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Lesson 1 Over view of Community Health Nursing in Ghana
Introduction

Mothers and children form about 70%of the nations population,mortality and morbidity rates were high meanwhile conditions causing them are preventable,hence the implementation of Community health Nursing in Ghana

Objectives
By the end of the lesson, the students should be able to:-

Identify the root of Community Health Nursing
Identify supportive organizations
Differentiate between Public Health Nurse and Community Health Nurse
Explain Community Health Nursing
Describe the qualities of the Community Health Nurse.

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:

    promote and maintain health
    prevent and control communicable diseases
    aid rehabilitation
    prolong the lives of individuals and families.

She is in contact with people in the community and achieve the above through health education.

The Public Health Nurse (P.H.N) A PHN is a qualified state registered nurse with a certifi

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