Lesson 1: Over view of Community Health Nursing in Ghana

=Lesson 1 Over view of Community Health Nursing in Ghana=

Introduction
Mothers and children form about 70%of the nations population,motality and mobidity rates were high meanwhile conditions causing them are preventable,hence the implimentation of Community health Nursing in Ghana

History of Community Health Nursing
The history of health visiting is bound up with the history of Maternity and Child Welfare Movement because the health visitors took care of both mother and children. MCH services started in Britain in 1782 by the MATERNITY AND Child Welfare Movement. They educated mothers on hygiene and diet of children.

In 1863, another group also made up of ladies was formed because the previous group was not making much impact. They distributed tracts, pamphlets and leaflets, however this approach was still not successful. This initiated a systematic house to house visiting irrespective of creed or circumstance to educate mothers especially the poorer ones. This was effective and a lot more were added on.

The aim of the Ladies groups was to popularize sanitary knowledge and devote the people physically, socially, morally and religiously. They performed by duty by dividing the area into districts where a lady superintendent, a voluntary worker and a health visitor were made responsible.

In addition to home visiting, meetings were organized at which simple talks were given followed by discussion. Topics were based on personal and environmental hygiene, prevention of infection, care of children, demonstration of food and sick nursing. The health visitors were appointed by the voluntary society in the early years, but later around 1890 the Manchester and Salford Corporation paid their salaries. The corporation charged the Medical Officer of Health to become responsible for the supervision and direction of the work of the health visitors.

Miss Florence Nightingale suggested a proper training programme for the health visitors which she called Health Missioners. By her efforts the first course for health visitors was started by the North Buckinghamshire Technical Committee by the Buckinghamshire Country Council from 1891-1892. Their syllabus are similar to current course content of health visitors. Sixteen women attended the lecturers, twelve entered for the examination but only six obtained the certificate.

Visiting in the early years was difficult because tracing homes of new born was very difficult this gave way to the need for Birth and Death Registration Act to be passed in 1874. Again, the London Country Council, which is the local supervising  authority under the Midwives Act, 1902 arranged for notification of births by the midwives, and forwarded this information weekly to the medical officer for health. This was embraced by other countries which led to the Notification of Births Act in 1907 and in 1915 notification of birth was made compulsory to all.

In 1909, the London Country Council Act on Health Visitors was passed. This order required that a candidate should be qualified for appointment as a health visitor if she possessed one of the following qualifications: a medical degree, three years training as a nurse, the certificate of the Central Midwives Board not less than six months training which included children’s nursing as well as nursing of adults and the Health Visitors Certificate must possess these certificates: Nurses’ Training Certificate of the Central Midwives Board and Health Visitors.

In 1919, the Ministry of Health was formed and the Board of Education (Health Visitors Training) Regulations were passed, it came out with two types of courses:
 * a full course of two years duration for ordinary people who had not knowledge or experience of a special nature likely to be of value in the work of a health visitor.
 * a shortened course of one year for trained nurses and others already possessing substantial knowledge or experience.

In 1925, the training of health visitors became the responsibility of the Ministry of Health, and has been till now.The syllabus was revised in 1950. Public Health Nursing started in Ghana in about 1928. Nurses of the Princess Marie Louis Hospital (PML) in Accra were used in rendering these services. They were not trained PHN. Their duties were as follows:- Visit the children who were receiving treatment at the hospital in their homes. Assist the health sisters in running Child Welfare Clinic at the hospital.. Give talk on hygiene in the homes.

In 1929, two assistant health visitors with no proper training accompanied the health inspectors in their daily house to house inspection. Cadbury and Fry Trading Company paid their salaries.

In 1932, the British Red Cross Society built clinics at Koforidua and Cape Coast. They also ran mobile clinics in the surrounding villages. During this period child welfare clinic was organized in Kumasi, Osu and Kpando. They took carte of minor ailments, well babies and antenatal. The common ailments treated at that time were yaws, scabies and malnutrition.

In 1936, Health Visiting was published in the gazette. Nurses educated mothers on the importance of growth monitoring and immunization. Initially clinics were held in churches, schools, market places and cinema halls. These effort yielded positive results, mothers enjoyed food demonstration and attendance kept increasing. The health visitors distributed Tab Quinine and skimmed milk to clients.

In 1950, a trained Public Health Nursing Tutor from UK was appointed for the training of Public Health Nurses in Ghana. In 1951 one of the pioneers in the person of the late Mrs. Samara Signge was sent for the tutorship course at the Royal College in London. She returned in 1952 and started the one year Public Health programme at the P.H.N.T.S. Korle Bu. The syllabus was the same as that of the royal college of nursing. Both QRNS AND SRNS with midwifery certificate were recruited for the training. The course did not attract many and the average intake was 10 even though 20 – 30 was expected. There is only one Public Health Nurses’ Training School in Ghana, however, two CHNTS. Winneba and Oda are piloting the training of Diploma in C.H.N.

History of Community Health Nursing in Ghana
In other to reduce infant and maternal mortality rate, control communicable diseases, promote and maintain the health of mothers and children. There was the need to train more public health nurses (PHNS) to work at the various health facilities.The training of PHN’s to a long period about 7 to 8 years. They were in great demand, there was therefore the need to train assistants for a short period 2 years to assist in working in the remote areas and also to assist PHNs in the urban areas.

In 1960, the training of females with Middle School Leaving Certificate for two years for the position of C.H.N was established in Tamale. This was followed by Akim Oda in 1962, then Ho in 1965, Winneba 1980, Esiama 2001.It is the plan of the government to get Community Health Nursing institutions in the 10 regions of Ghana.The government had achieved something, we have CHNTS at Jirapa (Upper West) and Navrongo in 2001, Tanoso 2002 and finally Fomina 2004.

The CHN is trained to assist the PHN in using human and material resources in the community to: She is in contact with people in the community and achieve the above through health education.
 * promote and maintain health
 * prevent and control communicable diseases
 * aid rehabilitation
 * prolong the lives of individuals and families.

The Public Health Nurse (P.H.N) A PHN is a qualified state registered nurse with a certificate in midwifery and has had an additional one year training in Public Health Nursing. Currently midwifery is not a criteria since males without midwifery background are recruited for the training.

Qualities of a P.H.N
 * She in depth the knowledge in both curative and preventive
 * She is a health educator
 * She is a medical social worker
 * She is a family counsellor
 * She had a good interpreting health services that are available in relation to health problems.

The C.H.N (Community Health Nurse) Is a male or female between the ages of 18 to 34 years, has an aggregate of 30 or better for 6 courses. She is an assistant to the PHN and works under his supervision.



=Qualities of a Community Health Nurse=

The CHN is in direct contact with people of different ideas, beliefs, superstition, customs and culture about health.She meets people with (different classes in the society). Meet people with different attitudes. She must therefore possess special qualities which will enable her work successfully.
 * She must be sympathetic, empathetic and understanding
 * She must be respectful, tolerant and patient.
 * She must tactful, observant and co-operative
 * She must be able to adjust and work freely with different people and different situations in the community.
 * She must appreciate the effort of all people and correct their mistakes tactfully and not condemn.
 * She must create good interpersonal relationship with colleagues and other health workers and clients
 * She must be trustworthy, punctual and serious with his/her work.

=Areas of Work of the CHN=
 * Homes
 * Villages
 * Schools
 * Work places
 * Clinics
 * Maternity Homes,
 * Health Centres.

Who is the Registered Community Health Nurse He or she is an SSS graduate with aggregate 24 or better, who has gone through a three year diploma programme and has satisfied the examining body and been registered as a professional nurse to practice. This makes her well matured in skills to work in the community. She is therefore a health teacher, social worker, family adviser. With his background, he is able to give technical assistance in matters of nursing care, control of community diseases and on nutrition, maternal and child care (Reproductive and Child Care), School health services and environmental health. As a social worker, she is able top carry social investigation in the homes, assess the health needs of the family and interpret the services which are available to the families and the country as a whole. She knows the existing social organization and voluntary groups in her area and works though them when necessary.

Objectives of Community Health Nursing

Include the following,To:
 * Provide antenatal, maternity and postnatal care to ensure safe pregnancy, delivery and puerperium for the mother and child.
 * Provide Under Fives’ Clinics for:
 * immunization
 * developmental assessment
 * advice on nutrition and child care
 * treatment of minor ailments
 * providing encouragement and support to mothers.
 * Provide clinics for treating adults and children for:
 * minor ailments
 * referral of major illness
 * health education
 * Provide facilities for family planning.
 * Teach the correct use of common medicines and drugs and the dangers of buying medicines at the chemist and market.
 * Explain and promote the use of local health services in the community, advising people to seek health care from safe, qualified heath personnel.
 * Promote projects in the community that will improve life for the people there eg. Women’s cooperatives, literacy programmes, provision of safe water.
 * Teach and demonstrate healthy ways of living (health education) according to local needs.
 * Assist in the prevention and control of communicable disease.
 * Visit people in their own homes and villages to identify health needs and priorities, and deal with the, effectively.
 * Promote the health of school children (through the health service.)
 * Promote the health of the worker (occupational health).
 * Maintain and promote the health of the elderly and handicapped.
 * Work in close cooperation with government and other local organizations to promote health and welfare of individuals, families and communities.

Duties of a Community Health Nurse
 * Home visiting
 * Running child welfare clinic
 * Running family planning clinic or assisting
 * Assist in running ANC and PHN
 * Conducts School Health Services (Hygiene Inspection)
 * Carries out or assist the PHN in inspection of Day Care Centres
 * Collection of information or data from the community
 * Health Education
 * Record Keeping

Responsibilities of the CHO The CHO’s duties mainly involve:
 * Disease Prevention
 * Health Promotion
 * Community Mobilization
 * Health Information
 * Advocacy
 * Improvement in communication for behaviour change

=PRINCIPLE OF COMMUNITY HEALTH NURSING= When posted to a new community under takes the following:
 * Introduces self to the in charge and other team members.
 * Surveys area to acquaint self with important structures like chief’s palace, schools churches, hospital etc.
 * Study previous records if any to identify existing problems.
 * Understands the people’s way of life their traditions, beliefs etc to identify useful ones and discourages harmful ones.
 * Address health needs of the people through their own efforts and materials available in the community.
 * Identify felt needs and put them in other of preference.
 * Involve community members in planning and implementation of services so that she can gain support.
 * Never decide for the people but use knowledge to educate them on service rendered.
 * Procedures and duties must be systematic making sure that people under stand.
 * Be familiar with organized groups and opinion leaders and work through them
 * Help people to assume responsibility so that in your absence work can still be carried out.
 * Do not give a promise which cannot be fulfilled.
 * Find out how people feel about your work so that you can institute the necessary changes to suit them.
 * Do not expect any material reward from community members.
 * Write report on work done and submit to immediate supervisor.

Jaquansah 15:35, 26 February 2007 (CET)