In Ghana, a 3-tier system of health manpower is being planned in conformity with the country's primary health care strategy. Since independence, the total number of hospital beds and cots has increased from 5787 in 1960 to 12,973 in 1975, resulting in a population per hospital bed of 705 in 1975. Since 1975, health manpower planning has been mainly based on training various cadres of health to work in the existing health institutions. The acceptance of the primary health care strategy, the country's health problems, the relatively simple nature of the tasks to be performed, and sometimes the refusal to conventional health workers to work in rural areas led the Ministry of Health to critically examine the types and number of health services personnel required. A human resources project team was set up in 1976 to investigate the present and projected supply of selected categories of health personnel and to make recommendations as to the types of personnel that should be the front-line health workers. The 3-tier health system is made up of Level A, the community level; Level B, the local council subareas; and Level c, the district. Level A health workers, who form the base of the system, are selected and compensated by the community itself but trained by the Minsitry of Health for 6 weeks and subsequently for weekly refresher courses as needed. The functions of these front line workers include: pregnancy management; personal health improvement with emphasis on infant and child development; community mobilization and social development projects; health education; and simple 1st level curative measures. Level B health workers, who serve the people living within 8 km of every community, comprise 1 or more community nurses/midwives and health station environmental and development workers. Their responsibilities include support and technical supervision of Level A workers, diagnosis and treatment of simple cases or referral to a higher level; immunizing infants and children at level A; and identifying pregnant women at high risk of complicatons. The district is considered the key level. Functions of the district health management team include management of the district health services serving as the basic unit for planning and budgeting, training and supervising Level B health workers within the district, and evaluating health work within the district. In all cases the Village Development Committee is responsibile for selecting Level A halth workers for training. Training should be arranged in a way that trainees can continue their routine work without being separated from their families and communities for a long time. The teaching method involves the use of demonstration and story telling.

作者：K P, Nimo

来源：Chinese medical journal 1984 年 97卷 2期