newly created Districts in 2008, approximately 30km from Accra. This proximity makes it easy to access social facilities and infrastructure and it also serves as a dormitory town for industry workers of the Tema Township. It is a sprawling urban settlement, exhibiting all the characteristics of a slum, especially in areas around the core business arena of the community. Ashaiman has 17 health facilities, with a mixture of public, private and quasi government hospitals.
Rich picture exercise conducted in Ashaiman and Madina.
Madina is the capital town of the La Nkwantanan Municipal Assembly. It located close to Accra and was created in 2012 as part of a decentralisation process. It is populated predominately by migrants and settlers from other regions of the country. These large groups of settler communities mainly from northern Ghana have evolved their own systems of organisation heavily influenced by cultural heritage. Again, there are a number of public and private health facilities offering primary health care and specialised services.