The research, carried out in the Ablekuma South District of the Greater Accra Metropolis during the first and last quarters of 2020, forms part of a broader effort funded by the Alliance for Health Policy and Systems Research through the RAISE project to adapt home visit guidelines for Ghana. Researchers from the University of Ghana and partner institutions conducted five focus group discussions with 36 participants, including community health nurses, community health officers and programme managers, alongside three stakeholder engagement meetings involving 46 people such as district health administrators, community volunteers, faith healers and herbal practitioners. All sessions were audio-recorded with consent, transcribed, and independently analysed by three qualitative scientists using the Braun and Clarke thematic approach, with findings validated back to stakeholders.

The results, published in Health Research Policy and Systems, paint a stark picture of physical deprivation. Nurses reported lacking the most basic tools of their trade: blood pressure apparatus, thermometers, weighing scales, cotton wool and first aid kits with essential medications. One nurse described her visiting bag as effectively empty, asking how she could responsibly administer family planning without first checking a client’s blood pressure. Protective clothing was equally absent, with no raincoats, umbrellas or footwear provided for staff who must walk long distances through hilly, rocky and densely populated terrain. When asked who should supply these resources, participants pointed to the government through the district health directorate, while noting that philanthropic support was irregular and that some nurses quietly paid out of their own pockets to fund essential care for clients.

Transportation emerged as a compounding physical barrier. Nurses are assigned large geographical catchment areas to cover repeatedly for months or years, and in rural postings motorbikes, training and fuel stipends are sometimes provided. In Greater Accra, however, heavy traffic and safety concerns mean motorbikes are withheld from community health nurses, who are predominantly women, and vehicles are often reassigned to male staff for non-visit duties. Participants who had worked in other regions described outreach vehicles and transport allowances there, contrasting sharply with the Accra facilities where nothing at all was provided. The inconsistency, they said, is poorly documented and leaves urban nurses dependent on unreliable stipends or their own feet.

Beyond logistics, the study identified a cluster of psychological challenges rooted in mistrust and fear. Clients seeking to avoid follow-up visits provide false addresses, unreachable phone numbers, or directions to locations that do not exist, such as a brown gate just around a corner that never materialises. Some families simply refuse entry, particularly when a newborn is in the house and grandparents wish to continue traditional practices that a nurse would object to. More alarmingly, nurses reported verbal and physical attacks from relatives of clients, stray dog attacks at gated homes, and even sexual assaults on unarmed young female staff by men in the communities. One nurse recounted how a husband threatened to organise boys to beat visiting staff; the visits stopped, and the woman he sought to shield from care later died.

Role conflict adds a professional dimension to these psychological strains. Community health nurses who care for pregnant women at home are expected to record their findings and medications, such as malaria prophylaxis, in antenatal booklets that midwives consider their own record space. Midwives queried nurses who wrote in these books, and nurses eventually stopped, creating fragmented documentation for women receiving care from both cadres. Participants argued that clearer job descriptions and defined boundaries of practice are needed so that midwives understand visiting nurses are supporting, not supplanting, their work.

Sociocultural interferences form the third major barrier. Many community members attribute illness to spiritual causes and exhaust herbal or faith-based remedies before considering medical treatment, with traditional healers referring patients to hospitals only after indigenous treatments fail. Sacred and festive days render entire communities inaccessible on scheduled days, forcing nurses to build their itineraries around fishing days and market days. Religious objections to modern family planning lead women to default on antenatal care and deliver at home without skilled supervision. Traditional newborn practices, including applying hot stones, saliva, ground chalk, gauze and towels to the umbilical cord, and keeping infants hidden until an out-dooring ceremony, directly restrict nurses’ access to the most vulnerable patients. Patriarchal household structures compound this, since male heads of family must often grant permission before health information can reach women and girls.

The solutions proposed by participants are strikingly practical. They called for well-stocked visiting bags, vaccine supplies, transport funding and expanded CHPS coverage, with some suggesting more male nurses on visiting teams so male clients can speak comfortably. For safety, they recommended community maps, walking boots, umbrellas and raincoats, a companion model pairing nurses with trusted community volunteers, walking in groups where no companion is available, and even defensive equipment such as pepper spray or tasers, possibly issued through police partnerships and returned at the end of each day. In-service training and, crucially, a dedicated Ghanaian home visit practice guideline specifying scope, boundaries, referral pathways, service set-up, logistics and human and financial resources were described as the foundation for everything else. The researchers note that the existing Disease Prevention Life Course Approach Model underpinning CHPS contains no clear-cut guidance on home visit activities, leaving staff uncertain and the practice difficult to evaluate.

The study’s authors argue that guidelines developed in high-income countries such as the United States and Canada, while useful, do not address the layered community, family and household gatekeepers, the absent addressing systems, the security realities and the cultural nuances of Ghana. Formative research to tailor training, public education campaigns, male Community Health Ambassadors recruited through men’s fellowship meetings, mixed-gender visiting teams, culturally sensitive uniforms and dedicated communication lines to the police are among the measures they propose. They caution that the findings, drawn from purposively selected participants in one district and vulnerable to recall and participation bias, cannot be generalised, but they believe the lessons apply broadly across low- and middle-income countries in Africa and Asia where patriarchal structures, poor road networks and weak addressing systems similarly constrain community health work. With dedicated, culturally grounded guidelines, they conclude, home visiting in Ghana could finally be prepared, protected and accountable enough to deliver on its century-old promise.

Subject of Research: Barriers to and solutions for nurse-led home visit practice in Ghana

Article Title: Challenges of home visit practice and perceived solutions for improvement in Ghanaian context: perspectives of healthcare professional and community informants

Article References: Ohene, L. A., Adjorlolo, S., Chandi, M. G., Aryeetey, C., Ansah- Ofei, A. M., Aikins, M., & Aziato, L. (2026). Challenges of home visit practice and perceived solutions for improvement in Ghanaian context: perspectives of healthcare professional and community informants. Health Research Policy and Systems, 24(S1), Article 72. https://doi.org/10.1186/s12961-026-01461-w

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01461-w

Keywords: home visits, community health nurses, Ghana, primary healthcare, CHPS, practice guidelines, universal health coverage, sociocultural barriers, nurse safety, qualitative research, Challenges, home