ASHANTI HALF YEAR 2010 REPORT - Ghana Health … EXECUTIVE SUMMARY The Regional Half Year Report...
Transcript of ASHANTI HALF YEAR 2010 REPORT - Ghana Health … EXECUTIVE SUMMARY The Regional Half Year Report...
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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.
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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.
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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.
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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 sub-
districts. 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
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PRIORITIES FOR 2010:
The regional priorities included the following:
• Improvement of Staff and Management capacity through leadership and regular in-
service 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
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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.
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No. Organization Location Topic Treated Resource Persons
Date
1. Methodist men’s Group
Effiduase Iron Fortification Programme & essence
of exclusively breastfeeding babies
Reg. & Dist. Nut.
off
April 2010
2. Aboabo Mosque Aboabo 1-Kumasi
Regenerative Health & Nutrition & importance of iodated salt usage
Reg. & Metro Nut.
Off
March 2010
3. Hairdressers Association
Kumasi Cultural Centre
Iodated Salt, Balance diet and it importance & Personal hygiene
Reg. & Metro Nut.
Off
June 2010
4. Boss, Ashh & Angel Fm
Boss-Adum, Ashh-Stadium
& Angel-Abrepo junction
Importance of Exclusive
Breastfeeding for children 0-6mths,
appropriate complementary
feeding etc
Reg. & Metro Nut.
Off
May 2010
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.
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See Table 1.2
Indicators SEX Jan- Dec 2009
20222221222Jan- June
2010422200
# Tested M 33327 31,345F 41879 46,049
# Positive M 310 326F 792 757
# Posttest counselled
M 33327 31,345F 41879 46,049
Total 75,206 77,394
KNOW YOUR STATUS CAMPAIGN, 2009KNOW YOUR STATUS CAMPAIGN, 2009--20102010
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 non-
communicable 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
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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 Target Audience
No. of Participants
March 10 Essence of iodated salt usage & Regenerative Health & Nutrition
Tourist Board, Reg. Nut. Off & Reg. Health Education Off
Food Vendors 102 Market Women 40
May 10 Iron Fortification Programme
National Coordinators (3) & Reg. Nut. Off
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
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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.
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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
REGIONAL AVERAGE
WHO STANDARDS
Average number of medicines per encounter 4.2 2 % of medicines prescribed generic name 95.0 100 % of encounter with antibiotics 35.0 20 % of encounter with injection prescribed 35.0 20 % of medicine prescribed from EDL 100 100 PATIENTS INDICATOR % of patient who understood drug instruction 91.0 100 FACILITY INDICATORS % availability of tracer drugs 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.
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Ownership of Health Facilities
Quasi-Govt, 8
Govt, 170
Mission, 71
Private, 278
OPD/CAPITA:
OPD Attendance Per Capita
0.8
0.4
0.6
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
2008 2009 2010 Half-YearYear
Per C
apita
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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 AttendanceOPD 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
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Rheumatism have also featured prominently over the years.
Top Ten OPD Morbidity, 2008 - 2010
No.
2008 2009 2010 Half Year
DISEASECASES
DISEASECASES
DISEASECASES
1 Malaria 814,998 Malaria 1,449,260 Malaria 797,629
2 Cough (IMCI) 119,490 Acute Respiratory Inf. 259,701 Acute Respiratory Inf. 148,366
3 Hypertension 80,429 Hypertension 125,453 Hypertension 66,098
4 Skin Disease 70,694 Diarrhoeal Disease 123,107 Diarrhoeal Disease 65,858
5 DiarrhoealDisease 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/OccupInjuries 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
Kumasi 38,388 6,118 36,605 8,200 15,721 3,677Asante Akim North 2,092 559 2,855 899 7,581 4,101
Obuasi 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
Mampong Municipal 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
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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 277Afigya 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
Sekyere Central 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
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 11Asante 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
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Hypertension & Diabetes Mellitus cases Reported 2008 – 2010 Half Year
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Year
% of
OPD
Morb
idity
Hy'sion 3.21 3.91 4.1Diabe 0.64 0.83 0.99
2008 2009 2010 Half Year
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Hospital Admissions
• Total Admissions 2008 2009 2010 Half Year107,743 162,591 86,173
• Hospital Admission Rate is 1.71 per 100 population as against 3.33 per 100 in 2009
• Bed Occupancy (Target = 80%)2010 = 56.7%2009 = 59.4%2008 = 37.4%
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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
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Top 10 Causes of Admissions, 2008 - 2010
2008 2009 2010 Half Year
No. DISEASE CASES DISEASE CASES DISEASE CASES
1 Malaria 8,914 Malaria 29,486 Malaria 16,3622 Diarrhoea 815 Diarrhoea 3,203 Diarrhoea 1,6353 Anaemia 663 Anaemia 2,148 Anaemia 1,0754 Hypertension 503 Hypertension 1,535 Hypertension 8315 Pneumonia 308 Enteric
Fev./Typhoid 994 Enteric Fev./Typhoid 576
6 Hernia Inguinal303
Hernia Inguinal 911
Hernia Inguinal 564
7 Asthma 277 Pneumonia 709 Gastritis 373
8 Gastritis 272 Gastritis 691 Asthma 3459 Enteric
Fev./Typhoid244 Abortion 683 Pneumonia 333
10 Single Spont Del. 183 Asthma 643 Abortion 325
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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
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Top Ten Causes of Death, 2008-2010
No. Diseases 2008 Diseases 2009 Diseases2010
Half Year
1 Malaria 67 Malaria 226 Malaria 126
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 8
10 Typhoid Fever 4 C V A 20 Cardiac Failure 6
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National Health Insurance Scheme
TABLE 2.7 NHIS – Utilization
NHIS - Utilization
0
10
20
30
40
50
60
70
80
Out-Pat 61.34 38.66 69.58 30.42 75.92 24.08In-pat 57.2 42.8 68.46 31.54 70.78 29.22
% Insured % Non-Insured % Insured % Non-Insured % Insured % Non-Insured2008 2008 2009 2009 2010 Half Year 2010 Half Year
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
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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
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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
Expected
No. Timely
Received
No. Lately
Received
% Timely
Received
2008 324 138 186 42.6
2009 324 228 96 70.3
2010 324 109 53 33.6 (Half Year)
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FIGURE 2.3
Specimen Results
Disease Specimen No. Positive
2008 2009 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
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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
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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
238
177
251
24 155
0
50
100
150
200
250
300
2008 2009 2010
newrecurrent
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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(%) REMARKS
2008 74.4
2009 74.5
2010 N/A 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
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H1N1 VACCINATION BY DISTRICTSNo District COVERAGE WASTAGE AEFI1 ADANSI NORTH 67.4 2.5 02 ADANSI SOUTH 66.6 1.8 73 AFIGYA KWABRE 56.4 18.4 04 AHAFO ANO NORTH 65.5 5.1 65 AHAFO ANO SOUTH 49.9 15.0 06 AMANSIE CENTRAL 70.3 1.3 07 AMANSIE WEST 56.3 5.3 28 ASANTE AKIM NORTH 50.9 7.5 29 ASANTE AKIM SOUTH 22.3 9.7 010 MAMPONG MUNICIPAL 42.7 5.6 211ATWIMA MPONUA 46.1 2.6 012ATWIMA NWABIAGYA 68.2 1.3 013ATWIMA KWANWOMA 52.9 32.3 014BEKWAI MUNICIPAL 56.5 0.2 515BOSOME FREHO 69.3 1.4 0
H1N1 VACCINATION BY DISTRICTSNo District COVERAGE WASTAGE AEFI17EJISU JUABEN 36.4 0.7 018EJURA SEKYEREDUMASI 25.3 9.2 019MANHYIA SOUTH 32.8 0.3 020ASOKWA 16.3 0.9 221BANTAMA 61.0 0.3 222MANHYIA NORTH 64.9 0.5 023SUBIN 279.2 0.3 024KWABRE 59.5 0.9 025OBUASI MUNICIPAL 61.8 6.2 026OFFINSO MUNICIPAL 61.1 6.7 027OFFINSO NORTH 36.7 8.5 028SEKYERE AFRAM PLAINS 51.3 0.5 029SEKYERE CENTRAL 53.2 21.4 330SEKYERE EAST 66.2 5.4 031SEKYERE SOUTH 65.5 0.5 0
TOTAL 58.5 4.4 31
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YAWS FIGURE 2.6
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OTHER ENDEMIC DISEASES:
TUBERCULOSIS
TB Case DetectionIndicator 2007 2008 2009 2010 HalfRegional Population 4,565,683 4,720,916 4,881,738 5,033,938Expected # of Cases 12,830 9,583 9,910 10,219Total Cases Detected 2,011 2,101 2,106 1,101Case Detection Rate 16 22 21 11New Smear Positives 1,181 1,269 1251 626New Smear Negatives 627 635 629 341Relapses 71 70 74 42Other RTR 28 58 37 21Extra Pulmonary 104 69 74 43Others 0 0 41 28
Tuberculosis Surveillance Unit
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TB TREATMENT OUTCOME
Indicator 2006 2007 2008 2009 HY1
Smear Positives 1,283 1,181 1269 650
Cured 1,033 (81%) 965 (82%) 1033 (81%) 504(78%)
Completed 69 99 113 78
Treatment Success Rate 86% 90% 90% 90%
Died 86 (7%) 83 (7%) 80 (6%) 42(6.5%)
Failed 8 6 9 4
Default 49 (4%) 14 (1%) 24 (2%) 10(1.5%)
Transferred Out 38 14 10 12Tuberculosis 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
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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,2008-2010HYIndicators 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%
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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.
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Total Malaria(2008-‐2010HY)
858822923521
301019
01000002000003000004000005000006000007000008000009000001000000
CASES
200820092010
Total Malaria admissions(2008-‐2010HY)
33649 33706
12143
0
5000
10000
15000
20000
25000
30000
35000
ADMISSIONS
200820092010
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Total Malaria deaths(2008-‐2010HY)
28
179
66
020406080100120140160180
DEATHS
200820092010
<5yrs Malaria Admissions(2008-‐2010HY)
1334812114
4778
0
2000
4000
6000
8000
10000
12000
14000
ADMISSIONS
200820092010
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<5yrs Malaria CFR(2008-‐2010HY)
0.058
0.042 0.045
0
0.01
0.02
0.03
0.04
0.05
0.06
%CFR
200820092010
IPT Trend(2008-‐2010HY)
0100002000030000400005000060000700008000090000
IPT1 IPT2 IPT3
200820092010
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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.
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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
2006 2007 2008 2009 2010 HY1
# Tested 176 20 6 20 11
V/c Ogawa 54 0 0 0 0
V/c Inaba 0 0 0 0 0
Zonal Public Health Laboratory, Kumasi
2.16. IMPROVE EARLY DETECTION, REPORTING AND MANAGEMENT OF NON-
COMMUNICABLE 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.
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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
28.425.58 26.47
64.758.86 58.49
4.110.34 10.92
2.8 5.22 4.20
10
20
30
40
50
60
70
2008 2009 1st Half 2010
% N
o. o
f Cas
es
YEAR
DIET RELATED DISEASES - 2008- 2010
Diabetes
Hypertension
Diab-Hypertension
Obesity
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Year 2007 2008 2010 1ST Half Yr
Type of Disease 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.
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ANC Coverage, 2008 – 2010 Half Year
Trend of ANC Coverage, 2008-‐2010 half year
0102030405060708090
2008 2009 2010
86.1 83
39.7% CO
VERA
GE
YEAR
TREND IN LOW BIRTH WEIGHT
0
2
4
6
8
10
12
14
2008 2009 2010
10.3
13.4
9.1
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% Caesarean section rate
0
2
4
6
8
10
12
2008 2009 2010
9.610.6
8
Trend in TT2+ coverage 2007-‐2010
0102030405060708090
2008 2009 2010
81.871.5
33
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Clients with 4+ visits
22
22.2
22.4
22.6
22.8
23
2008 2009 2010
22.8
26.3 27.5
SKILLED DELIVERY, 2008-‐2010HY
05
101520253035404550
2008 2009 2010
47.5 49.4
20.5
% CO
VERA
GE
YEAR
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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
1.651.71.751.81.851.91.952
2.052.1
2008 2009 2010
2.1 2.1
1.8
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
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• 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
SKILLED DELIVERY, 2008-‐2010HY
05
101520253035404550
2008 2009 2010
47.5 49.4
20.5
% C
OVER
AGE
YEAR
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TREND IN STILL BIRTH
1.651.71.751.81.851.91.952
2.052.1
2008 2009 2010
2.1 2.1
1.8
Assisted delivery/EOC 2010
0
1
2
3
4
5
6
7
8
caesarian vacuum forceps
8
0.60
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Post natal coverage 2008-‐2010
0
10
20
30
40
50
60
2008 2009 2010
51.647.8
18.6
Trend in FP acceptor rate
15.717.5
7.4
02468101214161820
2008 2009 2010
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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
0
10
20
30
40
50
60
2008 2009 2010
51.647.8
18.6
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% Caesarean section rate
0
2
4
6
8
10
12
2008 2009 2010
9.610.6
8
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. There was also close
collaboration with Marie Stoppes International. 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.
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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
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CHILD HEALTH
Child Welfare Average Visits
CWC PARAMETERSChildren 0- 23 months
Year 2008 2009 1st Half Year 2010
Total Registrants 299693 319642 205914
W/A <80% 7837 5432 3716
Target Population 372952 384606 398065
% Coverage 80.4 83.1 51.7
% Malnourished 2.6 1.7 1.8
CWC PARAMETERSChildren 24- 59months
Year 2008 2009 1st Half Year 2010
Total Registrants 96607 108810 75969
W/A <80% 2540 2111 1642
Total Population 405999 418683 433336
% Coverage 23.8 26.0 17.5
% Malnourished 2.6 1.9 2.2
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BFP PARAMETERS
Year 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
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BREASTFEEDING PROMOTIONYear 2008 2009 1st Half Year
2010
Total facilities 313 ( mat) 313 ( mat ) 313 ( mat )
Designated Nil Nil 28
% BF 0 0 0
• Twenty-eight (28) facilities awaiting assessment since 2004 have now been designated.
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Iodated Salt ProgrammeMarket & Household Survey
Year 2008 2009 1st Half Year 2010
May Nov. May Nov. May Nov.
% 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% 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.
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Growth Monitoring & Promotion 0 - 23months
Year 2008 2009 2010 1ST Half Yr Total Registrants 299693 319642 205914 W/A <80% 7837 5432 3716 Total Population 372952 384606 398065 % Coverage 80.4 83.1 51.7 % Malnourished 2.6 1.7 1.8
Growth Monitoring & Promotion 24 - 59months
Year 2008 2009 2010 1ST Half Yr Total Registrants 96607 108810 75969
W/A <80% 2540 2111 1642
Total Population 405999 418683 433336
% Coverage 23.8 26.0 17.5
% Malnourished 2.6 1.9 2.2
Growth Monitoring & Promotion 0 - 59months
Year 2008 2009 2010 1ST Half Yr Total Registrants 396300 428452 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
2.8 1.8 1.9
50.9 53.3
33.9
0
10
20
30
40
50
60
2008 2009 1st Half 2010
% Ma
l. & %
Cov.
Year
CWC % Malnourished & % Coverage for children 0-59months
% Malnourished
% Coverage
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Mother Support Groups were established in communities to support breastfeeding activities
as well complementary feeding.
No. District No. of Mother Support Groups
Communities where groups are established
1. Offinso North 2 Nkenkaaso & Akomadan 2. Amansie West 3 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 2009 2010 1ST Half Yr
Months May Nov. May Nov. May Nov.
% 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% 90%
Iodated Salt Survey-May & Nov/Dec (Food Vendors, Chop Bars & Rest. &
Institution)
Year 2008 2009 2010 1ST Half Yr
No. collected, Tested & % Passed No. Tested % Passed
No. Tested % Passed
No. Tested % Passed
Months M N M N M N M N M N M N
Food Vendors 1048
1235
74.5 63.9
1332 1621
72.5 76.3
1600
72.8
Institutions 86 158 81.4 81.6
262 174
80.9 83.9 249
81.9
Chop Bars & Restaurants
1115
1292
73.5 71.6
1659 1574
69.6 69.3
1726
79.1
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Lactation Management workshops were also organized in some district at selected facilities
for all staff to make the facilities baby friendly.
District No.
Trained Facility Trained
Resource
Person
Category of
Staff & No.
trained
Offinso
North 1
Nkenkaasu Government
Hospital
Reg. & Dist.
Nut. Off,
Midwife I/C
All the Staff in
the facility
totaling 86
people
Amansie
West 2
St. Martin Hospital Agroyesum
& Antoa Health Centre
Reg. & Dist.
Nut. Off,
DCO, Midwife
I/C
All the Staff in
the facility
totaling 76
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
Year 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
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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 2009 2010 1ST Half Yr
Month May Nov. May Nov.
Apr
(NID)
May
(CHPW)
Target 822183 843726 865269
Children Dosed 175655 833968 68628 759353 832389 10339
% Coverage 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.
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Year 2008 2009 2010 1ST Half
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.
11.8 7 11
13.1
8.1
11.5
9.7
5.2
9.5
0
2
4
6
8
10
12
14
2008 2009 1st Half 2010% Un
derw
eight
, Stu
ntin
g & W
astin
g
YEAR
NUTRITION SURVEILLANCE
% Underweight
% Stunting
% Wasting
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.
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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.
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BCG PERFORMANCE BY DISTRICTS
BCG PERFORMANCE BY DISTRICTS
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Penta 3 Performance by Districts
Penta 3 Performance by Districts
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Measles Performance by District
Measles Performance by District
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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.
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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.
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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
June 2009 June 2010
Total staff 4, 386 4,748
Retired 23 21Death 9 5
Resignation 3
Vacation of Post 3
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Retirement 1st Half Year 2010Staff 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
Total No of Applicants
No Selected
Community Health Nurses 150 486 159
Diploma Community Health Nurse
6 5 4
Medical Assistant 5 7 5
Staff Nurse 90 188 92Staff Nurses ( Mental) 9 21 9
Staff Midwives 20 62 22Technical Officer (HI) 3 13 5
Technical Officer (CH) 5 6 5
Field Technician 13 29 13
Medical Officer 9 12 6Health Assistant Clinical 160 530 178
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
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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
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On-‐going projectsProject Location Contractor Consult Works
done
Upgrading of Old TafoPolyclinic 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
AbrepoJunction
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.
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Suspended ProjectsProject 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
AbrepoJunction
DuoconServices
OcadsConsult
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
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Planned ProjectsProjects Location Remarks
Regional Hospital Sewua Procurement in Process
District Hospitals Bekwai KonongoTepa
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.
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EQUIPMENT INSTALLATIONNO INSTITUTION EQUIPMENT LOCATION QUANTITY
1 ASONOMASO UNIVERSAL OPERATING LAMPDELIVERY BED
THEATREMATERNITY
11
TABLE TOP AUTOCLAVECEILING THEATRE LAMP
THEATRETHEATRE
11
ANGLE POISED LAMPFLOOR MOUNTED OP LAMP
THEATRETHEATRE
11
SURGEON STOOLMAYO TABLE
THEATRETHEATRE
21
PATIENT TROLLEYSUCTION MACHINE
THEATRETHEATRE
11
AUTOCLAVETHEATRE LAMP
THEATRETHEATRE
11
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.
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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 typeVehicles 2009 2010Saloon 1 0Station Wagon 3 3Ambulances 16 20Pick - ups 58 89Water Tank 0 0Haulage Trucks 1 1Bus 2 2Total 81 115Motorbikes 331 531Boat 1 1
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Fleet SituationAges
Zone%2010%2009Vehicles
Green556332261-5 yrs
Yellow323758476-9 yrs
Red131510810 yrs +10011510081Total
M/BikesGreen74392672211- 3 yrs
Yellow2111027914 – 6 yrs
Red25296196 yrs+
100531100331Total
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.
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FIGURE.3.4
Drivers SituationAge Range 2009 % 2010 % ZONES
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
Year 2009 2010Driver Vehicle Ratio 1:1.0 1: 1.5
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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 StatusINDICATOR 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)
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Social Amenities at CHPS Compounds
Capacity of CHPS
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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
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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
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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
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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.
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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
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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.
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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
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APPENDIX 1- Trend in Performance Indicators 2008 - 2010 HALF
Objective Indicators
2008
Actual
2009
Target
2009
Actual
2010
Half
Actual
Healthy
lifestyle and
healthy
environment
Availability of communication
strategy and materials at health
facilities
80 100 100 80
% of facilities providing screening
and counselling services
60 100 80 60
# of inter-sectoral meeting on
RHN
NA 4 1 0
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
NA 10 1 0
# of schools with health
programmes
2550 2660 2660
# of health workers oriented in
RHN
50 ALL
H/Workers
180 180
# of community volunteers
oriented on RHN
NA NA 0
% of facilities with functional
occupational health services
NA 10 0 0
Objective Indicators 2008
Actual
2009
Target
2009
Actual
2010
Half
Actual
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Health,
Reproduction
and Nutrition
Services
Institutional maternal mortality 222 (253) 180 177 (189) 67
% of maternal deaths audited 86.9 90 162 (91.5) 56
(83.6)
% of facilities with functional customer
care services
NA 100 50 50
% of client satisfied with health care
services
60 100 75 0
# of facilities with functional Q.A system 10 25 15 15
% of facilities with adverse incident
monitoring register/guidelines in places
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
% increase in timeliness and
completeness of reporting
95 100 100 90
% of hospital with functional public health
units
18.5 81 80
Proportion of districts with functional
facility-based ambulance
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 0 2 0
% of district with functional facility based
ambulance
30 19 29.6
% district with functional EPR teams 100 80 0
%ANC coverage 90 83 83 39.5
# of health facilities that are youth
friendly
28 3 3 8
% of deliveries attended by trained health
workers
40.8 60 60 20.5
% PNC coverage 51.6 55 41.3 18.6
% of pregnant women attending at least
4 prenatal visits
22.8 60 26.8
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% WIFA accepting FP 15.7 17 17.5 7.5
% of children receiving Penta 3 77 100 83.7 41.6
% of children 0-6months exclusively
breastfed
N/A N/A 0
% of facilities offering basic EOC 100 100 74 74
% of facilities offering Comprehensive
EOC
100 100 74 74
% of children 6-59months receiving VAC 101.4 90 97.3
Number of specialist outreach services
conducted
NA NA NA
# of dentist 3 3 3
#of oral health nurse 3 4 4
# of surgeries performed 17399 24361 14902
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Objective Indicators 2008
Actual
2009
Target
2009
Actual
2010
Half
Actual
General Health
System
Strengthening
# of facilities network through
hospital computerisation
NA NA NA NA
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
of health infrastructure
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
Governance,
Partnership
and
Sustainable
Financing
# of managers trained in
leadership programme
NA 57 57 71
% of functional district health
committees hospital board
NA 100 40 40
% of functional hospital board NA NA NA NA
% sub-district that have
autonomy to manage their funds
0 0 0 0
% of staff appraised NA 100 80
% BMCs with performance
contracts
NA NA NA
# of staff trained in gender
mainstreaming
1 1 0
Per capita expenditure on health 4.55 4.55
Proportion of NHIS claims settled
within 4 weeks
0 0 0
%non wage GOG budgets
allocated to district level
52 64 62
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% of annual budget allocation to
items 2 and 3 (GOG and HF/
SBS) disbursed
52 76 39
% IGF generated from NHIS 78 87 86
% of IGF to total budget 80 90 89
# of audit queries 8 NA NA
% allocated budget utilized
according to approved plan
NA NA NA
% GHS budget contributed to by
NGOs/CBOs/FBOs/HPs
NA 8 10
APPENDIX 1- Trend in Performance Indicators 2007- 2009
Objective Indicators
2007
Actual
2008
Actual
2009
Target
2009
Actual Healthy
lifestyle and
healthy
environment
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Availability of communication
strategy and materials at health
facilities
80 80 100 100
% of facilities providing screening
and counselling services
50 60 100 80
# of inter-sectoral meeting on
RHN
NA NA 4 1
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
NA NA 10 1
# of schools with health
programmes
1979 2550 2660
# of health workers oriented in
RHN
50 ALL
H/Workers
180
# of community volunteers
oriented on RHN
NA NA NA
% of facilities with functional
occupational health services
NA NA 10 0
Objective Indicators 2007
Actual
2008
Actual
2009
Targe
t
2009
Actual
Health,
Reproduction
and Nutrition
Services
Institutional maternal mortality 179 (246) 222 (253) 180 177 (189)
% of maternal deaths audited 84.4 86.9 90 162 (91.5)
% of facilities with functional customer NA NA 100 50
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care services
% of client satisfied with health care
services
NA 60 100 75
# of facilities with functional Q.A system 25 10 25 15
% of facilities with adverse incident
monitoring register/guidelines in places
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
of reporting
95 95 100 100
% of hospital with functional public health
units
18.5 18.5 81
Proportion of districts with functional
facility-based ambulance
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 1182
# of cases of guinea worm 18 5 0 2
% of district with functional facility based
ambulance
62 30 19
% district with functional EPR teams 0 0 100 80
%ANC coverage 76 86 90 83
# of health facilities that are youth friendly 17 28 3
% of deliveries attended by trained health
workers
40.8 47.5 50 49.4
% PNC coverage 50.6 51.6 55 41.3
% of pregnant women attending at least 4
prenatal visits
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
% of children 0-6months exclusively
breastfed
N/A 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
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conducted
# of dentist 3 3 3
#of oral health nurse 3 3 4
# of surgeries performed 11005 17399 24361
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Objective Indicators 2007
Actual
2008
Actual
2009
Target
2009
Actual
General
Health
System
Strengthening
# of facilities network through
hospital computerisation
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
of health infrastructure
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
Governance,
Partnership
and
Sustainable
Financing
# of managers trained in
leadership programme
NA NA 57 57
% of functional district health
committees hospital board
NA NA 100 40
% of functional hospital board 100 100 100 100
% sub-district that have autonomy
to manage their funds
0 0 0 0
% of staff appraised NA NA 100 80
% BMCs with performance
contracts
NA NA NA
# of staff trained in gender
mainstreaming
0 1 1
Per capita expenditure on health 482P ₵₵2.46 4.55
Proportion of NHIS claims settled
within 4 weeks
0 0 0
%non wage GOG budgets
allocated to district level
50 52 64
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% of annual budget allocation to
items 2 and 3 (GOG and HF/ SBS)
disbursed
52 76
% IGF generated from NHIS 61 78 87
% of IGF to total budget 84 80 90
# of audit queries 26 8 NA
% allocated budget utilized
according to approved plan
NA NA NA
% GHS budget contributed to by
NGOs/CBOs/FBOs/HPs
NA NA 8
SECTOR WIDE INDICATORS 2007-2010 HALF
Indicators 2007 2008 2009 2009 2010 Half
Actual Actual Target Actual Actual Number of Infants deaths – Institutional 2,602 2,280 2,000 2,460 331 Number of Infants admissions – Institutional 6,285 6,133 6,000 8,647 5012 Number of under five deaths – Institutional 3,018 3,202 3,000 2,700 908 Number of under five admissions – Institutional 24,941 19,656 19,000 25,160 18947 Maternal Mortality ratio – Institutional (per 100,000 LBs) 246/100,000 253/100,000 200/100,000 189/100,000 167/100,000 Number of Under five years who are under weight presenting under facility & Outreach 16,872 16,000 14,005 8930 % Under five years who are underweight – Institutional 13.5 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
Number of admissions 117,326 138,484 140,000 140,557 85669
Hospital Admission rate 26 29 30 32 16.9 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 82 COHORT 82 81 78 TB Treatment Success Rate 90 COHORT 90 90 90
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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
Total number of malaria cases 797,748 964,545 950,000 900,000 773,389 Diseases targeted for Elimination Lymphatic filariasis treatment coverage Reproductive & Child Health
Safe Motherhood Number of Family Planning Acceptors 160,478 171,988 180,000 166,131 72,706 % of WIFA accepting FP 15.1 15.7 17 16 7.5
Number of ANC registrants 139,082 162,607 175,742 150,461 78,792 % ANC coverage 76 86 90 83 39.5 % ANC registrants given IPT2 25.9 41 41 67,158 37,592 Number of PNC registrants 92,397 97,351 102,305 89,070 37,130 % PNC coverage 50.6 51.6 55 40.4 18.6 Number of Supervised Deliveries (includes deliveries by trained TBAs) 74,507 89,753 98,999 17,961 40,786
% of Supervised Deliveries 40.8 60 60 60 20.5 Number of deliveries by skilled attendants 100,241 113,453 120,666 83,924 40,923 % of Deliveries by Skilled Personnel 40.8 60 60 60 20.5 CHPS No. of functional CHPS zones 5 8 10 36 36 Child Survival EPI coverage Penta 1 (%) 77 81 85 84 44.4 EPI coverage Penta 3 (%) 72 77 80 83.6 41.6 EPI coverage OPV3 (%) 72 77 80 83.7 41.6 EPI coverage Measles (%) 78 79 82 87.1 43.5 Total number of Under five malaria cases – Admissions 10,914 13,348 14,000 21,160 16,194 Number of maternal deaths audited 151 193 180 162 56
Total number of maternal deaths 179 222 200 177 67
% maternal death audits 84.4 86.9 90 91.5 83.6 Total number of Under five deaths due to malaria 139 121 100 146 35 Under five malaria case fatality rate 0.05 0.06 0.06 0.04 0.05 % Tracer Drugs available out of the tracer drug list at the Regional Medical Store 97 98 100 98
Total Number of TB Cases Cured 965 COHORT 361 504
AFP Non-Polio AFP rate (/100,000 population under 15 0.79 1.2 2 2.05 0.7
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years
Revenue Mobilization
IGF (bn¢) 11,407,149 21,177,134 24,353,704 12,890,204.98 Cash & Carry 4,636,084 5,331,497 3,288,926 1,760,368.11 NHIS 16,250,601 19,022,207 12,212,000 11,129,836.87 GOG Subsidy ((bn¢)) 162,446 620,497 713,572 183,487 220,990.61 Health Fund ((bn¢)) 105,446 0 0 144,925.92 MOH Programmes (Earmark Funds) (bn¢) 1,941,027 1,701,703 1,936,958 1,184,749 1,423,131.50 District Assembly Common Fund(bn¢) 0 0 10,000 41,500 0 Other Sources e.g. Financial Credits, HIPC (bn¢) 0 0 15,000 115,869 0
Expenditure by Item Item 1: Personal Emoluments (bn ¢) 0 0 0
4,052,101
0
Item 2: Administration Expenses (bn ¢) 0 0 15,000 178,790 106,256,.94 Item 3: Service Expenses (bn ¢) 0 0 15,000 295,468 70,314.80 Item 4: Investment Expenses (bn ¢) 0 32,344 37,196 0 Number of doctors 98 102 115 143 129
Population to doctor ratio 46,589/1 46,286/1 42,450/1 31,157/1 39153/1
Number of nurses 1,529 1,711 1,911 1,305 700
Population to nurse ratio 3,349/1 3,523/1 3,315/1 3,414/1 7215/1