A Winning Approach to Health Education in Rural Ghana
CHPS nurses and volunteers are using Amplio Talking Books to make health education easier.
How a "Best CHPS Zones Award" competition strengthened technology training, message reach, and community feedback for health education
How do you motivate community health workers to adopt new technology and habits to support their health promotion activities? This was the question Amplio Ghana sought to address in Ghana's Upper West Region.
Ghana's Community-based Health Planning and Services (CHPS) program aims to provide rural communities, especially women and children, with access to quality health services. But in the Upper West Region's under-resourced rural districts, CHPS health workers often face challenges in delivering health education and services effectively. In response to the challenge, Amplio Ghana, in partnership with UNICEF and Ghana Health Service, launched a UNICEF/CHPS Talking Book program. The program provides health education through the use of Amplio Talking Books, which are played during health visits, clinics, and household visits by CHPS nurses and community health volunteers.
With the Talking Book, CHPS nurses and community health volunteers can deliver consistent and accurate health messages, bridge language barriers with local language content, reduce clinic waiting time, and increase male involvement in maternal and child health through innovative technology and group listening sessions.
However, the program has seen varying levels of usage in different CHPS zones.
CHPS nurses and volunteers participate in a Talking Book health education training session.
Creating Incentive for Community Health Workers
The UNICEF/CHPS Talking Book program started with a pilot at 15 CHPS compounds in 2019 and was expanded to support COVID-19 risk communication in 2020. As vaccines rolled out, the project adapted to focus on maternal and child health and preventive care and was implemented in 47 CHPS zones in Jirapa Municipality, expanding to Daffiama Bussie Issah (DBI) and Lambussie districts in 2022.
When Amplio Ghana introduces Talking Books in a CHPS zone, they train CHPS staff and health volunteers on the technology use, as well as interpersonal communication, group facilitation, and social and behavior change communication (SBCC) best practices for health promotion activities. However, the team noticed that some CHPS zones were putting more effort into health education and achieving more success than others.
To incentivize CHPS zones and build their capacity for health education delivery, Amplio Ghana created an awards ceremony. The aim was to recognize outstanding nurses and volunteers and motivate others to use the Talking Book in their communities.
Awards Criteria for Evaluating Health Education Delivery
For establishing the Best CHPS Zones Awards competition, the three partners—Amplio, UNICEF Ghana, and GHS—looked at three main criteria:
1. Health Worker Training
At each CHPS site, one nurse represents the staff (2-5 nurses) and receives training on SBCC, group facilitation, and how to operate and maintain the Talking Book device. These nurses are expected to train colleagues at their facility. In addition, they also train any new posted nurses. For the award criteria, we want to make sure that all CHPS nurses can operate and use the device for their health education activities.
2. Health Message Reach
We want to ensure the devices are being used in different settings (antenatal care clinics, child wellness clinics, school health, home visits, OPD sessions, etc.) so that as many people as possible have access to the health messages. Therefore, we analyze Talking Book usage statistics to see where and how often the devices are being used, to identify CHPS sites with highest usage statistics. This data is crosschecked with Talking Book program activities recorded in the health promotion book.
3. Community Feedback
The Talking Book helps create an enabling environment for the promotion of healthy behaviors. In addition to listening to messages, community members can also use the device to record their feedback — including questions, concerns, ideas, and suggestions about health topics, as well as their experience with CHPS health services in general. Therefore, as part of the award criteria, we looked at which CHPS sites were recording community feedback, regardless of whether it was positive or negative.
For example, some women who recorded feedback cited a condescending attitude at the hospital as a reason why they preferred to deliver at home, while others mentioned extra charges they were made to pay. This feedback was shared during the stakeholders’ workshop, and an action plan was created to address community concerns.
Smile! Best CHPS Zones Award winners from Lambussie and DBI districts.
Making Health Education Easier
Overall, the Best CHPS Zones Award has encouraged healthy competition and best practices among CHPS staff and health volunteers. It also increased the number of people being reached across the 47 CHPS zones, as CHPS nurses and volunteers strive to deliver health education—reaching approximately 156,516 people (479 per device).
The award-winning CHPS zones from January to June 2022 were Dakyie CHPS Zone, Saapari CHPS Zone, and Lambussie CHPS. Here's what our winners had to say about the impact of the Talking Book:
"The Talking Book is a tool that came at the right time. I used it to train my community health volunteers to engage parents in listenership." —Huziemata A., Dakyie CHPS Zone
"The Talking Book has simplified our work and broken the language barrier." —Alice D., Saapari CHPS Zone
"The Talking Book has made health education easier. It engages the mothers while we do our entries and reinforces the messages we tell our community." —Moyiri CHPS Zone
Testimonials from CHPS staff affirm the Talking Book's impact as a tool for promoting health engagement. But true success lies in building the capacity of our community health champions. That's why Amplio Ghana is providing training for CHPS staff on the creation of audio health messages, helping them gain the skills to use the Talking Books to their full potential. By equipping health workers with the knowledge and resources they need, we are paving the way for sustainable programs and healthy communities.