Implementing Community-Based Health Promotion projects: A case study of the Nutrition and Malaria Control for Child Survival Project, Ghana

Background: The Nutrition and Malaria Control for Child Survival Project (NMCCSP) aims at reducing mortality among children under the age of two years, through improved utilization of selected community based health and nutrition services for children and pregnant women, delivered by Community Child Growth Promoters (CCGPs). The purpose of this assessment was to review the implementation of the NMCCSP in Bongo district of the Upper East Region of Ghana; and to identify perceptions of stakeholders about the role of the CCGPs. Methodology: Qualitative methods were employed: Key informant interviews with health workers and CCGPs; structured observations at growth promotion sites; exit interviews with caregivers; and two focus groups with CCGPs and Care givers. Findings: Despite one and half years since the inception of the project, there are still several problems with the implementation; high attrition of CCGPs due to lack of incentives, inappropriate sites with inadequate tools for growth promotion sessions; poor counseling of care givers; and inadequate training and supervision of CCGPs. The role of the CCGPs was well accepted by both care givers and health workers in the district. Increased Antenatal and Child welfare clinic attendance was attributed to the work being done by CCGPs. CCGPs perceived their role as very important in their communities. Conclusions: This appraisal adds to the growing evidence on the important role being played by Community Health Workers (CHWs) in the developing world. It however brings to bear challenges in program implementation posed by poor incentives, inadequate logistics, training and supervision of CHWs.