title: Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.
abstract: BACKGROUND
  The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.
  
  
  RESULTS
  Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.
  
  
  CONCLUSIONS
  Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.
authors: Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Fiifi Amoako
authors: FA
authors: Johnson
authors: Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana.
authors: Faustina
authors: F
authors: Frempong-Ainguah
authors: Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Zoe
authors: Z
authors: Matthews
authors: GeoData Institute, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Andrew J P
authors: AJ
authors: Harfoot
authors: Ghana Statistical Service, Head Office Building, Accra, Ghana.
authors: Philomena
authors: P
authors: Nyarko
authors: Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Angela
authors: A
authors: Baschieri
authors: Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford, United Kingdom.
authors: Peter W
authors: PW
authors: Gething
authors: Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, Faculty of Social and Human Sciences, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Jane
authors: J
authors: Falkingham
authors: Geography and Environment, University of Southampton, Highfield, Southampton, United Kingdom.
authors: Peter M
authors: PM
authors: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D016550:Birthing Centers; D018672:Community Health Planning / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005869:Ghana; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult