1. health and fitness

Table of Contents
Table of Contents ........................................................................................................ i
List of Tables ...............................................................................................................vi
List of Figures ............................................................................................................. vii
FOREWARD ............................................................................................................ viii
CHAPTER ONE ......................................................................................................... 1
1.0
INTRODUCTION........................................................................................... 1
1.1
Regional characteristics ............................................................................. 1
1.1.1
Area Boundaries and Demography ..................................................... 1
1.1.2
Health Institutions ................................................................................ 2
1.1.3
Geography .......................................................................................... 3
1.1.4
Socio-Cultural Characteristics ............................................................. 3
1.1.5
Educational status ............................................................................... 3
1.1.6
Economic Characteristics .................................................................... 3
1.2
Overview of major concerns at the beginning of year 2008. ...................... 4
1.2.1
Improve Quality of Service Delivery .................................................... 4
1.2.2
Improve Efficiency of Health Service Delivery ..................................... 4
1.2.3
Improve Collaboration ......................................................................... 5
CHAPTER TWO ......................................................................................................... 6
2.0
SERVICE DELIVERY.................................................................................... 6
2.1
Public Health Services ............................................................................... 6
2.1.1
Epidemic Prone Diseases ................................................................... 6
2.1.2
Cholera ................................................................................................ 6
2.1.3
Measles ............................................................................................... 6
2.1.4
Meningitis ............................................................................................ 7
2.1.5
Yellow Fever........................................................................................ 7
2.1.6
Diseases Targeted for Elimination....................................................... 7
2.1.6.1
AFP Surveillance (Poliomyelitis) .............................................................................. 8
2.1.6.2
Guinea worm........................................................................................................... 8
2.1.6.3
Neonatal Tetanus .................................................................................................... 9
i
2.1.6.4
2.1.7
2.1.7.1
Leprosy .................................................................................................................... 9
Diseases of Public Health Special Focus .......................................... 10
Tuberculosis .......................................................................................................... 10
2.1.7.1.1 ACTIVITIES OF TB CONTROL ............................................................................ 10
2.1.7.1.2 The Deputy Director’s Project......................................................................... 11
2.1.7.1.3 TB cohort analysis ........................................................................................... 11
2.1.7.2
MALARIA ............................................................................................................... 13
2.1.7.2.1 Activities Carried Out During the Year ............................................................ 16
2.1.7.3
HIV/AIDS................................................................................................................ 20
2.1.7.3.1 Sentinel Studies............................................................................................... 22
2.1.7.3.2 Voluntary Counseling and Testing (VCT)......................................................... 22
2.1.7.3.3 KNOW YOUR HIV STATUS CAMPAIGN (KYSC) ................................................. 23
2.1.7.3.4 Trend of HIV among Pregnant Women........................................................... 24
2.1.7.3.5 Highly Active Anti-Retrovairal Therapy (HAART) Services .............................. 25
2.1.7.3.6 Opportunistic Infections (OIs) ......................................................................... 25
2.1.7.3.7 Sites Providing Services................................................................................... 26
2.1.7.3.8 STI Syndromic Management ........................................................................... 26
2.1.8
NUTRITION ....................................................................................... 27
2.1.8.1
Routine Vitamin A Supplementation - Children 6-59 months .............................. 28
2.1.8.2
Vitamin A Supplementation - Postpartum ............................................................ 28
2.1.8.3
Diet Related Diseases ............................................................................................ 29
2.1.8.4
Nutrition Rehabilitation ........................................................................................ 29
2.1.8.5
Anaemia in Pregnancy........................................................................................... 30
2.1.8.6
Baby Friendly Health Facilities .............................................................................. 30
2.1.8.7
Other activities ...................................................................................................... 31
2.1.8.7.1 Fortified wheat flour and oil campaign........................................................... 31
2.1.8.7.2 Training in essential nutrition actions for health workers .............................. 31
2.1.9
REPRODUCTIVE AND CHILD HEALTH .......................................... 31
2.1.9.1
ADOLESCENT PREGNANCY .................................................................................... 32
2.1.9.2
Risk Factors Associated with Pregnancy ............................................................... 33
2.1.9.3
TEENAGE PREGNANCY .......................................................................................... 34
2.1.9.4
DELIVERIES ............................................................................................................ 34
2.1.9.5
Maternal Mortality................................................................................................ 35
ii
2.1.9.6
Essential Obstetric Care ........................................................................................ 37
2.1.9.7
Postnatal Coverage ............................................................................................... 37
2.1.9.8
Baby Friendly Initiative.......................................................................................... 38
2.1.9.9
Family Planning ..................................................................................................... 39
2.1.9.9.1 Method Preference ......................................................................................... 40
2.1.9.9.2 Men as partners .............................................................................................. 40
2.1.9.9.3 Couple Year of Protection (CYP) ..................................................................... 40
2.1.9.10 Child Health.......................................................................................................... 41
2.1.9.11 School health services.......................................................................................... 42
2.1.9.12 ADOLESCENT HEALTH .......................................................................................... 43
2.1.9.12.1 Youth Friendly Services ................................................................................. 43
2.1.10
HEALTH PROMOTION .................................................................. 43
2.1.10.1 Major Activities for 2008 ..................................................................................... 44
2.1.10.2 Other Regional Level Support Activities .............................................................. 45
2.1.10.2.1 Community Health Promotion ...................................................................... 45
2.1.10.2.2 School health promotion: ............................................................................. 45
2.1.10.2.3 Workplace health promotion: ...................................................................... 46
2.1.10.2.4 Collaboration with other sectors: ................................................................. 46
2.1.10.2.5 Analysis of data from district reports: .......................................................... 46
CHAPTER THREE ................................................................................................... 48
3.0
CLINICAL /INSTITUTIONAL CARE ............................................................ 48
3.1
Utilization of Hospital Services ................................................................. 48
3.1.1
3.2
Ten Top Causes of Hospital Consultation ......................................... 49
Hospital Admissions............................................................................... 50
3.2.1
Bed Occupancy ................................................................................. 51
3.3
Surgical Operations ................................................................................. 52
3.4
REGIONAL BLOOD BANK ...................................................................... 54
3.4.1
Regional Blood Collection and Screening Reports For 2008 ............ 54
CHAPTER FOUR ..................................................................................................... 55
4.0
HEALTH ADMINISTRATION AND SUPPORT SERVICES ........................ 55
4.1
Priorities of the Year ................................................................................ 55
4.2
HUMAN RESOURCE MANAGEMENT .................................................... 56
4.2.1
Revised Staff Performance Appraisal System ................................... 57
iii
4.2.2
4.3
MANPOWER SITUATION ................................................................. 59
TRANSPORT ........................................................................................... 59
4.3.1
Driver Vehicle Statistics ..................................................................... 62
4.4
ESTATE MANAGEMENT ........................................................................ 63
4.5
Maintenance ............................................................................................ 67
4.5.1
Health Care Waste Management ...................................................... 67
4.6
CLINICAL ENGINEERING SERVICES.................................................... 67
4.7
PROCUREMENT MANAGEMENT .......................................................... 68
4.8
STORES, SUPPLIES AND DRUGS MANAGEMENT.............................. 69
4.9
SECURITY ............................................................................................... 73
CHAPTER FIVE ....................................................................................................... 74
5.0
HEALTH TRAINING INSTITUTIONS .......................................................... 74
5.1
NURSES AND MIDWIVES TRAINING COLLEGE, CAPE COAST ......... 74
5.2
PSYCHIATRIC NURSES TRAINING COLLEGE ANKAFUL ................... 74
5.3
COMMUNITY HEALTH NURSES TRAINING SCHOOL WINNEBA ........ 75
5.4
HEALTH ASSISTANTS TRAINING SCHOOL, TWIFO PRASO .............. 76
CHAPTER SIX ......................................................................................................... 78
6.0
FINANCIAL MANAGEMENT ....................................................................... 78
6.1
FLOW OF FUNDS ................................................................................... 78
CHAPTER SEVEN ................................................................................................... 81
7.0
Innovations, Initiatives, Best Practices and Special Initiative to increase
Access .................................................................................................................. 81
7.1
National Health Insurance Scheme (NHIS).............................................. 81
7.2
Regional Health Awards Scheme ............................................................ 81
7.3
Peer review initiative ................................................................................ 81
CHAPTER EIGHT .................................................................................................... 82
8.0
COLLABORATION...................................................................................... 82
8.1
Activities of NGOs .................................................................................... 82
8.1.1
Plan Ghana ....................................................................................... 82
8.1.2
Prolink ............................................................................................... 82
8.1.3
Planned Parenthood Association of Ghana (PPAG) ......................... 82
8.1.4
World Vision International ................................................................. 83
iv
8.1.5
EC/UNFPA/GOG Project – Strengthening Community Based
Reproductive Health Services in the Central Region ...................................... 83
8.1.5.1
Collaboration with GPRTU .................................................................................... 83
CHAPTER NINE ...................................................................................................... 84
9.0
Challenges .................................................................................................. 84
9.1.1
PUBLIC HEALTH .............................................................................. 84
9.1.2
CLINICAL CARE ............................................................................... 84
9.1.3
SUPPORT SERVICES ...................................................................... 85
9.1.4
TRAINING INSTITUTIONS ............................................................... 85
9.2
WAY FORWARD ..................................................................................... 86
9.2.1
Clinical Care ...................................................................................... 86
APPENDIX ............................................................................................................... 87
v
List of Tables
Table 1.1 District, Size, Population and Relative Deprivation Ranking.............................. 2
Table 2.1: Reported Cases of Cholera C/R 2006-2008 ..................................................... 6
Table 2.2: Reported Cases of Suspected Measles C/R 2006-2008 .................................. 7
Table 2.3: Reported Cases of Meningitis C/R 2006-2008 ................................................. 7
Table 2.4: Reported Cases of Guinea Worm C/R 2006-2008 ............................................ 8
Table 2.5: Reported Cases of Neonatal Tetanus C/R 2006 – 2008 ..................................... 9
Table 2.6: Case detection rate by districts. C/R 2005-2008............................................. 12
Table 2.7: Cure rates by districts 2004-2007 ................................................................. 12
Table 2.8: Defaulters by districts ................................................................................. 13
Table 2.9: Trends in Malaria Morbidity and Mortality in the CR, 2006-2008 ................... 14
Table 2.10: Districts Performance on IPT Coverage in 2008 .......................................... 18
Table 2.11: Reported AIDS Cases (1998 – 2008) ........................................................ 21
Table 2.12: Summary of the CT service CR 2007-2008 ................................................. 22
Table 2.13: KYSC – DISTRICT SUMMARY CR 2008 ................................................ 23
Table 2.14: Overall Counseling & Testing Outcome ..................................................... 23
Table 2.15: Summary of the outcome of PMTCT services 2007-2008 ............................. 24
Table 2.16: HIV prevalence among pregnant women from the HIV Sentinel Survey and the
PMTCT ..................................................................................................................... 24
Table 2.17: Outcome of the ART services for adults and Pediatrics ................................ 25
Table 2.18: Outcome of OIs managed at the health facilities .......................................... 26
Table 2.19: Outcome of STIs Syndromic Management by Districts ................................ 27
Table 2.20: Risk Factors Associated with Pregnancy..................................................... 33
Table 2.21: Trends of supervised deliveries and outcome, 2004-2008, CR....................... 35
Table 2.22: Causes of Maternal Deaths Direct and Indirect causes .................................. 37
Table 2.23: Post Natal Care coverage by districts 2006-2008 ......................................... 38
Table 2.24: Newly Designated Baby Friendly Facilities by Districts ............................... 39
Table 2.25: Trend of Couple Year Protection By Method Cr. 2006-2008 ........................ 41
Table 2.26: Child health services coverage, CR 2006-2008 ............................................ 42
Table 3.1: Ten Top Courses of Hospital Consultation 2006-2008 (446,075) ................... 50
Table 3.2: Percentage bed occupancy 2007-2008 by districts Central Region. .................. 52
Table 3.3: Surgical Operations 2005-2008 ................................................................... 52
Table 3.4: Top Ten Causes of Surgical Operations ........................................................ 53
Table 3.5: Specialist Visits ......................................................................................... 54
Table 4.1: Manpower Situation CR, 2006-2008 ............................................................ 59
Table 4.2: Trend of Vehicles Key Indicators 2004-2008 ................................................ 60
Table 4.3: Trend of Motorcycles Key Indicators – Districts ........................................... 61
Table 4.4: Number and Type of Vehicles: .................................................................... 61
Table 4.5: Fleet Allocation by District/Institution 2008 ................................................. 61
Table 4.6: Fleet Inventory by Age Block – Vehicles...................................................... 63
Table 4.7: Fleet Inventory by Age Block – Motorcycles ................................................ 63
Table 4.8: Project Status CR, 2008 .............................................................................. 65
Table 4.9: Comparative Performance Indicators (Medicines), 2006-2008 ........................ 71
Table 4.10: Comparative Analysis of Performance Indicators (Non-Medicines) ............... 72
Table 5.1: Performance of Health Institutions 2008 ....................................................... 77
Table 6.1: Flow of Funds, CR 2007-2008..................................................................... 78
vi
List of Figures
Figure 2.1: AFP Case Detection by districts, 2006 - 2008 ................................................ 8
Figure 2.2: Prevalence Rate of Leprosy in Central Region. Less 1:10,000 pop . ............... 10
Figure 2.3: Total Malaria Cases 2004 – 2008................................................................ 16
Figure 2.4: Malaria Cases <5 and >5 2006-2008 ........................................................... 17
Figure 2.5: Districts Performance on IPT Coverage in 2008 ........................................... 19
Figure 2.6: Trend of IPT Coverages CR, 2004-2008. ..................................................... 19
Figure 2.7: Reported AIDS Cases (2004-2008) ............................................................. 21
Figure 2.8: Trend of vitamin A coverage by districts for the year 2008 ............................ 28
Figure 2.9: Coverage for Post Partum Vitamin A Suplementation (2008) by Districts. ...... 29
Figure 2.10: Trend of anemia in pregnancy CR. 2005-2008 ........................................... 30
Figure 2.11: Antenatal Care Coverage by Districts C/R- 2008 ........................................ 32
Figure 2.12: Early Teenage Pregnancy by district. CR. 2006-2008 ................................. 32
Figure 2.13: Teenage Pregnancy by District C/R, 2006 - 2008 ....................................... 34
Figure 2.14: Supervised Delivery Coverage by district. CR. 2008................................... 35
Figure 2.15: MMR Trends in CR and Ghana. 1994-2008 ............................................... 36
Figure 2.16: Maternal Mortality by Districts ................................................................ 36
Figure 2.17: FP Acceptor Rate (all methods) by district. CR. 2006-2008 ......................... 39
Figure 2.18: Pie Chart Showing the Method Preference in C/R, 2008.............................. 40
Figure 2.19: Trend of Couple Year of Protection, CR 2006-2008 ................................... 41
Figure 3.1: Trend in OPD Attendance Per Capita, CR. 2001 - 2008 ................................ 48
Figure 3.2: Trend in per capita OPD attendance by districts-C/R. 2006-2008 ................... 49
Figure 3.3: Trend of Admission per 1000 Pop, CR 2001-2007........................................ 50
Figure 3.4: Admission Pop Ratio by District CR 2007 – 2008 ........................................ 51
Figure 3.5: Surgical Operations 2008. 12,120 cases....................................................... 53
vii
FOREWARD
The report as a summary of the activities, achievements, challenges and constraints of the
health sector in the Central Region. It also contains targets and activities planned for 2009.
The information contained in the report does not comprehensively capture everything that
occurred in 2008 as some of the data were either inadequate or did not follow the reporting
format provided. More detailed information could be obtained from the respective institutions
and officers at the Regional level.
It is our hope that the information contained in the report will be useful to all stakeholders
interested in getting information on the health sector.
We are grateful to all institutions and individuals for the effort and support in making this
report possible.
We welcome comments, suggestions and criticisms from readers to enable us improve the
quality of the reports in subsequent years.
Thank you.
NANA OWUSU-BOAMPONG
DEPUTY DIRECTOR (ADM)
viii
CHAPTER ONE
1.0
1.1
INTRODUCTION
Regional characteristics
1.1.1 Area Boundaries and Demography
The Central Region occupies an area of 9,826 square kilometers, which is about 6.6% of the
total land area of Ghana. It is bounded in the south by the Gulf of Guinea and on the west by
the Western region. The region shares a border on the east with the Greater Accra region and
in the north with the Ashanti and on the north east with the Eastern region. It has 17
administrative districts with the historical city of Cape Coast as the capital with about 63% of
the region being rural (2000 population and housing census).
The Central region has an estimated population of 1,882,115 (2008) and an annual population
growth rate of 2.1%. With a population density of about 162 inhabitants per square
kilometers, the central region is the second most densely populated region after Greater
Accra.
The 2003 Ghana Demographic and Health Survey (GDHS) estimated the Infant Mortality and
the under-five Mortality rates as 50 and 90 per 1000 live births respectively. This shows an
improvement over the 1998 GDHS figures, which were 83 and 142 per 1000 live births
respectively. These current GDHS rates places the region as the second best in the southern
sector and the third best in the whole country for both infant and under five mortality rates.
1
The table below shows the various districts, size, projected population and their Relative
Deprivation Ranking (RDR).
Table 1.1 District, Size, Population and Relative Deprivation Ranking
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DISTRICTS
ABURA-ASEBU-KWAMENKESE
AGONA WEST
AJUMAKO-ENYAN-ESSIAM
ASIKUMAH-ODOBEN-BRAKWA
ASSIN NORTH
ASSIN SOUTH
AWUTU SENYA
CAPE COAST
GOMOA WEST
KOMENDA-EDINA-EGUAFO-ABERM
MFANTSIMAN
TWIFO-HEMANG-LOWER DENKYIRA
UPPER DENKYIRA EAST
AGONA EAST
GOMOA EAST
EFUTU
UPPER DENKYIRA WEST
TOTAL
DISTRICT CAPITALS
ABURA DUNKWA
NSABA
AJUMAKO
BREMAN ASIKUMA
ASIN FOSU
ASSIN KYEKYEWERE
AWUTU
CAPE COAST
APAM
ELIMINA
SALTPOND
TWIFO PRASO
DUNKWA ON OFFIN
SWEDRU
AFRANSI
WINNEBA
DIASO
POPULATION
106,390
111,817
108,599
105,565
126,792
105,201
148,485
139,469
104,881
132,774
180,504
130,312
82,164
75,890
125,145
52,232
45,895
1,882,115
1.1.2 Health Institutions
The region has in all 224 health facilities comprising 110 public, 84 private, 14 mission/quasi
and 16 Community/NGO Clinics. It also Includes 59 functional Community-Based Health
Planning and Services (CHPS) compound. There are 1,461 outreach points in the region
recording an increase of 14% (1,281) over that of the previous year. Most of these private
institutions however are located in the district capitals and other big towns. Four districts out
of the 17 districts do not have district hospitals. They are Assin South, Gomoa East, Upper
Denkyira East and Agona West. The distribution of health facilities does not favour the large
rural majority. The region has four Nurses Training Institutions each in the following towns
Winneba, Cape Coast, Ankaful and Twifu Praso.
2
1.1.3 Geography
There are two rainy seasons in the region; the peak of the major season is in June. The
vegetation is divided into dry coastal savanna stretching of about 15 km inland, and a tropical
rain forest with various reserve areas.
1.1.4 Socio-Cultural Characteristics
Adult literacy rate in the region is slightly more than 50%, with the highest being 75.3 % in
Cape Coast and the lowest 45.2 % in Abura-Asebu-Kwamankese. There is a larger proportion
of literate males (69.8%) than females (46.3%).The region is predominantly Akan, who
constitutes more than 90 per cent of the population. Majority of the Akans are Fantes, the
indigenes of most districts in the region.
The region is endowed with rich cultural events like annual festivals such as Aboakyer, Fetu
Afahye, and Bakatue, among others. An international festival, the Pan African Historical
Theatre Festival is also hosted every two years by the region. The region is also endowed
with historic monuments like castles and forts. These attract lots of tourist to the region.
1.1.5 Educational status
The region is considered as a citadel of education because it has more than 50 out of the 207
secondary schools in the country. In addition, there are three Teacher Training Colleges, a
Polytechnic and two Universities – the University of Cape Coast and the University of
Education, Winneba.
1.1.6 Economic Characteristics
Unemployment is 8.0%; 2.4% lower than the national average of 10.4%. The Mfantsiman
and Cape Coast districts have values of about 15 % and 11% respectively exceeding the
national average. Unemployment in females is 8.2%, about 0.4 % higher than in males in
almost all the districts. About 5 % of children under age 15 years are engaged in economic
activities in most districts.
The predominant industry in the districts, except Cape Coast metropolis is agriculture
(52.3%), followed by manufacturing (10.5%). Agriculture (including fishing) is the main
occupation and employs more than two thirds of the work force in many districts. Cocoa
3
production is concentrated in Assin, Twifo-Hemang-Lower Denkyira and Upper Denkyira
districts while oil palm production is grown in Assin and Twifo-Hemang-Lower Denkyira.
Other major agricultural enterprises are pineapple and grain production. Fishing is
concentrated mainly in the Coastal districts.
1.2
Overview of major concerns at the beginning of year 2008.
At the beginning of 2008, the Regional Health Directorate set itself to address the following:
1.2.1 Improve Quality of Service Delivery
•
Strengthen QA
–
Conduct attitude surveys
–
Hospitals to focus more on technical performance and use of professional
indicators
–
Encourage analysis of data at local levels (Hospital and Health Centres) for
decision making
–
Train/orientate QA teams at Health Centres
–
All managers demonstrate commitment to QA (put QA as agenda for
meetings)
–
Implement / advocate use of revised surgical consent forms
•
Continue improving the Referral System
•
Monitor compliance with Referral Protocol/Policy
•
Continue the Peer Review Mechanism and evaluate its effectiveness
•
Improve district based blood organization
•
Establish laboratory services for selected Health Centres
•
Monitor and evaluate the implementation of new NHIS tariffs.
•
Work towards retaining House Officers and Medical Officers
•
Disease Surveillance
•
Strengthen community based surveillance and timely reporting of outbreaks
1.2.2 Improve Efficiency of Health Service Delivery
•
Strengthen the accounting systems at all levels – Intensify Monitoring &
Supervisory visits
•
Ensure compliance with available financial rules and regulations
4
•
Improve Health Management information systems at district including the
development of ICT system
•
Ensure compliance with Planned Preventive Maintenance Systems at all levels.
•
Integrate Regenerative Health and Nutrition programme activities into district
programmes.
•
Strengthen and support Human Resource Development / Management programme
–
Staff welfare
–
Address the negative staff attitude
–
Operationalize performance standard management systems
–
Scale up the implementation of new Staff Performance Appraisal System
–
Strengthen and intensify monitoring, support and supervision at all levels
–
Refine and clarify strategies and programmes to promote gender equity
–
Complete pilot face and scale up of Leading – Together – To Achieve Results
(Leadership Programme) Initiative.
1.2.3 Improve Collaboration
•
Intensify inter-sectoral collaboration with other sectors e.g Education and Sports,
Water and Sanitation, Environment, Food and Agric
•
Dialogue with Regional Coordinating Council (RM), District Assemblies etc on
resourcing the newly created districts.
•
Monitor and evaluate implementation of MOU with Transport Union and Transport
owners
•
Strengthen collaboration with;
–
QHP, CHPS-TA, Net Mark, GSCP
–
EC/IMFAPA/GOG
–
PPAG, Plan international
–
Prepare grounds for UNICEF and Nutrition and malaria control for Child Survival
Project.
5
CHAPTER TWO
2.0
SERVICE DELIVERY
2.1
Public Health Services
Public health activities in the region were organized under the following units:
•
Disease Control and Surveillance
•
Reproductive and Child Health
•
Nutrition and
•
Health Promotion
2.1.1 Epidemic Prone Diseases
The Unit continued facilitating investigation, specimen collection, transport and follow up of
AFP, measles, yellow fever(suspected) and cholera cases in all districts.
2.1.2 Cholera
The region recorded no cholera outbreak during the year even though there were heavy rains.
This is attributed to the relative improvement in the environmental sanitation as a result of the
efforts put in place by the Zoom Lion Company and high level of awareness and sensitization
of the public on good health habits and environmental cleanliness.
Table 2.1: Reported Cases of Cholera C/R 2006-2008
No. of Cases
No. of Death
CFR
2006
1692
55
3.25
2007
0
0
0
2008
0
0
0
2.1.3 Measles
Forty eight (48) suspected cases were reported during the year and all were investigatedusing case based approach. Out of these 48 cases, 3 were positive for measles and 14 cases
were positive for rubella with laboratory confirmation.
6
Table 2.2: Reported Cases of Suspected Measles C/R 2006-2008
No. of Cases
No. of Death
CFR
2006
24 (4 +ve)
0
0
2007
28 (1 Indeterminate , 7 rubella)
0
0
2008
48 ( 3 +ve, 14 rubella)
0
0
2.1.4 Meningitis
The meningitis cases recorded over the past three years in the region had been constantly low.
The region recorded 16 cases of meningitis with 3 deaths in 2008 as compared to 45 cases
and 16 deaths in 2007. All the cases were reported from 4 districts namely Assin North,
AES, Mfantsiman and Agona. Laboratory test on the cases confirmed Streptococcal
pneumonia. There was no confirmed case of cerebrospinal meningitis (CSM).
Table 2.3: Reported Cases of Meningitis C/R 2006-2008
No. of Cases
No. of Death
CFR (%)
2006
4
2
50
2007
45
16
35.6
2008
16
3
18.8
2.1.5 Yellow Fever
For the past 3 years, no confirmed case of Yellow Fever was recorded in the region.
2.1.6 Diseases Targeted for Elimination.
Poliomyelitis and Guinea worm have been targeted for eradication and so surveillance has
been mounted on these diseases to the extent that have even rumours about these diseases are
investigated thoroughly to ensure the presence or absence of any of them. While Guinea
cases are monitored using the characteristic blister or hanging worm, poliomyelitis uses acute
flaccid paralysis.
7
2.1.6.1 AFP Surveillance (Poliomyelitis)
The search for AFP had been put in place to track poliomyelitis in the system. Sensitization
and active case search was done in both public and private health facilities as well as prayer
or healing camps. In all sixteen (16) cases were detected in the region in 2008. 100% of the
cases were investigated within 14 days and stool adequacy was also 100%. The figure below
shows the detection rates by districts
Figure 2.1: AFP Case Detection by districts, 2006 - 2008
2.1.6.2 Guinea worm
The fight against Guinea worm started yielding positive result when transmission was broken
in the year 2003. A case reported in Kasoa in the Awutu Senya District in 2008 was imported
from the northern region. No case of indigenous Guinea worm was reported in the district
since 2003.
Table 2.4: Reported Cases of Guinea Worm C/R 2006-2008
No. of Cases
No. of Death
CFR
2006
0
0
0
2007
0
0
0
2008
1
0
0
8
2.1.6.3 Neonatal Tetanus
Neonatal tetanus reporting continues to be a problem as the number of cases detected is
declining. This could be reduction in the number of actual cases or a decline in the
surveillance activities against neonatal tetanus in the health facilities.
Table 2.5: Reported Cases of Neonatal Tetanus C/R 2006 – 2008
No. of Cases
No. of Death
CFR
2006
11
6
54.5
2007
3
2
66.7
2008
1
1
100
2.1.6.4 Leprosy
The global leprosy elimination strategy, based on early case finding and widespread
administration of multi-drug-therapy (MDT) has achieved great success in the interruption of
transmission, patient compliance and prevention of disabilities. Central Region achieved its
elimination target in 2002 with a prevalence rate of 0.63:10,000 populations. The prevalence
rate for 2007 was 0.26:10,000 populations and reduced to 0.17: 10,000 in 2008.
However, there are still a lot of challenges that confront the programme at all levels. Ageing
leprosy trained officers who are committed to the leprosy service and deaths. Luke-warm
attitude and unwillingness of newly trained field technicians to integrate leprosy control into
other disease control activities. Lack of funds and other logistics to enhance performance at
all levels.
Despite the above mentioned constraints the region enjoyed an active case search support at
the later part of the year under review. The financial support helped two (2) districts to train
non health and health professionals on early diagnosis of leprosy.
9
Figure 2.2: Prevalence Rate of Leprosy in Central Region. Less 1:10,000 pop .
PREVALENCE RATE OF LEPROSY IN
CENTRAL REGION. LESS 1:10,000 POP.
1.6
1.4
1.44
1.24
1.2
1
0.8
0.63
0.6
0.4
0.5
0.48
0.48
0.41
0.2
0
2000
2001
2002
2003
2004
2005
2006
0.26
2007
0.17
2008
2.1.7 Diseases of Public Health Special Focus
2.1.7.1 Tuberculosis
2.1.7.1.1 ACTIVITIES OF TB CONTROL
The Regional Tuberculosis Control committee set itself the under listed priorities for the year
2009.

Expansion of DOT Centre services

Increase and improve Laboratory Service

Increase Community Based TB care

Establish PPM DOT in Cape Coast Metro

Strengthen TB/HIV collaboration

Strengthen TB & TB/HIV care and control in Prisons.
10
2.1.7.1.2 The Deputy Director’s Project
The Deputy Director Public Health’s project in TB/HIV collaboration was designed to
promote an improvement in the case management of persons co-infected with TB and HIV.
The Deputy Director used his influence and expertise as a clinical and public health
practitioner to speed up and entrench the system where TB is suspected and diagnosed in
HIV patients, managed at where patients are diagnosed without burdening the patients with
the problem of having to seek services elsewhere and vice versa.
The following set of activities were planned to achieve the objective of the Deputy Director’s
project:
1. Sensitization of Clinicians of the Central Regional Hospital
2. Sensitization of District Directors of Health services
3. Sensitization of Medical Assistants
4. Sensitization and training of Private medical practitioners
5. Training of District and Institutional TB Coordinators
6. Assisting treatment centres
7. Attend District TB review meeting.
8. Advocate for the establishment of Laboratories in Health centres.
9. Technical Support visits to AAK, AES, Assin South, AEE, Mfantseman
10. Visit Laboratories
11. Visit Prisons
All the activities were carried out both by the TB regional team and The Deputy Director’s
project contributed to the huge success of the region in management of TB.
2.1.7.1.3 TB cohort analysis
Case detection rate for the region in 2008 was 23.1% as compared to 25.7% in 2007. During
the year KEEA, Cape Coast, Mfantsiman were among the districts with the highest detection
rates. Increases were observed in AAK, AES, Assin South and Upper Denkyira districts.
11
Table 2.6: Case detection rate by districts. C/R 2005-2008
District
2005
2006
2007
2008
Assin north
146 (23.8%)
56 (16.4 %)
82(23.5%)
67 (18.8%)
Assin south
-
45 (15.9%)
52(17.9%)
37 (12.5%)
Agona
148 (29.9%)
92 (18.2 %)
136(26.3%)
124 (23.5%)
AAK
AEE
AES
AOB
Cape Coast
31 (11%)
67 (23.4%)
114 (21.5%)
81 (29.1%)
146 (39.7%)
32 (11.2%)
82 (28.0%)
107 ( 19.8)
58 (20.4%)
110 (29.3%)
41(14%)
78(26.1%)
101(18.3%)
70(24.1%)
115(29.9%)
59 (19.8%)
82 (26.9%)
130 (23.1%)
51 (17.2%)
110 (28.1%)
Gomoa
186 (30.6%)
187 (30.2%)
232(36.7%)
142 (22.0%)
KEEA
122 (34.8%)
134 ( 37.4%)
139(38.1%)
121 (32.5%)
Mfantseman
172 (36.1%)
122 (25.1%)
132(26.6%)
139 (27.4%)
THLD
66 (19.2%)
65 (18.5%)
78(21.8%)
65 (17.8%)
U/Denkyira
108 (31.9% )
77 (22.3%)
75(21.3%)
92 (25.6%)
Region
1387 (27.9%)
1167 ( 23.0%)
1331(25.7%)
1219 (23.1%)
Table 2.7: Cure rates by districts 2004-2007
District
2004
2005
2006
2007
Assin North
56.40%
68.40%
79.50%
90.20%
Assin South
-
-
55.20%
84.80%
Agona
24.50%
49.60%
76.30%
81.60%
AAK
46.20%
72.00%
65.40%
93.10%
AEE
59.30%
60.70%
58.10%
73.80%
AES
48.80%
57.00%
78.50%
85.70%
AOB
41.30%
82.80%
93.60%
85.50%
Cape Coast
43.30%
50.70%
69%
85.70%
Gomoa
53.40%
62.30%
61.50%
66.70%
KEEA
45.50%
60.40%
64.20%
79.00%
Mfantseman
34.50%
62.20%
76%
89.00%
THLD
60.50%
72.20%
88%
85.70%
Upper Denkyira
47.10%
85.90%
93.50%
84.10%
Region
45.40%
62.80%
72.10%
81.80%
12
The table above refers to patients who have undergone treatment and have been assessed a
year after starting treatment.
Table 2.8: Defaulters by districts
District
2004
2005
2006
2007
Assin North
6.00%
5.30%
0%
0%
Assin South
-
-
14%
0%
Agona
38.80%
34.50%
21%
7.80%
AAK
30.80%
16.00%
15%
3.40%
AEE
25.40%
17.90%
15%
0%
AES
35.00%
30.40%
3.80%
1.20%
AOB
14.30%
3.10%
0%
0%
Cape Coast
33.10%
29.90%
6%
7.80%
Gomoa
30.20%
21.70%
21%
5.90%
KEEA
28.80%
18.80%
6.60%
0%
Mfantseman
52.60%
19.30%
1%
0%
THLD
10.50%
14.80%
4%
3.20%
Upper Denkyira
17.10%
0%
0%
4.50%
Region
30.30%
19.60%
9.20%
2.90%
2.1.7.2 MALARIA
Malaria which is hyper endemic disease in the country in general had again been the leading
cause of morbidity and mortality in the Central Region in the year 2008. Transmission of the
disease in the region had been intense and stable and well reported in all the 13 districts as the
top ranking disease at the various out-patient departments (OPD) and in-patient admission
centres. It was also the top ranking cause of death in the health facilities. Since the year
2005, massive and consistent Global Fund (GF) sponsored and specified malaria control
interventions had been on-going in the region to fight the dreadful killer disease in 2008.
The goal and objectives of the Central Region Malaria Control Programme which are in line
with those of the National Malaria Control Programme are stated below.
13
Goal

To reduce malaria burden from the 2000 levels by 50% by the year 2010
Objectives

To implement the new Anti-Malaria Drug Policy in all districts in the region
by the year 2008.

To provide Intermittent Preventive Treatment (IPT) to 70% of pregnant
women in the region the year 2008.

To increase the usage of Insecticide Treated Nets in children under five years
(from 3.5% to 50%).

To increase the proportion of mothers/ care-takers (from 21.1% to 60%) who
are able to identify early signs and symptoms of uncomplicated and severe
malaria and seek treatment promptly.
Activities that had been in place to achieve the objectives are as follows:

Implementation of the new Anti-Malaria Drug Policy (AMDP).

Promotion and use of Insecticide Treated Nets (ITNs) in children under five
years and pregnant women.

Promotion and use of Intermittent Preventive Treatment (IPT) in pregnant
women..
Table 2.9: Trends in Malaria Morbidity and Mortality in the CR, 2006-2008
Indicator
2006
2007
2008
Total malaria cases
384,143
371,263(32.2%)
446,075(36.2%)
Malaria cases < 5 years
96,690
95,303
114,199
Malaria cases > 5 years
267,024
262,671
320,805
Malaria cases in preg. Women
20,429
13,289
11,071
15,797
19,452
Total
in-patients
admissions
due
to
-
malaria.
Under 5 admissions due to malaria
5,957
6,339
7,623
Above 5 admissions due to malaria
17,386
8,203
10,748
14
Pregnant women admissions due malaria
15,601
1,255
1,081
Total in-patient deaths due to malaria
494
609
739
No of < 5 in-patient deaths due to malaria
278
251
257
No of > 5 in-patient deaths due to malaria
215
355
481
No of in-patient preg deaths due to malaria 1
3
1
CFR for total malaria cases
1.10
3.9
3.8
CFR for < 5 malaria cases
4.7
4.0
3.4
CFR for > 5 malaria cases
1.24
4.3
4.5
CFR for pregnant cases
0.01
0.2
0.1
1,649
629
Preg. women who had severe malaria
In 2008, malaria was responsible for 36.2% of OPD attendances compared 32.2% in 2007 as
446,075 cases were recorded in 2008 as against 371,263 in 2007.
In-patient admissions due to malaria accounted for 33% of all admissions in 2008 as against
25.4% in 2007 and malaria was the highest cause of mortality accounting for 23.2% of total
deaths recorded in 2008 compared to 19% in the year 2007.
Even though total malaria cases and in-patient malaria admissions increased in 2008, there
was a drop in the CFR for total malaria cases from 3.9 in 2007 to 3.8 in 2008
Under 5 malaria admissions increased by 20.1% in 2008, from 6,339 in 2007 to 7,623 in
2008, however, the under 5 CFR reduced from 4.0 in 2007 to 3.4 in 2008.
Malaria cases in pregnant women have been reducing since 2006. It reduced from 13,289 in
2007 to 11,071 in 2008, a reduction of 16.7%.
Similarly, there was a drop in pregnant women admissions due to malaria from 1,255 1in
2007 to 1,081 in 2008 and a corresponding decrease in CFR for pregnant women from 0.2 in
2007 to 0.1 in 2008.
Again, there has been a drastic decline by 62% the number of pregnant women who had
severe malaria from 1,649 cases in 2007 to 629 cases in 2008.
The malaria situation is better in 2008 than in 2007 as a result of reduction in under 5
mortality and a drop in both morbidity and mortality in pregnant women.
This state of affairs is attributed to improved case management at all levels and the use of
ITNs and IPT by pregnant women.
15
The interventions introduced to control malaria since 2006, have started yielding some
positive results.
The upsurge of malaria cases in 2008 may be attributable to many contributory factors
•
People stay outside late at night and end up getting bitten by infective
Anopheles mosquitoes before getting indoors.
There is the need for behavioral change.
• A lot more people are accessing health care as result of the National Insurance
Health Scheme, hence report of increasing malaria cases.
•
Non use and or irregular use of ITNs because of the heat generated under the
ITNs because of the hot weather conditions.
2.1.7.2.1 Activities Carried Out During the Year
2.1.7.2.1.1 Capacity building
Malaria diagnosis in the region is mainly based on clinical signs and symptoms of patients
because of inadequate laboratory facilities. To improve upon the situation, the NMCP
supplied the region with 383 packets of Rapid Diagnotic Test (RDT) kits for the rapid
detection of Plasmodium falciparum infection.
Against this background, a total of 245 health staff from 11 districts were trained on the use
of the kits.

Ninety nine (99) health staff and 608 Community based agents (CBAs)/NGO workers
were trained on IPT.

Seventy nine (79) health staff and 1989 CBAs (967 by GHS and 1022 by NetMark)
were trained on ITN promotion and re-treatment.

Ninety six (96) CBAs were trained on Home Based Care
Figure 2.3: Total Malaria Cases 2004 – 2008
16
Figure 2.4: Malaria Cases <5 and >5 2006-2008
Malaria cases in pregnant women 2006 – 2008
2.1.7.2.1.2 2008 ITN distribution in the Central Region
In 2008, the region took delivery from the National Malaria Control Programme (NMCP)
157,800 long lasting ITNs from the Global Fund(GF) between February and June, 2008. Out
of this number, 118,800 ITNs were allocated to 13 districts for distribution to pregnant
women and children under one year for the redemption of 111,719 vouchers distributed to
pregnant women and children under one year throughout the region under the Integrated
Maternal and Child Health Campaign (IMCH) which took place from 28th-30th November,
2007.
The remaining GF ITNs were allocated to the 13 districts for sale to the two target groups at
subsidized rate of GHC2.00 as per the table below.
2.1.7.2.1.3 Long lasting GF ITNs distribution to Districts - 2008
IMCH Campaign 16th -18th October, 2008
On October 10, 2008, the CRHD received 79,600 pieces of “Interceptor” ITNs from UNICEF
for free distribution to children under one year, throughout the region, under the 2008 IMCH
Campaign which was slated for 16th to 18th October, 2008. Out of the above total number of
ITNs received, 79,127 were subsequently allocated to the 17 districts in the region for
distribution.
17
The ITN Voucher Scheme introduced by USAID/NETMARK
Under the VS, 150,247 ITNs were distributed to children under five years and pregnant
women in 2008, compared to 60,023 ITNs distributed to the same target group in 2007.
2.1.7.2.1.4 Implementation of Intermittent Preventive Treatment (IPT) in the Central
Region
There has been a significant improvement in 2008 regional IPT performance compared to
that of 2007.
In 2008, the number of women put on IPT 1, IPT 2 and IPT 3 were 65,792, 44,812 and
29,224 respectively and giving a total dose of 139,828. The total ANC attendance was
297,977.
This gives IPT 1, IPT 2 and IPT 3 percentage coverage of 22.1%, 15.1% and 9.8%
respectively which are higher than those for 2007 which were 20.3%, 13.1% and 7.7%
respectively when the number of women put on IPT 1, IPT 2 and IPT 3 were 51,171, 32,655
and 19,275 respectively with a total dose of 103,101 and a total ANC attendance of253, 555.
Table 2.10: Districts Performance on IPT Coverage in 2008
District
DOSES
IPT 1
IPT 2
IPT 3
INDICATOR
Total
doses
Total
ANC
IPT 1 %
IPT 2 %
IPT 3 %
AOB
2985
1734
1177
5896
13,547
22.0
12.8
8.7
KEEA
6007
4089
2676
12703
15,782
38.1
25.9
17.0
Ass N
3696
2601
1587
7884
15,779
23.4
16.5
10.1
Ass S
2613
2033
1214
5860
11,346
23.0
17.9
10.7
AEE
2908
2062
1596
6536
16,099
18.1
12.8
9.9
Mft
4001
2769
1414
8184
29,071
13.8
9.5
4.9
Agona
5953
4573
3216
13842
28,917
20.6
15.8
11.1
THLD
5639
3446
2401
10676
23,072
24.4
14.9
10.4
Gomoa
7126
5843
4311
17280
31,203
22.8
18.7
13.8
AES
13705
7186
3862
24753
46,571
24.9
15.4
8.3
CC
4317
3113
1939
9369
34,470
12.5
9.0
5.6
AAK
2833
2306
1743
6882
14,236
19.9
16.2
12.2
UD
4009
3047
2088
9144
19,242
20.8
15.0
10.9
65,792
44,812
29,224
139,828
297,277
22.1
15.1
9.8
REGN
18
Figure 2.5: Districts Performance on IPT Coverage in 2008
REGIONAL IPT COVERAGES FROM 2004 - 2008
Figure 2.6: Trend of IPT Coverages CR, 2004-2008.
19
2.1.7.2.1.5 Innovative ways to improve IPT Coverage
•
In Upper Denkyira East district, HWs visit homes, identify pregnant women
and give IPT services to the eligible ones under DOT.
•
In the THLD districts, CBAs identify pregnant women in their communities
and registered them in the community register. The women are then given
cards and referred to health facilities for IPT services. This system enables
HWs to make follow ups on pregnant women by referring to the community
registers and those eligible are given the drug as DOT at the community level
or are referred to the health facility. By this system, defaulters could be traced.
•
In the AEE and other districts, IPT services are rendered to pregnant women
during outreach programmes. Community Health Officers trace IPT
defaulters.
2.1.7.2.1.6 MANAGEMENT
OF
ARTESUNATE
AND
AMODIAQUINE
COMBINATION IN 2008
In accordance with the new Anti-Malaria Drug Policy, Artesunate and Amodiaquine
combination (AS+AQ) has been the type of Artemisinin-based combination therapy (ACT)
and the first line drug of choice for the management of uncomplicated malaria in the Central
region since 2006. The region had been receiving and continues to receive its drug supply
from the National Malaria Control Programme (NMCP).
In 2008, CRHD had a total of 7,440,940 tablets of AS+AQ in stock and distributed 7,039,160
tablets, leaving a balance of 401,780 tablets.
2.1.7.3 HIV/AIDS
The Central Region reported a total of 404 AIDS cases in the year under review as against
690 in 2007 and 730 in 2006
The graph below shows the trend of AIDS cases reportedly diagnosed in the health facilities
in the region from 2004 to 2008.
20
Figure 2.7: Reported AIDS Cases (2004-2008)
HIV/AIDS continues to be a major public health challenge in the region. The cummulative
cases as at 2008 stood at 8286. The peak group is 30-34 years which raises concern, as they
are in the econonically active population.
Table 2.11: Reported AIDS Cases (1998 – 2008)
Year
No. of AIDS Cases
No. of Cumulative AIDS Cases
1998
205
1844
1999
419
2263
2000
790
3061
2001
519
3580
2002
669
4249
2003
755
5004
2004
923
5927
2005
542
6462
2006
730
7192
2007
690
7882
2008
404
8286
21
2.1.7.3.1 Sentinel Studies
The 2008 HIV sentinel study which helps to monitor the epidemic and provide HIV
prevalence data was completed in December 2008 in the region. The selected sentinel sites
were Assin North, Cape Coast and Asikuma–Odoben–Brakwa (AOB) districts. All the three
sites were able to collect the samples as expected. Confirmed results are expected during the
first quarter of 2009.
2.1.7.3.2 Voluntary Counseling and Testing (VCT)
Summary results show that VCT services are provided in ninety six centers in the region. Of
the total number 9,346 clients who received counseling and testing, 1708 (31%) walk-in for
the service. The outcome of the walk-in has been shown per the table below.
Table 2.12: Summary of the CT service CR 2007-2008
Indicators
Sex
2007
Total
%
2008
Total
%
No. Pretest
Counseled
M
1771
5507
-
3447
9364
-
F
3736
M
1705
8786
F
3353
93.8% of
# pretest
counseled
No.
Receiving
Results
M
1693
8749
99.6% of #
tested
F
3351
No.
Receiving
Positive Test
Results
M
291
1165
13.3% of #
tested
F
635
No.
Receiving
Posttest
Counseling
M
1651
8586
98.1% of #
tested
F
3287
No. Tested
5917
5058
92% of #
pretest
counseled
5044
99.7% of
# tested
3300
5466
3509
5441
926
18.3% of
# tested
386
779
4938
97.6% of
# tested
3300
5286
22
2.1.7.3.3 KNOW YOUR HIV STATUS CAMPAIGN (KYSC)
Know Your HIV Status Campaign was organized by the districts. In all 16,976 clients were
listed, resulting in 1.2% testing positive. The number of clients benefiting from post-test
counseling was 16,112.
Table 2.13: KYSC – DISTRICT SUMMARY CR 2008
DISTRICT
No. TESTED
No. +VE
% +VE
Assin North
1229
11
0.9
Assin South
276
10
3.5
Agona
4624
36
0.9
AAK
737
17
2.3
AEE
1092
35
3.2
AES
1072
20
1.9
AOB
1089
5
0.6
CC
867
17
1.9
Gomoa
1668
15
0.9
KEEA
1399
17
1.2
MFANTSEMAN
643
2
0.3
THLD
1123
14
1.2
UD
1145
8
0.7
REGION
16,976
207
1.23
Table 2.14: Overall Counseling & Testing Outcome
Indicator
Source of Data
# Tested
Service
PMTCT
27083
CT
8857
KYSC
16976
Total
52916
No Positive
1934 (3.7%)
No Put on Anti retroviral therapy
893 (46.2%)
23
Table 2.15: Summary of the outcome of PMTCT services 2007-2008
Indicators
2007
200 8
No.of ANC Registrants
18844
41697
No. Receiving Pretest Counseling
11079
31344
No Tested
6023
27083
No Positive
172
561
No Receiving Positive Test Results
173
556
# Receiving Posttest Counseling
6151
25397
# Receiving ARVs at ANC
118
280
# Receiving ARV in labour
20
102
# of Babies Receiving ARVs
18
85
# of Mother/ Baby pairs that took ARVs
12
101
2.1.7.3.4 Trend of HIV among Pregnant Women
The trend of HIV prevalence among pregnant women from the HIV Sentinel Survey and the
PMTCT is compared per the table below.
Table 2.16: HIV prevalence among pregnant women from the HIV Sentinel Survey and the
PMTCT
Prevalence
2004
2005
2006
2007
HSS
3.5%
2.9%
2.5%
2.9%
PMTCT
-
3.8%
3.2%
2.8%
24
2008
2.1%
Outcome of PMTCT Intervention for Baby at 18 months
Success Story:
Six HIV+ pregnant women delivered & child tested HIV negative after 18 months
Central Regional Hospital (3) and Agona Swedru Hospital (3)
2.1.7.3.5 Highly Active Anti-Retrovairal Therapy (HAART) Services
Eight hundred and fifty (850) adult patients were on the clinical care of which 38.6% were on
ART with five deaths in the year and four lost to follow up. In the case of the paediatrics, 49
were on clinical care with 19 on ART and one death. The outcome of the ART service is
shown by the table below;
Table 2.17: Outcome of the ART services for adults and Pediatrics
ADULT 2008
CHILDREN 2008
INDICATORS
Overall
Total
Male
Female
Total
Male
Female Total
# on Clinical Care
210
640
850
17
32
49
899
# on ART
84
244
328
6
13
19
347
13
17
0
0
0
17
# with change of regimen due to 4
drug toxicity
# of Death
1
3
4
0
1
1
5
# Lost to follow-up
1
2
3
0
1
1
4
# on Second Line
0
1
1
0
0
0
1
640
850
17
32
49
899
119
184
0
0
0
184
20
43
0
0
0
43
#
of
new
clients
on
co- 210
trimoxazole prophylaxis
#of ART client screened for TB
65
#of clients tested positive for TB 23
2.1.7.3.6 Opportunistic Infections (OIs)
In the year under review, 489 patients were treated for Opportunistic Infections (OIs) of
HIV/AIDS.
25
Table 2.18 below shows the details of the drugs used to manage the OIs and the age groups of
the Patients
Table 2.18: Outcome of OIs managed at the health facilities
Indicators
Number
0-14
Receiving
OI
Prophylaxis
15-49
50+
Total
49
793
57
899
0
44
9
53
(Cotrimoxazole)
Number Receiving OI Prophylaxis (Diflucan)
2.1.7.3.7 Sites Providing Services
The number of sites providing CT, PMTCT and ART services are listed below.
Indicators
No. (Jan-December 2008)
Number of CT Centres
96
Number of PMTCT Centres
91
Number of ART Centres
9
Number of ART Centres with CD4 Machines
11
Number of OIs Centres
16
2.1.7.3.8 STI Syndromic Management
The sexually transmitted infections (STIs) as reported by the districts have been tabulated as
shown below.
26
Table 2.19: Outcome of STIs Syndromic Management by Districts
District
Urethral
Vaginal
Genital
Genital
Discharge
Discharge
Ulcers
Warts
Gonorrhoea
Urinary
Tract
Infections
AAK
52
240
10
0
19
0
AOB
67
87
71
0
62
505
AEE
42
34
11
0
12
16
AES
51
210
42
1
56
2
AGONA
34
261
21
9
101
1
C/C
101
305
65
13
233
342
KEEA
16
50
1
0
0
0
MFT
0
29
1
0
13
0
THLD
3
13
2
1
15
36
GOMOA
51
12
18
0
17
110
UD
46
19
12
0
17
212
ASSIN
45
245
30
0
20
692
ASSIN S
32
53
13
0
100
45
TOTAL
540
1556
297
24
655
1958
N
2.1.8 NUTRITION
Performance areas in nutrition for the year 2008 included: vitamin A supplementation, diet
related diseases management, nutrition rehabilitation, growth monitoring (CWC &
community), baby friendly initiative, iodated salt monitoring and anaemia control.
27
2.1.8.1 Routine Vitamin A Supplementation - Children 6-59 months
A total of 185,283 (56%) children 6 – 59 months were dosed during routine including Child
Health Promotion Week in the year under review. Gomoa district had the highest of 83%
whilst Assin North had the lowest of 33%.
The graph below is the routine coverage for the districts for the year 2008.
Figure 2.8: Trend of vitamin A coverage by districts for the year 2008
90
83
80
68
70
60
48
50
40
33
36
49
49
50
56
72
72
75
57
36
30
20
10
0
2.1.8.2 Vitamin A Supplementation - Postpartum
A total of 48,607 mothers were covered during the year under review. The routine
supplementation recorded 34,921 whilst the IMCH campaign recorded 13,686. This
represents 64.6% and 88.4% for expected and actual deliveries respectively. The graph below
shows the coverage for districts for both routine and the campaign.
28
Figure 2.9: Coverage for Post Partum Vitamin A Suplementation (2008) by Districts.
2.1.8.3 Diet Related Diseases
Hypertension, anaemia, diabetes are diet related diseases which have been recorded over the
years. Hypertension was high in Cape Coast, AOB, AES and Assin North, whilst anaemia
was high in Cape Coast and AOB. Diabetes was however high in AOB.
2.1.8.4 Nutrition Rehabilitation
In this programme severely malnourished children received day care services including
serving of a well balanced diet of usually local foods carefully planned to meet their
nutritional requirements. Mothers of such children are given education on proper child
feeding with related good health practices and income generation skills. This is done at the
Nutrition Rehabilitation centres and the Kids wards of the district hospitals.
A total of 3,313 cases were reported from all the districts. Over 70% of the cases were
underweight followed by marasmuos (9.8%), kwashiorkor (8.6%). The high rate of
malnutrition among children aged 6-11months and could be atributed to poor weaning
practices. About 72% were successfully treated and discharged
29
2.1.8.5 Anaemia in Pregnancy
Anaemia at term as shown in the chart above, has stagnated past two years at a very low rate
of 1.7 which is an indication of the fact that the anaemia control programme at the antenatal
clinics is working.
Figure 2.10: Trend of anemia in pregnancy CR. 2005-2008
2.1.8.6 Baby Friendly Health Facilities
During the year, 27 health facilities were prepared in four districts for designation as baby
friendly. Twenty six out of the total were designated, bringing the total baby friendly health
facilities in the region to 43 (30% of the 140 health facilities rendering maternity service in
the region).This places the region in third position after Upper West regions and Ashanti.
The distribution of the baby friendly health facilities in the district is as shown in the graph
below. The graph shows that four districts namely AOB, AEE, THLD and Agona are the
districts without any facility designated as baby friendly.
30
2.1.8.7 Other activities
2.1.8.7.1 Fortified wheat flour and oil campaign
A joint sensitization meeting/training was organized for district and regional public health
officers, leaders of bakers associations and media people in the region. This sensitization
programme was aimed at promoting advocacy in the fortified foods among the general
public. This training was structured as a training of trainers after which participants were
expected to train other members in the districts. Communication tools like leaflets, posters,
aprons and t-shirts were distributed for use by participants in the districts.
2.1.8.7.2 Training in essential nutrition actions for health workers
The overall goal of ENAs is to prioritize the key nutrition behaviors that have bearing on the
health and nutrition needs of children and women in vulnerable communities.
The training aimed at equipping the districts with at least four trainers who could in turn train
all the district staff and community based surveillance volunteers to finally send the essential
nutrition information to the house hold level. In all Sixty Eight participants were trained with
the sponsorship of UNICEF Ghana.
With the support of UNICEF, Essential Nutrition Actions wall chart was revised and
reproduced to suit community level communication
2.1.9 REPRODUCTIVE AND CHILD HEALTH
The Reproductive and Child Health (RCH) unit continues to provide services aim at
promoting and maintaining the health of women and children in the region.
In the year under review, the Region recorded ANC Coverage of 116.8% as compared to
108.4% in 2007. Average ANC visits in the region improved from 3.4 in 2007 to 4 in 2008.
Tetanus Toxoid administered improved from 88% in 2007 to 88.2 % in 2008. Eleven (11) out
of the 13 districts recorded coverages above 100%. AES recorded the highest coverage of
193% followed by Upper Denkyira with 131.7%. Even though the region recorded high ANC
coverage, some districts still need to improve on their coverage. AEE, KEEA and Assin
South recorded coverages below the regional target of 99%. The graph below depicts the
ANC situation in the region.
31
Figure 2.11: Antenatal Care Coverage by Districts C/R- 2008
2.1.9.1 ADOLESCENT PREGNANCY
Figure 2.12: Early Teenage Pregnancy by district. CR. 2006-2008
32
Late teen pregnancies reported were 14.7%, whilst early teen recorded 0.2%. AES and Assin
South districts recorded the highest coverage
in teen pregnancies, (12.6% and 16.2%)
respectively
2.1.9.2 Risk Factors Associated with Pregnancy
When risks are detected early measures are put in place to maintain and promote the health of
the women throughout pregnancy. The risk factors associated with pregnancy during the year
2008 as compared to the previous years is as shown in the table below.
Table 2.20: Risk Factors Associated with Pregnancy
Year
WIFA
rd
2005
2006
2007
2008
% %
early %
late %
over % parity %
3
teen
teen
35 yeears
trimester
pregnancy
pregnancy
36,831
149
11,289
9,834
(16%)
(0.20%)
(15.0%)
11,433
168
(15%)
4 plus
H/B %
<11gm
at Height
registration
<5 ft
17,875
21,482
3,940
(13%)
(24%)
(29%)
(5%)
11,396
8,954
14,204
42,564
4,116
(0.22%)
(15.16%)
(11.9%)
(19%)
(59%)
(5.5%)
12,960
187
11,522
9,597
9,113
28,522
4,743
(16%)
(0.2%)
(15.1%)
(9.8%)
(11.6%)
(43.8)
(5.9%)
15,010
183
12582
11442
10537
23151
4286
(17%)
(0.2%)
(14.7%)
(13.1%)
(12.1%)
(31.3%)
(4.9%)
On the average 17% of mothers attended ANC during the third trimester in the period under
review.
33
2.1.9.3 TEENAGE PREGNANCY
The number of teenage pregnancies has been increasing for the past three years. Districts
performance shows that Mfantsiman, Agona, Gomoa and AES continue to report high
numbers of teenage pregnancies.
Figure 2.13: Teenage Pregnancy by District C/R, 2006 - 2008
1796
1800
1600
1400
1200
1000
800
600
720
720
730
799
834
862
978
991
1152
1257
1401
2006
525
2007
400
2008
200
0
2.1.9.4 DELIVERIES
Institutional deliveries increased from 48.5% in 2007 to 56.2% in 2008, AES continued to be
the leading district in institutional deliveries with coverage of 95.2%, followed by Cape Coast
with 94.8%. The lowest coverage was 22.7% by Assin South. The Still birth rate reduced
from 3.3 to 2.7 in 2008 whilst the Low birth weight also reduced from 7.5 to 6.9.
34
Table 2.21: Trends of supervised deliveries and outcome, 2004-2008, CR
YEARS
COVERAGE
STILL BIRTH
LOW BIRTH WEIGHT
MMR
2004
77.9
2
9
1.34/1000
2005
79.2
2.1
8.1
1.04/1000
2006
74.0
2.3
5.8
1.67/1000
2007
48.5
3.3
7.5
1.90/1000
2008
52.2
3.3
2.7
160/1000
Figure 2.14: Supervised Delivery Coverage by district. CR. 2008
2.1.9.5 Maternal Mortality
The region recorded a total of 92 Institutional Maternal deaths in 2008 a reduction to that of
2007(102). This represents a decrease in maternal ratio from 1.90/1000 live births in 2007 to
1.60/1000 live births in 2008. Cape Coast recorded the highest, 4.36/1000 live births (25
maternal deaths), followed by Agona Swedru, 2.55 (15 maternal deaths). 82 (89.1%) out of
the total maternal deaths were audited in the year under review.
35
Figure 2.15: MMR Trends in CR and Ghana. 1994-2008
Figure 2.16: Maternal Mortality by Districts
Haemorrhage is the leading cause of maternal mortality across the region accounting for over
20% of all maternal deaths. Eclampsia is the other major cause of maternal mortality.
36
Table 2.22: Causes of Maternal Deaths Direct and Indirect causes
CAUSES
CASES (%)
PPH
20.7
Eclampsia
17.4
Haemorrhagic Shock With DIC
9.8
Abortion
6.5
Amniotic Fluid Embolism
6.5
Septicimia
6.5
Anaemia
3.3
Ruptured Ectopic
2.2
Ruptured Uterus
1.1
Pneumonia/Tuberculosis
1.1
Epilepsy
1.1
Alcoholic Syndrome
1.1
Assault
1.1
Obstructed labour
3
Sickle cell with haemorrhagic shock
1.1
Meningitis with cerebral malaria
2
2.1.9.6 Essential Obstetric Care
Only four (4) facilities offered basic EOC while thirteen (13) facilities offered both
comprehensive EOC and provided blood transfusion services in the year under review. Out of
the total deliveries of 42,385, emergency obstetric care covered 10.2% (4,342), 9.9% (4213)
had caesarean section and 40.3% (129) had vacuum extraction
2.1.9.7 Postnatal Coverage
Postnatal care refers to the care given to mothers and their babies from the end of delivery up
to six weeks post partum.
The objectives are:
o To promote and maintain physical and psychological well being of mother and baby.
37
o To perform screening for early detection of health conditions and abnormalities of
both mother and baby for treatment and referrals.
o To provide Family Planning Services.
PNC coverage for 2008 was 77.6 an increase of 4.2% as compared to the previous year
(73.4), AAK district had the highest coverage of 116.7% followed by Assin North who had
98.8%. Upper Denkyira recorded the lowest coverage of 53.5% and has continued to perform
poorly over the last three years.
Table 2.23: Post Natal Care coverage by districts 2006-2008
DISTRICTS
2006
2007
2008
AOB
76.5
70
73
KEEA
52
56.4
72.6
ASSIN NORTH
86.4
94.7
98.8
ASSIN SOUTH
71.4
98.7
86.2
AEE
72.7
50.4
82.3
MFANTISMAN
61.3
65
64.1
AGONA
56.6
65.4
70.5
THLD
77
73
85.7
GOMOA
62.3
70.3
73.2
AES
76.6
84.8
85.4
CC
62
66.3
65.3
AAK
99.5
123.3
116.2
UD
54.3
49.3
53.5
REGION
78.4
73.4
77.6
2.1.9.8 Baby Friendly Initiative
Twenty-six (26) facilities were designated as baby friendly facilities from 5 districts in the
region during the year under review.
38
Table 2.24: Newly Designated Baby Friendly Facilities by Districts
DISTRICTS
No. of facilities
GOMOA
8
AAK
2
ASSIN NORTH
6
ASSIN SOUTH
5
UPPER DENKYIRA
5
TOTAL
26
This brings the total number of baby friendly facilities in the region to 43 from 17 in 2007.
2.1.9.9 Family Planning
During the year under review Family planning acceptor rate was 33.6% in 2008, an increase
of 4.0% compared with the rate for 2007 (29.6%). KEEA district recorded the highest family
acceptor rate of 68.4% a huge improvement over that of 2007 which was 44.2 in the district.
On the other hand AES district which had the lowest also saw a district drop in coverage
from 19.1% to 16.2%.
Figure 2.17: FP Acceptor Rate (all methods) by district. CR. 2006-2008
39
2.1.9.9.1 Method Preference
Depo Provera, (37%) was the most preferred method used in the region followed by male
condom 45,218 (31.1%), combined pill , 25,111 (17.3%) , Norigynon 11954 (8.2% ), LAM
4,796 (3.3%), Mini Pill 1,693 (1.2%), Jadelle 1291 (0.9% ), Natural 1036 (0.7 %),Female
Sterilization 576 (0.4% ), Female Condom 517 (0.4% ) and lastly IUCD 279 (0.2% )
Figure 2.18: Pie Chart Showing the Method Preference in C/R, 2008
2.1.9.9.2 Men as partners
This is to provide male support for female actions related to reproduction and women’s
reproductive and sexual rights. It involved men with their spouses during counseling and
other reproductive health activities. A total of 34, 898 men visited the clinic for various
services.
2.1.9.9.3 Couple Year of Protection (CYP)
The amount of a particular contraceptive needed to provide one couple protection for one
year. It is a measure representing the total number of years of contraceptive provided by a
method over a specified period in the central region. Fifty-Six thousand, seven hundred and
two (56,702) couples were protected during the year under review as compared to Forty-five
thousand one hundred and Ninety (45,190) in 2007.
40
Figure 2.19: Trend of Couple Year of Protection, CR 2006-2008
53927.7
56702
45190.8
2006
2007
2008
Long and short-term methods from 2006-2008. CYP for short term was 43,422.6 whilst the
long term was 13,279 for the year under review.
Table 2.25: Trend of Couple Year Protection By Method Cr. 2006-2008
C. Y. P
2006
2007
2008
Short Term Method
45,261.2
32,350.8
43,422.6
Long Term Method
8,666.5
12,840
13,279
2.1.9.10
Child Health
Coverage’s for children 0-11 months registered at child welfare clinics (CWC) decreased for
the year under review from 104.7 in 2007 to 100.5 in 2008. Average number of visits per
registrations 0-11 months was 5.4, an increase over the 4.6 in 2007. Below is the table
showing child health servers from 2006-2008.
41
Table 2.26: Child health services coverage, CR 2006-2008
INDICATORS
2006
2007
2008
0-11mths coverage
103.6
104.7
100.5
Average visits
5.1
4.6
5.6
12-23months
50
45.7
46.0
Average visits
6
4.2
5.4
24-59months
10
8.2
10.1
Average visit
6
4.4
4.2
2.1.9.11
School health services
School Health includes all the strategies a school uses to keep pupils, families and
communities healthy. The objective is to ensure that children of school going age are given
the necessary health services including:
-
Physical examination
-
Environmental Sanitation
-
Health education
The target categories are the pre school, P1, P3, and JSSI, A total number of 256,326 pupils
were enrolled. 202,365 (78.9%) children were examined in 2,105 schools in 2008, as against
177,480(60.6%) in 2007. About 1,939 cases were referred which included ear and eye
discharge, dental carries, anaemia, short sightedness, hernia and skin problems.
42
2.1.9.12
ADOLESCENT HEALTH
2.1.9.12.1 Youth Friendly Services
This service has been integrated into the health service activities, however only three districts
have been reporting regularly on services for the youth. Out of 183 young mothers (10-14)
reporting at the health facilities only 24 (13%) had supervised delivery. 12,582 late teen
mothers (15-19yrs.) were seen at the ANC, but only 2,145 (17%) delivered at the health
facility
2.1.10 HEALTH PROMOTION
For some time now, the Central Region has continuously recorded very poor health and other
welfare indicators. For example, many children in the region do not live to celebrate their fifthbirth-days; many of those who survive live on with ill health and poor growth. Also some
pregnant women do not survive pregnancy or childbirth. Pregnant women who survive
pregnancy complications suffer on-going health problems such as infertility and damage to their
reproductive organs. This has generated a lot of concern among key stakeholders including
policy makers, programme managers, health partners and the general public.
The four health-related Millennium Development Goals (i.e. MDGs 1, 4, 5, and 6) include:
MDG 1: Reducing the prevalence of under-5 children who are underweight to 14.7% from
29.4% by 2015.
MDG 4: Reducing the under-5 mortality rate to 40 deaths per 1000 deliveries from 119 by 2015.
MDG 5: Reducing by 3/4 the maternal mortality rate, by 2015 relative to 1990 levels
MDG 6: Halt and reverse HIV/AIDS, Malaria, TB and other diseases.
The fact remains that health education and Behaviour Change Communication (BCC) activities
are very crucial to achieving all the four health related Millennium Development Goals (i.e.
MDGs 1, 4, 5, and 6).
43
The Goal of the Health Promotion Unit (HPU) for 2008 was to adequately support health
education and behaviour change communication (BCC) components of the interventions aimed at
improving the health and lives of women and children in the Central Region.
2.1.10.1
Major Activities for 2008
The major activity carried out by the Health Promotion Unit in 2008 was the Rolling out of
the national communications campaign strategies on malaria, family planning and
breastfeeding/complementary feeding using the GSCP participatory planning approach.
The HPU conducted planning meetings or training sessions for various stakeholders at the
district level and all the five sub-districts in the AES district.
Participants were taken through various sections of the strategies, viz:
•
National communication strategies on malaria, FP, BF and CF
•
Identification of sub-district specific issues
•
Target populations identified for the 3 campaigns
•
Key Messages for each of the campaign areas
•
Identification of local channels and resources
•
Geographic coverage of target populations
•
Developing Plans of Action
•
Monitoring and feedback
•
Coordination mechanism
Themes for the 3 campaigns were:
Malaria – 'Let's come together and drive away malaria'
Family Planning – 'Are You a Real Man?'
BF/CF – 'The Best Protection a Mother Can Give'
Targets identified for all the 3 campaigns included:
Health workers
Mothers of children under 5 years
Fathers with children under 5 years
Grandmothers
44
Chemical sellers
TBAs
The Regional HPU conducted training sessions for a total of 150 stakeholders in all 5 subdistricts in AES district.
Zonal teams in the 5 sub-districts developed Plans of Action for community activities.
The GSCP also supported some NGOs (viz: WORLD VISION, PLAN Ghana, ADRA, The
Red Cross Society of Ghana) in the Central Region to carry out similar exercise in all the
remaining 12 districts. The Health Promotion Unit coordinated activities of the NGOs, e.g.
Feedback is always received through reports from the districts.
It is believed that this initiative would help fieldworkers to work in the same direction so as
to avoid conflicting messages, etc.
2.1.10.2
Other Regional Level Support Activities
2.1.10.2.1 Community Health Promotion
The Health Promotion Unit conducted monitoring and support activities to Growth
Promotion communities in the former Agona and Awutu-Effutu-Senya (AES) districts.
Participation of care takers with children aged between 0 and 24 months was very
encouraging.
There is the need to improve on the incentive packages for volunteers (i.e., Growth
Promoters). Also, there is the need to ensure that key messages especially on breastfeeding
and complementary feeding given to care takers do not conflict.
2.1.10.2.2 School health promotion:
Hypertension and Diabetes screening was done in 6 selected basic schools for teachers in the
Cape Coast Metropolis; the schools included Flowers Gay, Bakatsir Methodist, Presby
primary and JSS, Jubilee, AME Zion, Master Sam Primary and JSS.
45
Results: A total of 277 teachers were examined: 32 and 8 were referred for hypertension and
diabetes respectively. Interestingly, those referred for further medical attention did not know
of their condition.
Implications: If this situation is allowed to persist there is the likelihood that students will
perform poorly due to ill-health leading to frequent absenteeism.
Recommendation: There is the need to replicate this exercise in other schools with the
collaboration of DHMTs and School Health Education Programme Coordinators of the
Ghana Education Service.
2.1.10.2.3 Workplace health promotion:
Health education durbars were held for workers of the Regional Health Directorate. The
sessions were on Proper Hand Washing with the aim of controlling infection. Efforts are
being made to ensure that appropriate supplies are made available to the staff to enable
practice ‘proper hand washing’.
Seven (8) clean-up exercises were organized and coordinated by the Health Promotion Unit
2.1.10.2.4 Collaboration with other sectors:
Supported durbars organized by an NGO (SYMPATHY INTERNATIONAL) in 8
communities in the Cape Coast Metropolis with video shows and talks on 'KNOW YOUR
HIV STATUS'
CELEBRATION of National Road Safety Week (video shows)
Launchings of FP Campaigns on long-term methods
Coordinated the Drivers Awards initiative in connection with the GHS/Transport Union
MOU.
Coordinated HEALTH – WALK in connection with celebration of WORD HEART DAY
2008; and WORLD NO TOBACCO DAY.
2.1.10.2.5 Analysis of data from district reports:
Health messages are reaching mostly nursing mothers attending child welfare services; and
that the traditional method of communication 'talks' and discussions were mostly used by
46
service providers. Out of the several health issues that were discussed with target audience,
TB did not feature. Service providers should make much effort to reach 'persons that
influence decisions of mothers at places outside the health facilities. There is the need to use
participatory approaches to facilitate the behaviour process. Key messages concerning TB
should be made available to service providers and the public.
47
CHAPTER THREE
3.0
3.1
CLINICAL /INSTITUTIONAL CARE
Utilization of Hospital Services
Facility utilization in 2008 showed a marginal gain compared to 2007 with Out-patient
attendance per capita increasing from 0.63 in 2007 against 0.68 in 2008 having remained the
same from 2003 to 2006 as shown in the figure below. Out of the total attendance of
1,242,196, 67% were insured and 33% non-insured with the NHIS. District distributions
showed that 11 out of the 17 districts recorded OPD per capita of 0.5 and above with Cape
Coast recording the highest of 1.98 while Upper Denkyira West and Gomoa East all recorded
OPD per capita of 0.3.
Figure 3.1: Trend in OPD Attendance Per Capita, CR. 2001 - 2008
0.8
0.7
0.68
0.63
0.6
0.5
0.5
0.4
0.4
0.5
0.5
0.5
0.4
0.3
0.2
0.1
0
2001
2002
2003
2004
48
2005
2006
2007
2008
Figure 3.2: Trend in per capita OPD attendance by districts-C/R. 2006-2008
3.1.1
Ten Top Causes of Hospital Consultation
Malaria continued to be a major cause of morbidity accounting for 44.73% of all out patient
consultation in 2008. This was followed by URTI, Disease Of The Skin, Diarrhoea Diseases,
Hypertension, Rheumatism/Joint Pains, Anaemia, Accidents, Intestinal Worms and Acute
Eye Infection were recorded as the ten top leading causes of OPD consultations.
49
Table 3.1: Ten Top Courses of Hospital Consultation 2006-2008
Disease
No. of cases
(2006)
No. of cases
(2007)
No. of cases
(2008)
Malaria
288,078 (42.3%)
570315(45.6%)
446,075 (44.73)
Upper resp. tract. Inf.
43,767 (8.9%)
112377(9.0)
49136(7.64)
Disease of the skin
23,955 (4.9%)
57425(4.6)
35206(5.47)
Diarrhoea diseases
-
-
21081(3.28)
Hypertension
15,766 (3.2%)
55126(4.4)
20008(3.11)
Rheumatism/Joint Pains
12,177 (2.5%)
35108(2.8)
16464(2.56)
Anaemia
10,369 (2.1%)
32327(2.6)
11531(1.79)
Accident
8,391 (1.7)
22572(1.8)
9451(1.47)
intestinal worms
-
Acute Eye Infection
All others
Total new cases
3.2
-
7625(1.19)
8,107 (1.6%)
14131(1.4)
67,521 (13.7%)
217394(17.4)
494,377
7390(1.15)
177354(27.56)
1249719
643408
Hospital Admissions
For the year 2008 the Central Region had a total bed complement of 1,666. However, hospital
admissions rate in the region decreased from 36.1 per 1000 in 2007 to 33.2 per 1000 in 2008.
Figure 3.3: Trend of Admission per 1000 Pop, CR 2001-2007
40
35
36.5
33.3
33
30
31.3
36.1
30
33.2
31
25
20
15
10
5
0
2001
2002
2003
2004
50
2005
2006
2007
2008
District distribution shows Effutu with an admission rate of 113 per 1000 pop
followed by Cape Coast with hospital admission rate of 105 per 1000. Only three
districts recorded admission rates below the regional average of 33.2 per 1000
population see figure below.
Figure 3.4: Admission Pop Ratio by District CR 2007 – 2008
The figure above shows the hospital admission ratio by districts for 2007 and 2008.
3.2.1 Bed Occupancy
Bed occupancy rate decreased from an average of 55.2% in 2007 to 53.1% in 2008 with
average length of stay also decreasing from 6.0 to 3.8 in 2008. The table below shows the
breakdown of the performance by districts.
51
Table 3.2: Percentage bed occupancy 2007-2008 by districts Central Region.
District
NO. OF
BEDS
ALOS 2007
%
Occupancy
2007
ALOS 2008
%
Occupancy
2008
KEEA
322
72.4
109.1
21.2
90.9
AOB
124
6.0
74.4
5.7
80.0
CAPE COAST
387
4.5
34.6
4.9
49.4
AGONA
101
3.6
63.7
2.7
65.1
ASSIN NORTH
126
4.0
63.9
4.1
83.9
GOMOA
105
4.1
67.1
3.8
43.5
ABURA ASEBU
KWAMANKESE
45
2.6
47
2.6
54.5
UPPER DENKYIRA
139
2.7
-
4.3
42.2
LOWER DENKYIRA
43
4.0
46.5
3.5
91.9
AWUTU EFUTU SENYA
130
2.5
55.9
3.3
40.7
MFANTSIMAN
108
3.6
63.1
2.1
21.4
AJUMAKO ENYAN
ESSIAM
36
4.2
14.1
2.4
50.9
CENTRAL REGION
1,666
6.0
55.2
3.8
53.1
3.3
Surgical Operations
The region preformed a total of 12,120 surgical operations in 2008 compared to 4029 cases in
2007.
Table 3.3: Surgical Operations 2005-2008
2005
Major cases
Minor cases
TOTAL
2006
2,755
2,029
4,784
2007
2008
3,316
2,710
5,411
2,426
1,319
6,709
5,742
4,029
12,120
52
Out of the 12,120 operations 10.5% of the cases were caesaren section cases followed by
hernia reducible. The table below shows the top ten causes of surgical operations in the
region.
Table 3.4: Top Ten Causes of Surgical Operations
CAUSES
PERCENTAGE
1
CAESAREN SECTION
10.5
2
HENIRA REDUCIBLE
1.8
3
FIBROID
1.5
4
MYOMECTOMY
0.7
5
LAPAROTOMY
0.5
6
APPENDICECTOMY
0.3
7
STERILIZATION
0.3
8
TYPHOID PERFORATION
0.2
9
THYOIDECTOMY
0.2
10
HENIRA STRANGULATED
0.2
The figure below shows the proportion of cases done under the insurance scheme, a rather
high proportion of 83% being insured clients and 17% being none insured clients.
Figure 3.5: Surgical Operations 2008. 12,120 cases
NON
INSURED
17%
53
INSURED
83%
3.4
REGIONAL BLOOD BANK
The regional blood bank embarked on the new district based strategy geared to mobilizing
safe blood in the region this included the following.
•
Ambitious plan drawn including most 2nd Cycle Institutions in various Districts.
•
No support from any District Directorate so far this year.
•
Targeted to collect 2,000 units from Voluntary Donors.
3.4.1 Regional Blood Collection and Screening Reports For 2008
Total amount of blood collected in 2008 was 972 units out of 2,000 units planned for
collection. Ten percent out of which 10.3% was screened for HBV, 0.3% for HCV, 1.1% for
VDRL, 1.9% HIV. Hence bringing the total percentage of safe blood collected in the region
to 80.2%. The regional blood bank team planned to conduct 45 visits to institutions but was
only able to carry out 20 visits.
Specialist Visits:
The Central Regional hospital played host to a total of 48 specialist visits made to the region
in 2008 (43-visits in 2007). The team saw 1,705 patients compared to 1,392 patients in 2007
an increase of 20%. See table below for details
Table 3.5: Specialist Visits
2005
No.
Visit
of Patie
nts
2006
2007
2008
No. of Patients
No. of Patients
No. of Patients
Visit
Seen
Visit
Seen
Visit
Seen
Seen
Plastic surgeon
3
33
-
-
-
-
-
-
8
212
12
485
7
184
7
196
Urology
4
64
-
-
-
-
-
-
Dermatology
12
324
12
285
13
295
12
374
ENT
16
997
24
1373
23
913
29
1135
TOTAL
43
1,630
48
2,143
43
1,392
48
1,705
Orthopaedics
Surgeon
54
CHAPTER FOUR
4.0
HEALTH ADMINISTRATION AND SUPPORT SERVICES
The report represents a summary of activities of the Health Administration and Support
Services department during the year under review. It covers mainly the priorities, activities,
achievements, challenges and constraints of the constituent units namely:
• General Administration/Registry
• Human Resource
• Transport
• Estates
• Clinical Engineering Services
• Procurement
• Stores and Supplies
• Security
4.1
Priorities of the Year
The priorities of the beginning of the year 2008 were:
•
To improve administrative support and management systems in the districts.
•
Enhance capacity building, increased staff productivity and morale.
•
Ensure availability of medical supplies and equipment to promote quality of care.
•
Ensure prolonged life span and satisfactory state of health infrastructure.
•
Improve communication at the various levels of management.
•
Implement the health waste management policy.
During the year, the department coordinated the inauguration of the reconstituted Regional
Health Committee in the latter part of the year to provide advice to the Regional Director of
Health Services. The committee met on two occasions.
•
The Regional Health Management Team could not meet regularly due to several
reasons. The team had only two (2) meetings. Monday Morning Meetings were
however, regular.
•
Other meetings worth reporting on included the Senior Management Committee
(SMC) and Procurement Committee.
55
Monitoring and supervisory visits were conducted in three (3) hospitals and four (4) districts.
The objectives of the visit were:
•
To assess the adequacy or otherwise of the administrative and support systems at the
district/facility levels.
•
To assess the extent of implementation of the national and regional policies and
programmes at the district/facility levels.
•
To discuss the constraints and challenges in the implementation of programmes and
policies.
•
To make recommendations for improvement in the administrative and support
systems.
Among the key observations were
• Limited dissemination of MOH/GHS policy manuals and documents including job
descriptions, scheme of service, various legislative acts and administrative manuals.
• Registry practices had seen some improvement with the posting of human resource
personnel officers,
• Administrative structures like Audit Report Implementation committees and Hospital
Advisory Committee were not active.
• Most District Health Committees were also inactive and had to be reconstituted to
play active roles to support service delivery.
It is pertinent to add that proper
orientation of the members is crucial.
4.2
HUMAN RESOURCE MANAGEMENT
Planned activities at the beginning of the year included:
•
Scaling up the revised Staff Performance Appraisal to all districts and institutions.
•
Conduct promotion interviews for all eligible staff and clear the backlog of delayed
promotions.
•
Build human resource data for the region.
•
Provide orientation for newly recruited and assigned personnel.
•
Provide HR support to management and BMCs.
56
•
During the year the unit carried out a TOT workshop for District Directors of Health
Services and Medical Superintendents, provided the SPA protocol and undertook
monitoring and support visits.
•
Conducted promotion interviews for eligible staff under the promotion plan and
submitted reports to Accra.
•
Organized an orientation workshop for newly assigned DDHS, Medical
Superintendents, key district staff and Community Health Nurses.
•
It also participated in the preparation of the 2009 Plans and Budget process
particularly personal emoluments (item 1).
•
Human Resource Officers were Training of Human resource officers in the
preparation of EWs, CHR and inputs and in building HR data in the districts
4.2.1
Revised Staff Performance Appraisal System
The monitoring visits to the various facilities revealed the following issues and challenges:
•
Both supervisors and appraisees had difficulty in setting annual objectives and
outlining the related mid-year activities.
•
Supervisors in 5 districts (Asikuma-Odoben-Brakwa, Agona (East & West),
Mfantsiman, Assin South and Twifu Hemang Lower Denkyira) could not go through
the revised SPA process with ease. The supervisors either unable to set objectives
and outline the related activities or
had difficulty differentiating an objective from an activity and mostly ended up listing
an activity as an objective;
•
Supervisors were either not trained on use of the SPA tool or the training was not
sufficient;
•
Some of the trained supervisors had left the facilities on posting to other regions;
•
Some of the supervisors mostly newly qualified Medical Assistants were need to be
trained in the new appraisal system.
•
Non commitment on the part of some supervisors and staff still persist;
•
The use of SPA log book was limited to a few districts
•
Regular support, and monitoring visits by the Region were seen to be very helpful in
helping address some of the implementation challenges especially in the area of the
difficulties associated with objective setting and outlining the related activities;
57
•
The revised SPA provided quality contact time between supervisors and their
subordinates;
•
Staff who that went through the SPA process were provided with
their job
descriptions;
•
Each subordinate knows what is expected of him/her which allows him/her to be
focused;
•
It is encouraging to note that staff recognised the usefulness of the SPA system.
The challenges and constraints of the unit include the following:
•
Cumbersome and frustrating system of processing inputs.
•
Delays in the processing of appointment letters and promotions.
•
Difficulties in securing financial clearance from the MOH/MOFEP.
•
In 2009, the unit would seek to institutionalize and sustain the new Staff Performance
Appraisal system by addressing the challenges in the implementation of the system.
•
Strengthen the Human Resource Committee to devise strategies to improve staff
retention and motivation, conduct needs assessment, and prepare succession plans.
•
Staff Orientation.
•
Continue efforts to replace critical support staff.
•
Support the preparation of plans and budgets especially, Personal Emoluments
•
Decentralize the preparation and processing of Establishments (EWs), Change of
Holders Return (CHOs) and inputs.
58
4.2.2 MANPOWER SITUATION
Table 4.1: Manpower Situation CR, 2006-2008
CATEGORY
2006
2007
2008
Medical officer
50
64
72
Housemen
13
7
6
Nurses
942
1,121
1,217
Health Services Administrator
11
9
10
Nurse Anaesthetist
6
9
9
Medical Assistant
46
50
36
Pharmacist
11
12
10
Dispensing Class
70
74
60
Technical Officers (DC/HI/Nut/Lep)
37
60
86
Technical Officers (X-Ray/Lab)
31
17
18
Technical Officer (Biostatistics)
49
86
99
Estate Manager
3
3
3
Human Resource Manager
1
1
1
Human Resource Officers
15
18
29
Hospital/Lab Technologist
8
18
10
Others
1,178
1,366
1,429
Total
2,470
2,903
3,097
4.3
TRANSPORT
During the year under review, the unit continued to provide effective vehicular support to the
National Immunization Programme. It also undertook monitoring and support visit to four (4)
districts and facilities.
The region took delivery of two (2) new Toyota pick-ups from the UNICEF. The vehicles
were allocated to the Gomoa East and Assin South Districts to improve reproductive health
services.
The unit assembled and distributed seven hundred (700) bicycles and five (5) motorcycles
provided under the UNICEF support and carried out repairs and maintenance work on 204
59
vehicles. Another major activity carried out by the unit was the training of twenty-six (26)
new motorcycles riders.
Among the key challenges and constraints were:
•
Improving patronage of the Regional Mechanical Workshop by facilities.
•
Lack of spare parts.
•
High indebtedness of facilities to the Regional Mechanical Workshop.
•
Broken down desk top computer hindered administrative duties including report
writing and monitoring.
•
Ageing vehicles, resulting in high running and maintenance cost. The process of
disposing some of them has started.
Table 4.2: Trend of Vehicles Key Indicators 2004-2008
Indicators
2004
2005
2006
2007
2008
Vehicles
93
95
104
96
116
Total K/M
2,331,613
2,785,817
29,859.95
964,905
723,514
% Availability
88.1
89.2
85.1
93.2
87.4
% Utilization
74.5
75.9
72.9
71.6
64.3
KM/Litres
7.9
8.5
9.7
7.6
8.3
606,119,602 439.2
160.6
296.2
30651.6
758.95
970.9
1,646.2
0.1924*
Total no of
Maintenance
Cost/KM
Average running
Cost/KM
1,199.2
*The running cost is in the new Ghana Cedis
60
Table 4.3: Trend of Motorcycles Key Indicators – Districts
Indicators
2004
2005
2006
2007
2008
Motorcycles
-
100
170
163
259
Total K/M
-
19,661
2,122,978
583,802
208,371
% Availability
-
93.1
96.9
94.6
91.9
% Utilization
-
68.6
71.1
72.4
63.7
KM/Litres
-
28.9
22
25.4
29.5
Maintenance
5.1
160.9
22.7
391.3
250.9
339.5
431.4
0.0419*
Total
of
Cost/KM
Average running
Cost/KM
-
*The running cost is in the new Ghana Cedis
Table 4.4: Number and Type of Vehicles:
Motor
Saloon Pickups Station Ambu- Haulage Water Bus Bicycle Cold Other
Cycles
259
2
80
Wagon Lance
Truck
Tank
8
1
0
15
9
Table 4.5: Fleet Allocation by District/Institution 2008
District/Institution
Vehicle
Motorcycle Bicycle Tricycle
RHD
19
9
31
0
Cape Coast
4
5
2
0
KEEA
3
22
23
0
Mfantsiman
2
15
191
0
AAK
2
18
21
0
Assin South
3
13
133
0
Assin North
2
18
24
0
AOB
3
21
19
0
61
1,044
Van
Vans
0
0
AEE
4
16
19
0
Gomoa
3
19
135
1
AES
1
15
42
0
Agona
7
20
16
0
THLD
9
15
237
0
Upper Denkyira
3
19
7
0
Cape Coast Dist. Hospital
8
2
1
0
Psychiatric 8
2
1
0
Winneba Govt. Hospital
5
2
10
0
Saltpond Govt. Hospital
3
5
2
0
CHNTS, Winneba
3
10
2
0
NTC, Ankaful
3
2
1
0
Central Reg. Hosp.
8
1
1
0
Dunkwa-On-Offin
6
1
2
0
Abura Dunkwa Hospital
7
1
2
0
Gomoa East
1
2
0
0
Agona East
0
2
100
0
Awutu Senya
0
0
0
0
Upper Denkyira East
0
2
0
0
Cape Coast NTC
2
0
0
0
Cape Coast Dist. Hospital
2
0
17
0
Apam Catholic Hospital
2
1
0
0
Leprosy/General Hospital
3
1
0
0
Total
116
Ankaful
Hospital
Hospital
4.3.1 Driver Vehicle Statistics
About eighty-two (82) drivers are on payroll.
Vehicle/Driver Ratio: 38.7 (1:38.7).
62
Vehicle/Driver Ratio 1:4 (1:1:4).
Table 4.6: Fleet Inventory by Age Block – Vehicles
Age Block
Zone
Number
Percentage %
1-5 Years
Green
54
46.6
6-9 Years
Yellow
25
21.6
10 Years and Above
Red
37
31.9
Total
116
Table 4.7: Fleet Inventory by Age Block – Motorcycles
Age Block
Zone
Number
Percentage %
1-5 Years
Green
140
54.1
6-9 Years
Yellow
14
5.4
10 Years and Above
Red
105
40.5
Total
4.4
259
ESTATE MANAGEMENT
The priorities of the unit at the beginning of the year among others were to promote
efficiency and equity in the siting of projects, promote maintenance culture, ensure adequate
documentation of properties and monitor the implementation of the capital investment
programme in the region.
The major activities of the unit included the initiative to secure indenture for the Regional
Hospital land which had been a subject of encroachment and agitation in the last couple of
years. It is hoped that the action would be intensified in the coming year.
Related to the above is the request to the headquarters to expedite action on the payment of
appropriate compensation to the affected land owners, to help address the problem of
encroachment. The districts were advised to initiate steps to acquire their lands.
Efforts were also made to update the existing inventories and asset registers in both the
offices and residential premises. Embossment of assets at the Regional Health Directorate
also commenced in earnest.
63
Under the Capital Investment programme, special mention is made of the commencement of
work on the new turnkey Ajumako District Hospital, Pokukrom Health Centre under the
OPEC Fund. Work on projects also continued but at a slow pace following the late release of
funds.
Under the rehabilitation programme, a block of flats at the regional hospital was rehabilitated
whilst a few residential apartments underwent some renovation.
64
Table 4.8: Project Status CR, 2008
No. Project Title
Location
Contractor
Consultant
%
of Funding
Status
Allocation
GOG
On Going
80,000.00
GOG
On Going
40,000.00
55%
GOG
On Going
80,000.00
Arch team 4 85%
GOG
On Going
30,000.00
GOG
On Going
40,000.00
GOG
On Going
30,000.00
GOG
On Going
100,000.00
GOG
Suspended
GOG
Suspended
Work
1.
Rehabilitation of Block Cape Coast
Bathur Ent
A.E.S.L.
Peemens
Arch
3Bedroom Bungalow
Company Ltd
4 Consult
Construction of Male Dunkwa-On-
Ramboll Co. A.E.S.L.
ward
Ltd
100%
A Regional Hospital
2.
3.
4.
Construction
of Assin Fosu
Offin
Construction of Health Gomoa Dago
Tadasgab Ent
Centre
5.
Consult
Construction
of Ola,
2bedroom Bungalow
6.
Construction
8.
9.
Extension
Cape Kofi
Coast
of Breman
3bedroom Bungalow
7.
Team 80%
of
Team 95%
Essuman Ent
4 Consult
E. Ofori Ent
Arch
Asikuma
Office Cape Coast
Arch
Team 90%
4 Consult
Rich Bebe
Arch
Team 40%
Block RHD
4 Consult
Construction of Ramp at Ankaful
Architectural
Psychiatric Hospital
Spring
Completion of OPD at Ankaful
Psychiatric Hospital
Donajos
Architectural
spring
65
10.
Rehabilitation
of
a Senya Bereku Modern
Health Centre
11.
Const. Ltd
Cadpro
OPEC
On Going
OPEC
On Going
OPEC
On Going
Saudi
Suspended
Saudi
Suspended
GOG
On Going
GOG
On Going
Consulting
Construction of District Ajumako
Hospital
12.
Construction of Health Opokurom
Centre
13.
UDD
Construction of Health Abakrampa
Centre
14.
Construction of Health Mankessim
Centre
15.
16.
Construction of Hostel Cape Coast
Kofi
Block at NTC
Essuman Ent
Construction of Septic Ankaful
Ansey
Architectural 10%
Tank
Enterprise
Spring
66
20,000.00
4.5
Maintenance
Generally, planned maintenance in the region received little attention.
number of facilities and residential apartments were in poor state.
A good
Repairs and
maintenance were skewed in favour of apartments occupied by the very senior staff.
Some drastic measures to improve the situation are needed at all levels. These
include adequate and motivated maintenance staff, committed management, staff and
adequate funding.
4.5.1 Health Care Waste Management
During the year, six (6) new incinerators were constructed in the following
districts/institutions:
• Efutu (Winneba)
• Awutu Senya (Awutu)
• Agona East (Nsaba)
• Gomoa West (Afransi/Obuasi)
• Gomoa West (Apam)
Although awareness regarding health care waste management has improved, there is
more room for improvement and this requires a more systematic and professional
approach in terms of segregation of waste, safe collection and storage and proper
treatment methods.
Delays in payment for work done, inadequate funds and absence of requisite staff
were the main problems of the unit.
In 2009 efforts would be made advocate for the early release of approved projects by
headquarters to ensure proper planning and monitoring ,complete work on the Capital
Investment Case ,complete the update of database and insertion of building drawings
and pictures into the database. It would also continue to provide technical assistance
to the various training institutions in the region.
4.6
CLINICAL ENGINEERING SERVICES
The unit as part of its mandate undertook the collation of equipment requirements and
distributed slightly used equipment to 6 facilities.
67
Equipment availability increased from 55% in 2007 to 73% in 2008, while
performance index increased from 50% to 61% in 2008.
New installations were carried out in Agona Swedru, Abura Dunkwa, Assin Fosu and
Dunkwa-On-Offin Hospitals.
Innovative electric installations to ensure 24 hour lighting were done at Antseambu
CHPS, Akumpoano CHPS, (Mfantseman West) Onyadze CHPS. Some were also
installed in 3 private homes.
•
The Equipment Manager participated in national dental equipment training
programme at the Kintampo Oral Health School.
•
The Equipment Manager provided user trainer for some staff.
•
Two dental units were installed at Fosu and Agona Swedru Hospitals.
The main constraints of the unit were the lack of basic equipment probably due to the
reluctance of health facility managers to purchase these equipments. The vehicle used
by the unit had broken down without replacement.
4.7
PROCUREMENT MANAGEMENT
Some modest achievements were made in the following areas:
• Preparation of 2008 Annual Procurement Plan.
• Regular meetings of the Entity Procurement Committee. It met on 7 occasions
to discuss procurement of goods and works.
• Update of Procurement register.
• Meeting of the Evaluation Panel for the evaluation and selection of 2009
Award National Competitive Tender (NCT) award liners.
• Placement of advertisement in the dailies for the National Competitive
Tendering (NCT).
• Conducted workshop on Procurement procedures for members of the Entity
Procurement Committee of the Twifu Praso Health Assistants Training
School (TP HATS) and the GHS Supply Chain Association in the Central
Region.
• Provided technical assistance to the Twifu Praso and Cape Coast District
Hospitals on the purchase of Pickup vehicles.
68
• Organized a day’s seminar on 2009 procurement procedures for registered
suppliers and contractors.
• Signed and implemented contracts with suppliers and contractors.
• Undertook monitoring visits to three (3) districts during the year.
The challenges of the unit continued to be:
•
Delayed payments/inadequate funds to pay for goods and services provided.
This resulted in poor customer relations.
•
High indebtedness by health institutions.
•
Lack of trained and motivated procurement staff in almost all the districts.
This posed perhaps the biggest challenge to the effective implementation of
the new procurement.
•
Poor appreciation and disregard of procurement procedures by some
managers.
4.8
STORES, SUPPLIES AND DRUGS MANAGEMENT
The priorities of the unit at the beginning of the year were:
•
To monitor and strengthen the Delivery of Health Commodities Programme.
•
Ensure the availability of the essential health commodities.
•
Reduce indebtedness of health facilities to the Regional Medical Stores.
•
Undertake planned monitoring and support visit to the health facilities.
•
Undertake quarterly review performance of suppliers.
•
Conduct stock audit of health commodities at selected health facilities.
Activities
•
The Medicines Section of the Regional Medical Stores (RMS) made five (5)
planned visits to the Central Medical Stores (CMS) to purchase routine
medicines and to collect HIV/AIDS medicines allocation for Central Region.
•
The medicine and non-medicine consumables sections of the RMS purchased
commodities five (5) times from private suppliers for the year 2008.
•
Stocktaking was conducted four (4) times for both sections of the RMS.
69
•
The Direct Delivery of health commodities committee met once in March of
the year under review.
•
Four (4) organized and four (4) emergency Direct Delivery of Health
Commodities were undertaken by 31st December, 2008.
•
There was a meeting to review the activities of focal persons on direct delivery
issues. It was agreed to ensure the following:
(a) Setting maximum and minimum re-order quantities and average monthly
consumption.
(b) Availability of worksheets to all focal persons for distribution to store
personnel or logistics managers in various districts.
•
The Regional Health Directorate with the support of DELIVER organized the
4th Integrated Logistics Management workshop from 19th to 22nd August, 2008
at Betanya for 35 officers (p Medical Assistants, 6 Public Health Nurses and 6
Stores officers).
•
Undertook stock audit of the medicine section of the RMS and some selected
health facilities to determine their consumption levels which would then
enable the RMS to establish its consumption patterns.
•
Took part in the procurement process for the year.
70
Table 4.9: Comparative Performance Indicators (Medicines), 2006-2008
Y E A R
INDICATORS
Percentage
tracer
Medicines
Availability
Purchases
from
private suppliers as
percentage of total
Purchases
Purchases
from
CMS as percentage
of total Purchases
Amount owed to the
medicine section as
percentage of total
sales
Number of items
supplied to facilities
as percentage of
total
items
Requested
Number of items
Stocked
Percentage
of
wastage
through
expiry/unwholesome
to total Purchase
Volume of Sales
Volume
of
Purchases
Percentage of slow
moving
to
fast
moving Medicines
2006
2007
Projection 2008
Projection
for 2008
for 2009
90%
94.6%
95%
93%
95%
78%
80.3%
-
81%
-
22%
19.7%
-
19%
-
36%
54.85%
40%
55%
40%
90%
92%
94%
91%
94%
159
264
270
270
275
-
2.54%
2%
0.75%
1%
346,171.127 813,750.510 343,850.689 798,657.65 -
1,510,490.94 1,451,923.23 -
-
12.4%
-
-
71
10%
Table 4.10: Comparative Analysis of Performance Indicators (Non-Medicines)
INDICATORS
YEAR
2006
2007
2008
Projection for
2009
Percentage
tracer
Non-Medicines
100%
100%
97%
100%
84%
71%
80%
16%
29%
20%
33.04%
50%
40%
98%
99%
100%
149
170
180
Availability
Purchases
from
private suppliers as 77%
percentage
of
total
Purchases
Purchases from CMS
as percentage of total 23%
Sales
Amount owed to the
medicine
percentage
section
of
as 58%
total
Sales
Number
of
items
supplied to facilities as 92%
percentage
of
total
items Requested
Number
of
items 152
Stocked
Volume of Sales
153,123.53
291,000.31
467,336.87
-
Volume of Purchases
135,308.4
330,539.14
306,447.07
-
The challenges include the lack of adequate stores personnel and the knowledge and
skills in logistics management.
•
Organize a meeting with the District Focal persons to review and update their
knowledge and skills in the Direct Delivery Programme.
72
•
Continually update the knowledge and skills of untrained and already trained
logistics managers and stores personnel in the Standard Operating Procedures
in Logistics Management.
•
Conduct regular monitoring and supervisory visits to the districts and sub
districts to review activities in Direct Delivery and to provide on the job
training to store personnel and logistics managers especially in the
establishment of their maximum and re-order levels for the various health
commodities.
•
Incorporate logistic management checklist into peer review meetings of the
Clinical BMCs which will improve performance of health facilities in logistics
management.
4.9
SECURITY
There were no major incidents. However, of major concern in most facilities was the
lack of motivated security staff. Most of them were illiterate casuals and have little
training. The absence of fence walls in most facilities did not help matters
The objectives for 2009 would be to intensify efforts to regularize their appointments
and organize a training programme for the staff.
73
CHAPTER FIVE
5.0
HEALTH TRAINING INSTITUTIONS
There are four health training institutions in the region. These are the Nurses and
Midwives Training College (NMTC), in Cape Coast, the Nurses Training College
(NTC), at Ankaful, the Community Health Nurses Training School (CHNTS) at
Winneba and the Health Assistants Training School (HATS) at Twifo Praso.
5.1
NURSES AND MIDWIVES TRAINING COLLEGE, CAPE COAST
In the year 2004, the college began running the diploma in midwifery programme.
During the year under review 149 students were admitted which consisted of 120
general nursing students of 58 females and 62 males and 29 train midwives. The total
population of students was 456 made up of 309 female and 147 males. There were 17
regular tutors giving a teacher-student ratio of 1:27, 4 part-time tutors an
improvement to that of last year which was 1:30. The institution also has 33 nonteaching staff.
The performance of students on their semester examinations were encouraging for all
the year groups and for both the general nursing and the midwifery students.
The major contrains/challenges of the NMTC were inadequate staff accommodation,
preceptors to enhance clinical teachings, the relatively high cost of running the two
campuses i.e Ankaful annex and Cape Coast main is very expensive especially in
terms of fuel e.g. the cost of fuel for one month clinical experience for students in
Family Planning and Emergency and Disaster nursing was about One Thousand Nine
Hundred and Twenty Ghana cedis (GH¢1,920.00). The college also needed an
industrial gas cylinder for the student hostel annex at Ankaful Psychiatric Hospital.
5.2
PSYCHIATRIC NURSES TRAINING COLLEGE ANKAFUL
The NTC, Ankaful began training post basic Registered Mental Health Nurse in
August 1974 and in August 2003 the college began the training of mental health
nurses at the Diploma level. The RMN certificate programme continued until 2005
74
when the prospective applicants numbers became very low and uneconomical to
pursue. It also receives on a regular basis students from general nursing colleges and
community health nursing schools in the country for Psychiatric-mental health
courses. In 2008
ten diploma general nursing schools, 3 CHNTS and 2 HATS
brought their students for affiliation courses.
The total population for the regular student in 2008 was 512 and that for the affiliation
was 1021 with the total number of tutors being 16 giving a tutor student population
ratio of 1:32 and 1:65 for the regular and affiliation students respectively. With
regards to the performance of the student, the college had 54% passes in the 2008
licensure examination.
The school in the year under review was able to complete their sports complex,
renovate the entire infrastructure with paint, the school has acquired an electronic bill
board. The SRC has also purchased Public Address System which is being used by
students during lectures and other social activities on the campus. The Ministry of
health also assisted the school with an 80 seated Macerello bus to help in transporting
students to and from campus. The Regional Health Directorate returned the sick bay
and conference center to the school; this was termed as the greatest achievement for
the year under review.
5.3
COMMUNITY HEALTH NURSES TRAINING SCHOOL WINNEBA
The CHNTS was established in 1980 for a two year certificate course in community
health nursing programme. This programme is ongoing and in the year 2005, the
school was selected to run a three year diploma course in community Health Nursing
on a pilot basis.
For the year under review, the school reduced its intake of students by 19%, from its
highest since its establishment of 281 in 2007. The total student population was 599,
which is made up of 533 females and 66 males. The teaching staff strength was 14,
with 4 part time tutors and the non-teaching staffs were 30. The teacher-student ratio
therefore was 1:33.
The school had 97.5% pass on the licensure examinations held in November, 2008.
The performance of the students in the semester examinations for the various year
groups were also encouraging as the least percentage pass in a subject was 73.7% and
the highest was 100%.
75
The major challenges/constraints experienced in the past year have been the increased
workload, the ageing cooks who could not cope with increasing student population,
and the very high fuel cost for field work. Inadequate supportive staff e.g.
Procurement Officer, Internal Auditor, Executive Officer, Typist and Housekeeper
and over aged vehicles used at the school leads to high maintenance cost for the
school.
5.4
HEALTH ASSISTANTS TRAINING SCHOOL, TWIFO PRASO
The Health Assistants Training School (HATS) was established in October 2007 to
run a two-year programme aimed at training auxiliary cadre of health staff to assist
clinical service delivery.
The school is currently housed at the former Twifo Praso secondary school premises.
The school has a total population of 375 students and has a tutor strength of 4 giving a
tutor student ratio of 1:93.
The school has built a storey building to accommodate 294 female students.
Developed three classrooms to accommodate 81 male students. Developed 250 bunk
beds, developed 306 mono desks and purchased 250 plastic chairs.
The challenges of the school were as follows, Low teaching staff strength, Lack of
relevant text books and teaching materials, Transportation problems – no vehicle to
carryout daily activities.
76
Table 5.1: Performance of Health Institutions 2008
Institution
Student
No
Population
Tutors
Of Tutor Student Performance
Ratio
On
2006
Licensure
Exams
Nurses & Midwives training 456
17
College, Cape Coast
(4 part-time)
Nurses
Training
College, 512
Ankaful
1:27
65.4%
17
1:32
54%
(4 part-time)
1:65 (affiliation
Students)
Community
Health
Nurses 533
Training School, Winneba
11
1:33
98%
4
1:93
-
(include 63
Diploma)
Health
Assistant
Training 375
School
77
CHAPTER SIX
6.0
6.1
FINANCIAL MANAGEMENT
FLOW OF FUNDS
Generally the regions traditional sources of funding i.e. GOG service and GOG
Administration saw an increase from GH¢ 690,934.00 in 2007 to GH¢1,381,258 IN
2008 an increase of 99% . This increase came about because of the governments
support to the Ankaful psychiatric hospital which was reporting for the first time. The
hospital received GH¢ 440,976.00 for GOG service and GH¢ 176,630.00 in 2008.
Internal Generated Funds (IGF) went up by 63 % i.e. from GHC¢ 5,787,207.00 to
GHC¢.9, 604,914.00 this achievement can partly be attributed to revenue from
National Health Insurance. Below is a table showing flow of funds to the region.
Table 6.1: Flow of Funds, CR 2007-2008
FUND TYPE
2,007 (GH¢)
2,008 (GH¢)
% CHANGE
GOG SERVICE
291,626
800,081
23
GOG ADMIN
399,308
581,177
1
IGF
5,787,207
9,604,914
63
TOTAL
6,478,141
10,986,172
70
In the year under review programme funds went up by 23%
SOURCE OF FUNDS
2007
2008
% CHANGE
PROGRAMME
1,852,456
1,921,836
23
78
Key Achievements
•
Re alignment and classification of Revenue and Expenditure items to match
NHIA new billing system.
•
Replacement of REPAC with, ACCPAC software for financial reporting to
meet changing needs in the financial environment.
•
Reduction in outstanding audit queries.
Key Challenges
•
Non functioning of Audit implementation committees in some BMC’s.
•
Lack of staff with book keeping knowledge in handling Health Center
Finances
•
High indebtedness of facilities to the Regional Medical Stores
•
Mounting NHIS debt to facilities
•
Late submission of returns
Other/Concerns
Last year some facilities had over 50% of their IGF Revenue coming from Health
Insurance and by the end of first quarter this year (2007), Swedru Hospital was
already hovering around 58%.
Some BMCs were marking efforts to network their facilities.
During our rounds it came to light that some BMCs were not using the Ministry of
Health’s receipts for collection of monies but the Treasury’s General Counterfoil
Receipts which may not help Audit Trail better. A circular had already been issued to
that effect.
Recommendations
From the above, we deem it fit to recommend the following:-
Underpayments which are not justified should be treated against the
respective Health Insurance Scheme as outstanding to be paid.
-
Some rates on the Health Insurance price list should be reviewed.
-
Though payments are not unduly delayed to a large extent, it should be
improved, as we now rely heavily on it.
79
-
BMCs especially hospitals should consider networking their facilities
seriously as it will help seal revenue leakages.
-
Henceforth no General Receipts counterfoil should be bought and use
without approval of the Office of the Regional Director of Health Service.
-
Training of nonfinance officers in simple book-keeping to handle health
centre books of accounts.
Brief Description of Activities in the Year
•
Two Regional Validation workshops were held in January and July. The
objective of the exercise was to confirm BMC’s balances and reconciled
financial reports to their books of Accounts
•
Advanced Excel Training for Regional Monitors was held in Accra to equip
them with skills to use the projected software, ACPAC
•
Workshop on ACPAC software to replace REPAC was held in Accra for
Regional Accountants and Financial Monitors.
•
Financial monitoring visits were made to 10 Districts. In all ten DHA’s, six
hospitals, six Health Centers and three Training Institutions were visited.
80
CHAPTER SEVEN
7.0
Innovations, Initiatives, Best Practices and Special Initiative to
increase Access
A number of innovations and initiatives were undertaken in the region and the
districts in the region. A number of them had received national recognition and were
presented at senior managers meetings.
7.1
National Health Insurance Scheme (NHIS)
The objective of the Regional Health Insurance Coordinating Secretariat under the
Regional Health Directorate is to facilitate the implementation of the district-wide
NHIS in the region. Strategies to achieve their objectives include sensitization of
health staff, monitoring and evaluation and coordination of activities.
7.2
Regional Health Awards Scheme
The scheme with the objective of motivating hardworking personnel, rewarding
collaborative institutions and high profiled health institutions.
7.3
Peer review initiative
The initative continued to provide the needed impetus to improve service delivery in
the region. Personnel from the region served as resource persons in the attempt by the
Volta and Borng Ahafo Regions to adopt the initiative
81
CHAPTER EIGHT
8.0
COLLABORATION
8.1
Activities of NGOs
The region has about thirty five community based organizations working in the area
of Reproductive Health .The report focuses on the activities of a few who are directly
involved in Reproductive Health activities.
8.1.1 Plan Ghana
Plan Ghana continued to give support to communities in five districts i. e. Abura –
Asebu – Kwamankese, Gomoa, Mfantsiman and Awutu- Efutu – Senya and Agona
districts. They are involved in Reproductive Health, as well as Child Survival
Activities.
A new NGO, Hope for Future Generation is also in the AEE district and providing
RH services, but working hand in hand with PLAN Ghana.
8.1.2 Prolink
Pronlink focuses on Adolescent Health issues and are operating in Mfantsiman
district. They also give support to People Living With HIV/AIDS (PLWAID).
8.1.3 Planned Parenthood Association of Ghana (PPAG)
PPAG continued tooperate in three-districts in the region, Cape Coast, AES, and
THLD. In the Cape Coast municipality they have a daily family planning clinic, VCT
services, ASRH activities, treatment of minor ailment, STI treatment and BCC
activities. Once a week they have a visiting gynaecologist who attends to their
referred cases. The Association has a static clinic at Cape Coast where they provide
RH services to clients in the municipality and other surrounding communities. Using
BCC promoters and peer educators they provide information, counselling service and
non-prescriptive contraceptive distribution in the three selected districts.
82
In THLD, PPAG has a project that provides Information on HIV/AIDS to five (5)
communities in THLD. The aim is to motivate clients to go in for VCT and also try to
reduce discrimination against People Living with HIV/AIDS.
8.1.4 World Vision International
World Vision International (WVI) continued to support three districts Viz.
Mfantseman, Assin and THLD in the areas of Reproductive and Child health,
8.1.5 EC/UNFPA/GOG Project – Strengthening Community Based
Reproductive Health Services in the Central Region
The project is to strengthen activities on reproductive health service. The goal of the
project is to contribute to increased adoption of better health seeking behaviour and
access to quality reproductive health services. Activities carried out in 2008 were
mostly done in the six selected districts. However the programme came to an end in
September 2008.
8.1.5.1 Collaboration with GPRTU
This programme continued during the year under review. Drivers who participated in
the programme by sending pregnant women to the hospital were given awards in the
form of TV Sets, fridges, fans, suitcases, certificates etc. The aim was to encourage
more drivers to be part of the programme.
83
CHAPTER NINE
9.0
Challenges
Key challenges facing the region under each BMC are discussed below:
9.1.1 PUBLIC HEALTH
-
Increasing workload
-
Delayed report submission to the Directorate
-
High attrition of trained staff
-
Weak follow up of IMICI clients
-
Difficulties in ART defaulter tracing
-
Slow implementation of MOH work place policy
-
High indebtedness of Districts to the Regional Health Directorate in respect of
ITNs issued.
-
Poor documentation of ITN distribution and other malaria control activities.
-
Pharmacovigilance forms for effect of ACT and IPT are not filled.
-
Lukewarm attitude and unwillingness of newly trained Field Technicians to
integrate leprosy control in other disease control activities.
-
High staff attrition and wastage rate e.g. Nurses
9.1.2 CLINICAL CARE
-
Inadequate logistics/equipment e.g. photocopier, etc.
-
Non use of advanced drug reaction report forms.
-
Non compilation of self monitoring of Professional and Clinical Outcome
Indicators .
-
Non adoption and implementation of Referral Guideline.
-
Poor staffing especially Professional and Technical grade.
-
Inadequate funding for the Clinical BMC presenting a challenge in the
implementation essential progress.
84
9.1.3 SUPPORT SERVICES
-
General shortage of critical staff, doctors, medical assistants, midwives,
biomedical scientists, stores officers, poor mix of staff.
-
Unavailability of specialist staff, e.g. paediatrician, physician specialists, ENT,
ophthalmologist particularly at the Regional Hospital.
-
Refusal of Doctors to accept postings to the region.
-
Low patronage of the Regional Base Workshop due to lack of spare parts.
-
High indebtedness of BMCs and health institutions to the workshop.
-
Inadequate funding for administrative work, monitoring and maintenance.
-
Inadequate funds for rehabilitation of buildings including residential
apartments resulting in deterioration.
-
Delay in releasing list of approved projects.
-
Delay in payment of health commodities supplied to various BMCs.
-
Lack of adequate store personnel to carry out required logistics at the Regional
Medical Stores and the districts.
9.1.4 TRAINING INSTITUTIONS
-
Lack of residential accommodation for staff.
-
Inadequate number of Health Tutors e.g. Mental staff.
-
Inadequate number of support staff – procurement officers, Internal Auditor,
Executive Officers, typists and housekeepers.
-
Lack of school bus.
-
Over-aged vehicles leading to high maintenance cost.
-
Excessive pressure on all facilities.
-
Lack of dinning halls.
85
9.2
WAY FORWARD
9.2.1 Clinical Care
The BMC will undertake the following:
-
Organise meetings of Medical Superintendents and District Directors to
discuss issues arising from monitoring and the way forward.
-
It also collaborates between clinical and public health units.
-
Re-schedule planned monitoring and supervision programmes that could not
be executed in 2008.
-
Organise Regional Review meeting for Hospital Quality Assurance Teams.
86
APPENDIX
Service Delivery Data
Indicator
Number of Institutional infants deaths
2005
2006
2643
2007
3150
Number of Infants admissions
53933
10469
Number of institutional under five deaths
3297
766
Institutional maternal mortality ratio
1.04
1.67
1.7
Number of Under five years who are under
weight presenting at facility & Outreach
N/A
N/A
N/A
2008
391
4514
588
1.7
3960
Clinical Care
Utilization
Number of outpatient visits
858903
881448
1,196,827
Outpatient visits per capita
0.5
0.5
0.65
Number of cases seen and treated by the
CHOs.
% of OPD visits by insured clients
1281602
0.68
46477
31.8
Number of admissions
53829
53933
76194
30
31
41
N/A
N/A
N/A
Number of specialist visits received from the
national level
Number of patients seen by national team
0
0
43
0
0
1391
Number of operations performed by national
team
Number of specialist visits made by regional
team
Number of patients seen on specialist visits to
the districts
Number of operations performed by regional
team by specialty at the district
DISEASE SURVEILLANCE
0
0
0
Hospital Admission rate
Number of people benefiting from
rehabilitation services
Specialist Outreach
62536
33.2
N/A
48
1705
0
0
0
N/A
0
0
N/A
0
0
N/A
0
0
0
No. of TB patients Detected
1387
1116
1302
No. of HIV positive cases diagnosed
683
730
690
Number of HIV+ cases receiving ARV
therapy
No. of guinea worm cases seen
52.1
1219
404
236
347
1
87
0
0
0
No. of AFP cases seen
14
Total number of malaria cases
10
284482
384143
1
0
26
400023
16
446075
Diseases targeted for Elimination
Number of guinea worm cases
Lymphatic filariasis treatment Coverage
0
0
0
0
13347
15766
35461
0
0
Non-communicable diseases
Cases of Hypertension reported
Cases of diabetes mellitus reported
11341
6575
Number of people screened for noncommunicable diseases
Reproductive & Child Health
Safe Motherhood
Number of Family Planning Acceptors
136138
154730
115023
34
37
29.6
Total Couple Years of Protection (CYP)
59631
53927.7
76103
Number of ANC registrants
75281
74945
80155
% ANC coverage
106.4
103.8
108.7
Proportion of ANC registrants given IPT2
7518
26078
12.9
Proportion of pregnant women who use ITN
N/A
N/A
N/A
55468
49477
54120
78.4
68.5
73.4
Total number of deliveries
95482
89165
35738
Number of Supervised
56022
53688
54203
55.8
49.1
48.5
Number of deliveries by skilled attendants
(by doctors and nurses only)
% of Deliveries by Skilled attendants
39460
35477
35738
55.8
49.1
48.5
Proportion of fresh still births to total still
births
% of children under 5 using ITN
2.1
2.3
43.1
%WIFA accepting family planning
Number of PNC registrants
% PNC coverage
145468
33.6
56702
879713
115.5
55.8
N/A
58439
77.6
58887
42385
deliveries (includes TBAs)
% of Supervised Deliveries
56.3
42385
N/A
N/A
N/A
56.3
42.6
N/A
CHPS
No. of CHPS zones demarcated
258
No. of functional CHPS zones
44
88
52
59
Child Survival
EPI coverage Penta 1
97
EPI coverage Penta 3
89
88
92
EPI coverage OPV3
93
88
92
EPI coverage Measles
84
88
94
Proportion of children under 5 years receiving
at least 1 dose of Vitamin A
Total number of Under five malaria cases –
Outpatients
Total number of Under five malaria cases –
Admissions
Exemptions granted (No. of Patients by
category)
Children Under 5yrs
N/A
N/A
N/A
90896
96690
95303
0
92
90
92
N/A
114199
5661
5957
6339
7623
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Elderly (>70yrs)
N/A
N/A
N/A
N/A
Poor (Paupers)
N/A
N/A
N/A
N/A
All other Diseases
N/A
N/A
N/A
N/A
57
87
Ante-natal
Deliveries
Total number of maternal deaths
Number of maternal deaths audited
102
90
% maternal death audits
97.8
Total number of Under five deaths due to
malaria
Under five malaria case fatality rate
277
278
4.9
2.33
1.8
Number of drugs available out of the tracer
drug list at the Regional Medical Stores
Number of drugs available out of tracer drug
list at the regional hospital
TB Cases Cure Rate
131
131
131
62.8
72.1
81.8
92
78
85.3
251
257
AFP non polio rate per 100,000 population
under 15 years
HIV sero-prevalence among
3.4
0.85
15 – 19 year olds
0.7
0.8
20 – 24 year olds
3.7
4.8
=
Clinical Care
Total number of beds
1666
1623
1109
Total number of discharges
49676
51525
44332
89
1046
54802
Total number of deaths
2795
Number of patient days
2643
2855
288971
197844
2484
219284
% Bed Occupancy
49.4
99.1
48.6
Bed Turnover Rate
32
32
43
Doctor Patient Ratio
36110
25603
Nurse Patient Ratio
1763
1627
63
50
60
Population to doctor ratio
32747
36109
31369
Number of nurses
1032
942
1121
Population to nurse ratio
1714
1917
1679
28
28
28
1985
28
24
22
20
20
0
0
34
Number of doctors
Total number of Management positions
(RDHS+ Deputies, DDHS, Medical
Directors)
Number of Management positions filled by
personnel with required qualification
Number of community resident Nurses
(CHOs)
Proportion of staff appraised
53.1
50.8
16431
1352
78
24130
948
90
Proportion of Drs & Midwives Trained in
Life Saving Skills
Total number of IST programmes organized
42
21
No. of Staff trained on Facility-IMCI
% of communities with CBAs trained on CIMCI
Total number of staff receiving IST
programmes
% of clinical staff who received IST
Transport and Estate
Proportion of vehicles road worthy
95
104
107
Proportion of motorbikes road worthy
100
170
170
Proportion of non salary recurrent budget
spent on buildings (PPM)
N/A
N/A
N/A
5
9
9
Number of facilities with Ambulance
90
116
259
N/A
7
Prevalence Rate from 2004 to 2008
DISTRICT
2004
2005
2006
2007
2008
AAK
0.51
0.1
0.51
0.1
0.28
AGONA
0.52
0.46
0.052
0.38
0.21
AEE
0.5
0.49
0.5
0
0
AOB
0.51
0.71
0.51
0.29
0.28
ASSIN NORTH
0.42
0.51
0.42
0.49
0.16
ASSIN SOUTH
0
0
0
0
0
0.22
0.32
0
0.51
0.2
0
0
0.22
0.08
0
0.33
0.14
0
0.14
0.17
0
0.16
0.33
0.08
0
MFANTSIMAN
0.21
0.12
0.21
0.06
0.22
THLD
1.08
0.74
1.08
0.32
0.23
U/DENKYIRA
0.51
1.08
0.51
0.4
0.31
REGION
0.48
0.48
0.42
0.26
0.17
AES
CAPE COAST
GOMOA
KEEA
91
NAMES OF CT & PMTCT OF HIV SITES – C/R HIV/AIDS PROGRAMME
DISTRICT
Mfantseman
AAK
Cape Coast
Agona West
Agona East
Assin North
Assin South
Upper Denkyira East
CT & PMTCT FACILITIES/SITES
Saltpond Hospital
Abeadze Dominase Health Centre
Mankessim Health Centre
Anomabo Health Centre
God’s Gift Mat Home-Ekumfi Ekroful
Atuam Health Centre
Esuahyia Health Centre
Biriwa Community Clinic
Kormantse Community Clinic
Nanaben CHPS
Abura Dunkwa Hospital
Moree Health Centre
Asuasi Rural Clinic
Abura Gyabankrom CHPS
Asomdwee CHPS
Abakrampa H/C
Regional Hospital
District Hospital
Ewim Urban Health Centre
U. C.C Hospital
Adisadel Health Centre
Efutu Clinic
Swedru Gov’t Hospital
Nyakrom H/C
Abodom H/C
Nkum H/C
Kwanyako H/C
Nsaba H/C
St. Francis Xavier, Assin Foso
Assin Bereku Health Centre
Assin Kushea Health Centre
Assin Praso Health Centre
Bediadua Health Centre
Assin Akropong H/C
Fante Nyankomasi Health Centre
Assin Nsuta H/C
Assin Manso H/C
Assin Ongwa H/C\
Assin Anyinabirim H/C
Assin Jakai H/C
Akoti H/C
Dunkwa –On-Offin Gov’t Hospital
Opponso Health Centre
Kyekyewere Health Centre
Buabin CHP
92
Upper Denkyira West
AEE
Gomoa East
Gomoa West
THLD
KEEA
AOB
Awutu Senya
Efutu
Diaso Health Centre
Ajumako Hospital
Ann Mat Home (Entumbil)
Ajumako Baa Salvation Army Clinic
Ajumako Sunkwa H/C
Enyan Abaasa H/C
Ajumako Bisease H/C
Ajumako Community Clinic
Anyinasu CHPS
Gomoa Obuasi Health Centre
Nyanyano H/C
Buduatta H/C
Apam Catholic Hospital
Oguaa H/C
Mankoadze H/C
Onyadze Community Clinic
Twifo Praso Hospital
Topp Clinical Hospital
Twifo Hemang Health Centre
Jukwa Health Centre
Twifo Mokwaa H/C
Ankaful Psychiatric Hospital
Ankaful General Hospital (RCH)
Elmina Health Centre
Kissi H/C
Komenda H/C
Our Lady of Grace – Breman Asikuma
Amanfopong H/C
Brakwa H/C
Odoben H/C
Bedum H/C
Gyamera H/C
Kasoa Health Centre
Connies Mat Home (Kasoa)
Mayenda CHPS
Awutu H/C
Gyangyanadze CHPS
Senya H/C
Winneba Gov’t Hospital
NAMES OF HIV ART SITES – C/R HIV/AIDS CONTROL PROGRAMME
DISTRICT
HIV ART FACILITIES/SITES
Mfantseman
AAK
Cape Coast
None
Abura Dunkwa Hospital
Regional Hospital
93
Agona West
Agona East
Assin North
Assin South
Swedru Gov’t Hospital
None
St. Francis Xavier, Assin Foso
None
Upper Denkyira East
Upper Denkyira West
AEE
Gomoa East
Gomoa West
THLD
KEEA
AOB
Awutu Senya
Efutu
Dunkwa –On-Offin Gov’t Hospital
None
None
None
Apam Catholic Hospital
Twifo Praso Hospital
None
Our Lady of Grace – Breman Asikuma
None
Winneba Gov’t Hospital
94