The UN estimates that by 2050,  68% of the world population will be living in urban areas. In Ghana the urban population continues to grow, increasing from about 51% in 2010 to about 57% in 2021 with a considerable percentage of this increase in Greater Accra (92%-Urban) and Ashanti regions (62%- Urban).

Studies show that the urban poor are routinely being left behind in employment, educational opportunities and access to basic health services and in some instances, have reported poorer health outcomes than some of their rural counterparts. Increasingly, urban areas are exacerbating health inequalities and the most vulnerable are being left behind.

As highlighted in UNDP’s HIV, Health and development strategy, conditions in which people live greatly impact on their health and well-being. To attain universal health coverage (UHC), we need to strengthen primary health care and implement measures to reduce inequalities and exclusion of the most marginalized and vulnerable.

Progress towards UHC will thus only be a mirage without deliberate and appreciable investment in primary health care at the community level. The CHPS concept in Ghana is very laudable and is aimed at bringing primary healthcare closer to deprived communities with the strong participation of all community members. It has yielded impact in rural communities but is yet to reach its full potential in urban centres.

Access to health services for the urban poor

Having identified the need to bridge the gap in access to health services for the urban poor, the United Nations Development Programme (UNDP), in partnership with the Ghana Health Service and with funding from the Government of Japan, is addressing health inequalities in urban centres and  strengthening service provision for the urban poor.

Through a multi-pronged approach, the intervention has strengthened health service delivery in Ga Central and Accra Metro in the Greater Accra region of Ghana, through the provision of a CHPS compound, equipment, and logistics.  The capacity of community health officers who play pivotal roles within these urban CHPS have also been strengthened. Other interventions under the project include provision of outreach health services to the vulnerable and those in hard to reach areas and community engagement with opinion and community leaders, to encourage active participation in improving health outcomes within their localities.

Thanks to the interventions, residents of Chorkor and Anyaa in the Greater Accra region do not have to travel long distances often at a cost to access basic health care, antenatal care/post-natal or child welfare services.

Home visits conducted by community health officers to provide health education and related services in the districts have also improved because of access to the requisite logistics.

These communities are also receiving routine non-communicable diseases (NCDs), prevention information and linkage to care to curb the projected increase of NCDs as a result of rapid urbanization.

Furthermore, by utilizing an integrated approach which combines HIV testing with other forms of health screening, community members including female head porters, sea farers, truck drivers their mates and other high risk men in the two districts received HIV testing services.

Reflection and key takeaways

Strengthening healthcare for the urban poor, requires rethinking, retooling and more partnerships.

• The urban CHPS concept should be strengthened, and innovative methods employed to ensure that service provision is tailored to fit the experiences of the urban dwellers.
• Community health officers critical to the functioning of the urban CHPS should regularly receive refresher trainings and needed logistics. This will enhance service delivery and provide the needed motivation to continue their work in often difficult terrains and contexts.
• Efforts should also be made to thoroughly understand the leadership and local governance dynamics within these urban areas to ensure buy-in and ownership of health interventions and infrastructure.
• Efforts should be made to address the social and environmental determinants of health or the non-medical factors that influence people’s health outcomes. This calls for partnerships beyond the health sector.

An inclusive approach that puts the urban poor at the centre of all interventions will help improve the basic living and working conditions of the urban poor and enhance their access to primary health care. In this way, we will begin to move the needle to reduce health inequalities and achieve improved health outcomes for the urban poor thereby leaving no one behind.

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By Belynda Amankwa, Programme Specialist (Health) at UNDP Ghana