POST 00916E : COMMUNITY HEALTH PLANNING
Follow-up on Posts 00888E, 00893E and 00907E
24 April 2006
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This posting contains two contributions coincidently both from Ghana.
The first is from J. Koku Awoonor (mailto:[email protected]) who
answers some of the concerns expressed by A.T Seddoh in Post 00893E. He
also shares some interesting results of a new impact assessment especially
on vaccination.
The second is from Francis Abotsi (mailto:[email protected]) who
comments on the reminder slip.
May I appeal again to members who may know of a recall system in
developing countries that has been assessed.
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"I have followed the debate generated by the CHPS paper I posted and it
makes interesting reading all the arguments being made. I read the
argument by Dr. Seddoh. I have also followed the ACSD experiment in the
UER that was cited and am fully aware of the results that was
disseminated. I have my personal opinion on this and can comment on this
later.
But coming to CHPS regarding Dr. Seddoh's argument, let me say that the
main issue about BCG - perhaps needs more clarification along with an
equation. Yes, the method hasn't been used before and therefore lacks
precedence. However, it is a commonly used probability and statistics
method. It is not as simple as just assuming anyone with a BCG will have
received a certain amount of immunizations.
Rather it is a four step process.This is calculated using observed sample
of children with cards, to estimate joint probabilities.
Calculate for children with BCG scar--proportion that have received each
vaccination
Calculate for children with BCG scar--proportion that have not received
each vaccination
Calculate for children without BCG scar--proportion that have received
each vaccination
Calculate for children without BCG scar--proportion that have not received
each vaccination
These proportions are transformed into estimated joint probabilities given
BCG scar status.
Then for the children without records, estimated joint probabilities are
assigned for each vaccination given their BCG status.
I am aware this is an accurate method for calculating joint probabilities.
It should be known that this was only used for descriptive statistics and
was not used for the regression analysis -in which only children with
records were used.
Let me also say that CHPS is intended to increase resources within the
district and not take away from static health facilities. The community
health compounds (CHC) are built as a partnership from district mobilized
and community-level mobilized resources.
It is not the facility itself that produces results, but the manner in
which the nurse provides services - reaching her clients instead of
waiting for the clients to come to her. More importantly, since she is an
integral part of the community she is more likely to hear of a pregnancy
and delivery in an informal or casual way and consequently more births are
likely to be immunized, registered and followed-up for continuing
immunizations. This is about the effectiveness of community involvement
and district-village partnerships..."
There are enough evidence taking from the Ghana CHPS Initiative the
positive impact front-line health workers (CHOs) are making on health
outcomes. We have just concluded our second district-wide CHPS impact
assessment and the results are impressive. Just to cite a few of these, we
found that
• Women in CHPS zones where frontline CHOs are working were 2.2 times more
likely to know of at least one method of Family Planning than NOT YET CHPS
women (where frontline health workers CHOs are not working), controlling
for a number of demographic and wealth indicators (p
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