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Innovation to Achieve UHC from the Field: Krachi West Case to Expand Access to Healthcare in Hard-To-Reach Communities

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Innovation to Achieve UHC from the Field: Krachi West Case to Expand Access to Healthcare in Hard-To-Reach Communities J Glob Health Sci. 2019 Jun;1(1):e14 https://doi.org/10.35500/jghs.2019.1.e14 pISSN 2671-6925·eISSN 2671-6933 Letter from Field Innovation to achieve UHC from the field: Krachi West case to expand access to healthcare in hard-to-reach communities Hyejin Jung Korea Foundation for International Healthcare Ghana Office, Accra, Ghana Received: May 16, 2019 Editor's note: Ms. Hyejin Jung is serving as the Representative of Ghana Office of Korea Accepted: May 17, 2019 Foundation for International Healthcare (KOFIH). Correspondence to Hyejin Jung Korea Foundation for International Healthcare Nowadays, everybody in global health industry talks about universal health coverage (UHC), Ghana Office, Ghana Health Service Head financial structure and innovations. However, application in real world seems far from being Office, Dodoo Ln, Accra, Ghana. realized. One district in Korea Foundation for International Healthcare (KOFIH) maternal E-mail: [email protected] neonatal and child health improvement project sites in Ghana exemplifies practicalities of © 2019 Korean Society of Global Health. how to achieve UHC in terms of increasing coverage for the people who are desperately in This is an Open Access article distributed need of essential medical services. The district's name is Krachi West, a peninsula located under the terms of the Creative Commons in the northern-most part of the Volta Region (Now Oti Region, with new regional division Attribution Non-Commercial License (https:// which took place in March 2019). creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any When I first visited the district, among many other infrastructural challenges, I witnessed medium, provided the original work is properly lack of accessibility and availability in both physical and human resources. With the total cited. population of about 60,000, the district has 14 health facilities; 1 district hospital, 4 health Conflict of Interest centres, 8 Community-based Health Planning and Service compounds/zones, 1 clinic and 1 No potential conflict of interest relevant to this private Reproductive and Child Health centre. The district hospital which serves as a referral article was reported. centre in the district could boast of only 2 medical officers including district health director of health service (Dr. Abiwu). The district is essentially rural with most inhabitants in the lower socio-economic class. There are few accessible roads connecting communities within the district and these are often un-motorable during the rainy season. Referrals to the regional hospital in Ho must cross the Oti River at Dambai, where a ferry transports vehicles only twice a day (Fig. 1). Including the waiting time at the Dambai port, it takes ten to twelve hours in total to get to the Krachi West district hospital from Accra, the capital city of Ghana. Many lives have been lost during the referral due to the lack of accessibility. Dr. Abiwu took an initiative to tackle the accessibility issue within limited resources the district had. KOFIH worked side by side with him to help develop interventions to achieve improved accessibility to healthcare in the hard-to-reach communities in the district. Baseline survey conducted in 2014 showed the district had 3 major issues in healthcare delivery: firstly, poor access to healthcare especially in hard-to-reach inland and island communities; secondly, low skilled delivery rate (46%), low antenatal care (ANC) coverage https://e-jghs.org 1/4 Krachi West case to expand access to healthcare Fig. 1. Dambai port. (85.6%, at least once) resulting in high maternal mortality ratio of 493 deaths per 100,000 births and low immunisation coverage (average 72.2%); and lastly, inadequate number of critical health care staff in the district mainly due to the inconveniences coming from lack of infrastructure. In order to tackle the issues, KOFIH set specific objectives and action items. To improve the poor accessibility to healthcare service, the district health directorate (DHD) made a specialized outreach task-force called “KOFIH Buffalo Team.” The team made visits to the hard-to-reach communities and islands every month to provide integrated ANC, postnatal care, and immunization services (Fig. 2). KOFIH provided funds for motorbikes and ice-boxes as well as Ambu-bags for them to carry to the outreach service. They used small boats to reach islands, and climbed up the mountains to reach inlands. On top of the outreach services, DHD utilized simple social media platform such as WhatsApp application or short message service to communicate with the communities to provide remote consultation and coordinated referrals whenever needed (Fig. 3). KOFIH fund was also used to improve facilities and build critical staffs' accommodations. Community people have actively participated in identifying needs, and renovating each health facility (Fig. 4). It helped the district to deploy more health professionals such as midwives to community facilities. When I was invited to attend opening ceremonies of newly built or renovated facilities, they were having a big community party where every member celebrated. Fig. 2. Outreach to islands. https://e-jghs.org https://doi.org/10.35500/jghs.2019.1.e14 2/4 Krachi West case to expand access to healthcare Fig. 3. Short message service for information sharing. Referrals also have been strengthened through training and continuous engagement of key players in the sector. The health system has been strengthened by shifting some tasks to midwives including performing gynaecologic/obstetric ultrasound scans, and strengthening technical and logistical support between district hospital and sub-district facilities, periodic monitoring and supervisory visits. Quarterly family meetings of all facilities and districts that refer cases to the Krachi West District hospital in addition to maternal death audits and e-consultations from higher level facilities to lower level facilities also helped reduce mortalities. As a result, number of maternal deaths in the district has been decreased from 6 to Zero in 2017 resulting in maternal mortality ratio significantly dropping from 493 in 2014 to Zero in 2017 and it has been kept low up to now (May 2019). ANC coverage has increased from 85.9% in 2014 to 100% in 2018, and Expanded Program on Immunization coverage also increased from 72.2% in 2014 to 100% in 2018. Fig. 4. Community-based Health Planning and Service compound construction by community members. https://e-jghs.org https://doi.org/10.35500/jghs.2019.1.e14 3/4 Krachi West case to expand access to healthcare Fig. 5. Health Summit 2018. Dr. Abiwu has been invited to make a presentation about his success story in National Health Summit in 2018 (Fig. 5). The Minister as well as other leadership, international development partners of the health sector in Ghana applauded the approach and suggested other district health teams to follow Krachi West case. Krachi West is a great example on how we can achieve UHC in real world where the needs are the most. https://e-jghs.org https://doi.org/10.35500/jghs.2019.1.e14 4/4.
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