Local patterns of social capital and sustenance of the Community-Based Health Planning Services (CHPS) policy: a qualitative comparative study in Ghana

Abstract

ObjectiveSocial capital—the resources embedded in social relationships—has been associated with health severally. Notwithstanding, only a handful of studies have empirically examined how it shapes health policies. This paper extends the discourse by comparatively examining how variations in local patterns of structural and cognitive social capital underpin the successes and challenges in managing and sustaining the Community-Based Health Planning Services (CHPS) policy in Ghana. The CHPS is an intervention to address health inequalities.DesignQualitative study involving individual in-depth interviews and focus group discussions using a semi-structured interview guide. Thematic analysis approach, inspired by McConnell’s typology of policy success (or failure) was adopted.SettingTwo rural communities in two districts in Ashanti region in Ghana.ParticipantsThirty-two primary participants as well as four health personnel and four traditional and political leaders.ResultsBoth structural and cognitive components of social capital underpinned efficient functioning of the CHPS initiative regarding funding, patronage and effective information transmission. Sufficient level of social capital in a community enhanced understanding of the nature and purpose of the CHPS policy as well as complementary ones such as the referral policy. Contrary to popular conclusions, it was discovered that the influence of social capital was not necessarily embedded in its quantity but the extent of conscious activation and application. Furthermore, the findings contravened the assertion that social capital may be less potent in small-sized communities. However, elevated levels of cognitive social capital encouraged people to access the CHPS on credit or even for free, which was injurious to its sustenance.ConclusionThe CHPS initiative, and pro-poor policies alike, are more likely to thrive in localities with sufficient structural and cognitive social capital. Lack of it may render the CHPS susceptible to recurrent, yet preventable challenges.

“I have to provide for another life emotionally, physically and financially”: understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa

“…The theme of healthcare service problems suggests that long distances and transportation costs, unsympathetic nursing staff, mistreatment, and limited stocks of medication impact young mothers. A growing body of literature has also revealed that barriers in accessing maternal and child healthcare services include distant geographical locations, long travelling periods, expensive transportation, and healthcare workers' negative attitudes [70][71][72][73]. Limited stocks of medication (or stock-out) has particularly been noted in several South African health districts [74].…”

“…Limited stocks of medication (or stock-out) has particularly been noted in several South African health districts [74]. Sumankurro [70] argues that running out of medication is a barrier to optimal maternal and child healthcare services in low and middle income countries.…”

Adolescent pregnancy and parenting: Perceptions of healthcare providers

“…36 Geographical locations and the costs of transport are also barriers to maternal and child healthcare in low and middle income countries. [38][39][40] The current study found that girls' preference for using traditional healers was also a factor that affected their willingness to access healthcare services. The preference for using traditional healers is often cited in the literature [41][42] as approximately 80% of people in Africa use traditional medication, especially for maternal and reproductive health issues.…”

“I have to provide for another life emotionally, physically and financially”: Understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal, South Africa

“…A growing body of literature has also revealed that barriers in accessing maternal and child healthcare services include distant geographical locations, long travelling periods, expensive transportation, and healthcare workers' negative attitudes. [63][64][65][66] Limited stocks of medication (or stock-out) has particularly been noted in several South African health districts. 67 Sumankurro 63 argues that running out of medication is a barrier to optimal maternal and child healthcare services in low and middle income countries.…”

“…[63][64][65][66] Limited stocks of medication (or stock-out) has particularly been noted in several South African health districts. 67 Sumankurro 63 argues that running out of medication is a barrier to optimal maternal and child healthcare services in low and middle income countries.…”