The results of the study were grouped under two headings, socio-demographic characteristics of participants and thematic results from the content analysis process. Three broad thematic results emerged from the study; motivations for becoming a CHMC, the roles and responsibilities of the CHMC, as well as the challenges facing the CHMC in the conduct of their duties. Quotes from the participants were used in presenting the data and also informed the structure of the discussion section. A frequency table was, however, used to present the socio-demographic characteristics of the participants.
Socio-demographic characteristics of participants
Table 1.0 presents the demographic characteristics by zone. Both Nkwanta and Central Tongu had 10 each (50.0%) in Z1 and Z3 zones, however, more, 9 (52.1%) participants were in Z2 in Nkwanta. Majority 9 (45.0%) of the participants in Z2 were aged 40–49 years and same in Z4 7 (41.2%). Overall, there were more 30 (81.1%) males who participated compared to females. Similarly, the main occupation of the participants was farming, 27 (73%). In terms of NHIS, there were more non-subscribers, 19 (51.4%) compared to subscribers.
Table 1: Socio-demographic characteristics of participants
Variable
|
Frequency [Z1&Z3, N=20] n (%)
|
Frequency [Z2 &Z4, N=17] n (%)
|
Total [N=37] n (%)
|
System Learning District
|
Nkwanta South
|
10 (50.0)
|
9 (52.9)
|
19 (51.4)
|
Central Tongu
|
10 (50.0)
|
8 (47.1)
|
18 (48.6)
|
Age group (years)
|
Mean age (SD)
|
|
|
|
<40
|
2 (10.0)
|
3 (17.6)
|
5 (13.5)
|
40-49
|
9 (45.0)
|
7 (41.2)
|
16 (43.2)
|
50-59
|
2 (10.0)
|
2 (11.8)
|
4 (10.8)
|
60+
|
7 (35.0)
|
5 (29.4)
|
12 (32.4)
|
Sex
|
Male
|
19 (95.0)
|
11 (64.7)
|
30 (81.1)
|
Female
|
1 (5.0)
|
6 (35.3)
|
7 (18.9)
|
Qualification
|
None
|
4 (20.0)
|
2 (11.8)
|
6 (16.2)
|
Primary
|
0 (0.0)
|
3 (17.6)
|
3 (8.1)
|
JHS
|
3 (15.0)
|
6 (35.3)
|
9 (24.3)
|
SHS/Vocational
|
11 (55.0)
|
4 (23.5)
|
15 (40.5)
|
Tertiary
|
2 (10.0)
|
2 (11.8)
|
4 (10.8)
|
Religion
|
Christian
|
19 (95.0)
|
15 (88.2)
|
34 (91.9)
|
Muslim
|
0 (0.0)
|
1 (5.9)
|
1 (2.7)
|
Traditional
|
1 (5.0)
|
1 (5.9)
|
2 (5.4)
|
Ethnicity
|
Ewe
|
10 (50.0)
|
10 (58.8)
|
20 (54.1)
|
Guan
|
10 (50.0)
|
7 (41.2)
|
17 (45.9)
|
Marital status
|
Married or living together
|
20 (100)
|
16 (94.1)
|
36 (97.3)
|
Widowed
|
0 (0.0)
|
1 (5.9)
|
1 (2.7)
|
Occupation
|
Public Servant
|
1 (5.0)
|
1 (5.9)
|
2 (5.4)
|
Farmer
|
13 (65.0)
|
14 (82.3)
|
27 (73.0)
|
Teacher
|
3 (15.0)
|
1 (5.9)
|
4 (10.8)
|
Trader
|
2 (10.0)
|
0 (0.0)
|
2 (5.4)
|
Tradesman
|
1 (5.0)
|
1 (5.9)
|
2 (5.4)
|
National Health Insurance
Subscription
|
Subscriber
|
9 (45.0)
|
9 (52.9)
|
18 (48.6)
|
Non-subscriber
|
11 (55.0)
|
8 (47.1)
|
19 (51.4)
|
Average monthly income (GH₵)
|
Mean (SD)
|
|
|
|
<100
|
2 (10.0)
|
5 (29.4)
|
7 (18.9)
|
100-400
|
12 (60.0)
|
7 (41.2)
|
19 (51.4)
|
500+
|
6 (30.0)
|
5 (29.4)
|
11 (29.7)
|
Motivations for becoming a CHMC member
For the purpose of this study, only three constructs of the functional approach to volunteerism (value, self-improvement and protective), out of the six, were discussed. Discussants provided various reasons as to why they accepted to work as CHMC members in their various CHPS zones. Notable reasons cited were the desire to provide leadership in one’s community to improve its health outcomes through effective needs assessment conduction (the value function), financial expectations for being a volunteer (self-improvement function) as well as the guilt of allowing committed CHOs to work in isolation in their communities (protective function).
The value function
With reference to the value function, some discussants explained that they wanted their communities to progress; hence they saw volunteerism as an opportunity to improve the health needs of their communities. This, they said could be achieved through provision of good leadership to ensure an effective functional CHPS compound, as explained by a CHMC member from Z3; "Every human institution needs people to lead them”.. The following quotes express the views of the participants:
“We accepted the offer because we wanted an improvement in our health needs and service delivery. Nobody from outside will come and make it [CHPS compound] work better for us except ourselves so it is our duty to serve on the committee to help improve our own health” (CHMC member, Z1).
“If the majority of the members repose their trust in you, you do not need to reject it but accept it with happiness……lead the community and help the clinic to deliver good services to the people” (CHMC member, Z3).
The self-improvement function
With reference to the self-improvement function, some participants revealed that although they voluntarily accepted to serve on their respective committees, they expecting some financial benefits in the end, as explained by the following discussants:
“We thought from the beginning that, as time goes on there will be some financial reward but now we understand that is not the case and the community is looking up to us so we can’t disappoint them” (CHMC member, Z3).
“Everybody want to progress in life, so I for instance thought that while we serve on the committee, there come be a time when the government would say ok, you have something [money] small for your efforts, even if to buy a soap. By the way, we are yet to receive anything like that” (CHMC member, Z2).
The protective function
The protective function was also found to be a motivation for CHMC volunteerism. In this regard, allowing a hard working CHO who was not even an indigene in the community to work in isolation made some CHMC members felt guilty and pledged to assist the CHO in any way they could, leading to volunteerism. Hence, they served on their respective CHMCs, as a way of dealing with the guilty conscience they had. They explained:
“I accepted the work because of the hard working nature of the CHO. It will not be fair to refuse to assist him in his work looking at the way he cares about us even though he is not from here. I wouldn’t have been able to sleep well if I had refused to serve” (CHMC member, Z1).
Responsibilities of the CHMC
Being a CHMC member comes with various responsibilities. Some of the responsibilities of the CHMC as identified by discussants were provision of support for the CHPS facility and the CHO in terms of needs assessment conduction, overseeing the smooth running of the CHPS facility and mediating between the CHO and community members in disseminating information. They were also to be involved in planning of activities of the CHO for the CHPS zone. Thirdly, as CHMC they are supposed to be aware of the various activities undertaking by the CHO in their respective communities. Finally they are to assist in resolving conflicts between the CHO and community members.
Provision of support services to the CHPS facility and the CHO
The CHMC provided services such as mobilisation of community resources in building and maintaining CHPS compounds, home visiting to conduct health needs assessment in the community, monitoring the wellbeing of the CHO and logistics availability and mobilising community members for health educational talks.
On mobilising resources for development and maintenance of respective CHPS compounds, the following quotes provide insight into the activities undertaking by the various CHMCs in that regard:
“We mobilise our communities to help in putting up the building for the nurses” (CHMC member, Z1).
“We mobilise the women to be clearing the place [of weeds] once in a while and all communities in the catchment area also come to clean up the place” (CHMC member, Z3).
With reference to helping in identification of community health needs assessment, the CHMC regularly paid home visits to identify the pressing health needs of the people and provide the necessary guidance and support and feedback to the CHO, as mentioned by a CHMC member from model zone 1:
“Some of our responsibilities are that we visit communities to help fish out or identify sick persons. Also, when community members are sick, they come to us and we help them to the hospital” “when we see pregnant women, we ask whether they have gone for check-ups. If they answer no, we show them the ways and the steps to the clinic. This is because some of the pregnant women are shy to and reluctant to go to the hospital so we check up on them and send them to the CHO” (CHMC member, Z2).
“The nurse cannot do everything by herself in all the communities. So [CHMC volunteers] we report cases and problems we find in our communities to the nurse during our home visits” (CHMC member, Z4).
On their oversight responsibility, they plaid this by checking on the well-being and safety of the CHO and also monitored logistics availability at the facility in order to take the appropriate action, should the need be. A discussant narrated:
“Sometimes, we group ourselves and visit the CHPS compound to check up on the nurse. We find out about their wellbeing. We also find out if they have drugs then we send a report to the district director” (CHMC member, Z1).
“These nurses are not from here, sacrificing to stay in this village to help us so as CHMC, it is our responsibility to ensure that they are safe” (CHMC member, Z4).
The CHMC further assisted the CHOs in community mobilisation for health education activities by pre-informing community members of a health education or promotion programme to enable the CHO undertake such an activity with ease. A discussant recounted:
“We also help the nurses by disseminating information to community members. Also, if the nurse wants to organise programmes, we first inform the community before the nurse goes ahead with the programme so that every community member can help or support the nurse” (CHMC member, Z2).
“We also inform the community not to go to their farms anytime the nurse wants to come and talk to us about any health issue. Sometimes we even arrange with the schools to wait for the nurses to go and talk to them” (CHMC member, Z3).
Assisting CHO with planning of activities
Another salient responsibility of the CHMC was in assisting CHOs in the planning of activities for their various CHPS zones. All CHMCs noted that one of their core mandates was to be involved in the planning of activities for their respective zones. Hence, the CHOs were expected to be involving the committee in the planning their activities. This, they said was often the case as they often planned activities such as how to address challenges hampering the smooth running of CHPS compounds, drawing of action plans for the zones, strategies on treating of neglected tropical diseases, and on how to keep the CHPS compound clean. The following quotes sums discussants views:
We also help with planning of activities for our zone, even our action plan, the CHO, the committee and the chief and members of the community sat together to draw our action plan (CHMC member, Z3).
…For instance, the recent injection against measles and rubella, he informed us. What we do is that we have a communication centre, so if he wants to do any announcements, he comes to us then we go on to inform the chief before making the announcement to community members.Also in the distribution of the oncho [onchocerciasis] medication, we decided on the date and time together (CHMC member, model zone 2).CHMC member, Z1)
Awareness on the services rendered by the CHO
Another key responsibility of the CHMC as mentioned by discussants was to be aware of the various services rendered by their respective CHOs in their communities. In this regard, discussants mentioned that there were fully aware of the activities undertaking by their respective CHOs as they were often involved in the planning of such activities. The following quotes explain their views:
“Yes, we are aware of what they do in our communities. The nurse sometimes visits from house to house to take care of the elderly who are sick and could not come to the hospital and they check blood pressures for those that are to not too sickly. The nurse also attends to children’s health during home visits” (CHMC member, Z1).
“Because some of us are not educated, when the nurse tells us the prescription, we forget, so they are supposed to come to our homes to ensure we take the right dosage on time” (CHMC member, Z4).
Conflict resolution
The CHMC was also responsible for resolving conflict between health workers and community members. They are always on hand to quell tensions between a CHO and an aggrieved community member to ensure peaceful coexistence. They explained:
“One of our responsibilities is that whenever there is any confusion between a nurse and a community member, we [the committee] sit down with them [the aggrieved parties] to resolve the problem” (CHMC member, Z4).
“Sometimes there can be a disagreement between the nurse and a community member, especially during weighing sessions, we ensure that there is peace before everybody goes home” (CHMC member, Z2).
Challenges faced by CHMCs
The data also revealed that CHMCs faces some challenges that affect their operations. The most common challenges faced by the CHMCs included financial challenges, logistical challenges such as wellington boots and bicycles, lack of cooperation from community members, lack of motivation for members, unavailability of telephone communication network and lack of refresher training courses for traditional birth attendants (TBAs).
Financial challenges
Discussants explained that they were peasant farmers who do not get much income from their farming activities, hence the decision by government for communities to solely finance CHPS compounds pose a challenge to the CHMC and the communities at large. They said:
“We were here the last time when the district [health directorate] came and said that if we don’t provide security for the nurse, they are taking her away. We know it is our duty to provide security put at least they [government] should help us in paying him since it is not easy to mobilise money every month to pay him. In such a case, it is us the committee members that suffer because people think we are receiving some form of remuneration from the government” (CHMC member, Z1).
“Our security officer just vacated his post because we weren’t able to pay him for over five months so he got fed up with the job. We had to contribute some money to persuade him to come back to work since the nurse was feeling unsafe being alone at the facility. This affects us a lot since we are also not paid for what we do” (CHMC member, Z3).
Logistical challenges
The lack of logistics such as ‘Wellington boots’ bicycles, motor cycles for ease of movement and lack of mowing machines, hampered the activities of CHMC members. The following statement summarises their views:
“Just as said earlier, bicycle and motorbike. If at least, each of the villages gets a bicycle and a motorbike each, it will enhance our work. A mowing machine to be weeding the CHPS compound will also be a very good motivation” (CHMC member, Z1).
“We live in a muddy and swampy area. The formal director supplied us with wellington boots to help protect us. For example, when you are walking late in the night and you even step on a snake you won’t get bitten. That was the reason behind the former director giving us the Wellington boot and rain coat and some touch light to volunteers but for some time now, those things have not been coming again”(CHMC member, Z4).
Lack of cooperation from community
Another pressing challenge mentioned by the discussants was the lack of cooperation from community. They explained that community members were not willing to even clean CHPS compound for free, as narrated by model zone 1 member; "We need a cleaner to be cleaning the floor but no one is willing to do so”. Other forms of non-cooperation stated by discussants are include:
“Some of the challenges we have faced are that some community members are reluctant when we call for some communal work to be done. But finally, we try hard to involve everybody” (CHMC member, Z4).
Lack of recognition
Lack of recognition for the CHMS was also mentioned as serious challenge facing the smooth running of CHMC activities. They received no reward or recognition for their voluntary work which affected the commitment levels. The following quotes represent their views:
“We started working as a committee since 2012, till date the health directorate has not rewarded us in any form. If they could even give us GH₵ 1 every month as a reward, we can use it to as buy soap to wash our clothes. I won’t lie to you; this has made some of us relax a bit” (CHMC member, Z2).
“No one sees the importance or the sacrifice we are making in this community. Some people even insult us on top of our sacrifice, without offering us anything. It is very sad” (CHMC member, Z3).
Poor telecommunication network
The non-availability of telephone communication network in some communities served as a serious challenge in the performance of CHMC roles. Participants had these to say:
“There is no telephone network for making calls to at least to report emergency cases, hence, the bicycle or motor cycle will be of important use to us” (CHMC member, Z1).
“Our network here is not always good so when you want to report a case to the nurse or even call people for meetings, it becomes difficult. I will say that is one of the challenges I wished could be solved” (CHMC member, Z3).
Lack of refresher course training
The lack of frequent skill development training programmes for traditional birth attendants served as a disincentive to TBAs who also served as CHMC members. They were frustrated that their skills have not been upgraded over the years, as explained by a participant from zone 2:
“We the TBAs usually go for routine training at Nkwanta but for close to 2 years now, we have not been invited for training. We need to update our skills in skilled delivery” (CHMC member, Z2).
“The only motivation I used to get was the trainings they were organising for us [TBAs] but now there is nothing like that. I really don’t know what the problem with them is [Health Directorate]. Maybe it could be because they have sent a midwife to us now” (CHMC member, Z 4).