In sub-Saharan Africa, cardiovascular disease (CVD) has risen dramatically and has become a leading cause of morbidity and mortality. (1-3) According to The world health report, in 2001 CVD accounted for 9.2% of all deaths in the African region. (1) In Accra, Ghana, CVD was the leading cause of death in 1991 and 2001. (5)
While communicable diseases continue to drain health resources in sub-Saharan Africa, the rising CVD epidemic poses a new public health challenge. Poverty and health-care worker shortages have seriously hindered the response to this mounting non-communicable disease burden. (2,6-8) Cost-effective strategies to prevent, detect and control CVD are urgently needed.
To address the critical shortage of health professionals and increase access to health care, Ghana's Ministry of Health has begun to utilize community health workers (CHWs). Since 2000, volunteer-based CHW programmes have been included in Ghana's Community-based Health Planning and Services (CHPS) initiative, a national policy programme that was developed to mobilize resources to support community-based primary care. (9) The CHPS requires six steps: (i) preliminary planning, (ii) community entry, (iii) creating community health compounds, (iv) posting community health officers to community health compounds to provide health services, (v) procuring essential equipment, and (vi) training CHW volunteers. (9,10)
Surveillance statistics for the CHPS showed that in 2008 the programme was being more widely implemented in regions with fewer health-care resources than Accra, even though in this city the programme would be more beneficial because the prevalence of CVDs is higher. (5) Nyonator et al. attribute this and the lack of training of volunteer CHWs in Accra to concerns about sustainable funding. (9,11) Thus, a new way of thinking in connection with the CHW model for CVD prevention in Accra may be needed.
The development of CHW programmes within faith-based organizations may be an alternative approach for Ghana. This is supported by the fact that: (i) faith-based organizations have successfully run programmes for the primary prevention of CVD and cancer in developed countries, (12) and for HIV/AIDS prevention, screening and treatment in sub-Saharan Africa); (13-17) (ii) a large percentage of Ghanaians attend activities in faith-based organizations; (18) and (iii) faith-based organizations consider it their mission to increase their parishioners' awareness of social issues, including health care. Indeed, the Christian Health Association of Ghana, a nongovernmental organization, provides 42% of the health services in the country. (19) However, we know of no reports documenting organized efforts to conduct CVD prevention within Ghanaian faith-based organizations.
The objective of this study was to evaluate the feasibility of having CHWs implement CVD prevention programmes in faith-based organizations in Accra. Our feasibility assessment considered four dimensions: (i) the context of programme delivery (a faith-based organization); (ii) the people delivering the programme (CHWs); (iii) barriers to implementation and sustainability; and (iv) influential factors related to the target population (e.g. community members' knowledge about CVD). We studied four specific research questions:
* Do faith-based organizations have the capacity to deliver CVD prevention programmes?
* Is it feasible to engage CHWs to deliver CVD prevention programmes in faith-based organizations?
* What barriers could hinder the implementation and undermine the sustainability of a CVD prevention programme within a faith-based organization?
* What do church members know about CVD?
We used a mix of qualitative and quantitative methods. (20) The first included in-depth interviews and focus groups with church leaders and health committee members which served to explore these individuals' views on CVD and health programmes within faith-based organizations. …