Ghana NCD Alliance meeting

Ghana includes NCDs in community healthcare monitoring scorecard

04th April 2023

Ghana NCD Alliance leads social accountability initiative to update country’s community healthcare scorecard to integrate NCDs. 

Ghana NCD Alliance, in collaboration with the Ministry of Health and Ghana Health Service, have built the capacity of community members, including people living with NCDs, to advance efforts towards health service delivery, resource allocation and meaningful involvement of people living with NCDs in decision-making at the community level. This was done through community-led monitoring using the country’s existing community score card (CSC) which is used to evaluate health services. As a community-based social accountability tool, the CSC gathers feedback from service users and improves communication between communities and service providers.  

In January 2018, the CSC was developed by the Ghana Health Service and the Ministry of Health. Ghana’s CSC is a web-based management, action, accountability, and advocacy tool used by community members to assess the quality of health service delivery in their communities. Nine indicators make up Ghana’s CSC, which the local communities review quarterly at Community-based Health Planning Services (CHPS) meetings. Ghana’s CSC concept was built to ensure that all health facilities are assessed by Community Health Management Committees (CHMCs) in the demarcated areas and then reported. The CHMCs are also used to develop Community Health Action Plans (CHAPs) and implement actions. 
Given that there is an existing system of CSC in Ghana, Ghana NCD Alliance leveraged the system to demonstrate the efficiency of integrating noncommunicable diseases (NCDs) into the CSC. The aim was to ensure meaningful involvement of people living with NCDs and civil society to improve access to quality, affordable and timely NCD services at the primary healthcare level.  
Two project sites, Greater Accra (Accra Metro and Ga South Districts) and Ashanti (Adansi Akrofoum District) Regions, were identified. These regions and districts were selected due to the higher NCD prevalence there. The criteria for selection of the specific health facilities within the districts mentioned above was based on CSC implementation being weak or absent. 
Capacity building of a total of 95 participants, including CHMC members, people living with NCDs, and healthcare workers, was undertaken with quarterly scoring of nine indicators of the CSC. The results were uploaded on the web-based platform, and the resulting community-led monitoring (CLM) report was launched and disseminated at a multi-stakeholder meeting held on 14 February 2023 in Accra, under the chairmanship of NanaHemaa Adjoa Awindor, the Development Queenmother of Afigya Kwabre District inof the Ashanti Kingdom in Ghana.  
The report recommends that policymakers consider integrating NCDs into Ghana's PHC strategy to build sustainability toward achieving the Universal Health Coverage (UHC) agenda and Ghana's NCD Policy and Strategy. 
“I will no longer be a bystander; I will monitor and support my nurses and doctors in their work. They are my responsibility’’ - CHMC member and women leader in Wamase community. 

Community-led monitoring key findings 

The CHMC members in every facility, including people living with NCDs, were able to identify challenges on NCDs, develop action plans and started collaborating with the management of their health facilities to take action. The action plans highlight gaps at the health facility level, such as lack of funds for quarterly wellness clinics, lack of payment for glucometer strips, and lack of batteries for blood pressure machines.  
CLM has built the capacity of community members and people living with NCDs to demand improved services at the primary healthcare level, and built the capacity of community members and people living with NCDs to demand quality care and play active roles in planning, implementing and monitoring health interventions in their respective communities. Additionally, community members have assumed their rightful role as accountability partners, providing reliable feedback to service providers for action and policy formulations.  
The Ghana NCD Alliance has been able to increase the number of health facilities using the CSC and created a platform for community engagement to strengthen NCD services at primary health centre level.  
The report also makes key recommendations for action and policy formulations, including, an integrated approach in scaling up the scorecards, involvement of civil society and people living with NCDs in improving health services, an intentional allocation of funds to support mental health services at all levels and empower community health workers to educate community members about mental health conditions. 
Ghana NCD Alliance was supported in this work by NCD Alliance thanks to its partnership with Access Accelerated.