1. health and fitness

FORWARD
This report highlights some of the major health service activities and programmes carried
out in the Ashanti Region during the year under review.
The activities were largely determined by the priorities and action plans of the region in line
with the Ghana Health Service Strategic Objectives and New Paradigm of the Ministry of
Health. It also highlights the broad policy and operational direction of the Ashanti Regional
Health Directorate in 2010.
A detailed description of the key activities in the region has been expressed, though other
areas of service delivery have not been highlighted. It is hoped that the final report at the
end of 2010 would bring all into focus. Certain information has been added and other parts
have been documented in more detailed to make sure the report serves as a valuable
reference material.
We acknowledge with many thanks the contributions from all the Institutions,
Headquarters, Regional Coordinating Council, Health Partners, NGOs, DHMTs and units of
the Regional Health Directorate towards the overall service delivery in the region.
1
EXECUTIVE SUMMARY
The Regional Half Year Report 2010 reflects the major activities undertaken by the Regional
Health Directorate under the four health sector strategic objectives and its results as
measured by the key sector indicators. The Regional Health Directorate viewed the first six
months of the year 2010 as successful though challenging. The region appears to be on
course in achieving most of the set targets particularly in the areas of key priorities.
There was a conscious effort to sensitize the populace on healthy lifestyles and
environmental management and these were achieved through Radio shows, health
talks and durbars.
The District Health Information Management System (DHMIS) has been implemented
throughout the region though there are challenges with timelines and completeness
of reporting from the districts.
Though maternal deaths have reduced over the period, other indicators like postnatal,
TT2+, ANC coverage and Caesarean rate have reduced. Maximum effort would be put in
the second half of the year to ensure improvement in the maternal and child health
indicators as we push to achieve the MDGs 4 and 5.
There have been substantial improvements in the indicators of malaria leading to a
significant reduction in deaths in U-5. IPT coverage however deceased due to the erratic
supply of SP. The OPD per capita of 0.4 appears to be on course in line with that of 2009.
It is hoped that with increasing coverage of NHIS, OPD utilization would increase further.
However Hypertension is the third most reported disease at OPD and this call for more
efforts to address non communicable diseases in the region.
Routine EPI coverage has been impressive.The two NIDs during the half year also
recoreded coverage of more than 100% in both rounds. However the H1N1 vaccination has
received a lot of negative reports from the media with rumours of severe adverse reactions.
The region has officially recored 31 AEFIs and there are no reports of any severe reaction.
The region reported one outbreak of H1N1 in a secondary school and was well managed by
the District Epidemic Response Team with support from the Regional level.
2
The Leadership Development Programme has trained several key managers in the region
and it is hoped that the acquired leadership skills would impact greatly in the second half of
the year as the rest of the untrained manpower in the region are brought on board the
programme.
Financial support from central Government has continued to be below par and is greatly
affecting planned activities. Delayed payments to health facilities from the NHIA are also
impeding health service delivery at the hospitals and health centres. It is hoped that
financial inputs to health service would improve in the second half of the year to enhance
total health delivery.
3
INTRODUCTION
1.0 REGIONAL PROFILE
Ashanti Region lies approximately between longitude 0.15’ to 2.25’ west and latitude 5.50’
to 7.40’ north. It has common boundary with Brong Ahafo Region in the north, Central
Region in the south, Eastern Region in the east and Western Region in the west. The
Region has a land size of 24,390sq km representing about 10.2% of the land area of
Ghana.
Ashanti is the most heavily populated region in Ghana, with a population of 4,881,738 for
2009 (Projection from the 2000 Housing and Population Census, Ghana Statistical Service).
It has a population density of 169.3 per sq. km. The region has 27 districts and 132 subdistricts. Kumasi has the highest population of 1,559,807 (32.4%) of the regional total.
About 47% of the population are in the rural areas. The region has a large proportion of
hard to reach areas especially in the Afram Plains sections of Sekyere Afram Plains, Ejura
Sekyedumase, Sekyere Central and Asante Akim North districts.
There are five hundred and twenty-seven (527) health facilities in the region. The Ghana
Health Service operates about 33% of all health facilities in the region. Kumasi has the
highest number of facilities (29%) with Ejura-Sekyedumase having the least (2%). The
population hospital ratio is 48,276.
TABLE 1. 1–HEALTH FACILITIES
TYPE
NUMBER
Government Hospitals and Health Centres
170
Mission Health Institutions
71
Private Maternity Homes and Clinics
278
Quasi – Government
8
Total
527
4
PRIORITIES FOR 2010:
The regional priorities included the following:
•
Improvement of Staff and Management capacity through leadership and regular inservice training
•
Improve staff motivation
•
Ensure staff performance measurement
•
Strengthen health information system
•
Improvement of customer care
The activities carried out in respect of the above are well articulated in the respective
strategic objectives.
The Key Priorities for the year are:
§
Maternal Mortality
§
Low TB case detection
§
Stillbirth
§
Low AFP detection
§
Malaria
§
HIV
§
NTDs
§
Low EPI Coverage
§
School Health
§
Adolescent Health
§
Poor Data Management
§
Malnutrition in Children U-5
5
CHAPTER ONE
1.1.1 Strategic Objective
Healthy Lifestyle and Healthy Environment
1.1.2 Increase awareness on health promotion and protection
Various strategies were used by the region to increase awareness on health related issues.
In the hospitals, health education talks are being held on regularly basis at the Out Patient
Departments on selected diseases like malaria, H1N1, TB and HIV/AIDS and also
Regenerative Health.
For the period a lot of sensitization was also on the H1N1
vaccination. The RHD is collaborating with local FM stations particularly Angel FM and Hello
FM to promote health.
During the year under review, Health talks were given on the local FM stations i.e. Hello
Fm, Nhyira Fm, Angel Fm etc, churches, mosques, outreach points, facilities and other
social organizations to increase awareness on the new paradigm shift of Regenerative
Health and Nutrition, importance of optimal exclusive breastfeeding and benefits of iodated
salt and fortified products usage.
The general populace were educated on the importance to eat healthy meals, drink a lot of
water, exercise three times a week, as well as make time for recreation and to rest for at
least 8 hours a day. Discussions were centered on eating plant based diet and to limit the
intake of animal based food products which are high in fat, salt and sugar. Environmental
and personal hygiene were also stressed so that people would maintain a hygienic and
sanitary environment as well as live sensible lifestyles. Babies are to be breastfed
exclusively for six months, continued along side the introduction of appropriate
complementary feeding.
6
No.
Organization
Location
Topic Treated
1.
Methodist men’s
Group
Effiduase
2.
Aboabo Mosque
Aboabo 1Kumasi
3.
Hairdressers
Association
4.
Boss, Ashh &
Angel Fm
Kumasi
Cultural
Centre
Boss-Adum,
Ashh-Stadium
& AngelAbrepo
junction
Iron Fortification
Programme & essence
of exclusively
breastfeeding babies
Regenerative Health &
Nutrition & importance
of iodated salt usage
Iodated Salt, Balance
diet and it importance
& Personal hygiene
Importance of
Exclusive
Breastfeeding for
children 0-6mths,
appropriate
complementary
feeding etc
Resource
Persons
Reg. &
Dist. Nut.
off
Date
April
2010
Reg. &
March
Metro Nut.
2010
Off
Reg. &
June
Metro Nut.
2010
Off
Reg. &
May 2010
Metro Nut.
Off
The Health directorate through the Health Learning Material unit (HLM) has also
organized health educational programmes on radio, in churches, communities and
schools.
The topics treated in the schools focused mainly on personal and
environmental hygiene as well as prevention of minor ailments. The topics treated in
the churches included; predisposing factors to lifestyle diseases such as
Hypertension, Diabetes, Malaria, Hepatitis, HIV/AIDS, TB and prevention of home
accidents among others.
As part of the efforts to prevent the spread of HIV, ‘know your status’ campaign was
organized by the region in the course of the year under review. The target groups
included; students, beauticians, women and men groups in churches and
communities. The total number of people screened was 77,394. One thousand and
eighty three (1083) representing 1.4% out of the total number screened were
positive.
7
See Table 1.2
KNOW YOUR STATUS CAMPAIGN, 20092009-2010
Indicators
SEX
Jan- Dec
2009
20222221222
Jan- June
2010
422200
# Tested
M
33327
31,345
F
41879
46,049
M
310
326
F
792
757
M
33327
31,345
F
41879
46,049
75,206
77,394
# Positive
# Posttest
counselled
Total
1.1.3 Work with other stakeholders and communities to help members maintain
healthy lifestyle behaviours
Ghana Health Service in collaboration with other stake holders like Ministry of Agriculture,
Department of Social Welfare, Ghana Tourist Board, Food and Drugs Board, District
Assembles, Ghana Standard Board, Ghana Education Service, Women’s Groups, Religious
Bodies etc., organized workshops, seminars, community durbars in March and May 2010
with the Regional Nutrition Officer, Regional Health Education Officer and Regional Tourist
Board as resource persons to educate food vendors, hoteliers, market women, school
children, health workers, teachers on the need to make the right choice of food, demand
for healthy environment, adopt healthy life styles to reduce the disease burden, be friendly
to water bodies that have become a major source of water borne and water related
diseases. Participants were made to understand the need not to take nutrition for granted
by eating all the wrong foods at the wrong times, at the wrong places, constipate heavily
and generate toxic waste in their bodies which also become the cause of many noncommunicable diseases.
Participants were informed to always make time for rest and recreation to refresh them for
the next production week and not to crowd their week ends with all kinds of unnecessary
8
activities. The three food groups were also discussed as well as their uses in the body,
food hygiene, food microbiology, oral hygiene were amongst the topics treated.
WORK WITH OTHER STAKEHOLDERS
Date
Programme
Resource Persons
March 10
Essence of
iodated salt
usage &
Regenerative
Health &
Nutrition
Iron
Fortification
Programme
Tourist Board, Reg. Nut.
Off & Reg. Health
Education Off
May 10
National Coordinators
(3) & Reg. Nut. Off
Target
Audience
Food Vendors
Market Women
No. of
Participants
102
40
Traditional
Caterers
25
1.1.4 Develop HR capacity to plan, implement and evaluate Regenerative Health
and Nutrition (RGN)
As part of measures to carry out the above, a five member team made up of, the regional
nutrition officer, the regional training coordinator, the regional DDNS, the regional Health
Educator and a representative from the sports council were invited to a trainer of trainers’
workshops at cape-coast. Afterwards, the training was replicate at the Regional level for all
the 27 districts and five (5) sub-metros. Participants were put into four (4) major groups
being maternal and child health, healthy lifestyle, nutrition and practicals.
TOPICS TREATED AND DISCUSSED WERE CENTERED ON
1. Water and Nutrition
a) The health benefits of water
b) Nutrients
c) Food groups in Ghana
d) How to combine your food and plan your meals
e) Feeding the family
The practical sessions took participants through the preparation of regenerative health
diets. Questions posed by participants were answered to their satisfaction. A period within
the programme was allocated for exercise. In all about one hundred and eighty (180)
people participated in the category of nutrition, public health nurses, community health
9
nurses, disease control and health promotion officers. It was well attended, patronized and
successful.
1.1.5 Promote food safety
The regional health directorate in collaboration with School Health Education Programme
(SHEP) Coordinators, Nutrition Officers and the Environmental Health department organized
workshops for heads of schools and food vendors. The objective was to promote food
safety in schools.
Some of the topics treated include; food hygiene, personal and
environmental hygiene, cooking practices and food storage among others. A certificate of
participation was given to all the food vendors who attended the workshop.
1.1.6 Promote occupational health and safety
The goal of occupational health services is to establish and maintain a safe and healthy
working environment which will facilitate optimal physical and mental health in relation to
work. It is therefore imperative that workers are periodically given training on occupational
health and safety and also should be provided with protective equipment in order to control
risk and departures from health.
The RHD also ensured the regular supply of personal protective equipment to staff. These
included; wellington boots, goggles, gloves and gowns. The health facilities also have fire
extinguishers and smoke detectors.
1.1.7 Advocate for improved access to water and sanitation infrastructure
The Regional Health Directorate has always been advocating for safe water for drinking.
This is to reduce the number of water related diseases in the region especially in children
U-5.
Equally the Regional Health Directorate in collaboration with the Environmental Health unit
have been working to improve the health status of the people of the region through the
provision of quality environmental sanitation services that are accessible and affordable.
10
CHAPTER TWO
2.0 Strategic Objective 2- Health, Reproduction and Nutrition Services
2.1.1 Improve quality of clinical care
In order to improve staff capacity to provide quality care, a series of in-service training
sessions were organized for health workers during the year. Notable among these were;
prevention of injection abscess, management of post partum haemorrhage, hypertensive
states in pregnancy, neonatal resuscitation and management of diarrhoea.
2.2 Quality Assurance (QA)
Surveys were conducted in most health facilities on the rational use of medicines. Plans are
underway to meet all prescribers and dispensers in the region with the aim of improving
the indicators for rational use of medicines. See table 2.1 below for the results of the
survey.
TABLE 2.1 Rational Use of medicines indicators
PRESCRIBING
INDICATORS
Average number of medicines per encounter
% of medicines prescribed generic name
% of encounter with antibiotics
% of encounter with injection prescribed
% of medicine prescribed from EDL
PATIENTS INDICATOR
% of patient who understood drug instruction
FACILITY INDICATORS
% availability of tracer drugs
REGIONAL
AVERAGE
4.2
95.0
35.0
35.0
100
WHO
STANDARDS
2
100
20
20
100
91.0
100
100
100
Facilitative supervision undertaken during year revealed that most of the facilities had
quality assurance teams in place. In 2009, client satisfaction survey was conducted by
most hospitals. About 96% of clients indicated their satisfaction with services provided.
There is a need to revamp the quality assurance systems in all health facilities in the period
ahead.
11
Ownership of Health Facilities
Quasi-Govt, 8
Govt, 170
Private, 278
Mission, 71
OPD/CAPITA:
OPD Attendance Per Capita
0.9
0.8
0.8
0.7
0.6
Per Capita
0.6
0.5
0.4
0.4
0.3
0.2
0.1
0
2008
2009
2010 Half-Year
Year
12
OPD ATTENDANCE
Generally, OPD attendance has increased over the years. Districts with mission institutions
in the region contributed almost 60% of total OPD attendance See table 2.2 below.
FIGURE 2.1 OPD Attendance, 2008 – 2010 Half Year
OPD Attendance
Year
Out-Patients Visits
2010 Half-Year
2,046,993
2009
3,962,986
2008
3,140,880
MORBIDITY PATTERN
Table 2.3 shows the regional top 10 leading causes of OPD attendance for the past three
years. Malaria continues to be the leading cause of OPD attendance. Malaria alone
accounted for almost half (50%) of the total OPD attendance. Hypertension, URTI and
13
Rheumatism
have
also
featured
prominently
over
the
years.
Top Ten OPD Morbidity, 2008 - 2010
2008
No.
2010 Half Year
2009
CASES
DISEASE
CASES
DISEASE
1
Malaria
814,998
2
Cough (IMCI)
119,490
3
Hypertension
4
CASES
DISEASE
1,449,260
80,429
Malaria
Acute Respiratory
Inf.
Hypertension
Malaria
797,629
259,701
Acute Respiratory Inf.
148,366
125,453
Hypertension
66,098
Skin Disease
70,694
Diarrhoeal Disease
123,107
Diarrhoeal Disease
65,858
5
Diarrhoeal
Disease
57,252
Skin Disease
115,212
Skin Disease
62,839
6
Rheumatic
Conditions
42,617
Rheumatic Conditions
94,531
Rheumatic Conditions
51,229
7
Urinary Tract Inf.
33,900
Urinary Tract Infection
58,324
Intestinal Worms
34,102
8
Intestinal Worms
28,258
Intestinal Worms
54,719
Urinary Tract Infection
32,300
9
Home/Occup
Injuries
26,363
Acute Eye Infection
49,509
Acute Eye Infection
26,619
10
Chicken Pox
22,552
Home/Occup Injuries
43,820
Anaemia
21,574
Hypertension & Diabetes Mellitus cases Reported by District
2008 – 2010 Half Year (a)
District
2008
2009
2010
Half Year
Hyp’sion
Diabetes
Hyp’sion
Diabetes
Hyp’sion
Diabetes
38,388
6,118
36,605
8,200
15,721
3,677
2,092
559
2,855
899
7,581
4,101
20,614
5,310
26,750
6,087
7,121
1,691
Atwima Nwabiagya
3,363
930
7,555
2,217
4,564
448
Ejisu Juaben
3,588
581
5,304
1,247
4,101
1,144
Sekyere South
2,940
661
5,025
1,152
3,988
1,156
588
688
1,073
130
3,475
887
Sekyere East
3,672
960
4,389
920
2,734
465
Sekyere Afram Plains
2,339
467
4,728
587
2,221
227
Kumasi
Asante Akim North
Obuasi
Mampong Municipal
14
Hypertension & Diabetes Mellitus cases Reported by District
2008 – 2010 Half Year (b)
District
2008
2009
2010
Half Year
Hyp’sion
Diabetes
Hyp’sion
Diabetes
Hyp’sion
Diabetes
Adansi South
2,241
237
3,000
292
2,042
277
Afigya Kwabre
3,343
836
3,005
592
1,945
330
Mampong Municipal
2,003
688
2,210
899
1,540
571
Ejura Sekyedumase
1,320
234
1,181
65
951
46
Bekwai Municipal
3,315
600
2,759
422
903
216
Adansi North
1,380
189
1,818
152
898
86
0
0
1,678
111
801
60
Ahafo Ano South
1,257
326
1,081
258
752
177
Kwabre
1,159
60
1,711
99
671
62
Sekyere Central
Hypertension & Diabetes Mellitus cases Reported by District 2008 –
2010 Half Year (c)
District
2008
2009
2010
Half Year
Hyp’sion
Diabetes
Hyp’sion
Diabetes
Hyp’sion
Diabetes
Atwima Kwanwoma
1,431
62
1,794
40
618
11
Asante Akim South
2,348
660
5,015
1,214
594
62
Offinso Municipal
1,490
123
1,402
126
548
32
Amansie central
765
135
768
182
479
58
Bosome Freho
265
1
572
38
459
0
Amansie West
237
40
550
98
383
53
Offinso North
799
49
582
66
376
64
Ahafo Ano North
1,116
452
1,420
418
361
96
Atwima Mponua
261
21
216
62
136
23
15
Hypertension & Diabetes Mellitus cases Reported 2008 – 2010 Half Year
4.5
4
3.5
% of OPD Morbidity
3
2.5
2
1.5
1
0.5
0
2008
2009
Hy'sion
3.21
3.91
2010 Half Year
4.1
Diabe
0.64
0.83
0.99
Year
Hospital Admissions
• Total Admissions 2008
107,743
2009
162,591
2010 Half Year
86,173
• Hospital Admission Rate is 1.71 per 100 population
as against 3.33 per 100 in 2009
• Bed Occupancy (Target
2010
2009
2008
= 80%)
=
56.7%
=
59.4%
=
37.4%
15
16
Inpatients:
Hospital Admissions have been increasing over the years, but the half year apperas to be
just marginally high. The Average bed occupancy rate also appears to be marginally similar
to the figure in 2009.
TABLE 2.4 Hospital Admission
Causes of Admission
Malaria, Diarrhoea, Hypertension, Aneamia, Gastritis, Asthma, Pneumonia, Abortion, Hernia
and Enteric fever were the ten top causes of admissions in the year under review. Malaria
was the highest among the ten leading causes of admissions accounting for over
30.1%.See table 2.5 below.
TABLE 2.5
Top 10 Causes of Admissions, 2008 – 2010 Half Year
Top 10 Causes of Admissions, 2008 - 2010
2008
2010 Half Year
2009
No.
DISEASE
CASES
1
Malaria
2
Diarrhoea
815
Diarrhoea
3,203
Diarrhoea
1,635
3
Anaemia
663
Anaemia
2,148
Anaemia
1,075
4
Hypertension
503
Hypertension
1,535
Hypertension
831
5
Pneumonia
308
Enteric
Fev./Typhoid
994
Enteric
Fev./Typhoid
576
6
Hernia Inguinal
303
Hernia
Inguinal
911
Hernia
Inguinal
564
7
Asthma
277
Pneumonia
709
Gastritis
373
8
Gastritis
272
Gastritis
691
Asthma
345
9
Enteric
Fev./Typhoid
244
Abortion
683
Pneumonia
333
10
Single Spont Del.
183
Asthma
643
8,914
DISEASE
Malaria
CASES
29,486
DISEASE
Malaria
Abortion
CASES
16,362
325
16
17
Causes of Death
The mortality profile shows Malaria, Anaemia, Hypertension, Pneumonia, Septicaemia,
Diarrhoea, HIV/AIDS, Diabetes, Bronchopneumonia and CVA as the ten leading causes of
deaths with Malaria accounting for over 30% cases. See table 2.6 below.
TABLE2.6
Top 10 Causes of Death, 2008 – 2010 Half Year
Top Ten Causes of Death, 2008-2010
No.
Diseases
2008
Diseases
2009
Malaria
2010
Half
Year
1
Malaria
67
Malaria
2
Anaemia
22
Anaemia
83
Anaemia
36
3
Hypertension
21
Hypertension
50
Diarrhoea Dis.
25
4
Diarrhoea
16
Septicemia
35
HIV/AIDS
22
5
Pneumonia
13
Pneumonia
34
Hypertension
20
6
HIV/AIDS
12
HIV/AIDS
34
Pneumonia
17
7
Diabetes Mellitus
9
Diarrhoea Dis.
33
C V A
16
8
Bronchopneumonia
7
Diabetes Mellitus
26
Diabetes Mellitus
12
9
C V A
5
Bronchopneumonia
25
Septicemia
Typhoid Fever
4
C V A
20
Cardiac Failure
10
226
Diseases
126
8
6
17
18
National Health Insurance Scheme
TABLE 2.7 NHIS – Utilization
NHIS - Utilization
80
70
60
50
40
30
20
10
0
Out-Pat
In-pat
% Insured
% Non-Insured % Insured
% Non-Insured % Insured
% Non-Insured
2008
2008
2009
2009
2010 Half Year 2010 Half Year
61.34
38.66
69.58
30.42
75.92
24.08
57.2
42.8
68.46
31.54
70.78
29.22
Rational Use of Medicine
Indicator
2008
2009
2010
Ashanti
WHO
Av No. of Medicine Pres
4.2
4.2
3.8
4.0
2.0
% Generic
88.0
67.8
77.3
95.0
100.0
% Antibiotic
41.8
43.0
46.0
35.0
26.0
% Injection
36.0
18.9
22.0
35.0
20.0
% EDL
100.0
87.5
85.0
100.0
100.0
% Diagnosis
100.0
100.0
100.0
100.0
100.0
19
Drug Availability
2.1.2 Promote and facilitate physiotherapy services
Currently only KATH and Mampong hospital provide physiotherapy services in the region.
Mampong Municipal Hospital in the course of the year received and treated the following
types and number of case: Arthritis, CVA, Painful shoulder, Injection neuritis/paralysis and
Low back pain.
2.1.3 Promote and facilitate Prosthetics and Orthotics Services
Clients are referred to KATH for such services.
2.1.4 Improve early detection, reporting and management of communicable
diseases
The Region organized various health talks on TB/HIV at the local FM station, which aimed
at educating the public on signs and symptoms of the diseases, as well as their preventive
measures, Know your status campaign was also highlighted. 270 newly qualified Health
staff and laboratory technicians were trained on TB management care and control. Durbar
on awareness creation to increase case detection was also organized during the World TB
Day celebration. There were health talks at the local information centres to create
awareness on TB disease and the need for early reporting .Over 2000 cases were detected
over the period. See figure 2.3
20
Case search on some selected communicable diseases like AFP, Buruli Ulcer, Guinea worm,
Leprosy and Yaws was conducted by CBSVs in all the communities in the district to enable
them detect early and report suspected conditions to health facilities for management.
The key activities carried out included:
•
Sensitization of districts on IDSR
•
Distribution of IDSR materials such as Fact Sheets, Reporting forms and Sample
Collection kits
•
Specimen collection and transportation to the appropriate destination
•
Feedback and Reports to the districts
•
Two Press Conferences on H1N1 and Guinea Worm
•
Regional Technical Committee Meeting involving KNUST, KATH and MRS.
Timeliness and Completeness reporting (CD1)
Year
%Timely (> 80)
% Complete (>90)
2008
94.4
100
2009
93
98.7
2010
89.3 (Half Year)
100
Timeliness and Completeness reporting (CD2)
Year
Reports
No.
Timely No.
Lately %
Timely
Expected
Received
Received
Received
2008
324
138
186
42.6
2009
324
228
96
70.3
2010
324
109
53
33.6 (Half Year)
21
FIGURE 2.3
Specimen Results
Disease
Specimen
2008
2009
No. Positive
2010
2008
2009
2010
Measles
219
103
76
11
4
1
Meningitis
92
21
137
83
0
3
YF
28
46
47
0
0
0
AFP
28
48
29
0
0
0
Cholera
0
11
4
0
0
0
22
Positive Cases
Case
District Detected
Measles
Ahafo Ano North
Meningitis
Atwima Nwabiagya (type c)
Kumasi – KATH (type w135)
Sekyere East (type c)
GUINEA WORM PROGRAMME
– About 1000 health and non-­‐health staff(CBS) through training
– Communities sensitized through durbars, community meeting, etc
– Case search in two districts, Sekyere Central and Sekyere Afram Plains
– Distribution of GW materials such as registers, reporting forms, posters, etc to districts
Districts reporting Guinea Worm Cases
District
No. of cases
Amansie West
5
Asante Akim South
1
Atwima Nwabiagya
1
Ejura Sekyedumase
1
Sekyere Afram Plains
1
Total
9
23
Diseases Earmarked for Eradication and Elimination
BURULI ULCER;
Cases of ulcer have reduced from over 350 in 2008 to below 200 in 2009.Seee figure 2.4
below
FIGURE 2.4
Trend of Buruli Ulcer cases, 2008 - 2010
Year
New
Recurrent
Clinical Forms
Nodules
Ulcer
Others
2008
235
24
36
164
0
2009
177
15
22
129
46
2010 Half Year
251
5
72
180
47
Trend of BU cases in Ashanti region, 2008-­‐2010
300
250
251
238
200
177
new
recurrent
150
100
50
24
15
5
0
2008
2009
2010
24
Onchocerciasis
About 400,000 people at risk. Two hyperendemic districts, Offinso North and Asante Akim
South carried out CDTI activity with coverage of 81% and 79.3% respectively
TRENDS ON ONCHO(CDTI), 2008-­‐2010
YEAR
COVERAGE(%)
2008
74.4
2009
74.5
2010
N/A
REMARKS
Two Hyper endemic districts were dosed in January. All endemic districts will be dosed in December 2010
Leprosy Cases:
The region registered some few new cases in the year. See figure 2.5 below:
Trends on Leprosy cases 2008 - 2010
Year
No. of cases
2008
44
2009
50
2010(HY)
26
25
H1N1 VACCINATION BY DISTRICTS
No
District
1 ADANSI NORTH
2 ADANSI SOUTH
3 AFIGYA KWABRE
4 AHAFO ANO NORTH
5 AHAFO ANO SOUTH
6 AMANSIE CENTRAL
7 AMANSIE WEST
8 ASANTE AKIM NORTH
9 ASANTE AKIM SOUTH
10 MAMPONG MUNICIPAL
11 ATWIMA MPONUA
12 ATWIMA NWABIAGYA
13 ATWIMA KWANWOMA
14 BEKWAI MUNICIPAL
15 BOSOME FREHO
COVERAGE
67.4
66.6
56.4
65.5
49.9
70.3
56.3
50.9
22.3
42.7
46.1
68.2
52.9
56.5
69.3
WASTAGE
2.5
1.8
18.4
5.1
15.0
1.3
5.3
7.5
9.7
5.6
2.6
1.3
32.3
0.2
1.4
AEFI
0
7
0
6
0
0
2
2
0
2
0
0
0
5
0
H1N1 VACCINATION BY DISTRICTS
No
District
17 EJISU JUABEN
18 EJURA SEKYEREDUMASI
19 MANHYIA SOUTH
20 ASOKWA
21 BANTAMA
22 MANHYIA NORTH
23 SUBIN
24 KWABRE
25 OBUASI MUNICIPAL
26 OFFINSO MUNICIPAL
27 OFFINSO NORTH
28 SEKYERE AFRAM PLAINS
29 SEKYERE CENTRAL
30 SEKYERE EAST
31 SEKYERE SOUTH
TOTAL
COVERAGE
36.4
25.3
32.8
16.3
61.0
64.9
279.2
59.5
61.8
61.1
36.7
51.3
53.2
66.2
65.5
58.5
WASTAGE
0.7
9.2
0.3
0.9
0.3
0.5
0.3
0.9
6.2
6.7
8.5
0.5
21.4
5.4
0.5
4.4
AEFI
0
0
0
2
2
0
0
0
0
0
0
0
3
0
0
31
26
YAWS FIGURE 2.6
27
OTHER ENDEMIC DISEASES:
TUBERCULOSIS
TB Case Detection
Indicator
2007
2008
2009 2010 Half
Regional Population
4,565,683
Expected # of Cases
12,830
9,583
9,910
10,219
2,011
2,101
2,106
1,101
16
22
21
11
1,181
1,269
1251
626
627
635
629
341
Relapses
71
70
74
42
Other RTR
28
58
37
21
104
69
74
43
0
0
41
28
Total Cases Detected
Case Detection Rate
New Smear Positives
New Smear Negatives
Extra Pulmonary
Others
4,720,916 4,881,738
Tuberculosis Surveillance Unit
5,033,938
28
TB TREATMENT OUTCOME
Indicator
2006
2007
2008
2009 HY1
Smear Positives
1,283
1,181
1269
650
1,033 (81%) 965 (82%) 1033 (81%)
504(78%)
Cured
Completed
Treatment Success Rate
Died
Failed
Default
Transferred Out
69
99
113
78
86%
90%
90%
90%
86 (7%)
83 (7%)
80 (6%)
42(6.5%)
8
6
9
4
49 (4%)
14 (1%)
24 (2%)
10(1.5%)
38
14
10
12
Tuberculosis Surveillance Unit
TB/HIV (2008-­‐2010 HY)
Indicator
2008
2009
2010HY1
New Patients Diagnosed
2101
2106
1101
# Counseled
1493
1616
900
# Patients Tested for HIV
1305
1437
775
# of Patients HIV Positive
293
314
159
# Starting CPT
159
128
99
# Registered at HIV Clinic
112
171
77
# on ART
52
37
70
Tuberculosis Surveillance Unit
29
HIV/AIDS:
The table 2.10 below shows CT trend analysis of HIV/AIDS activities carried out in the Haly
Year 2010. See table below:
CT Trend Analysis,2008-2010HY
Indicators
2008
2009
2010HY
# Pretest
Counseled
16949
24794
8706
# Tested
16530
23631
8278
# Receiving
Positive Test
Results
2485
3718
2182
# Receiving
Posttest
Counselling
16530
23631
8278
PMTCT-Trend Analysis(2008-2010)
Indicators
Jan - Dec 08
Jan - Dec 09
Jan - Jun 10
# of ANC Registrants
78782
69919
42801
# Tested
62996
54031
33308
% Tested
80%
77%
90%
# Positive
1275
1141
850
# Given ARVs
1037
845
222
% Given ARVs
81%
74%
26%
30
MALARIA CASES:
Malaria control activities carried out in the year under review included training of health
staff on management of uncomplicated and complicated malaria as well as Malaria in
Pregnancy (MIP).
The policy on malaria is now on definitive diagnosis especially in persons above 5 years. As
a result Rapid Diagnostic Test (RDT) kits were provided to aid in diagnosis especially in
health facilities without microscopy.
Chemical sellers were also trained on home based care which included recognising
symptoms of malaria and knowing when to refer. There were also radio discussions on the
use of ITNs and recognising symptoms of malaria throughout the region.
With the support of Ghana Sustainable Change Project (GSCP), CBSVs, some districts were
able to train community leaders and religious leaders in communication skills to educate
community members on malaria, breastfeeding and on complementary feeding. The Figure
2.7 below shows 3-year trend of malaria cases recorded at Outpatient departments
throughout the region.
31
Total Malaria(2008-­‐2010HY)
1000000
900000
858822
923521
800000
700000
600000
2008
2009
2010
500000
400000
301019
300000
200000
100000
0
CASES
Total Malaria admissions(2008-­‐2010HY)
35000
33649
33706
30000
25000
20000
15000
12143
10000
2008
2009
2010
5000
0
ADMISSIONS
32
Total Malaria deaths(2008-­‐2010HY)
179
180
160
140
120
100
80
60
40
66
2008
2009
2010
28
20
0
DEATHS
<5yrs Malaria Admissions(2008-­‐2010HY)
14000
12000
13348
12114
10000
8000
6000
4778
4000
2008
2009
2010
2000
0
ADMISSIONS
33
<5yrs Malaria CFR(2008-­‐2010HY) 0.058
0.06
0.05
0.042
0.045
0.04
2008
2009
2010
0.03
0.02
0.01
0
%CFR
IPT Trend(2008-­‐2010HY)
90000
80000
70000
60000
50000
40000
30000
2008
2009
2010
20000
10000
0
IPT1
IPT2
IPT3
34
2.1.5 Strengthen disease surveillance, emergency preparedness and response
Surveillance activities were carried out at the various levels throughout the region.
Community Health Officers and community based surveillance volunteers played an active
role in disease surveillance activities in the districts
All CBSVs and health personnel were sensitized on the preparedness, such as CSM, HINI
and Measles and others. Clinician sensitization and records review were conducted on a
regular basis at the various health facilities. See table 2.11 below.
All suspected measles, tuberculosis and acute-flaccid paralysis cases were investigated.
Some blood samples and stool samples were sent to the Public Health Reference
Laboratory and Noguchi Memorial Laboratory for investigations respectively.
All Districts have been sensitized on the preparation of Epidemic Preparedness and
Response plans and the formation of District Epidemic Management Committees and
Response teams.
H1N1 Situation
Cases of H1N1 are being reported in the Region since the first cases in August 2009. By
28th July, there had been 110 suspected cases with 47 being confirmed positive. The main
reporting facilities are KATH, Kumasi South Hospital, MRS, St Michael’s and KNUST
Hospital. Kumasi South Hospital and MRS are the regional designated Influenza Sentinel
Sites.
Two outbeaks have been reported in Asante Akim South and Bosome Freho districts and
these were in schools.
The region has substantial stocks of Tamiflu, but the challenge is the limited supply of Viral
Transport Media for collecting specimen.
Currently the region is free of sporadic cases though there is intensive surveillance on all
Influenza Like Illnesses.
35
LABORATORY SURVEILLANCE
CSM Surveillance
2006
2007
2008
2009
2010 HY1
# Tested
8
13
33
21
37
N. meningitidis A
2
1
7
0
0
S. pneumoniae
3
5
10
0
2
H. influenzae b
0
0
0
0
0
N. meningitidis C
0
0
0
0
1
Zonal Public Health Laboratory, Kumasi
Cholera Surveillance
# Tested
V/c Ogawa
V/c Inaba
2006
2007
2008
2009
2010 HY1
176
20
6
20
11
54
0
0
0
0
0
0
0
0
0
Zonal Public Health Laboratory, Kumasi
2.16. IMPROVE EARLY DETECTION, REPORTING AND MANAGEMENT OF NONCOMMUNICABLE DISEASES
Non-communicable diseases such as diabetes, hypertension, stroke, cancer that were
earlier attributed to developed countries are now becoming major causes of mortality,
morbidity and disability in Ghana.
36
THE UNDERLINING DETERMINANTS INCLUDE
•
High consumption of alcohol and nutritionally deficient food that are also high in fat,
sugar, and salt
•
Reduced levels of physical activity at home, at school and at work
•
Obesity and
•
Lack of rest and recreation
During the year under review diet related diseases clinic were set up in selected health
facilities to manage reported cases and to give counseling, Health and Nutrition talk to
clients visiting these facilities. In all 6,244 clients were seen and of these 3651 were
hypertensive, 1649 were diabetic, 682 had both conditions and 262 were obesed. After
analyzing their body mass index (BMI) 4140 females and 2004 males were seen.
Diet Related Diseases
DIET RELATED DISEASES - 2008- 2010
70
64.7
58.86
% No. of Cases
60
58.49
50
Diabetes
40
Hypertension
30
28.4
Diab-Hypertension
26.47
25.58
Obesity
20
10
10.34
4.1
0
2008
2.8
5.22
2009
10.92
4.2
1st Half 2010
YEAR
37
Year
Type of Disease
2007
2010 1ST
Half Yr
2008
No.
%
No.
%
No.
%
Diabetes
3357
28.40
3051
25.58
1649
26.47
Hypertension
7646
64.70
7022
58.86
3651
58.49
Diabetes-hypertension
486
4.10
1233
10.34
682
10.92
Obesity
316
2.80
623
5.22
262
4.20
Total
11805
11929
6244
2.1.7 Improve access to Quality Maternal, Newborn and Reproductive Health
Service
The vision of the reproductive and child health unit is to improve the health and quality of
life of persons in the reproductive age and beyond as well as children by providing high
quality reproductive and child health service.
Improving access to quality maternal, newborn and reproductive health service requires the
provision of focused Ante Natal Care (ANC), Supervised Delivery, Post Natal Care, Family
Planning Services, promotion of Exclusive Breastfeeding and Prevention of Mother to Child
Transmission (PMTCT) of HIV.
Antenatal Care
During ANC visits the Weight, Height, HB, Urine and Blood Pressure were checked by public
health unit of all facilities to detect any risks or complications associated with the
pregnancy.
The target set for ANC Registrants during the year was 90% while 83% representing a
decrease of 3.1% over the previous year. Operational research will be conducted in 2010 to
assess the reason for the downward trend. The table 2.14 below shows a three – year
(2007-2009) trend of the coverage and registrants.
38
ANC Coverage, 2008 – 2010 Half Year
Trend of ANC Coverage, 2008-­‐2010 half year
86.1
83
% COVERAGE
90
80
70
60
50
40
30
20
10
0
39.7
YEAR
2009
2008
2010
TREND IN LOW BIRTH WEIGHT
13.4
14
12
10.3
10
9.1
8
6
4
2
0
2008
2009
2010
39
% Caesarean section rate
12
10
9.6
10.6
8
8
6
4
2
0
2008
2009
2010
Trend in TT2+ coverage 2007-­‐2010
90
80
81.8
71.5
70
60
50
40
33
30
20
10
0
2008
2009
2010
40
Clients with 4+ visits
23
22.8
26.3
27.5
2009
2010
22.8
22.6
22.4
22.2
22
2008
% COVERAGE
SKILLED DELIVERY, 2008-­‐2010HY
50
45
40
35
30
25
20
15
10
5
0
49.4
47.5
20.5
2008
2009
YEAR
2010
41
Low Birth Weight and Still Birth
Year
LBW
Still Birth
Macerated
Fresh
Total
2008
9200
1080
777
1857
2009
11143
1341
631
1972
2010
3291
488
242
730
TREND IN STILL BIRTH
2.1
2.1
2.1
2.05
2
1.95
1.9
1.85
1.8
1.8
1.75
1.7
1.65
2008
2009
2010
FIGURE2.9
Supervised Delivery
This is done by skilled staff to ensure safe delivery of babies to reduce infant and maternal
mortality. However TBAs also conduct deliveries because there are not enough midwives.
Activities carried out include:
•
Midwives encouraged to use partograph to monitor progress of labour
42
•
Trained midwifery staff on resuscitation of the newborn.
•
Mothers were encouraged to practice exclusive breastfeeding after delivery for six
months and they were also given Vitamin A after delivery.
During the year a target of 60% was set .The region however achieved 49.4% which again
indicated a decrease of 5.9 % over the previous year. See the figure 2.10.
The low skilled delivery could be attributed to the low numbers of trained Midwives in the
facilities and in some cases the absence of Midwives in most of the rural clinics as a result
of diploma Midwives refusing posting to the rural areas.
Figure 2.10
Skilled Delivery, 2008 - 2010
% COVERAGE
SKILLED DELIVERY, 2008-­‐2010HY
50
45
40
35
30
25
20
15
10
5
0
49.4
47.5
20.5
2008
2009
YEAR
2010
43
TREND IN STILL BIRTH
2.1
2.1
2.1
2.05
2
1.95
1.9
1.85
1.8
1.8
1.75
1.7
1.65
2008
2009
2010
Assisted delivery/EOC 2010
8
8
7
6
5
4
3
2
0.6
1
0
caesarian
vacuum
0
forceps
44
Post natal coverage 2008-­‐2010
60
51.6
50
47.8
40
30
18.6
20
10
0
2008
2009
2010
Trend in FP acceptor rate
20
18
16
14
12
10
8
6
4
2
0
15.7
2008
17.5
7.4
2009
2010
45
Post Natal Care
This service has to do with a follow up care of both mother and baby to assess the mother
and baby’s health in order to detect any complications early and manage them promptly.
Mothers were sensitized to report within the 1st 48hrs. The coverage for the half year is
very low compared to 2008 and 2009. Efforts would be made to address this shortage. The
RHD as part of the LDP project assessed “Pregnant women’s perefection of Maternal Health
Services” in the region and the findings and recommendations would be implemented for
improvement in health care quality.
Post natal coverage 2008-­‐2010
60
50
51.6
47.8
40
30
18.6
20
10
0
2008
2009
2010
46
% Caesarean section rate
12
10
9.6
10.6
8
8
6
4
2
0
2008
2009
2010
FAMILY PLANNING
Family planning services are carried out to prevent unwanted pregnancies and help in the
reduction of maternal deaths. The acceptor rate for the previous year was quite low and as
part of measures to improve the rate, durbars were held in a number of districts e.g.
Kumasi Metro, Ahafo Ano South, Atwima Kwanwoma and Bosomtwe.
In Kumasi Metro, satisfied trained with support from Engender Health were used to give
testimonies about various methods.
To scale up the use of Jadelle, some districts namely Bosomtwe, Ahafo Ano South, Amansie
West and Atwima Kwanwoma in collaboration with the Metro Director of Health Services
trained a number of service providers in Jadelle insertion.
collaboration with Marie Stoppes International.
There was also close
There is an increasing demand for the
Jadelle. However the acceptor rate apperas to be low at 7.4% compared with 2009 figure
of 17.5%.
However there has being a steady increase in the number of males accompanying their
spouses to access reproductive and child health services.
47
MATERNAL DEATHS
Maternal deaths recorded for the half year is 67 which compare favourably with 177 and
222 in 2009 and 2008 respectively.This represents a significant reduction of maternal
deaths in the region. The regional maternal committee was re activated though it met only
once for the half year. A region wide sensitization of Safe Motherhood protocol has been
undertaken and this would enable practitioners handle emergency situations.
Reported Maternal Mortality 2008 – 2010
Institution
Death
G H S Institutions
18
KATH
49
Total
67
Maternal Deaths – 1st Half Year
Institution
Death
G H S Institutions
18
KATH
49
Total
67
No. Audited
56
Not Audited
11
% Audited
83.6
48
CHILD HEALTH
Child Welfare Average Visits
CWC PARAMETERS
Children 0- 23 months
Year
Total Registrants
W/A <80%
Target Population
% Coverage
% Malnourished
2008
2009
1st Half Year
2010
299693
319642
205914
7837
5432
3716
372952
384606
398065
80.4
83.1
51.7
2.6
1.7
1.8
CWC PARAMETERS
Children 24- 59months
Year
Total Registrants
W/A <80%
Total Population
% Coverage
% Malnourished
2008
2009
1st Half Year
2010
96607
108810
75969
2540
2111
1642
405999
418683
433336
23.8
26.0
17.5
2.6
1.9
2.2
49
BFP PARAMETERS
2008
2009
1st Half Year
2010
Expected
delivery
188837
194736
201552
B.F < 1hr
41332
62386
31237
% Initiation
40
67.94
74.96
% M. Vitamin A
43
45.80
41.1
Year
50
BREASTFEEDING PROMOTION
Year
Total facilities
Designated
% BF
•
2008
2009
1st Half Year
2010
313 ( mat)
313 ( mat )
313 ( mat )
Nil
Nil
28
0
0
0
Twenty-eight (28) facilities awaiting assessment since
2004 have now been designated.
51
52
Iodated Salt Programme
Market & Household Survey
Year
2008
1st Half Year
2010
2009
May
Nov.
May
Nov.
May
% Availability
72.1
66.4
62.3
76.8
77.2
% Use
66.8
70.5
59.9
75.1
77.6
Target
90%
90%
90%
90%
90%
Nov.
90%
Promote the survival growth and development of all children
To ensure the survival and growth of children in the region, many activities including
exclusive breastfeeding for the first six months of life, complementary feeding, Vitamin A
supplementation, child welfare services, nutrition, and integrated management of child
hood illness were some of the key activities undertaken during the year.
53
Growth Monitoring & Promotion 0 - 23months
Year
Total Registrants
W/A <80%
Total Population
% Coverage
% Malnourished
2008
299693
7837
372952
80.4
2.6
2009
319642
5432
384606
83.1
1.7
2010 1ST Half Yr
205914
3716
398065
51.7
1.8
Growth Monitoring & Promotion 24 - 59months
96607
2009
108810
2010 1ST Half Yr
75969
2540
2111
1642
405999
418683
433336
% Coverage
23.8
26.0
17.5
% Malnourished
2.6
1.9
2.2
Year
2008
Total Registrants
W/A <80%
Total Population
Growth Monitoring & Promotion 0 - 59months
Year
Total Registrants
2008
396300
2009
428452
2010 1ST Half Yr
281883
W/A <80%
11282
7543
5358
Total Population
778951
803289
831401
% Coverage
50.9
53.3
33.9
% Malnourished
2.8
1.8
1.9
CWC % Malnourished & % Coverage for
children 0-59months
% Mal. & % Cov.
60
53.3
50.9
50
40
33.9
30
% Malnourished
% Coverage
20
10
2.8
1.8
1.9
0
2008
2009
1st Half 2010
Year
54
Mother Support Groups were established in communities to support breastfeeding activities
as well complementary feeding.
No.
District
1.
2.
No. of Mother
Support Groups
2
3
Offinso North
Amansie West
Communities where groups
are established
Nkenkaaso & Akomadan
Manso Kwanta, Antoakrom &
Agroyesum
Sale and promotion of the use of iodated salt was also carried out in majority of the
communities in the districts, in addition to surveys carried out in market areas, households,
institutions, restaurants and chop bars to assertain the status of the districts.
Iodated Salt Survey (Market & Household)
Year
2008
2010 1ST Half Yr
2009
Months
May
Nov.
May
Nov.
May
% Availability
72.1
66.4
62.3
76.8
77.2
% Usage
66.8
70.5
59.9
75.1
77.6
Target
90%
90%
90%
90%
90%
Nov.
90%
Iodated Salt Survey-May & Nov/Dec (Food Vendors, Chop Bars & Rest. &
Institution)
Year
No. collected,
Tested & %
Passed
Months
2008
No. Tested
Food Vendors
M
104
8
N
123
5
Institutions
Chop Bars &
Restaurants
86
111
5
158
129
2
% Passed
M
74.
5
81.
4
73.
5
2010 1ST Half Yr
2009
N
63.9
81.6
71.6
No.
Tested
M
N
13
32 1621
26
2
174
16
59 1574
% Passed
M
72.
5
80.
9
69.
6
N
76.3
83.9
69.3
No.
Tested
M
160
0
249
172
6
N
% Passed
M
72.
8
81.
9
79.
1
N
55
Lactation Management workshops were also organized in some district at selected facilities
for all staff to make the facilities baby friendly.
District
No.
Facility Trained
Trained
Offinso
North
Amansie
West
1
2
Category of
Resource
Staff & No.
Person
trained
Reg. & Dist.
Nkenkaasu Government
Nut. Off,
Hospital
All the Staff in
the facility
totaling 86
Midwife I/C
people
Reg. & Dist.
All the Staff in
St. Martin Hospital Agroyesum
Nut. Off,
the facility
& Antoa Health Centre
DCO, Midwife
totaling 76
I/C
people
All trained facilities were assessed by the National assessors for designation. On the 27TH of
July 2010, twenty-eight trained facilities in lactation management in Ashanti Region were
designated as Baby Friendly at Prempeh Hall in Kumasi.
Maternal Vitamin A Supplementation was carried out in all delivery facilities to boost the
Vitamin A levels in breast milk especially for postnatal mothers within eight (8) weeks of
postpartum. This would cater for the vitamin A needs of children 0-5 months of age who
are being exclusively breastfed.
Maternal Vitamin A
2008
2009
2010 1ST Half Yr
Expected Delivery
188837
194736
201552
BF<1HR
41332
62386
31237
% Initiation
40
67.94
74.96
% Mat. Vit. A
43
45.80
41.1
Year
56
Two rounds of Vitamin A supplementation was carried out for children 6-59 months of age
during the National Immunization days to boost the vitamin A levels in their bodies and also
to fight against infection. Children under 2 years of age were also given dewormers as a
measure to prevent anaemia.
Vitamin A supplementation (6-59mths)
Year
2008
Month
May
Target
Nov.
May
822183
Children Dosed
% Coverage
2010 1ST Half Yr
2009
Nov.
Apr
May
(NID)
(CHPW)
843726
865269
175655
833968
68628
759353
832389
10339
21.4
101.4
8.1
90
96.2
1.19
PROMOTE THE REDUCTION OF MALNUTRITION
A PUBLIC HEALTH AND DEVELOPMENTAL PROBLEM
During the year under review existing Rehabilitation centres in the Region were strengthen
to carry out their activities. Those that were dormant were reactivated to rehabilitate
malnourished cases seen in the community, With support from UNICEF, a workshop
organized for front line providers on the use of ready to use therapeutic foods, equipped
health officers with the technical know how on the preparation of the feed using locally
available ingredients.
57
Year
2008
2010 1ST Half
2009
Yr
Total No. of Cases seen
7651
4347
2135
Kwashiorkor
642
484
273
Marasmus
4780
2598
1308
Kwash-Marasmus
354
396
235
Anemia
1875
869
319
Rehabilitation Rate
34.0
62.7
74.9
Case Fatality Rate
0.41
0.60
0.80
Nutrition surveillance was also carried out in selected day care centres to determine the
nutritional status of the children. Nutrition and health talks on Breastfeeding, importance
of good weaning practices among others were given to mothers and caregivers so they
could take good care of these children in terms of their Nutritional needs.
% Underweight, Stunting & Wasting
NUTRITION SURVEILLANCE
14
13.1
11.5
12
10
9.7
8
8.1
9.5
% Underweight
% Stunting
6
% Wasting
5.2
4
2
0
11.8
2008
7
11
2009
1st Half 2010
YEAR
The Regional Health Directorate in collaboration with the District Health Management
Teams supported the school feeding programme at all levels. Several workshops were
organized for caterers and other stakeholders in charge of the feeding programme on menu
preparation, basic Nutrition etc.
58
The National Commission on children organized several seminars and workshops on early
childhood Development for all stakeholders of which the Ghana Health Service and the
Department of social welfare were part. The programme sought to improve upon the skills
and performance of day care attendance at day care centres. Food demonstrations were
organized in Kumasi, Sekyere East, Ejura Sekyereduamse and Asante Akim North with the
support of world vision International to show case the various balanced diets that can be
fed to children to improve upon their nutritional status. Resource persons included District
Nutrition officer and DHMT members. Topics treated included the three food groups, how
to combine them and the need to give fruits and vegetables.
IMMUNIZATION COVERAGE:
Routine immunization and NID’S were intensified in the half year of 2010 in all Districts
with supervision from the Regional Health Directorate. Some of the activities included
House to house immunization, defaulter tracing and mop-up.
EPI Activities Half Year 2010
§
Routine Immunization
§
Two (2) Rounds of NID
§
H1N1 Vaccination
There has been appreciable increase in EPI coverage in all the antigens. The main
improvement was from Kumasi Metro where various strategies were implemented to boost
the coverage.
On other hand the BCG/Measles drop out is way above the accepted value of 10%.
However the NIDs carried out throughout the year were successful and this goes on to
ensure the region’s fruitful fight towards Polio eradication.
59
BCG PERFORMANCE BY DISTRICTS
BCG PERFORMANCE BY DISTRICTS
60
Penta 3 Performance by Districts
Penta 3 Performance by Districts
61
Measles Performance by District
Measles Performance by District
62
NIDS
NIDS
Target Population
Total Vaccinated
Coverage
ROUND 1
950,190
1,000,927
105.3%
ROUND 2
950190
977,507
102.9
Children missed between March and April NIDS - 23,420
2.2.0 Improve access and quality of oral health services
Improving access and quality of oral health services is one of the major key activities of the
clinical care services. However, except KATH, Kumasi South and Suntreso Hospital there is
no such facility in most of the District Hospitals.
During the year under review Kumasi South and Suntreso Hospitals treated 2034 and over
9,140 dental patient’s respectfully. The type of cases recorded was: Periodontal diseases,
Apical trauma, Impacted teeth, Oral tumours and Gingival and tongue ties
2.2.1 Improve access and quality of eye care services
Reduction of blindness and low vision is generally the main objective of the eye service .
During the year under review the eye care centre of the Regional Hospital screened and
treated various types of eye conditions. See table 2.20 below.
63
CHAPTER THREE
3.0 Strategic Objective 3- General Health System Strengthening
3.1.1 Develop and use information technology to improve information
management and service delivery
The Region has an ICT Unit. The key role was to supervise and prompt repair of ICT
equipment as and when they broke down. During the year Unit installed and configured 10
new ICT equipments brought to the Regional Health Directorate including the installation of
anti virus software for the districts who had procured some computers.
The use of the District Health Information Management System (DHIMS) software to
process and analyze health service data has improved access to timely and accurate
information. It has enhanced planning, management and evidence-based decision making
at all levels of health service delivery. All the 27 districts were trained and are currently
using the DHIMS in managing their data. The data submission rate as at the time of
collating this report had increased.
The National Health Insurance Authority has also provided health facilities within the
Region with a computerized networked clients’ registration system.
Most ofl the districts are currently connected to the World Wide Web internet system and
have greatly enhanced information management and accessibility.
3.1.2 Improve human resource recruitment, deployment and retention and
management
As part of measures put in place by the health sector, quota systems of staff distribution
were given to Regions for the engagement of clinicians and other Technical Staff based on
the needs of Regions and the availability of the professionals.
Based on that directive the region conducted formal placement interviews together with
CHAG officials for the recruitment some key staffs.
In the case of the Doctors those who completed the placement forms wanted to work in
CHAG facilities even though there were vacancies in the GHS quota whereas the CHAG
quota had been exceeded. The Region formally expressed concern about this situation to
the national level.
64
A posting committee was set up to review and submit recommendations to the Regional
Director, all request for study leave.
HUMAN RESOURCE SITUATION
The total regional staff strength in 2009 was 4952 as against 4192 in 2008. See Table 3.1
below.
Manpower Situation
Total staff
Retired
Death
June 2009
June 2010
4, 386
4,748
23
21
9
5
Resignation
3
Vacation of Post
3
65
Retirement 1st Half Year 2010
Staff Category
No
District
Nurse
2
Kumasi , Mampong
Midwives
5
Ejisu, Bekwai (2), Kumasi, Mampong
Accountant
2
RHD, Ahafo Ano North
Dispensing Assistant
1
Asante Akim South
Orderly
1
Amansie West
Security
3
Kumasi, Atwima Nwabiagya (2)
Medical Assistant
2
Atwima Mponua. Amanise West
Technical Officer
2
Ahafo Ano North, Ejura Sekyedumase
Storekeeper
1
Adansi South
Health Assistant
1
Offinso Municipal
Driver
1
Kumasi
Total
21
Appointment and Placement of Newly Qualified Health Professionals – Ashanti Region 2010
Category
Regional
Quota
150
Total No of
Applicants
486
No Selected
6
5
4
5
7
5
Staff Nurse
Staff Nurses ( Mental)
90
9
188
21
92
9
Staff Midwives
Technical Officer (HI)
20
3
62
13
22
5
Technical Officer (CH)
5
6
5
13
29
13
9
160
12
530
6
178
Community Health Nurses
Diploma Community Health
Nurse
Medical Assistant
Field Technician
Medical Officer
Health Assistant Clinical
159
CHALLENGES
The constraints the Region faced in the management of Human Resource included the
following:
1. Inadequate clinicians (Doctors, Medical Assistants and Midwives)
2. Large number of staff applying for study leave
66
3. Large number of “Casual” appointees in facilities.
4. Ageing work force (Midwives especially)
5. Increasing numbers of staff with intention to pursue higher education
3.1.3 Expand infrastructure to support effective and efficient service delivery at
all levels
In spite of being the Region with the largest population in the Country, Ashanti has not had
a befitting Regional Hospital. The Kumasi South Urban Health Centre has for some time
being referred to as the Regional Hospital for Ghana Health Service in the Region. The
status of this facility which is below that of a District Hospital does not come anywhere near
that of a Regional Hospital.
Again only two of the facilities referred to as District Hospitals in the Region were put up
purposely as District Hospitals.
The Region has continued to carry out advocacy for the construction of a Regional Hospital
and District Hospitals especially in the newly created Districts which do not have Hospitals.
A priority list for the construction of District Hospitals in the Region was developed. The
priority list for the construction of District Hospitals in Ashanti outside the areas mentioned
earlier is as follows:
1. Adansi North
2. Bosome Freho
3. Sekyere Afram Plains
4. Sekyere Central
5. Atwima Kwanwoma
6. Afigya Kwabre
7. Amansie Central
67
On-­‐going projects
Project
Location
Contractor
Consult
Works
done
Upgrading of Old Tafo
Polyclinic to
District Hospital
Tafo
Konneh Ent
BIC
68%
Upgrading of Manhyia
Hospital - Construction
of OPD Block
Manhyia
Consar Ltd
ACP
68%
Construction of
Coldchain Room
Abrepo
Junction
Al-Raxmak
Ocads
40%
Staff Accommodation
The availability of residential and office accommodation in both the Regional and District
level is a factor that helps to attract qualified critical personnel to enhance improvement in
Service delivery. We did not make much progress in this area. An eight (8) flat residential
accommodation block at Bantama in Kumasi has not seen any additional works within the
last three (3) years due to lack of funding. The situation is similar in the Districts. There are
quite a number of abandoned projects in the region and it is hoped that capital investments
would be made available to complete them.
68
Suspended Projects
Project
Location
Contractor
Consult
Works
done
Rehab/Expansion (Const of
Wards)
Kumasi
South
Konneh Ent
BIC
68%
Const of 3 B/room staff quarters
Kumasi
South
Rafcofe Ent
BRRI
85%
Const of 4 storey 3 B/room staff
q’ters
Abrepo
Junction
Duocon
Services
Ocads
Consult
60%
Const of DHMT Office
Ejura
Gyaba Const
AESL
60%
Const of 2 storey
Adm/Pharm/Lab Blk
Ejura
Gyaba Const
AESL
75%
Construction of Cold Chain Room, Abrepo
69
Planned Projects
Projects
Location
Remarks
Regional Hospital
Sewua
Procurement in
Process
District Hospitals
Bekwai
Konongo
Tepa
Stakeholders levels
DHMT Blocks
All newly created
districts
3.1.4 TO IMPROVE SUPPLY AND EQUIPMENT MANAGEMENT
Most of the equipment in the facilities were old and therefore part failure and ageing
constituted major causes of equipment breakdown. However with the Planned Preventive
Maintenance Program that was in place and an active response to service calls from the
Clinical Engineering Unit, our facilities were able to use the equipment to render fairly
uninterrupted medical care to the people.
The Region had also in previous years submitted a request to the National Level for basic
equipment requirements to support our vision of no tolerance for maternal deaths. Follow
ups revealed that the new equipment could be available in 2010.
The introduction of job card system and Medical Equipment tracking system by the Clinical
Engineering Unit in the course of the year are good practices that enhanced better
management of the equipment. Again, the offices in the Unit were able to come up with
local modifications to keep some of the equipment working. The Unit was also able to
design and construct basic medical equipment like Phototherapy Unit for some Hospitals.
70
EQUIPMENT INSTALLATION
NO
INSTITUTION
EQUIPMENT
LOCATION
QUANTITY
1
ASONOMASO
UNIVERSAL OPERATING LAMP
DELIVERY BED
THEATRE
MATERNITY
1
1
TABLE TOP AUTOCLAVE
CEILING THEATRE LAMP
THEATRE
THEATRE
1
1
ANGLE POISED LAMP
FLOOR MOUNTED OP LAMP
THEATRE
THEATRE
1
1
SURGEON STOOL
MAYO TABLE
THEATRE
THEATRE
2
1
PATIENT TROLLEY
SUCTION MACHINE
THEATRE
THEATRE
1
1
AUTOCLAVE
THEATRE LAMP
THEATRE
THEATRE
1
1
2
NKAWIE
CYCLINDRICAL AUTOCLAVE
THEATRE
1
3
TAFO
NEBULIZER
WARD
1
3.1.5 Improve supply of essential medicines and essential commodities
The regional health directorate through prudent procurement planning has been able to put
structures in place to procure essential medicines, pharmaceutical raw materials, non
medicine consumables to ensure the availability of quality health commodities at affordable
cost.
Procurement activities are carried out through the National Competitive Tendering Method
of procurement.
The process is carried out twice a year. Advert is placed in the news papers to invite
potential suppliers to tender in their bids for consideration.
CHALLENGES
Money has been a problem as health facilities are not able to pay the RMS when they
collect the medicines and non-medcines commodities. This is because of delays in the
payment of medical bills by the National Health Insurance Schemes.
The regional medical store has to cut down what to buy, and this really affects the supply
of essential medicines and commodities to the health facilities.
71
3.1.6 Improve transport availability and management
In the beginning of 2009 the Region disposed of 113 motorbikes and 43 vehicles which
were mostly over aged, very expensive to maintain when some were off road and just
increased the numbers on the Regions inventory of vehicles. The Region had in previous
years gone through the process for the disposal of the vehicles and motorbikes. While 200
new motorbikes were assembled and distributed to facilities in the Region as part of the
motorbike revamping project, only 4 new pick ups were received in the Region in the
course of the year. See TABLE.3.2 below
Fleet Inventory by type
Vehicles
Saloon
Station Wagon
Ambulances
Pick - ups
Water Tank
Haulage Trucks
Bus
Total
Motorbikes
Boat
2009
1
3
16
58
0
1
2
81
331
1
2010
0
3
20
89
0
1
2
115
531
1
72
Fleet Situation
Ages
Vehicles
2009
%
2010
%
1-5 yrs
26
32
63
55
Green
6-9 yrs
47
58
37
32
Yellow
10 yrs +
8
10
15
13
Red
81
100
115
100
1- 3 yrs
221
67
392
74
Green
4 – 6 yrs
91
27
110
21
Yellow
6 yrs+
19
6
29
25
Red
Total
331
100
531
100
Total
Zone
M/Bikes
Ambulances
Five (5) of the Twelve (12) facility based ambulance in the Region were in good condition
while five (5) of the rest could be said to be in fair condition. The other two (2) were off
road. Ten (10) facilities are in urgent need of ambulances in the region.
Boat Service
The only natural lake in the Country is in the Ashanti Region. The only boat that is utilized
in support of service delivery is nine (9) years old. This boat like some of the vehicles in the
Region is in red zone and needs to be replaced with a fibre glass boat. There is also only
one coxswain on the boat. There is the need for the organisation of regular survival training
for staff in the area to cover new staff in the District.
Drivers
About 48% of the drivers in the service were between 50 and 60 years old. Only 14% of
the drivers were below 40 years old.
73
FIGURE.3.4
Drivers Situation
2009
%
2010
%
39 & below
yrs
11
14
9
11
Green
40- 49 yrs
30
38
29
36
Yellow
50 – 60 yrs
39
48
42
53
Red
Total
80
100
80
100
Age Range
ZONES
Year
2009
2010
Driver Vehicle Ratio
1:1.0
1: 1.5
74
Promote Research and Development
The Regional Health Directorate undertook a baseline survey to assess the CHPS situation
in the region. The key findings were that CHPS is much active in the rural districts as
compared to the urban and preiurban districts.
Current CHPS Status
INDICATOR
NUMBER
No of sub districts
133
DHMTs trained
3
No of Demarcated Zones
341
No of CHPS Zones
171
No of functional CHPS compounds
36
Roll Out Plan(2010-­‐2015)
75
Social Amenities at CHPS Compounds
Capacity of CHPS 76
Way Forward
• Appointment of District CHPS Focal Persons
• Formation of Community Health Management Committees(CHMC)
• Training of CHMC
• CBRDP districts-­‐ ASS, OFM, AAS, AAN, AMC, ATN, ATM
• GHS/MOH financing of 2 CHPS compounds per district
108
Community Health Management Committee
• Community Health Officers (CHO)
• Chief(Rep of Traditional Authority)
• Sub District Leader
• Queen mother
• Herbalist
• Teacher
TBA
Volunteer (s)
Chemical Seller
Agric Extension Officer
Environmental Health Assistant
• Assembly Member
• Women’s group Leader
• Other opinion leaders
•
•
•
•
•
109
77
Health Promotion • Mabel Kissiwah Asafo appointed as new Regional Health Promotion Officer
• Review a draft strategic document on Health Promotion on the 1st and 2nd March, 2010
Activities 1
Celebration of World No Tobacco Day
• May, 24th is World no tobacco day • Radio talk show on Nhyira FM on tobacco use and its effect on the users. Time was allowed for phone -­‐in where people raised various concerns about tobacco and were addressed accordingly
78
Activities 2
Production of Materials on Pandemic Influenza H1N1 • Jingles produced and aired on Nhyira FM & Garden City FM. • Jingles aired for two months
• Audio CDs produced for distribution to all the districts for continuous education at the OPDs and communities.
Activities 3
Tuberculosis Training
• The unit in collaboration with Metro TB coordinator trained information services department staff on TB. • All district representatives of the service were present. • They were also given recorded messages on TB to aid their public education.
79
CHAPTER FOUR
4.0 Strategic Objective 4- Governance, Partnership and Sustainable Financing
4.1.1 Strengthen management systems
The Regional Health Directorate organized Monthly Health Management meetings through
out the year. During the meeting, issues bordering on the management of health services
at the various levels were discussed and amicable solutions arrived at. Weekly core
management meetings were also held to plan health programmes and activities.
The same process was replicated at various District and facility levels. Core management
and various committee meetings were held to ensure the effective running of facilities.
Quarterly staff durbars were also organized in the various facilities to identify staff needs
and promote the involvement of staff in the decision-making process.
As part of strengthening management and leadership skills, Regional health management
team members as well as their counterparts from the Districts participated in a six-month
training program on Leadership Development Program organised by the Ghana Health
Service in partnership with Management sciences for Health (MSH). The training treated
topics like:
1. The tools of effective management (Scanning, focusing, aligning etc.)
2. The mission and vision
3. Improving work group climate.
4. The challenge and how to address the challenge
5. Changing complaints into request
6. Coaching
7. Breakdowns and other topics
80
4.1.3 Establish performance monitoring framework and reporting system for
organizational accountability
During the year under review the Region could not undertake any integrated monitoring to
the districts and health facilities. However some Regional BMC’S such as the clinical care
and the public health units carried out some form of facilitative supervision to DHMT’S ,
Sub-districts and all the facilities during the year.
Half yearly Performance reviews were organized during the year in collaboration with key
stakeholders. Performance indicators of the various districts and regional programmes were
critically examined to identify weak areas and also to outline strategies needed to improve
service delivery.
Teams from National level visited the Region to monitor and supervise the performance of
both clinical and public health activities.
Monthly reports were submitted regularly to National Health Directorate and feedback
received especially from the public health directorate.
4.1.4 Mainstream gender and ensure equity in health programmes
In all our activities in the region, gender issues were critically taken into consideration.
During the year under review staffs from the regional training unit of the regional health
directorate undertook some training in gender mainstreaming. It is hoped that orientation
would be given to key staff in the period ahead so that gender issues would be inculcated
into health service planning and provision in the municipal.
4.1.5 Develop mechanism to achieve effective intersectoral collaboration
In all our health service delivery systems collaboration with stakeholders was pursued to
improve access and quality of care.
Advocacy meetings were held with stakeholders such as Ghana Education Service,
Traditional rulers and Ministry of Food and Agriculture and NGO’S
Private sector collaboration was also enhanced by inviting staff in some facilities to
workshops organized by the Regional health Directorate. Regular feedback on regional
activities was also communicated in the form of reports to them.
Metro, Municipal and District Assembly meetings were regularly attended which provided a
forum to raise issues of health concern. They are also briefed regularly on health events.
81
Priorities /WAYFORWARD FOR 2010
The under-listed items of priorities would constitute the regional plan of action for 2010.
The priorities are:
•
Addressing the issue of delay in data capture and submission
•
Addressing high number of still birth
•
Investigating all maternal deaths and instituting measures to limit avoidable
causes
•
Promoting healthy lifestyle to reduce high incidence of hypertension and
diabetes mellitus.
•
Promote good linkage with NHIS to reduce delays in the payment of medical
bills to the health facilities
NEXT STEPS
1. Schedule for RHMT/SMC Meetings for 2010
2. Regional staff awards
3. Schedule for Regional Staff appraisal
4. Schedule for monitoring and support visit to facilities
5. Workshop on ATF rules
6. Orientation and induction for newly recruited staff
7. Submission of hard/soft copy of Annual Reports to National by the end of March
10. Refresher training on DHIMS for data managers
11. Refresher training course for motorbike riders
12. Ensuring that all facilities have Quality Assurance (QA) and Drug and Therapeutic
Committee (DTCs) in place
82
APPENDIX 1- Trend in Performance Indicators 2008 - 2010 HALF
Objective
Indicators
Healthy
lifestyle
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
and
healthy
environment
Availability
of
communication
80
100
100
80
60
100
80
60
NA
4
1
0
NA
10
1
0
2660
2660
180
180
NA
0
0
0
strategy and materials at health
facilities
% of facilities providing screening
and counselling services
# of inter-sectoral meeting on
RHN
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
#
of
schools
with
health
2550
programmes
# of health workers oriented in
50
ALL
RHN
#
H/Workers
of
community
volunteers
NA
% of facilities with functional
NA
oriented on RHN
10
occupational health services
Objective
Indicators
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
83
Health,
Institutional maternal mortality
222 (253)
180
177 (189)
67
% of maternal deaths audited
86.9
90
162 (91.5)
56
Reproduction
and
Nutrition
Services
(83.6)
% of facilities with functional customer
NA
100
50
50
60
100
75
0
# of facilities with functional Q.A system
10
25
15
15
% of facilities with adverse incident
NA
100
85
90
Non-polio AFP rate
0.79
1.2
1.4 (48)
0.7 (29)
% increase in completeness of reporting
95
100
80
90
%
95
100
100
90
18.5
81
80
6/27
4/27
8/27
TB case detection rate
2101(22)
2106(21)
1101(11)
TB treatment success rate
90
90
COHORT
90
# of lymphatic filariasis cases
0
0
0
0
Hiv + clients receiving ARV therapy
1290
1182
1286
# of cases of guinea worm
5
2
0
% of district with functional facility based
30
19
29.6
care services
% of client satisfied with health care
services
monitoring register/guidelines in places
increase
in
timeliness
and
completeness of reporting
% of hospital with functional public health
units
Proportion of districts with functional
facility-based ambulance
0
ambulance
% district with functional EPR teams
100
80
0
%ANC coverage
90
83
83
39.5
# of health facilities that are youth
28
3
3
8
40.8
60
60
20.5
% PNC coverage
51.6
55
41.3
18.6
% of pregnant women attending at least
22.8
60
26.8
friendly
% of deliveries attended by trained health
workers
4 prenatal visits
84
% WIFA accepting FP
15.7
17
17.5
7.5
% of children receiving Penta 3
77
100
83.7
41.6
N/A
0
%
of
children
0-6months
exclusively
N/A
breastfed
% of facilities offering basic EOC
100
100
74
74
% of facilities offering Comprehensive
100
100
74
74
EOC
% of children 6-59months receiving VAC
101.4
90
97.3
Number of specialist outreach services
NA
NA
NA
# of dentist
3
3
3
#of oral health nurse
3
4
4
# of surgeries performed
17399
24361
14902
conducted
85
Objective
Indicators
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
General Health
# of facilities network through
NA
NA
NA
NA
System
hospital computerisation
Doctor population ratio
46281/1
42450/1
31157/1
39153/1
Nurse population ratio
3523/1
3315/1
3414/1
7215/1
OPD per capita
0.7
0.8
0.8
0.4
Equipment performance index
100
100
88
% of population living within 8km
60
100
80
80
# of functional CHPS zone
8
8
36
36
Tracer drugs availability
98
100
86.8
Fleet performance index
NA
NA
NA
NA
in
NA
57
57
71
% of functional district health
NA
100
40
40
% of functional hospital board
NA
NA
NA
NA
%
0
0
0
0
NA
100
80
Strengthening
of health infrastructure
Governance,
#
of
managers
trained
Partnership
leadership programme
and
Sustainable
Financing
committees hospital board
sub-district
that
have
autonomy to manage their funds
% of staff appraised
%
BMCs
with
performance
NA
NA
NA
1
1
0
contracts
# of staff trained in gender
mainstreaming
Per capita expenditure on health
Proportion of NHIS claims settled
4.55
4.55
0
0
0
52
64
62
within 4 weeks
%non
wage
GOG
budgets
allocated to district level
86
% of annual budget allocation to
52
76
39
% IGF generated from NHIS
78
87
86
% of IGF to total budget
80
90
89
# of audit queries
8
NA
NA
NA
NA
NA
NA
8
10
items 2 and 3 (GOG and HF/
SBS) disbursed
%
allocated
budget
utilized
according to approved plan
% GHS budget contributed to by
NGOs/CBOs/FBOs/HPs
APPENDIX 1- Trend in Performance Indicators 2007- 2009
Objective
Indicators
Healthy
lifestyle
2007
2008
2009
2009
Actual
Actual
Target
Actual
and
healthy
environment
87
Availability
of
communication
80
80
100
100
50
60
100
80
NA
NA
4
1
NA
NA
10
1
1979
2550
strategy and materials at health
facilities
% of facilities providing screening
and counselling services
# of inter-sectoral meeting on
RHN
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
#
of
schools
with
health
2660
programmes
# of health workers oriented in
50
ALL
RHN
#
180
H/Workers
of
community
volunteers
NA
NA
of facilities with functional NA
NA
NA
oriented on RHN
%
10
0
occupational health services
Objective
Indicators
2007
2008
2009
2009
Actual
Actual
Targe
Actual
t
Health,
Institutional maternal mortality
179 (246)
222 (253)
180
177 (189)
% of maternal deaths audited
84.4
86.9
90
162 (91.5)
NA
NA
100
50
Reproduction
and
Nutrition
Services
% of facilities with functional customer
88
care services
% of client satisfied with health care
NA
60
100
75
# of facilities with functional Q.A system
25
10
25
15
%
NA
NA
100
85
Non-polio AFP rate
0.79
0.79
1.2
1.4 (48)
% increase in completeness of reporting
95
95
100
80
% increase in timeliness and completeness
95
95
100
100
18.5
18.5
81
11/21
6/27
4/27
TB case detection rate
2011(16)
2101(22)
2106(21)
TB treatment success rate
86
90
90
COHORT
# of lymphatic filariasis cases
0
0
0
0
Hiv + clients receiving ARV therapy
695
1290
# of cases of guinea worm
18
5
% of district with functional facility based
62
30
% district with functional EPR teams
0
0
100
80
%ANC coverage
76
86
90
83
17
28
3
40.8
47.5
50
49.4
% PNC coverage
50.6
51.6
55
41.3
% of pregnant women attending at least 4
22.7
22.8
60
26.8
% WIFA accepting FP
15.1
15.7
17
17.5
% of children receiving Penta 3
74.3
77
100
83.7
N/A
N/A
% of facilities offering basic EOC
100
100
100
74
% of facilities offering Comprehensive EOC
100
100
100
74
% of children 6-9months receiving VAC
99.7
101.4
90
Number of specialist outreach services
NA
NA
NA
services
of
facilities
with
adverse
incident
monitoring register/guidelines in places
of reporting
% of hospital with functional public health
units
Proportion
of
districts
with
functional
facility-based ambulance
1182
0
2
19
ambulance
# of health facilities that are youth friendly
% of deliveries attended by trained health
workers
prenatal visits
%
of
children
0-6months
exclusively
N/A
breastfed
89
conducted
# of dentist
3
3
3
#of oral health nurse
3
3
4
# of surgeries performed
11005
17399
24361
90
Objective
Indicators
2007
2008
2009
2009
Actual
Actual
Target
Actual
NA
NA
NA
NA
Doctor population ratio
46589/1
46281/1
42450/1
48334/1
Nurse population ratio
3349/1
3523/1
3315/1
2271/1
OPD per capita
0.5
0.7
0.8
0.8
Equipment performance index
100
100
100
88
% of population living within 8km
60
60
100
80
# of functional CHPS zone
5
8
8
31
Tracer drugs availability
97
98
100
86.8
Fleet performance index
66
60
100
86
in
NA
NA
57
57
% of functional district health
NA
NA
100
40
% of functional hospital board
100
100
100
100
% sub-district that have autonomy
0
0
0
0
NA
NA
100
80
NA
NA
NA
0
1
1
Per capita expenditure on health
482P
₵₵2.46
4.55
Proportion of NHIS claims settled
0
0
0
50
52
64
General
# of facilities network through
Health
hospital computerisation
System
Strengthening
of health infrastructure
Governance,
#
of
managers
trained
Partnership
leadership programme
and
Sustainable
Financing
committees hospital board
to manage their funds
% of staff appraised
%
BMCs
with
performance
contracts
#
of
staff
trained
in
gender
mainstreaming
within 4 weeks
%non
wage
GOG
budgets
allocated to district level
91
% of annual budget allocation to
52
76
items 2 and 3 (GOG and HF/ SBS)
disbursed
% IGF generated from NHIS
61
78
87
% of IGF to total budget
84
80
90
# of audit queries
26
8
NA
utilized
NA
NA
NA
% GHS budget contributed to by
NA
NA
8
%
allocated
budget
according to approved plan
NGOs/CBOs/FBOs/HPs
SECTOR WIDE INDICATORS 2007-2010 HALF
2007
Indicators
Actual
Number of Infants deaths –
Institutional
2,602
Number of Infants admissions –
Institutional
6,285
Number of under five deaths –
Institutional
3,018
Number of under five admissions
– Institutional
24,941
Maternal Mortality ratio –
Institutional (per 100,000 LBs)
246/100,000
Number of Under five years who
are under weight presenting
under facility & Outreach
% Under five years who are
underweight – Institutional
13.5
2008
2009
2009
2010 Half
Actual
Target
Actual
Actual
2,280
2,000
2,460
331
6,133
6,000
8,647
5012
3,202
3,000
2,700
908
19,656
19,000
25,160
18947
253/100,000
200/100,000
189/100,000
167/100,000
16,872
16,000
14,005
8930
11.8
11.7
7.0
11.0
Number of outpatient visits
2,809,681
3,140,880
3,900,000
3,500,286
2,041,603
Outpatient visits per capita
0.5
0.7
0.8
0.8
0.4
117,326
138,484
140,000
140,557
85669
26
29
30
32
16.9
82
90
COHORT
COHORT
82
90
81
90
78
90
Number of admissions
Hospital Admission rate
Specialist Outreach
Number of specialist visits
received from the national level
Number of patients seen by
national team
Number of operations performed
by national team
Disease Surveillance
TB cure rate
TB Treatment Success Rate
92
HIV prevalence (among
pregnant women)
3.2
3
2
2.9
2.55
No. of guinea worm cases seen
18
5
3
2
0
No. of AFP cases seen
17
27
30
48
29
797,748
964,545
950,000
900,000
773,389
160,478
15.1
171,988
15.7
180,000
17
166,131
16
72,706
7.5
139,082
76
25.9
92,397
50.6
162,607
86
41
97,351
51.6
175,742
90
41
102,305
55
150,461
83
67,158
89,070
40.4
78,792
39.5
37,592
37,130
18.6
74,507
89,753
98,999
17,961
40,786
40.8
60
60
60
20.5
100,241
113,453
120,666
83,924
40,923
40.8
60
60
60
20.5
5
8
10
36
36
77
72
72
78
81
77
77
79
85
80
80
82
84
83.6
83.7
87.1
44.4
41.6
41.6
43.5
10,914
13,348
14,000
21,160
16,194
151
193
180
162
56
Total number of maternal deaths
179
222
200
177
67
% maternal death audits
Total number of Under five
deaths due to malaria
Under five malaria case fatality
rate
% Tracer Drugs available out of
the tracer drug list at the
Regional Medical Store
84.4
86.9
90
91.5
83.6
139
121
100
146
35
0.05
0.06
0.06
0.04
0.05
97
98
100
98
Total Number of TB Cases Cured
965
COHORT
AFP Non-Polio AFP rate
(/100,000 population under 15
0.79
1.2
Total number of malaria cases
Diseases targeted for
Elimination
Lymphatic filariasis treatment
coverage
Reproductive & Child Health
Safe Motherhood
Number of Family Planning
Acceptors
% of WIFA accepting FP
Number of ANC registrants
% ANC coverage
% ANC registrants given IPT2
Number of PNC registrants
% PNC coverage
Number of Supervised Deliveries
(includes deliveries by trained
TBAs)
% of Supervised Deliveries
Number of deliveries by skilled
attendants
% of Deliveries by Skilled
Personnel
CHPS
No. of functional CHPS zones
Child Survival
EPI coverage Penta 1 (%)
EPI coverage Penta 3 (%)
EPI coverage OPV3 (%)
EPI coverage Measles (%)
Total number of Under five
malaria cases – Admissions
Number of maternal deaths
audited
2
361
504
2.05
0.7
93
years
Revenue Mobilization
IGF (bn¢)
Cash & Carry
NHIS
GOG Subsidy ((bn¢))
Health Fund ((bn¢))
MOH Programmes (Earmark
Funds) (bn¢)
District Assembly Common
Fund(bn¢)
Other Sources e.g. Financial
Credits, HIPC (bn¢)
Expenditure by Item
Item 1: Personal Emoluments
(bn ¢)
Item 2: Administration Expenses
(bn ¢)
Item 3: Service Expenses (bn ¢)
Item 4: Investment Expenses
(bn ¢)
Number of doctors
Population to doctor ratio
Number of nurses
Population to nurse ratio
11,407,149
162,446
105,446
21,177,134
4,636,084
16,250,601
620,497
0
24,353,704
5,331,497
19,022,207
713,572
0
3,288,926
12,212,000
183,487
12,890,204.98
1,760,368.11
11,129,836.87
220,990.61
144,925.92
1,941,027
1,701,703
1,936,958
1,184,749
1,423,131.50
0
0
10,000
41,500
0
0
0
15,000
115,869
0
0
0
0
4,052,101
0
0
0
0
0
15,000
15,000
178,790
295,468
106,256,.94
70,314.80
0
98
32,344
102
37,196
115
143
0
129
46,589/1
46,286/1
42,450/1
31,157/1
39153/1
1,529
1,711
1,911
1,305
700
3,349/1
3,523/1
3,315/1
3,414/1
7215/1
94