FAMILY HEALTH DIVISION ANNUAL REPORT 2016 i
ABBREVIATIONS/ACRONYMS
ACSM Advocacy, Communication and Social Mobilization ADH Adolescent Health ADHD Adolescent Health and Development AIDS Acquired Immune Deficiency Syndrome ANC Ante Natal Care ART Anti-Retroviral Treatment ASH Adolescent School Health AYFHS Adolescent Youth Friendly Health Service BCC Behaviour Change Communication BFHI Baby Friendly Health Facility Initiative C4D Communication for Development CHN Community Health Nurses CHPS Community Based Health Planning and Services CHPW Child Health Promotion Week C-IYCF Community Infant and Young Child Feeding CMAM Community Management of Acute Malnutrition CPBF Community Performance-Based Financing CPT Contraceptive Procurement Tables CSB+ Corn-Soya Blend Plus (Super cereal) CSB++ Corn-Soya Blend Plus Plus (Super cereal Plus) CSE Comprehensive Sexuality Education CTC Community-Based Therapeutic Care CYP Couple Year Protection DDPH Deputy Director Public Health DFID Department for International Development DHIMS2 District Health Information Management System 2 DOTs Directly Observed Therapy ECNHA Essential Community Nutrition And Health Actions ECP Emergency Contraceptive Pills EHO Environmental Health Officers ENAs Essential Nutrition Actions EPI Expanded Programme on Immunization EVD Ebola Virus Disease FANTA Food and Nutrition Technical Assistance
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FDA Food and Drugs Authority FP Family Planning GAC Ghana AIDS Commission GAIN Global Alliance for Improved Nutrition GES Ghana Education Service GFPCIP Ghana Family Planning Costed Implementation Plan GHS Ghana Health Service GOG Government of Ghana GSFP Ghana School Feeding Programme GSS Ghana Statistical Service Hb Haemoglobin HBC Home-Based Care HFFG Hope for Future Generation HIV Human Immune Deficiency Virus HPD Health Promotion Department HPO Health Promotion Officer ICC/CS Inter-Agency Coordination Committee for Contraceptive Security ICC/HP Inter-Agency Coordination Committee on Health Promotion ICN International Conference on Nutrition IDD Iodine Deficiency Disorder IEC Information Education and Communication IPC Inpatient Care IPTP Intermittent Preventive Treatment in Pregnancy ITN Insecticide Treated Nets IUD Intra Uterine Device IYCF Infant and Young Child Feeding IYCN Infant and Young Child Nutrition JICA Japanese International Cooperation KOFIH Korea Foundation for International Health LQAS Lot Quality Assurance Sampling LSTM Liverpool School of Tropical Medicine MAF MDG Acceleration Framework MCHNIP Maternal Child Health and Nutrition Improvement Project MDG Millennium Development Goal MEC Medical Eligibility Criteria MFWA Media foundation for West Africa iii | P a g e FHD | Annual Report 2 0 1 6
MICS Multiple Indicator Cluster Survey MIYCN Maternal, Infant and Young Child Nutrition MLGRD Ministry of Local Government and Rural Development MMDAS Metropolitan, Municipal and District Assemblies MNH Maternal and Newborn Health MOFA Ministry of Food and Agriculture MoGCSP Ministry of Gender, Children and Social Protection MOH Ministry of Health MOTI Ministry of Trade and Industry
MSIG Marie Stopes International, Ghana MUAC Mid-Upper Arm Circumference NACP National AIDS Control Program NACS Nutrition Assessment Counselling and Support NADMO National Disaster Management Organization NANUPAC National Nutrition Partner Coordination NCCE National Communication for Civic Education NCD Non-Communicable Disease NCLS National Condom and Lubricant Strategy NGO Non-Governmental Organization NIDS National Immunisation Days NRCs Nutrition Rehabilitation Centres NSIC National Salt Iodization Committee NTD Non-Tropical Diseases NTP National Tb Control Programme OPC Outpatient Care OTPs Outpatient Therapeutic Programmes PDOs Project Development Objectives PHN Public Health Nurse PLHIV People Living With HIV/AIDS PPAG Planned Parenthood Association of Ghana PPH Post-Partum Haemorrhage PSM Procurement and Supply Management RH Reproductive Health RHCS Reproductive Health Commodity Security RMNCH Reproductive, Maternal, Neonatal and Child Health
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RTI Respiratory Tract Infection RTK Rapid Test Kits RUTF Ready-To-Use Therapeutic Food SADA Savannah Accelerated Development Agenda SAM Severe Acute Malnutrition SBCC Social and Behaviour Change Communication SCs Stabilization Centres SDP Service Delivery Points SFPs Supplementary Feeding Programmes SHEP School Health Education Programme SRH Sexual Reproductive Health STI Sexually Transmitted Infection SUN Scaling Up Nutrition TB Tuberculosis THR Take-Home-Ration TOR Terms of Reference TOT Training of Trainers TUC Trade Unions Congress UNFPA United Nations Fund for Population Activities UNICEF United Nations Children’s Fund USAID United States Agency for International Development USI Universal Salt Iodization WAHO West African Health Organization WB World Bank WFP World Food Programme WHO World Health Organization YMK You Must Know
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PREFACE
PREFACE
The Ghana Health Service through the Family Health Division, over the years have implemented several interventions and programs to ensure maternal, newborn, child and adolescent survival as well as prevent or reduce mortality. The division collaborates with other divisions within the Ghana Health Service as well as relevant institutions, NGOs and CSOs to carry out this mandate.
The year 2016 ushered the Family Health Division into strategizing to sustain the gains made in the past year in reducing malnutrition prevalence and avoidable new born and maternal deaths as well as addressing identified gaps of unmet targets in reaching all mothers and children. Key priorities for 2016 included:
• Operationalizing an effective M&E system that will inform evidence based implementation of health promotion activities at all levels
• Improving health promotion advocacy and communication strategies • Scale up RMNCAH services at all levels to improve access • Implementation of Focused Antenatal Care and ensure CoC • Development of SOPs and Protocols for integration of PMTCT/EID into RMNCAH programs and services • Setting up of National Secretariat for Confidential Enquiry into Maternal Deaths (CEMD) • Scale up of Maternal Infant and Young Child Nutrition at all levels • Decentralization of Baby Friendly Health Facility Initiative& Monitoring of the LI 1667 • Promotion of LARC and increase access
To achieve these priorities, activities were carried out mainly in the areas of material development and review, capacity building activities including in-service training, orientations, mentoring and coaching on the job as well as monitoring. The division recorded significant progress in most of its service indicators. This report highlights the status of the performance indicators in the year 2016.
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The data presented in this report was collected from both public and private health facilities who report to the districts. Family planning acceptor rates improved in the year under review. Following the unexpected decrease in 2015, efforts were intensified to improve uptake of family planning services. This has reflected in the significant increase in acceptor rate of 33.8% recorded for 2016. In terms of coverage for ANC services, more than 80% of pregnant women had at least one contact with a skilled provider during pregnancy and 56.2% of deliveries were attended by skilled health providers in 2016. Routine data analysed suggests that almost all infants delivered within the health facilities are put to breast within the first 30 minutes of life, which may be indicative of the fact that the targets have been achieved. Vitamin A supplementation, coverage in children 6-11 months improved in the year under review, recording 70% in January and over 90% by the end of December, 2016. Notwithstanding this commendable progress the division continues to grapple with inadequate human resource and logistics, poor data management as well as inadequate monitoring and supervision of service provision especially at the peripheral levels. These coupled with weak community engagement have contributed to the stagnation and downward trends of some service indicators captured in this report. To address the challenges, several actions have been initiated at the national and regional levels including capacity building for midwives, task shifting, staff rationalization and reposting as well as the revision an orientation of service providers on data collection and reporting tools. In addition, monitoring and supervision have been intensified as well as monthly data validation and verification. In terms of the outlook for 2017, the division will continue to focus on the sustaining desired program outcomes. The division plans to implement new initiatives including the establishment of Nutrition Clinics, implementation of the iron folate supplementation for menstruating women and also continue implementation of existing innovations including the training of midwives in obstetric ultrasonography
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and deployment of ultrasound machines to trained staff at the service delivery level (V-Scan Project) and task shifting. It is expected that the year 2017 will see an improvement in performance indicators and sustaining the gains made in 2016. This can be achieved through scaling up and prioritizing a package of high-impact interventions, strengthening health systems, and integrating efforts across the various sectors such as health, education, water and sanitation The Family Health Division acknowledges and appreciates the dedication of staff at all levels and the significant contributions by health and development partners including the private sector towards carrying out its mandate. We look forward to strengthened collaboration in the coming year.
…………………………………………. …………………………………… Dr. Anthony Nsiah-Asare Dr. Patrick Kuma Aboagye Director General, Ghana Health Service Director, Family Health Division
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Contents
ABBREVIATIONS/ACRONYMS ...... ii PREFACE ...... vi Contents ...... ix ORGANIZATIONAL STRUCTURE OF THE FAMILY HEALTH DIVISION ...... 12 CHAPTER 1: ...... 1 BACKGROUND ...... 1 1.1 INTRODUCTION ...... 1 CHAPTER 2: ...... 3 PERFORMANCE OF PROGRAMME INDICATORS ...... 3 2.0 REPRODUCTIVE AND CHILD HEALTH ...... 3 2.1.2. Trend in ANC 4+ Visit ...... 9 2.1.3 Timing of Registration at Antenatal care ...... 10 2.1.4 Anaemia among Pregnant Women ...... 11 2.1.5 Prevention of Maternal and Neonatal Tetanus ...... 15 2.1.6. Skilled Delivery ...... 16 2.1.7. Caesarean Section Rate ...... 18 2.1.8. Maternal Mortality ...... 19 2.2. Family Planning Programme ...... 23 2.2.1 Acceptor Rate ...... 23 Figure 2.2.2: Trend in Family Planning Acceptor Rate by Region 2014-2016 ...... 24 2.2.2. Couple Year Protection (CYP) ...... 25 2.3. Child Health Programme ...... 26 2.3.1. Still Birth rate ...... 26 2.3.2. Neonatal Death ...... 27 2.3.3 Exclusive Breastfeeding at Discharge ...... 29 2.4 Adolescent Health Programme ...... 29 ix | P a g e FHD | Annual Report 2 0 1 6
2.4.1 Adolescent Pregnancies ...... 30 2.4.2: Trends in Adolescent Pregnancies 2014 – 2016 by Regions ...... 32 3.0 – NUTRITION DEPARTMENT ...... 34 3.1 Maternal Infant and Young Child Nutrition (MIYCN) ...... 34 3.1.1 Initiation of Breastfeeding within 1hour of Delivery ...... 34 3.1.2 Exclusive Breastfeeding at 3 Months ...... 35 3.2 Management of Severe Acute Malnutrition ...... 36 3.3 Micronutrient Deficiency Control ...... 39 3.3.1 Vitamin A Supplementation Programme ...... 39 3.4 Growth Monitoring and Promotion ...... 42 4.0. HEALTH PROMOTION DEPARTMENT ...... 44 5.0 UPDATES AND SPECIAL INITIATIVES ...... 45 5.1. Safe Motherhood ...... 45 5.2. Family Planning ...... 45 5.3. Child Health ...... 47 5.4. Adolescent Health and Development ...... 48 5.5. Nutrition ...... 49 5.6. Health Promotion Department ...... 50 6.0 CHALLENGES AND WAY FORWARD ...... 52 6.1 Challenges ...... 52 6.2 Way Forward ...... 52 APPENDIX C: PERFORMANCE BY REGION/DISTRICT FOR SELECTED INDICATORS OF NATIONAL PRIORITY ...... 56
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Table of Figures
Table of Figures ...... xi
1.2 VISION ...... 1 1.3 MISSION ...... 1 1.4 OBJECTIVES ...... 2 2.1 SAFE MOTHERHOOD ...... 3 2.1.1. Antenatal Care Coverage ...... 3 Figure 2.1.2 Trend in ANC Coverage by Regions 2014-2016 ...... 5 2.1.4.1 Haemoglobin tested at Antenatal Care Registration ...... 11 2.1.4.2 Trends in Anaemia Prevalence at Registration and at Term ...... 12 Figure 2.1.11: Trend in Caesarean Section Rate by Regions 2014 – 2016 ...... 18 Figure 2.1.12a Institutional Maternal Mortality 2016 ...... 19 Figure 2.1.12b: Trend in Total Maternal Deaths 2012 - 2016 ...... 19 2.1.13: Trends of Maternal Deaths by Regions/Institution 2014 - 2016 ...... 20 Figure 2.3.2: Trend in Neonatal Deaths per 1000 Live births by Region 2014-2016 ...... 28 Figure 2.4.7: Trend in Percentage of Adolescents (10-19 years) Delivered by a Skilled Attendant 2012-2016 ...... 33 Initiation of Breastfeeding ...... 34
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ORGANIZATIONAL STRUCTURE OF THE FAMILY HEALTH DIVISION
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CHAPTER 1:
BACKGROUND
1.1 INTRODUCTION
The Family Health Division was established in May 2008 at the Ghana Health Service Headquarters level. The division was carved out of the Public Health Division and comprises the Reproductive and Child Health, Nutrition and Health Promotion Departments. This was done to improve focus, foster resource mobilization and strengthen programme coordination at the headquarters level to more efficiently and effectively support the regions, districts and other levels and sectors. The division implements the policies of the Ghana Health Service with an emphasis on primary level care. This is done through promotion, prevention, treatment and rehabilitative aspects of health in non-diseased physiologic states such as pregnancy, child bearing, feeding, growth and development as well as in disease states. The division plans for an additional department to address issues of ageing and general health.
The mandate of the Family Health Division includes, translating policies for implementation, tracking policy/strategy implementation, resource mobilization, ensuring timely disbursements and implementation of activities, Information sharing, monitoring initiatives, standards and levels of integration, evaluation and quality control and proposing corrective strategic measures where necessary. Furthermore, the division provides technical support to regions, to guide the district level where actual implementation occurs.
1.2 VISION
The vision of the Division is to have healthy and well-nourished adults and children for national development.
1.3 MISSION The mission of the Family Health Division (FHD) is to contribute to improvement in the health and quality of life of persons of reproductive age and beyond as well as children (including adolescents) by:
• Providing high quality reproductive, child health and nutrition services
• Optimal health and nutrition promotion through well informed, highly skilled and motivated staff.
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1.4 OBJECTIVES
In carrying out its mandate, the Family Health Division seeks to:
• Improve women’s health in general and especially, to reduce maternal morbidity and mortality and to contribute to reducing infant and child morbidity and mortality.
• Assist couples and individuals of all ages to achieve their reproductive goals and improve their general reproductive health.
• Provide individuals and communities (including adolescents) with information and equip them with life skills needed to adopt and maintain healthy behaviour and optimal nutrition, supported by a responsive health system.
• Strategize (plan and coordinate) health activities aimed at promoting and maintaining healthy pregnancies and deliveries and the optimal growth and development of children from birth to 18 years. • Improve awareness and knowledge on nutrition issues, infant and young child feeding practices, management of malnourished children/persons and prevent/control micronutrient deficiencies (due to iodine, iron and vitamin A)
The Division has three administrative departments which see to the implementation of its health programmes for the population with emphasis on children, mothers, adolescents and older adults. These departments which include Reproductive and Child Health, Health Promotion and Nutrition, ensure synergy in all the health programmes implemented in the division together with its health and development partners.
This document highlights the key achievements and performance in relation to service indicators for the 2016. The data analysed are derived from service provision in line with the mandate of the division from both public and private health facilities.
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CHAPTER 2: PERFORMANCE OF PROGRAMME INDICATORS
2.0 REPRODUCTIVE AND CHILD HEALTH
The Reproductive and Child Health Department implements the following health programmes: o Safe Motherhood o Family Planning o Child Health o Adolescent Health o School Health o Prevention of Mother-to Child Transmission of HIV
2.1 SAFE MOTHERHOOD The goal of the safe motherhood programme is to improve the health of women and their new-borns in general and specifically to contribute to the reduction in maternal and new-born morbidity and mortality. The component of services under the safe motherhood programme covers pre-conception and antenatal care, through to skilled delivery and postpartum care. The data analysed reflect these components of services.
2.1.1. Antenatal Care Coverage Global evidence suggests a strong correlation between benefiting from antenatal care (ANC) services and positive pregnancy outcomes. Essential interventions in ANC include intermittent preventive treatment for malaria during pregnancy (IPTp), identification and management of obstetric complications such as preeclampsia, tetanus toxoid immunisation, intermittent and identification and management of infections including HIV. In addition, ANC affords the opportunity to promote the utilization of skilled attendance during delivery and healthy actions such as breastfeeding, early postnatal care, and family planning. Antenatal coverage continues to be a success story in the country. More than 80% of pregnant women had at least one contact with a skilled provider during pregnancy in 2016. Notwithstanding the country has been recording declines in antenatal coverage over the past three years (Figure 2.1.1.).
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Figure 2.1.1: Trend in ANC Coverage 2012-2016 - National
Trends in ANC Coverage 2014 – 2016 - Regional
Figure 2.1.2 below describes the ANC performance of regions in the past 3 years. Northern region recorded the highest coverage of over 100% and Volta recorded the least of about 69% in the year under review. Brong Ahafo, Eastern, Upper East, Western and Volta regions recorded marginal declines. Four out of the 5 regions have continuously recorded declines in coverages for the past three years (Figure 2.1.2).
A careful analysis of data from the Northern Region revealed that 50% of districts in the region have recorded ANC coverages of over 150% in the last 5 years and in some cases over 200%. Tamale Metropolis has recorded coverage of over 200% in the last 5 years. This could be one of the reasons contributing to the over 100% ANC coverage consistently recorded from 2012 to 2016 in the region.
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Figure 2.1.2 Trend in ANC Coverage by Regions 2014-2016
Figure 2.1.2a below shows a mixed picture of performance among the districts in Volta region, ranging from a very low of less than 40% in Ho West, Adaklu, Afadjato South, Akatsi North and Hohoe to a high of 160% for Nkwanta North. Inadequate health facilities accounted for low coverages in Ho West and Afadjato South. High performance in Nkwanta North district is reported to be due to increased attendance from other districts. Ten (10) out of the 25 districts have recorded declines consistently from 2014, and only Krachi West has recorded consistent increases over the same period.
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Figure 2.1.2a: Trend in ANC Coverage 2014 – 2015 – Volta Region
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Feedback reports from the regions identified inadequate human resource and logistics, poor data management as well as inadequate monitoring and supervision of service provision especially at the peripheral levels and weak community engagement as among the key contributory factors to the downward trends.
To address the challenges, several actions have been initiated by regions including capacity building for midwives, task shifting, staff rationalization and reposting and orientation of service providers on data collection and reporting tools. In addition, monitoring and supervision were intensified and monthly data validation and verification schedules were adhered to.
Furthermore, home visits to register pregnant women were carried out in some districts. Pregnancy schools were also initiated by some facilities. These approaches also provided the avenue for in-depth interactions with pregnant women to identify their peculiar needs and address them.
The Health Promotion Department would liaise with all regions, particularly those which recorded declines to improve engagement with communities to promote awareness about the need for early and continuous ANC attendance.
2.1.2. Trend in ANC 4+ Visit
Inadequate care during pregnancy breaks a critical link in the continuum of care which can affect the outcome of pregnancy. In order for the pregnant woman to benefit adequately from the essential interventions designed for antenatal care, provision of a minimum of four visits at specified intervals is recommended for pregnant women with no underlying medical problems.
Whiles ANC coverage remains high, the coverage of at least four ANC visits remains lower at approximately 76 percent which, is a slight improvement over what was recorded in 2015 (Figure 2.1.3). Interventions implemented over the years include SBCC to create awareness of the need for early and regular ANC attendance, the Community-based Health Planning Services (CHPS) strategy to improve access to maternal and child health services as well as capacity building for improved client-service provider relationship; however, progress to achieve the set target of 85% has remained slow. Some of the obstacles include challenges with the implementation of the CHPS strategy, lack of adequate numbers of human resource and logistic supply and in some instances persistent poor provider-client relationships. Ghana is yet to adopt WHO’s new antenatal care model which increases the number of contacts a pregnant woman has with health providers throughout her pregnancy from 4 to 8. The average number of ANC visits still remains at 4.2. There is need for the progress being made to be consolidated as well as improve the stagnating performance as shown in the trends for the past three years.
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Figure 2.1.3: Trends in ANC 4+ Visits 2012-2016
2.1.3 Timing of Registration at Antenatal care Pregnant women are expected to register for antenatal care within the first trimester in order to benefit from comprehensive and effective care; however, over the past 5 years, first attendance at ANC within the first trimester has stagnated around 45%. Persistent superstitious and cultural beliefs are some of the reasons that prevent women from accessing care during the first trimester of pregnancy. SBCC campaign targeting early attendance to ANC would be intensified. Marginal reduction in first attendance in the 3rd trimester was recorded in the year under review (Figure 2.1.4).
Figure 2.1.4: Trend in Timing of ANC Registration 2012-2016
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Interventions to reduce negative pregnancy outcomes e.g. anaemia prevention or treatment and counselling on maternal nutrition and infant feeding are most effective if contact with mothers is frequent. Having less than 50% of women attending their first ANC in the 1st trimester may reduce the number of contacts and thereby effective interactions that would lead to positive pregnancy outcomes. Moreover, opportunities for thorough discussion and eventual adoption of exclusive breastfeeding and family planning may be missed, necessitating the need for intensified SBCC campaign.
2.1.4 Anaemia among Pregnant Women
WHO defines anaemia as a shortfall of haemoglobin to less than 11g/dl. For pregnant women, anaemia could lead to low birth weight (birth weight <2.5kg), premature delivery and increased risk of postpartum haemorrhage and death. Pregnant women are given iron and folic acid supplements as one of the strategies to reduce anaemia, improve the health and wellbeing of the pregnant woman as well as pregnancy outcomes.
One of the measures of the state of health of all pregnant women is to have their haemoglobin levels determined at least on their first visit for antenatal care and again when they turn 36 weeks.
2.1.4.1 Haemoglobin tested at Antenatal Care Registration
The proportion of expectant mothers whose Hb level was tested at ANC registration increased from 81.6% in 2015 to 82.4% in 2016 (Figure 2.1.5). However, this is still a shortfall from 100% due to lack of testing facilities in some hospitals, health centres and CHPS compounds leading to women having to seek testing services elsewhere without feedback to the requesting facilities. Additionally, some women are required to make payment for the testing in private laboratories and this has the potential to reduce the number of pregnant women tested at ANC registration. Some regions reported shortages of maternal health records which also made recording and reporting a challenge.
Most regions have stagnated in the rate of testing of ANC registrants; however Northern region recorded the biggest increase of over 10% between 2015 and 2016. The major contributor to this achievement was the supply of hemocues to midwives in some districts by USAID sponsored projects SPRING and RING which also trained health staff in the identification and management of anaemia in pregnant women and children. Other regions which recorded marginal increases are Upper East, Volta and Upper West. Upper West recorded the lowest coverage of 62.2%.
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Figure 2.1.5: Trend in Proportion of Pregnant women with HB tested at Registration 2012-2016
100 90 80 70 60 50 40 30 20 10 0 Brong Greater Norther Upper Upper Ashanti Central Eastern Volta Western GHANA Ahafo Accra n East West 2014 90.33 92.06 86.91 84.14 82.01 74.68 83.64 64.90 66.81 87.32 83.06 2015 86.42 89.49 89.88 84.54 94.11 63.44 76.95 58.61 63.46 80.54 81.58
2016 87.40 89.96 87.98 83.93 86.81 76.30 83.23 62.26 67.13 77.25 82.37
2014 2015 2016
Scattered communities and lack of testing facilities in most districts were the main contributors to this trend. Within the Upper West region, Wa Municipal and Nandom are the only districts with adequate number of testing facilities. Similarly, Volta region reports of large numbers of overseas communities where health facilities are unavailable. Lack of boats and/or fuel hampers efforts to reach them; contributing to their poor performance over the years.
It is important to provide health facilities where possible, but equally important is the willingness of staff to accept posting to such difficult terrains, with incentives including prompt release for further education or re-posting to well-endowed districts after specified number of years.
2.1.4.2 Trends in Anaemia Prevalence at Registration and at Term
Anaemia among ANC registrants increased marginally by about 1% over the 2015 rate in the year under review. A cursory look at the trends (Figure 2.1.5) shows that anaemia among pregnant registrants has been increasing since 2014.
Similarly, anaemia among pregnant women at term (36weeks) increased marginally between 2015 and 2016; after recording a dip between 2014 and 2015. Anaemia in a pregnant women is a risk factor for low birth weight and haemorrhage during and after delivery, which increases the risk of maternal mortality.
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In Ghana, the major strategy to prevent anaemia in pregnancy is the provision of iron and folic acid (IFA) supplements during pregnancy till 6 weeks postpartum. Issues of lack of compliance to IFA and appropriate dosing regimens as well as inadequate counselling have been cited as factors affecting anaemia prevention strategies; however empirical data for decision making in this area is lacking.
Figure 2.1.5: Trends in Anaemia Prevalence at Registration and at Term 2014 – 2016
40 35 30
25 20 15
(%) rate Anaemia 10 5 0 2014 2015 2016
Anaemia at Registration Anaemia at Term
There is an initiative to improve anaemia levels among menstruating women and adolescents, through SBCC to create awareness and generate demand for actions to reduce anaemia among the target group and by extension improve the health of women before they enter pregnancy. In the mean time, ensuring adequate stocks of IFA, appropriate counseling for improved compliance to IFA regimens as well as increase in contact time during pregnancy for anaemia prevention actions would help reduce negative pregnancy outcomes due to anaemia.
Anaemia trends in Regions – Registrants
Figure 2.1.6 below describes the regional variations in anaemia prevalence among ANC registrants. Most of the regions have stagnated in anaemia prevalence, except Northern region which recorded a marked increase and Greater Accra region which recorded a decline in 2016. Volta region has consistently recorded the highest proportion of antenatal clients with anaemia over the past three years.
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Figure 2.1.6: Trend in Anaemia among ANC Registrants by Region 2014 – 2016
50 45 40 35 30 25 20 15 10 5 0 Brong Greater Upper Upper Ashanti Central Eastern Northern Volta Western Ahafo Accra East West 2014 33.95 29.04 40.19 28.85 36.24 26.59 37.33 38.26 45.47 31.05 2015 33.81 29.79 39.47 30.64 35.72 32.79 39.37 39.03 46.30 35.87 2016 34.54 29.56 40.08 31.14 32.97 43.00 41.02 41.19 47.28 36.49 2014 2015 2016
Reasons for the high anaemia rates among the general population but particularly in Volta, Central, Upper East and West and Northern regions are not farfetched: high malaria rates, helminth infection, iron deficiency linked to poor quality and amount of iron in the diets have been named as causes of the high anaemia rates among women in the child bearing age. However, the exact contributions of these factors remain unknown. The Ghana Health Service over the years has implemented malaria control programmes, including distribution of long lasting insecticide nets and mass house spraying, deworming and promotion of intake of iron-rich foods. A Micronutrient study currently underway is expected to provide the needed answers to help quantify the contributors to the high levels of anaemia, and provide the basis for improved and more targeted interventions.
Trends in Anaemia at 36 weeks by regions
Northern and Upper West regions recorded significant increases in anaemia rate among pregnant women at 36 weeks in 2016 (Figure 2.1.7). Haemorrhage was reported as the leading cause of maternal deaths in 2016 in the country, giving credence to the assertion that anaemia is a risk factor for increased blood loss during delivery. Iron and folic acid supplementation have been employed as the major intervention to prevent and reduce anaemia in pregnancy; however, the continuously high anaemia levels at term may be indicating that this intervention is facing a number of challenges.
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Figure 2.1.7: Regional Trends in Anaemia among Pregnant women at 36 weeks 2012-2016
45 40 35 30 25 20 15 10 5 0 Brong Greater Upper Upper Ashanti Central Eastern Northern Volta Western Ahafo Accra East West 2014 27.17 26.46 34.55 23.75 30.01 20.58 41.00 22.89 31.82 28.09 2015 21.95 22.98 26.87 22.21 25.70 22.97 32.98 29.62 25.62 23.39 2016 22.74 24.54 27.92 26.41 201421.19 201532.4120163.35 36.53 26.48 27.35
Reduction in anaemia level through Iron and folic acid supplementation are proven to be more effective when the supplements have been taken over longer durations of at least three months. In the light of the high anaemia rates at registration and the possibility of giving supplemental doses because of late testing at registration rather than treatment doses if anaemia is detected early, more pregnant women may get to term not having recovered from anaemia.
It is implied therefore that if more pregnant women do not register early during pregnancy, and issues related to lack of testing facilities in health facilities are not addressed, coupled with poor compliance to IFA regimen, anaemia prevention and control measures may not achieve the desired impact.
2.1.5 Prevention of Maternal and Neonatal Tetanus Provision of at least 2 doses of Tetanus-Diphtheria (TD2) to all pregnant women in high risk areas is one of the key strategies for achieving elimination of maternal and neonatal Tetanus recommended by WHO/UNICEF/UNFPA. Although Ghana is among several countries which have successfully eliminated maternal and neonatal tetanus, data collated for 2016 shows a decline in the coverage of Tetanus vaccination among ANC clients and the Women-in-Fertile-Age (WIFA) population.
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Figure 2.1.9: Trend in TT/TD Vaccination among WIFA and Pregnant Women 2012-2016
Poor record keeping for TD vaccination leading to incomplete data on immunization status of pregnant women is among the key factors contributing to the low coverage.
2.1.6. Skilled Delivery
Globally consensus has been reached over the past years on the interventions that are significant in reducing maternal mortality. Attendance by skilled health staff during delivery is
proposed to be one of the crucial factors and this is reflected in the use of proportion of birth attendance by skilled health staff as a benchmark indicator for monitoring progress towards the Millennium Development Goals (MDGs). In general, births with skilled attendants are associated with lower rates of maternal mortality.
In 2016, 56.2% of deliveries were attended by skilled health providers (Figure 2.1.10). The fact that this is lower than the figure of 73.7% recorded by the 2014 Demographic and Health Survey (DHS) underscores the concern that deliveries from private health facilities and maternity homes may be under reported due to the lack of a formal system to actively capture data from these sources. Achieving the national target of 80% will continue to be an unsurmountable challenge unless this issue is addressed.
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Figure 2.1.10: Trend in Skilled Delivery 2012-2016
Skilled delivery – Regional trends
Figure 2.1.11 describes the regional trends in skilled delivery from 2014 to 2016. Upper East region has consistently recorded the highest skilled delivery coverage over the past 3 years with a reduction from 2015 to 2016; whilst Volta region has consistently recorded the lowest within the same time period.
Brong Ahafo, Eastern and Volta region have consistently recorded declines in skilled delivery coverage for the past three years. (Figure 2.1.11).
Analysing performance for 2016 within the Volta region, 4 districts (Akatsi North, Afadjato South, Ho West and Adaklu) recorded less than 20% skilled delivery and a total of 15 districts recorded less than 50% skilled delivery rate. Only Kpando district recorded 77%, which was a significant decline from 89% in 2015 (Figure 2.1.11).
Figure 2.1.11: Trends in Skilled Delivery 2014-2016, Regional
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2.1.7. Caesarean Section Rate The proportion of deliveries by caesarean section recorded for 2016 was above the recommended rate of between 5% and 15% of all births by the WHO (Figure 2.1.11). The proportion has increased from 14.6% in 2015 to 16.0% in 2016. Regional variations show a general increase across the country apart from the Upper East which recorded a decrease in 2016 (Figure 2.1.11)
Figure 2.1.11: Trend in Caesarean Section Rate by Regions 2014 – 2016
Greater Accra contributed the highest percentage (24.3%) and the Northern region recording the lowest percentage (8.7%). Several factors can be attributed to the high CS rate in Greater Accra region, including having the largest teaching hospital, which also serves as the national referral centre. In addition, there is better access due to the high numbers of health facilities with capacity to conduct caesarean sections.
Despite the non-availability of a reliable and internationally accepted classification to enable comparisons across the regions, the division would initiate measures to ensure that the procedure is not being used for non-emergency reasons to prevent the exposure of mothers to unnecessary risks associated with anaesthesia and surgery.
In addition, the division will liaise with the research unit and the regions performing above target to develop a tool to investigate drivers of the upward trend in caesarean section rate in public and private health care facilities and to ascertain the impact of this high rate on the outcome of deliveries recorded over a record period of time. This is also to ensure that health care resources are being used efficiently.
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2.1.8. Maternal Mortality
Maternal Deaths
In 2016, a total of 955 women died from pregnacy related causes, which is an increase over that recorded in 2015 (Figure 2.1.12b). Ghana Health Service (GHS ) facilities reported 61% of all maternal deaths, the Christian Health Association of Ghana (CHAG) facilities contributed 15% and the teaching hospitals contributed 24% in 2016.
Figure 2.1.12a Institutional Maternal Mortality 2016
Teaching Hospitals CHAG
Ashanti 9%
Brong Ahafo 2% 6% 24% Central 3% Eastern 5% Greater Accra
Northern 13% 15% Upper East Upper West 10% Volta 5% 4% Western 4%
Figure 2.1.12b: Trend in Total Maternal Deaths 2012 - 2016
1020 1000 980 960 940 920 900 880
Total Maternal deaths deaths Maternal Total 860 840 820 2102 2013 2014 2015 2016 Year
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Total Maternal deaths by Regions/Institutions
Figure 2.1.13 below describes trends in institutional maternal deaths by regions from 2014 till 2016. It reveals that the teaching hospitals have been recording consistent increase in deaths over the period. Among the regions, Greater Accra continues to record the highest number of maternal deaths (Figure 2.1.13). It is reported that the region is facing what they call “no bed syndrome”, where pregnant women who have referred are moved around from one facility to the other, being rejected on account of no bed. This situation results in the clients finally being attended to when the condition is very critical. In the light of this, the region has instituted a call centre to coordinate facilities and provide up to date information on bed availability. Facilities referring women would call to the centre and are immediately told which facility is prepared to receive the client.
2.1.13: Trends of Maternal Deaths by Regions/Institution 2014 - 2016
250 200 150 100 50 0
Number of maternal deaths maternal of Number
Regions/Institutions
2014 2015 2106
In the Volta region, lack of critical health staff and high cost of scan were some challenges enumerated. Also Upper West region reported highly scattered communities and poor access as major challenges. Most regions complained that only few facilities have the capacity to receive referred clients and provide comprehensive care. Women having challenges travelling from overbanks of rivers were reported in some districts and the galamsey menace were also cited as major challenges to maternal health in the country.
Causes of maternal deaths
Out of the 1,033 maternal deaths recorded, 872 (84.4%) were audited and causes identified. Most (56.6%) of the deaths were due to direct causes as shown in figure 2.1.14. Haemorrhage
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(39%) continues to be the leading direct cause of maternal death, with hypertensive disorders (35%) following closely as the second direct cause of maternal death in the country.
Figure 2.1.14 Direct Causes of Maternal Deaths 2016
Direct Cause of maternal deaths, 2016
Other direct Ectopic 7% 1% Sepsis 7% Obstructed Labour/Ruptured Uterus 4% Haemorrhage Unsafe Abortion 39% 7%
Hypertensive Disorders 35%
Indirect causes including malaria, severe anaemia, HIV, embolism and sickle cell disease accounted for 26% of the maternal deaths and 1.7% was due to unknown causes.
Most of the causal factors were documented. Regardless of this, there remain gaps in our knowledge of the scope, with 1.7% of the deaths attributed to unknown causes.
Maternal Mortality Ratio (MMR)
The number of maternal deaths recorded for 2016 reflects a corresponding increase in maternal mortality ratio which had declined from 2013 to 2015 during the implementation of the MDG Acceleration Framework (MAF) programme. However, this decline was not sustained as shown by the significant increase in figure 2.1.12b. This implies that the risk of a woman dying when she becomes pregnant has relatively increased.
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Figure 2.1.14 Trend in Institutional Maternal Mortality Ratio-2012-2016
250
200 163.5 152 153 150
144 142
100 MMR/100000lb
50
0
2012 2013 2014 2015 2016
Maternal mortality Ratio by Regions
The Upper East region recorded the lowest obstetric risk in 2016, although maternal mortality ratio for the region has increased from what was recorded in 2015 (Figure 2.1.15). Seven out of the ten regions recorded increases in maternal mortality ratio; however, data collated over the past three years shows that pregnant women in the Northern region have an increased risk of dying when compared with their counterparts in the other regions. The Northern region has recorded steady increase in risk over the past three years.
Figure 2.1.15 Trend in Institutional Maternal Mortality Ratio-2012-2016 250
200
150
100
MMR/100000lb 50
0 AS BAR CR ER GAR NR UER UWR VR WR 2014 114.9 134.9 105.2 175.5 184.7 107.5 138.7 161.1 178.8 149.5
2015 136.4 130.6 108.4 176.1 176.8 144.3 89.7 155.8 134.3 124.5 22 | 2016P a g e149.4 117.1 218.7 170.4 180.4 207.3FHD 107.9| Annual109.1 Report167.7 2148.3 0 1 6
The country is implementing cost-effective interventions which are proven to address maternal mortality. Some of these interventions include quality antenatal care providing a comprehensive package of health and nutrition services, promoting access to family planning services, access to skilled health personnel at delivery, availability of basic and comprehensive emergency obstetric care services. However, there still remain both human and systemic challenges which have slowed down the efforts of reducing maternal mortality significantly over the years.
2.2. Family Planning Programme
Pregnancy by choice and not by chance is the basic requirement for women’s health. Fertility regulation is also a major component of the safe motherhood strategy and has been delineated under the family planning programme for emphasis and increased focus. The goal of the family planning is to assist couples and individuals of all ages achieve their reproductive goals and improve their general reproductive health.
The strategies adopted include the provision of information, education and counselling, affordable contraceptive services and the prevention and management of reproductive tract infections and STIs/HIV among others. During the year under review the programme carried out various interventions which have been reflected in its performance discussed below.
2.2.1 Acceptor Rate Following the unexpected decrease in 2015, which was attributed to a major decrease in the acceptor rate for the Brong-Ahafo Region, efforts were intensified to improve uptake of family planning services. This has reflected in the significant increase in acceptor rate of 33.8% recorded for 2016. Greater Accra Region was the highest contributor to this achievement (Figure. 2.2.2).
2.2.1: Trends in Family Planning Coverage
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Analysis of service data from the regions show consistent increase in the acceptor rates in the past 3 years for Greater Accra from 33% in 2014 to 38% in 2015 to over 50% in 2016; and Ashanti region from 22% in 2015 to 25% in 2016. Significant increases in acceptor rate were also observed for the Central, Northern and Brong Ahafo regions following the considerable declines between 2014 and 2015. However, Volta, Upper East and West and Western regions either showed a plateaued performance or slight increase in acceptor rate. Eastern region has shown a consistent decrease in the acceptor rate from 2014 to 2016.
Figure 2.2.2: Trend in Family Planning Acceptor Rate by Region 2014-2016
Key among the initiatives that have contributed to the improved performance in some regions is the active re-registration of clients on long term methods which was a challenge in the previous years. Also, the availability of local resource persons at service delivery points has led to training being decentralized and improved on-site coaching and mentoring contributing to improvement in the capacity of providers to render family planning services.
Other contributing factors include the scale up of implementation of the implant task shifting policy affording community health and enrolled nurses the opportunity to be trained to provide implant services. Other initiatives included family planning outreach programmes, strengthened collaboration with other implementing partners and the private sector, actively promoting male involvement and identification and training of community leaders as advocates and champions for family planning.
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Eastern region, which recorded a decline between 2015 and 2016 cited poor data management, artificial stock outs at service delivery points and persistent myths and misconceptions on the use of contraceptives as well as inadequate monitoring and supportive supervision as some reasons for the observed decreases. It is expected that certain-specific measures would be put in place to address the challenges identified to be contributing to the decrease in acceptor rate in the regions.
2.2.2. Couple Year Protection (CYP) In line with programme plans, projections and expectations, the national CYP trend showed significant increases over the years (Figure. 2.2.4). This CYP measures the programme performance by providing information about the volume of all contraceptives sold or distributed and is an immediate indication of the volume of programme activity. Again, this trend can be attributed to the scale-up of task shifting allowing community health and enrolled nurses to provide implant services, an overall increased access to long acting and reversible methods and improved commodity security.
All regions recorded increase in CYP from 2015 to 2016 (Figure 2.2.5), with the Greater Accra and Ashanti regions contributing the highest proportions to the national CYP figure.
Figure 2.2.4: National Trend in Total Couple Year Protection 2012-2016
TOTAL COUPLE YEARS OF PROTECTION 3,000,000 2,757,789
2,500,000
1,951,913 2,000,000 1,592,401 1,657,490 1,500,000 1,222,230
1,000,000
500,000
0 2012 2013 2014 2015 2016
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Figure 2.2.5: Trends in Total Couple Year Protection by Region 2014-2016
2.3. Child Health Programme
The child health programme focuses on the first five years of life as the most vulnerable period of childhood, which sets the tone for child growth and development thereafter.
Although some progress has been made over the years in reducing childhood morbidity and mortality, there are several challenges that need to be addressed. Newborn deaths are an important component of child mortality and currently represents over 40% of all under-five deaths. Mortality varies between geographic areas and by many factors including the age and level of education of the mother and household incomes, with the most deprived having higher mortality rates. The complex and multifaceted causes of child morbidity and mortality call for a shared vision and an effective integrated approach among various stakeholders across a number of sectors apart from the health sector.
2.3.1. Still Birth rate Still births are a reflection of the quality of care given to women and newborns during antenatal and delivery.
In the year under review, still birth rate was 1.6% as in the preceeding year. Among the regions, significant changes were not recorded; however marginal declines occurred in the Western, Upper West, Bronhg Ahafo and Ashanti regions. The trend seem to be increasing in Volta, Upper East, Central and Greater Accra regions. With the roll out of the perinatal 26 | P a g e FHD | Annual Report 2 0 1 6
death audits programme, the underlying causes of still births should be identified and interventions put in place to reduce them.
Figure 2.3.1: Trend in Still Birth Rate by Region 2014-2016
2.3.2. Neonatal Death
In Ghana, most of the deaths that occur in the neonatal period are as a result of 3 main conditions – adverse intrapartum events, mainly birth asphyxia, prematurity and infections. Interventions to reduce these conditions are clearly outlined in the National Newborn Strategy and Action plan. Perinatal death audits can unearth some of the reasons behind these deaths.
From 2015 to 2016, neonatal death rates decreased in the Greater Accra, Northern, Upper East and Western regions (Figure 2.3.2). However the other regions reported increases in neonatal deaths per 1,000 live births. The national trend has not seen any significant change over the past three years as shown in figure 2.3.2.
Infant mortality rates on the other hand increased in all regions except the Northern and Upper East egions (Figure 2.2.3). This is worrying and calls for further study to determine and address the causes.
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Figure 2.3.2: Trend in Neonatal Deaths per 1000 Live births by Region 2014-2016
Figure 2.3.3: Trend in Institutional Infant Mortality by Region 2014-2016
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2.3.3 Exclusive Breastfeeding at Discharge The percentage of mother/infant pair exclusively breastfeeding at discharge has seen a consistent increase since 2014. This gain should be sustained through scaling up of the baby friendly initiative in all health facilities providing maternity services. Mothers should be supported to sustain the practice of exclusive breastfeeding when they go back to their communities.
Figure 2.3.4: Trend in Percentage of Mother/Infant pairs Exclusively Breastfeeding Feeding at Discharge
2.4 Adolescent Health Programme The National Adolescent Health and Development Programme constitutes a comprehensive care for young people (10-24yrs). This comprehensive care is about bridging the gap between clinical and public health programmes to promote adolescent health. The elements of this comprehensive care are promotive, preventive, clinical and rehabilitative health care. The goal of the ADHD programme is to integrate adolescent friendly health services into both public and private health facilities at all levels of service delivery including the community level.
The key strategy of the programme is to make health services adolescent/youth friendly. This means health services at every level should be available, accessible, acceptable, equitable and affordable for every young person no matter their social or economic status. Every young person should be considered an individual with all rights reserved for the population of the country and so be treated with dignity and respect.
The ADHD programme targets primarily young people aged 10-24 years, parents, teachers, social workers and health workers (the stakeholders) and health and related sectors (the system). FHD | Annual Report 2 0 1 6 29 | P a g e
2.4.1 Adolescent Pregnancies
Adolescent pregnancy presents both health and social challenges. Adolescents who get pregnant are more constrained in their ability to pursue educational opportunities than their counterparts who delay childbearing. Adolescent pregnancy contributes to the cycle of maternal mortality and morbidity because they are more likely to experience adverse pregnancy outcomes than their older counterparts. In addition, babies born to adolescent mothers are at increased risk of sickness and death; therefore, they need special attention during pregnancy.
The proportion of adolescents who sought antenatal care services for 2016 reduced marginally from 12.1% in 2015 to 11.8% in 2016 (Figure 2.4.1). Coupled with this is an increase in the proportion of adolescents accessing family planning services. For the past five years, institutional data shows a decrease in reported adolescent pregnancies and proportions accessing safe abortion services with a steady increase in the use of contraceptives among adolescents.
Figure 2.4.1: National Trend in Percentage of Adolescents (10-19 years) attending ANC 2014-2016
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Figure 2.4.2: National Trend in Percentage of Adolescents (10 – 19 years) Accessing Family Planning Services 2012-2016
Figure 2.4.4: National Trend in Percentage of Adolescents (10-19 years) having Abortions 2012- 2016
In 2015, where the proportion of adolescents accessing family planning services decreased slightly (Figure 2.4.2), there was a corresponding rise in adolescents accessing safe abortion services (Figure 2.4.3) with no change in the proportion of adolescent pregnancy (Figure. 2.4.1). These patterns reiterate the importance of contraceptive use among sexually active adolescent as a preventive measure against unintended pregnancies.
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2.4.2: Trends in Adolescent Pregnancies 2014 – 2016 by Regions Four out of the ten regions recorded slight increases in the proportion of antenatal registrants who were adolescents in 2016 compared with 2015. Greater Accra region recorded the lowest proportion of 6.2 percent and the Upper East recorded the highest of 15.4 percent.
Figure 2.4.5: Trend in Percentage of Adolescents (10-19 years) attending ANC – by Region 2014 - 2016
Figure 2.4.5b: Trends in Percentage of Adolescents (10-19 years) accessing Family Planning Services by Region 2014-2016
The proportion of ANC registrants who were adolescents or adolescents accessing family planning or abortion services or skilled delivery rises with age. For all these indicators, most of the clients were late adolescents 15-19 years (Figure 2.4.6.) This is consistent with the 2014 GDHS report that sexual activity increases with age. 32 | P a g e FHD | Annual Report 2 0 1 6
Figure 2.4.6: Service Indicators by Age Groups - 2016
Approximately the same proportion of ANC registrants who were adolescents sought skilled attendance during delivery. The assumption is that contact with a skilled attendant during pregnancy increases the likelihood of the adolescent delivering with a skilled attendant.
Figure 2.4.7: Trend in Percentage of Adolescents (10-19 years) Delivered by a Skilled Attendant 2012-2016
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3.0 – NUTRITION DEPARTMENT
The Nutrition Department coordinated the implementation of the Maternal, Infant and Young Child Nutrition Programme, Nutrition Rehabilitation with emphasis on management of severe acute malnutrition and moderate malnutrition, Micronutrient Deficiency Control and Nutrition Support for Vulnerable Groups.
In the year under review, priority actions were focused on Maternal, Infant and Young Child Nutrition (MIYCN), Improving coverage of Vitamin A Supplementation for children 6-59 months and Integration of management of severe acute malnutrition protocols into Integrated Management of Neonatal and Childhood Illnesses.
3.1 Maternal Infant and Young Child Nutrition (MIYCN)
3.1.1 Initiation of Breastfeeding within 1hour of Delivery
National recommendations on breastfeeding stipulates that all infants be put to the breast within 30 minutes after delivery and be placed in skin-to-skin contact for at least 1 hour. Early initiation of breastfeeding has been shown to reduce neonatal deaths by about 13%. Early initiation of breastfeeding has been routinely monitored over the years as an indicator of quality of care for all facilities offering maternity services. In 2016, feeding status of babies at 3 and 6 months were included in the routine health data systems to be monitored.
Initiation of Breastfeeding
The National Nutrition Policy and the Newborn Strategy has targeted that at least 85% of all new-borns should be put to the breast within 30 minutes of delivery. Routine data analysed suggests that almost all infants delivered within the health facilities are put to breast within the first 30 minutes of life, which may be indicative of the fact that the targets have been achieved. However, DHS 2014 indicates that early initiation rate is 56%, revealing a discrepancy between routine data and data from the national survey.
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Figure 3.1. Trend in Initiation of Breastfeeding 2014-2016
100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 (%) Initiation Early 20.00 2014 2015 2016 NB Trgaet DHS 2014 Year
2014 2015 2016 NB Trgaet DHS 2014
It is interesting however to note that the 2014 Demographic and Health Survey report puts early initaition rate at 56%, an acheivement much lower than the national acheivement for the past three years (Figure 3.1). The difference in routine service data and the survey may be due to the differences in practices between public and private health facilities and challenges with recollection bias during the survey. Public health facilities are mandated to follow policies developed by the service as against private hospitals and/or maternity homes which may not do so.
In the light of this development, there was a nationwide drive to build capacity on the Lactation Management and use the opportunity to explain the practice to health staff as an approach to improve the practice and how it is reported. It is imperative to bridge the gap between survey and routine data and by extension afford every Ghanaian child the best start in life. The decentralization of BFHI assessment process, which has capacity building for acquisition of skills to change facility practices to that which supports breastfeeding initiation and success for the first 6 months as a major strategy, would target private facilities. Additionally, opportunities to engage all health facilities, especially the private health facilities would be explored, with every platform including monthly meetings and monitoring visits used to discuss breastfeeding issues.
3.1.2 Exclusive Breastfeeding at 3 Months
In the year under review, the Nutrition Department introduced a new indicator onto the routine data collection system (DHIMS II) to track how infants are fed at the time of PENTA 3 vaccination, when the babies are about 3 months. This was done because apart from the national surveys, there was no indicator to track the practice.
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Figure 3.2 below shows the percentage of infants who were being exclusively breastfed at 3 months in 2016. Caregivers who presented their infants at 3 months for growth monitoring and promotion were asked how the infants were fed. The responses were coded under whether they were giving only breastmilk or they were adding other liquids or foods. A total of 1,144,960 caregivers were enumerated, out of which 880,548 women indicated that they were giving only breastmilk at the time of the visit. This translates into a national prevalence of 77%, ranging from about 68% in the Northern region to almost 90% in the Volta region.
Figure 3.2 Exclusive Breastfeeding at 3 Months by Region
100 90 80 70 60 50 40 30 20 3mo EBF at Caregivers % 10 0 Ashanti Brong Central Eastern Greater Northern Upper Upper Volta Western National Ahafo Accra East West Region
Clinical staff and frontline health workers were trained in breastfeeding promotion, with the aim of designating more facilities as baby friendly. This effort contributed to the massive promotion of exclusive breastfeeding in all regions within the year.
3.2 Management of Severe Acute Malnutrition
In 2008, Ghana adopted the Community-based Management of Acute Malnutrition (CMAM) protocol to manage children with severe acute malnutrition (SAM). Globally, it is expected that over 75% of children who are identified are cured, less than 15% default and less than 5% die while in care.
Figure 3.3 below shows the CMAM performance indicators for 2016. A cure rate of 69.7% was achieved, defaulter rate of 14.1% and non-recovery rate of 14%. The highest non-recovery cases were reported in Berekum (605), followed by Ofinso (324) and then Sefwi Wiawso (272). Interestingly, Berekum district does not implement CMAM programme. In all the years of SAM management, non-recovery rate has been less than 1%. A closer look at the data revealed huge challenges in data reporting, with some facilities currently not managing SAM recording high cases of non-recovery. Findings from mentoring and support visits carried out in the year indicated a lack of understanding of management and reporting protocols due mainly to lack of adequate training of staff and in some instances untrained staff managing SAM cases. 36 | P a g e FHD | Annual Report 2 0 1 6
Figure 3.3: CMAM Performance Indicators 2016
CMAM Cure Rates 2014 – 2016 by Regions
Figure 3.4 below shows the CMAM cure rates from 2014 to 2016. The national cure rate dipped from 78% in 2015 to just below 70% in 2016 after increasing slightly between 2014 and 2015. Cure rates are expected to be at least 75% according to the universal standards. The regions that contributed to this decline are Brong Ahafo, Eastern and Western Regions. These 3 regions have not yet scaled up fully; and clients default in between care when their children get better. There is poor follow-up, which is a major challenge; especially when clients are not from immediate environs of the health facility.
Additionally, non-use of approved tracking forms, poor data capture and reporting were identified as other challenges leading to the significant decline in cure rate.
Northern, Upper East and Upper West regions had cure rates over 75% in 2016 improving steadily in Northern and Upper West regions over the years. Continuous capacity building for SAM management and regular mentoring are some factors contributing to this achievement.
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Figure 3.4: Trend in CMAM Cure Rates – 2014 – 2016
100 90 80
70
60
50
Percentage cured Percentage 40
30
20
10
2014 Cured Rate 2015 Cured Rate 2016 Cured Rate
CMAM Defaulter Rates 2014 – 2016 by Regions
Defaulter rates have steadily improved from about 20% in 2014 to 14% in 2016 (Figure 3.5). Defaulting occurs mostly children with SAM improve after they begin treatment. Coupled with inadequate counselling at the beginning of treatment, some mothers return with children in a worst state after defaulting, which in some instances lead to death of the children. Defaulter rates have decreased in all the regions. Central, Greater Accra and Eastern regions have defaulter rates over 20%, with Greater Accra recording the highest of over 30%.
Over the years, support for capacity building and programme implementation in the phase 2 regions – Brong Ahafo, Western, Ashanti, Volta and Greater Accra has been a challenge. Adequate support in funding for capacity building for health staff and community level activities as well as logistics like RUTF and other supplies would go a long way to improve case admission and management.
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Figure 3.5: Trend in CMAM Defaulter Rates by Region 2014 - 2016
70
60
50
40
30
Defaulting Percent 20
10
0 Ashanti Brong Central Eastern Greater Northern Upper Upper Volta Western Ghana Ahafo Accra East West
2014 Defaulter Rate 2015 Defaulter Rate 2016 Defaulter Rate
Non-Recovery Rates
Data inconsistencies and poor entries accounted for the high non-recovery rate of 14% recorded in the year under review. Three districts, Berekum, Sefwi wiawso and Offinso contributed over 50% (1,201) to the total number of 1,727. Intensive mentoring and reporting as well as regular feedback on data enteries by facilities and districts would be employed to ensure accurate reporting.
3.3 Micronutrient Deficiency Control
3.3.1 Vitamin A Supplementation Programme
Adequate intake of vitamin A has been shown to improve immunity, increase resistance to infections and improve sight. In Ghana, the vitamin A supplementation programme provides high dose supplements to infants 6-59 months. A national coverage of at least 80% is expected. Dosing eligible children has been achieved primarily through mass campaigns, routine child welfare service delivery points, school health and home visits. The latter two have been least explored over the years.
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Coverage in children 6-11 months improved in the year under review, recording 70% in January to June and over 90% in July to December (Figure 3.6). Most of the children within this age group attend child welfare clinics regularly for vaccinations, hence it is easier reaching them and dosing at the appropriate time.
Coverage among the 12-59 age group however remains a challenge due to their non- attendance to child welfare clinics, especially after 18 months when they have received Measles-Rubella 2 vaccination. It is expected that after the vaccinations at 18 months, children continue to visit the child welfare clinics for growth monitoring and promotion and supplementation with vitamin A; however, this does not happen. With more children being sent to schools at this age and the inadequate school health services coverage, especially to crèches, the avenues to reach them remains untapped. Supplementation coverage in all semesters for 2014 and 2015 and the first half 2016 hovered around 20-30%. In the second half of 2016, coverage improved to almost 40% (Figure 3.6). This improvement is due to improved supplementation among that age group from 5 regions which received support to conduct analysis of the reasons why they remain unreached and draw up strategies to reach them.
Figure 3.6: Trend in Vitamin A Coverage for Children 6-59 months 2014-2016
Vitamin A Coverage Improvement Pilot
In the second half of 2016, 5 regions (Northern, Volta, Western, Ashanti and Brong Ahafo) were supported to do analysis of the vitamin A supplementation programme, focusing on reasons where coverage among the age group 12-59 months is low. Strategies outlined and
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implemented by facility staff included periodic visit to pre-schools within the respective catchment areas, introduction/intesification of school health activities, home visits, dosing missed opportunities at the out-patient departments and periodic mop-ups.
Figure 3.7 below describes coverage among the regions which were supported and those which were not. Strategies implemented by the 5 supported regions included regular and improved school health visits, including vitamin A capsule administration during home visits, conducting social mobilization activities on vitamin A, intensifying education and identifying other avenues like OPD to dose missed opportunities.
As shown in figures 3.7 and 3.7a below, coverage in the supported areas (Brong Ahafo, Northern, Western, Ashanti and Volta) for the second semester of 2016 increased substatially with Volta region recording the highest coverage. Cummulative analysis shows that the supported regions increased in coverage from 30% (January to June) of 2016 to about 57% in July to December (Figure 3.7a). Discussions would be initiated on possible support to the other 5 regions to improve their coverage.
The Greater Accra and Eastern regions though did not receive any support, recorded high coverage for the 6-11 group; while Upper West reported average coverage for the 12-59 months. Visits to creches and intensified home visits were among activities conducted to achieve such coverage. This reveals that with some support, coverage would improve markedly.
Figure 3.7: Vitamin A Coverage among 6-11months 2014 - 2016 by Region
140
120
100
80
60
Coverage 40
20
0 Ashanti Brong Central Eastern Greater Northern Upper Upper Volta Western Ahafo Accra East West 2014 I SEM 2014 2 SEM 2015 1 SEM 2015 2 SEM 2016 1 SEM 2016 2 SEM
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Figure 3.7a: Vitamin A Coverage among 12-59months 2014 - 2016 by Region
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00 Ashanti Brong Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western 2014 SEM1 2014 SEM 2 2015 SEM 1 2015 SEM 2 2016 SEM 1 2016 SEM 2
3.4 Growth Monitoring and Promotion
Growth monitoring and promotion services are provided through static points and outreach activities to monitor the growth of children. The weights of children are monitored monthly with the aim of detecting onset of under nutrition early and intervening to prevent growth faltering.
All children 0-59 months who attend growth monitoring sessions are weighed and the weight plotted on the growth chart to determine their growth trend. Monthly data on nutrition status of all children weighed are recorded.
Underweight among children attending CWC in 2016 was 4.34% (Figure 3.8). Among the age categories, the burden of underweight is borne by the 12-23 months age category with a rate of 4.7%, of which 0.42% is severe.
In the past year, training of staff in infant and young child feeding and counselling on the 4-star diet was intensified. Additionally, health staff were trained in breastfeeding promotion towards the designation of their facilities as baby friendly. It is believed that these efforts would improve the capacity of staff to counsel and support caregivers for optimal nutrition behaviour uptake.
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Figure 3.8: Underweight among Attendants to Child Welfare Clinics
5 4.5 4 3.5 3 2.5
2
Underweight 1.5 1 0.5
0 0-11 12-23 24-59 Age Category
Underweight Severe
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4.0. HEALTH PROMOTION DEPARTMENT
The mandate of the Health Promotion Department (HPD) to enhance behaviour change and the adoption of positive lifestyles amongst the populace through the provision appropriate health information and to advocate for an environment which enables individuals to translate the information into desired action.
The Department met its obligation of providing communication strategies and support to other programmes such as Nutrition, Adolescent Health, Family Planning, Malaria, reproductive and Child Health, TB just to mention few.
Capacity building of staff was prominent in the year under review. This was done through the Capacity Assessment Development and Set-for-Change programmes. To ensure effective, efficient delivery of activities, HPD staff were attached to Mullen Lowe for internship purposes.
Seminars on selected monthly health themes were re-instituted. These seminars targeted particularly media practitioners to ensure that accurate health information is churned out from their outlets to the general public and to ensure that issues related to healthy living are given prominence in the media. In line with this the department carried out media monitoring by carrying out content analysis of reportage and news items to track the number of times the topics on various key health interventions were done.
A total of 214 publications including articles and news commentaries were done at the national level during the year under review. Figure 4.1 below shows the various proportions published by dominant print media such as the Daily Graphic and Ghanaian Times.
Figure. 4.1. Publications by Health Topics New-born care Adolescent 5% WASH health 16% Breastfeeding 8% 6%
Family planning HIV/AIDS 5% 12% Maternal and child health Malaria 7% 5% TB 4% Malnutrition 5% Obesity Cholera Meningitis 3% 6% 4% School Feeding immunization Cadiovascular programme 2% 6% 7%
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5.0 UPDATES AND SPECIAL INITIATIVES
5.1. Safe Motherhood
Training of Midwives in Ultrasonography
The free maternal health care initiative introduced in July 2008, covers the cost of services and drugs for six ANC visits as well as two ultrasounds for pregnant women. However, the inadequate access to ultrasound services for pregnant women at the primary level serves as a barrier to expectant mothers benefiting from the full package of cost-free services under the initiative.
In response to this challenge, the division with support from General Electric (GE) have begun the training of midwives in limited obstetric ultrasound. Under this programme 500 v-scan ultrasound units are to be deployed to 500 health facilities across the country and also train 600 midwives. This is to improve access to quality maternal and newborn care services at the primary health care level. A total of 121 midwives were trained with 120 machines deployed for use by the midwives in 2016.
Training of Community Health Nurses as Midwifery Assistants
In line with the implementation of the task sharing policy to improve access to skilled care and during childbirth, the division initiated the Midwifery Assistant Training Programme to build the capacity of community health nurses in basic midwifery skills. As part of this initiative community health nurses are given a minimum of two days orientation and provided with the resource materials for self-paced learning for two weeks. They are examined at the end of two weeks, after which they are required to go through on-the-job training under the supervision of a midwife for six weeks.
In 2016, a total of 99 community health nurses in the Eastern and Ashanti regions were trained as midwifery assistants.
5.2. Family Planning
Mapping, development and dissemination of a compendium of contraceptives and family planning products and services
Limited access to information especially from referral points such as pharmacies, over the counter medicine sellers and limited access to information on availability of clinical methods in the private sector has been a barrier to the provision of family planning information and
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services over the years. Following several consultative and collaborative meetings with stakeholders in family planning, a need was expressed for the development of a document that would provide service providers at all levels and clients, with general information on family planning, as well as a directory for easy identification of service delivery points and referral of clients; Compendium of Contraceptives and Family Planning Products and Services.
After several working group and stakeholders’ meetings, as well as months of data collection and compilation, the first edition of a Compendium of Contraceptives and Family Planning Products and Services was finalized and disseminated to stakeholders from the government sector, civil society organizations, nongovernmental organizations and other key family planning partners.
The print version of the document is currently being worked on, whereas a mobile version has been deployed unto the Reproductive and Child Health Department Mobile Application, available at the Google Play store.
Review of national family planning protocols
The National Family Planning Protocols which was developed in 2007 was reviewed in 2016 mainly to align family planning service delivery with the updated Reproductive Health Services Policy and Standards. The document was also reviewed for the following reasons:
o To update document in line with current trends and emerging issues on service delivery o To align document with the 2015 WHO Medical Eligibility Criteria (MEC) o To incorporate elements from new job aids; Comprehensive Family Planning Learning Guide, Community Based Providers Handbook o To improve on structure of document; to more acceptable and user friendly
As part of the review process, a series of stakeholders and technical working group meetings were held with stakeholders from GHS/Family Health Division, Planned Parenthood Association of Ghana (PPAG), Marie Stopes International Ghana (MSIG), USAID/Systems for Health Project, Korle Bu Nursing and Midwifery Training College, Komfo Anokye Teaching Hospital and Korle Bu Teaching Hospital, other health facilities and some independent consultants.
At the end of the review process, significant structural changes included; new chapter for each method and standardized the steps for each method with sub headings. With respect to the contents, changes made include:
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o Aspects of the Reproductive Health Policy and Standards o Social And Behavior Change Communication o Counselling o Contraception for special groups o Emergency Contraception o Management of Infertility o Community Based Contraceptive Services o Logistics Management of Contraceptives o Infection Prevention and Control On Outreach Medical Emergency Preparedness on Outreach
5.3. Child Health
Perinatal death audit tool and guidelines
The perinatal death audit tool and guidelines which were developed in 2015 was rolled out through training of regional teams and teams from the Teaching Hospitals.
Chlorhexidine for Cord Care
Ghana seeks to introduce 7.1% chlorhexidine digluconate which has been proven to be effective in cord management in many countries across the world as a replacement for methylated spirit, which is currently in use. The Standard Treatment Guidelines and Essential Medicines List have included chlorhexidine for cord care.
The first phase of the research to explore the feasibility, acceptability and the form of chlorhexidine (gel or liquid formulation) for cord care among mothers and caregivers, and healthcare providers planned in conjunction with the Research and Development Division of the Ghana Health Service has been completed. The study has uncovered a number of cord care practices which make the infant prone to infections. Findings from the study will guide the crafting of appropriate health messages on cord care practices.
Mother Baby Friendly Health Facility Initiative (MBFHI)
This is a strategy to expand the Baby Friendly Hospital Initiative (BFHI) to include the optimal care of mothers and newborn babies during the intra-partum and early postnatal period (0- 7days). The focus is the revival, strengthening and expansion of the BFHI beyond breastfeeding to optimal care of the mother-baby pair at all levels of health facilities.
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The purpose of the MBFHI is to transform health facilities into Mother - Baby Friendly facilities through implementation of quality care at the time of birth and early postnatal period, and promotion of breastfeeding practices with a goal to reduce maternal and newborn morbidity and mortality.
The package includes provision of respectful, courteous, and supportive facility-based care for the mother and baby, promotion of early and exclusive breastfeeding, provision of basic essential newborn care including Kangaroo Mother Care (KMC) at the hospital level, cord care, eye care and promotion of mother support groups at the community level. The initiative is currently being piloted in the Upper East region.
Child Health Record books
Development of a combined maternal and child health record book (CHRB) was initiated with support from JICA in the year under review. The document would be piloted in selected districts in the second half of 2017 and final revision done. National implementation of the CHRB would begin in 2018. The major revision was in the introduction of routine length measurement and tracking to ensure adequate growth of children by identifying stunting early and intervening promptly to reduce it.
5.4. Adolescent Health and Development
Adolescent Health Service Policy and Strategy
The Family Health Division was supported technically and financially by the WHO, UNICEF and the UKaid through the Palladium Group to develop a service policy for adolescent health and development. This was a recommendation from an evaluation carried out on the previous seven-year adolescent health strategic plan (2009 – 2015). The findings from the evaluation necessitated the development of an over-arching service policy for adolescent health and development. The new policy informed the development of a new strategy for 2016 to 2020. The new current service policy and strategy has been launched and disseminated in all the ten regions.
National Standard Register for Adolescent Health Services
The Adolescent Health and Development Programme in collaboration with stakeholders and service providers developed a national register to collect information on adolescent health services. Hitherto the programme had no systematic mechanism for collecting data on
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services rendered to adolescents. A situation which posed a challenge to monitoring services rendered at the adolescent health corners.
The register has been uploaded unto the DHIMS II platform; making it the formal data collecting tool on adolescent health in the Ghana Health Service.
5.5. Nutrition
Decentralization of Code Monitoring
Ghana has ratified the International Code of Marketing of Breastmilk Substitutes and enacted a law, The Breastfeeding Promotion Regulation, LI 1667. Health staff and management of health facilities are empowered to enforce the law by refusing interactions between health staff and caregivers with representatives from formula producing companies; refusing to accept free samples of products mentioned under the scope of the law. Over the years, teams at national level have been conducting monitoring of the code nationwide, and this has been plagued with delays.
A decision was taken to decentralize this activity to:
o Build capacity within regions to conduct code monitoring
o Deploy the current monitoring tool which was reviewed by a task team comprising officers from the Family Health Division, Korle-Bu Teaching Hospital and UNICEF.
o Facilitate regional ownership of the monitoring activities and reporting
Increase capacity within facilities to create a gatekeeper system and ensure that health facilities and staff are not used as conduits to market products from formula companies.
A training of trainers’ workshop was held as part of which a code monitoring exercise was carried out in the Ashanti region. Further training of health staff from teaching hospitals are planned for 2017 as well as national monitoring activities and support to downstream code gatekeeper training by regions. Dissemination of the code would also be intensified as part of all maternal, infant and young child nutrition programmes.
Decentralization of Mother Baby Friendly Health Facility Initiative
In 2015, FHD started the decentralization of the BFHI as was recommended by the national task team. In 2016, activities towards increasing the number of baby friendly facilities began earnestly. Activities that have been undertaken include:
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o Development of a participant’s manual to inform facility- level training and to provide a quick reference material for the staff after the training.
o Training of facility staff which was carried out in two sessions of training:
a. 20-hour course for over 1500 clinical staff including midwives, paediatricians, obstetrics and gynaecology specialists, nutrition officers, community health nurses among others. National officers
b. A one-day orientation was held for over 1600 non-clinical staff comprising orderlies, administrative staff, laboratory personnel and field technicians on breastfeeding management.
o Assessment of facilities by all regional assessment teams. It is expected that reports and results and/or summary sheets would be forwarded to the national office.
Launch of the National Nutrition Policy and Strategic Implementation Plan
The Department was supported by UNICEF to finalize the strategic implementation plan to be included in the nutrition policy and launched. Several task team meetings were held and the draft plan was developed. The plan needs to be costed and finalized for launching.
The National Nutrition policy was launched mid-year by the Minister for Health.
Development of the Breastfeeding Communication Strategy
The department was supported by UNICEF to develop a communication strategy to re-brand exclusive breastfeeding for 6 months. A multi-sectoral task team was formed which worked with the Communication for Development unit from UNICEF and other advertising agencies to develop a draft strategy. In the process, a communication strategy was also developed to promote optimal complementary feeding for children from 6 months to 2 years.
The strategy should be finalized and launched in the coming year.
5.6. Health Promotion Department
“Good Life, Live it Well” Campaign
The “Good life, live it well” campaign is a GHS behaviour change initiative programme supported by USAID since 2010. Over the years the “Good life” brand has served as the
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flagship initiative for health promotion in the Ghana Health Service which conveyed information about many health issues including malaria, family planning, nutrition, maternal and child health among others. Initially, it was implemented in only three regions including the Greater Accra, Central and Western regions.
In 2016 however; it was rebranded to convey messages across the country along all life stages. With technical support from USAID Communicate for Health, the Health Promotion Department repackaged the Good Life brand into a consistent, recognizable brand that connects with major proportion of the Ghanaian population. This new Good Life brand is aimed at keeping the general public updated on doable health seeking behaviours that leads to a healthier, happier living.
Orientation on the “Good Life Live it Well” Brand
Following the successful launch of the “Good life, live it well” brand, orientation workshops were carried out in all the regions. The main purpose of the orientation was to facilitate regional ownership of this brand for health promotion in the Ghana Health Service through: Communicating the evolution of the repackaged “good life, live it well” brand Encouraging the effective use of all “good life, live it well” brand materials including the brand manual Advocating the use of the brand by agencies and partners in health Supporting the planning for roll out campaign activities at all levels Monitoring campaign activities at all levels
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6.0 CHALLENGES AND WAY FORWARD 6.1 Challenges
1. Persistent high maternal death and still birth rates across all regions.
2. Low Vitamin A supplementation coverage among infants and children 6-59months
3. Low TD coverage among women in fertile age
4. Stock-outs of child health record booklets and maternal health record booklets
5. Non-attainment of 75% cure rate in SAM management Increased numbers of non- recovered SAM cases Non-recording and poor reporting due in part to lack of source data in some registers and lack of effective and regular data verification and validation
6. Poor data capture as well as the non-use of data to inform decisions at the lower levels
7. Inadequate scan facilities at peripheral facilities make service delivery difficult, especially in instances where women have to be referred over long distances to conduct scans for their pregnancies
8. Inadequate number of midwives and trained family planning service providers
9. Continuous reports of violations of the breastfeeding code in facilities
10. Inadequate access to adolescent and youth-friendly health services
6.2 Way Forward
1. Implementation of recommendations from the maternal death study carried out for 2015/2016.
2. Implement the neonatal death audit programme and use findings to improve service delivery.
3. Scale-up V-Scan initiative to improve skills of staff at the peripheries
4. Review progress in the 5 supported regions and support the other 5 regions to conduct BNA on their Vitamin A Programme for improvement.
5. Review all source documents and registers and conduct nationwide training on the use of all new forms and registers. 52 | P a g e FHD | Annual Report 2 0 1 6
6. Strengthen mentoring, coaching and supportive visits to peripheral levels
7. Print and distribute copies of the Child Health Records and Maternal Health Record booklets to the regions.
8. Intensify task shifting trainings in regions to improve access to MCH services
9. Conduct training for code gatekeepers in facilities and implement strategies to reduce and end violations of the code in the facilities
10. Finalize costing of the Nutrition Strategic Implementation Plan and launch
11. Complete the communication strategy on re-branding exclusive breastfeeding for 6 months and complementary feeding from 6-24 months for roll-out
12. Operationalize the iron and folic acid supplementation for adolescents and menstruating women
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APPENDIX C
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APPENDIX C: PERFORMANCE BY REGION/DISTRICT FOR SELECTED INDICATORS OF NATIONAL PRIORITY
ASHANTI REGION
Percentage Percentage Percentage Pregnant of Total Institutional of clients Pregnant Vitamin A Vitamin A of ANC Percentage Still Women Organisation Annual ANC adolescents couple Maternal whose Hb Women Coverage- Coverage- clients skilled birth Anaemic unit Population Coverage attending year Mortality was tested Anaemic at 6-59m (Jan- 6-59m making 4th deliveries rate at 36 ANC 10- protection Ratio at Registration June) (July-Dec) visit weeks 19 registration Adansi North 119269 79.4 58.2 18.5 44.2 12935.6 1.5 0 80.6 34.6 27.4 44.9 35.6 Adansi South 130109 71.9 65.5 17.2 32.6 11662.1 2.3 179.9 89.7 42.7 20.1 30.6 45.6 Afigya- 151795 104.2 64 11.6 71 13186.2 0.69 48 86.2 Kwabre 43.4 38.7 20.1 62.5 Ahafo-Ano 108434 67.5 83.3 13 44.5 5949.9 0.1 52.5 52.1 North 59.4 31.0 37.4 45.6 Ahafo-Ano 135529 65 77.4 16.1 45.3 7706.7 1.1 122.1 77.5 South 38.1 17.3 38.3 41.3 Amansie 103074 52.1 91.3 22.3 29.4 4249.3 1.5 0 50.8 Central 50.0 49.4 35.3 33.7 Amansie 151799 114.5 75.1 17.8 62.9 6515.3 2.3 235.7 67.3 West 38.4 33.9 31.2 36.4 Asante Akim 81310 78.9 95.7 14.2 65.4 3847.3 0.69 92.7 89.3 Central 32.1 10.6 32.7 41.0 Asante Akim 75886 100.5 44.8 12.1 87.7 5402.7 3.5 114 79.2 North 33.4 20.0 49.2 49.9 Asante Akim 135540 70.6 49.4 15.1 43 5847.8 0.93 0 86.4 South 39.9 18.0 27.4 37.2 Asante- 97581 100.7 52.1 10.5 71.3 8956.6 2.2 116.1 118.7 Mampong 64.7 40.1 36.2 38.7 Asokore- 346964 26.6 58.7 9.7 13.8 2959.3 0.61 0 94.5 Mampong 37.0 35.5 20.3 34.1
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Atwima 135529 63.9 64.6 15.9 37.2 9634.4 0.83 0 78.5 Mponua 39.5 29.1 82.9 43.0 Atwima 168058 150.7 73.1 10.3 105.9 6902.2 1 57.3 91.8 Nwabiagya 21.4 15.7 43.8 42.8 Atwima- 103004 106.1 81.4 10.5 77.7 3369.5 0.8 32.2 91.4 Kwanwoma 30.5 17.2 31.2 37.0 Bekwai 120389 89.9 92 12.9 74.7 4782.6 1.2 55.3 88.3 40.1 36.9 35.8 45.3 Bosome 70475 42.8 58.3 25.5 24 4702.5 0.76 0 39.4 Freho 45.5 35.4 40.6 47.6 Bosomtwi 108429 113 77.1 9 92.2 11435 1.4 100.1 85.5 34.3 33.5 36.8 74.8 Ejisu-Juaben 162644 118.8 63.7 10.3 85.8 8316 1.7 161.6 96.1 38.6 34.9 38.6 39.5 Ejura- 97579 135.1 73.7 11.8 83.7 5584.2 1.3 0 91.8 Sekyedumase 32.5 22.0 57.7 52.2 Kumasi Metro 1962509 53.6 92.7 6.8 41.7 68450 1.7 211.7 91.4 26.5 16.6 9.1 34.2 Kwabre East 130112 138.7 71.3 10.5 81.3 3296.2 0.33 23.7 90.2 21.6 15.9 27.6 66.7 Obuasi 189740 85.3 83.5 9.9 68.9 14035.1 1.4 78.8 95.9 34.8 18.7 24.1 38.1 Offinso 86749 164.7 68.6 12.7 162.8 9575.5 1.6 72.3 99.8 45.3 25.7 42.6 66.6 Offinso 65052 97.7 51 13.8 63.8 8267.6 1.2 60.1 64.5 North 35.3 10.0 61.5 67.9 Sekyere 32529 41.5 25.3 14.4 16.6 902.8 0.5 0 65.6 Afram Plains 45.6 87.0 32.5 32.0 Sekyere 81319 55.3 47.6 17.4 23.6 5023 1.1 0 47.9 Central 70.8 49.7 77.1 45.5 Sekyere East 70476 84.6 90.1 14.2 72.5 6108.3 1.7 100.1 94.5 54.8 36.8 30.8 36.9 Sekyere 75899 50.1 65.9 14.9 31.4 1356.1 0.72 0 84.6 Kumawu 30.5 13.3 76.4 45.1 Sekyere 108429 76.7 80.7 16.1 71.7 4192.2 1.7 99.3 91.1 South 38.8 26.1 47.5 50.3 Ashanti 5406211 74.7 76.2 11.4 53.4 336459.4 1.4 114 87.4 34.5 22.7 26.8 40.7
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BRONG AHAFO
Percentage Percentage Percentage Pregnant of Total Institutional of clients Pregnant Vitamin A Vitamin A of ANC Percentage Still Women Organisation Annual ANC adolescents couple Maternal whose Hb Women Coverage- Coverage- clients skilled birth Anaemic unit Population Coverage attending year Mortality was tested Anaemic at 6-59m 6-59m making 4th deliveries rate at 36 ANC 10- protection Ratio at Registration (Jan-June) (July-Dec) visit weeks 19 registration Asunafo North 143907 75.7 42.2 14.7 63.6 9702.6 1.7 82 99 22.4 19.7 33.3 45.8 Asunafo South 109308 69.8 99 16.6 39.3 4456.4 0.99 0 95.4 24.0 24.3 28.4 38.0 Asutifi North 61374 76.4 92.5 14.5 35.1 4678.2 0.58 0 98.7 38.8 18.2 53.6 76.4 Asutifi South 61318 106 76.8 12.4 133.2 3227.6 1.8 0 99.1 28.6 15.7 43.6 63.4 Atebubu-Amanten 122630 84.9 63.4 15.1 39.4 4200.5 1.9 154.7 70.2 35.3 22.8 28.5 47.8 Banda 23995 77.8 70.6 13.6 49.8 3808.3 0 0 94.7 25.4 19.8 61.9 57.6 Berekum 149301 65.5 75.4 12.6 60.1 4967 1.7 222.3 99.1 33.8 31.8 46.6 64.1 Dormaa East 58658 78.2 84.4 17.4 55.7 2338.6 1.3 76.7 98.2 28.2 24.9 35.9 69.1 Dormaa Municipal 130624 56.5 111.4 15.1 57.8 14899.7 2.2 98.9 71.3 32.4 29.6 33.3 41.8 Dormaa West 55991 69.7 90.1 16 36.2 3472.2 0.73 0 92.1 35.8 32.4 26.9 50.3 Jaman North 95968 66 76.8 16.9 44.9 1959.2 1.8 0 91.3 45.4 36.5 33.6 45.8 Jaman South 106647 76.8 111.5 15.9 70 2767.9 1 67.9 99.4 26.7 29.7 31.6 53.4 Kintampo North 109308 113.2 113.6 15.1 72.5 9749.4 2.4 31.7 95.3 21.4 16.7 57.9 80.2 Kintampo South 93312 46.4 96.4 19.1 24.7 7157 0.54 0 65.4 39.1 23.6 35.5 40.8 Nkoranza North 77319 42.9 70.1 16.9 25 19329.8 0.4 0 93.5 23.3 16.3 32.6 76.3 Nkoranza South 106638 88.4 79.2 16.1 63.2 4559.5 1.9 149.4 97.7 33.3 37.0 39.4 66.1 Pru 149296 99.4 89.1 15.9 64.9 16502 2.1 102.4 87.9 35.6 22.8 46.6 84.8 Sene East 69308 46.8 28.7 13.8 11.5 7035.8 0.34 0 16.8 26.5 33.3 44.1 54.8 Sene West 66656 85.1 86.7 10.9 42.9 6586.4 1.4 174.2 53.5 32.8 31.9 47.1 47.8 Sunyani Municipal 141296 123.1 74.4 7.9 124.8 7220.2 2 283 97.9 27.2 27.8 37.3 50.2 Sunyani West 98644 73.6 104.1 15.7 39.5 8206.7 0.45 0 86.7 33.3 11.7 30.4 58.5 Tain 101302 72 81.8 14.6 57.5 8514.1 0.63 42.3 60.7 26.5 17.7 41.9 60.6 58 | P a g e FHD | Annual Report 2 0 1 6
Tano North 93312 74.3 52.2 13.9 54.2 2382.6 0.82 97.4 99.2 44.6 32.7 31.2 46.3 Tano South 90647 81.1 68.3 15.8 64.9 2535.9 1.1 84.3 99.1 22.6 25.8 30.5 38.4 Techiman 170605 138.5 162.2 12.3 119.1 13639.3 1.6 258.8 95.9 Municipal 24.7 18.3 36.4 45.4 Techiman North 69312 55 64.3 20.4 25.7 23725.6 0.29 0 100.4 9.0 2.9 42.8 57.8 Wenchi 103972 86.2 67.7 13.9 78.6 17583.6 1.7 0 100 34.1 34.7 33.9 40.5 Brong Ahafo 2660648 81.9 89.7 14.3 61.7 269657.2 1.5 117.1 90 29.6 24.5 37.9 55.1
CENTRAL REGION
Percentage Percentage Percentage Pregnant Total Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Still Women Annual ANC couple Maternal whose Hb Women Coverage Coverage Organisation unit clients adolescents skilled birth Anaemic Population Coverage year Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries rate at 36 protection Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration Abura-Asebu-Kwamankese 122498 72.8 104.1 16.7 51.3 19637.2 1.2 39.3 89.6 53.4 51.1 28.6 27.9 Agona East 97456 88.4 75.8 15.9 49.5 5670.6 0.5 0 81.4 23.4 19.4 31.8 31.1 Agona West 130226 109 55.1 11.9 100.4 4474.5 1.8 125.3 87.8 36.9 22.8 28.9 26.3 Ajumako-Enyan-Essiam 145188 69.5 93.6 17.7 44.9 6443.2 0.57 38 89.8 37.7 26.2 40.5 34.4 Asikuma-Odoben-Brakwa 158158 61.6 88.1 18.1 50.7 8513.1 2 0 81.9 48.4 8.3 54.2 28.0 Assin North 183591 77.9 52.6 15.7 57.5 21311.1 3.5 215.8 89.5 36.4 20.2 22.9 26.7
Assin South 115700 53.2 68.4 17.5 26.3 2789.6 0.42 0 83.7 47.3 45.3 24.8 20.9 Awutu Senya 97981 185 54 13.6 82.9 7945.3 0.3 30.6 89.8 40.6 13.9 32.2 33.2 Awutu Senya East 123254 173.6 88.2 7 84.4 10903.6 0.95 24.6 90.2 39.4 29.2 14.8 26.0 Cape Coast 180334 85.7 71.7 7.9 92.8 15816 3.2 707 97.2 40.9 42.9 23.4 23.7 FHD | Annual Report 2 0 1 6 59 | P a g e
Efutu 77876 122 76.6 11.2 134.6 13824.5 3.6 144.5 76.1 44.3 31.1 31.1 48.1 Ekumfi 57767 47.7 86.6 18.5 17.7 7511.5 0 0 89.2 58.7 56.7 36.5 28.4 Gomoa East 235630 82.1 50.6 9.3 45 24905.9 1.5 94.2 96.3 42.5 23.1 20.4 24.3 Gomoa West 150900 69.9 55.6 17.1 51.1 6676.1 1.8 130 80.2 62.4 52.9 24.9 25.6 Komenda-Edna-Eguafo-Abirem 152691 70.1 78.1 17.5 35.8 10231.4 1 0 92.1 38.9 29.1 23.4 29.6 Mfantsiman 153963 84.9 93.6 13 72.1 23267.7 2 112.6 89.1 41.1 41.2 38.3 35.9 Twifo-Ati-Mokwa 70087 130.6 43.2 15.8 72.2 3334.4 1.6 147.4 80.7 43.6 34.9 32.1 33.7 Twifo-Hemang Lower 62468 50.4 60.7 19.3 19.3 2979.2 0.41 0 69.1 38.1 34.1 Denkyira 66.9 69.5 Upper Denkyira East 82379 233.2 47.7 9.8 95.5 10677.3 1.9 222.4 89.2 26.8 24.5 36.8 30.1 Upper Denkyira West 67545 123 73.9 19.7 46 3050.3 1.6 0 80.9 16.4 23.9 30.4 26.5 Central 2465692 94.4 68.8 13.3 61.3 209962.6 1.9 158.6 88 40.1 27.9 29.8 28.9
EASTERN REGION
Percentage Percentage Percentage Pregnant Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Total Still Women Annual ANC Maternal whose Hb Women Coverage Coverage Organisation unit clients adolescents skilled couple year birth Anaemic Population Coverage Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries protection rate at 36 Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration
Afram Plains South 133528 40.3 48.2 15 14 6045 0.53 0 42.5 25.3 3.4 25.2 25.2
Akwapim North 157652 57.8 61.2 14.8 39.9 8474.9 0.83 79.7 85.5 22.8 24.9 27.1 36.6
Akwapim South 42486 88.3 57.6 13.3 30.7 9901.4 0 0 100.1 10.9 3.4 56.9 52.8
Akyemansa 112281 53.3 57 18.7 26.1 8875.3 0.34 0 87.4 15.1 30.3 22.9 31.1
Asuogyaman 112281 64.9 97.9 15.4 49.7 6955.9 1.4 90.4 67 29.1 30.8 24.1 28.3
Atiwa 127461 70.5 86.7 16.1 44.4 6376.3 2.5 91 96.5 30.9 23.7 25.9 24.4
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Ayensuano 88002 74.9 89.9 16.4 29.5 9575.2 0 0 68.8 18.0 14.9 38.8 36.5
Birim Central 166929 89.4 58.8 13.5 66 17553 2.6 136 78.5 54.8 50.6 26.2 29.6
Birim North 91038 70.2 73.8 17.7 42.7 10403.8 1.6 193.5 90.4 28.6 9.8 35.8 28.0
Birim South 136564 50.4 115.5 17 17 8519 0.43 0 99 11.2 5.8 31.0 31.0
Denkyembour 91039 60.1 84.8 14.1 74.2 2780.9 2 147 77.7 52.7 45.1 20.1 24.6
East Akim 194225 57 95.7 11.2 43.9 7057.9 1.6 146.4 93.9 47.1 35.7 37.5 28.1
Fanteakwa 124408 58.6 72.6 18.3 31 12710.1 2 194.7 81.2 27.5 33.3 24.1 27.5
Kwaebibirem 130442 58.9 53.1 17 38.4 6463.4 0.49 0 87.7 55.0 44.4 27.3 26.2
Kwahu East 88007 71.6 78.3 13.5 35.7 2688.4 0.16 0 83.2 34.2 21.0 35.1 31.5
Kwahu North 118346 37.5 54 17.6 22.7 46728.5 1.9 375.9 46.5 53.7 50.6 36.5 43.1
Kwahu South 78894 82.5 123.6 16 85 7303 1.7 148.5 65.9 27.4 10.7 32.5 28.0
Kwahu West 109258 106.7 52.6 13.1 91.8 16067.4 2.1 74.9 86.3 29.0 19.5 32.9 37.4
Lower-Manya Krobo 103185 86.7 84 16.3 76 6708.3 1.4 253.2 82.3 46.6 16.9 31.6 35.5
New Juaben 212398 72.2 53.3 8.4 79.5 27858.3 2.9 659.8 99.3 20.7 10.4 35.8 30.2
Nsawam-Adoagyiri 100140 221.3 61.1 9.5 180.7 8554.9 0.91 27.4 91.1 19.8 30.0 26.7 28.2
Suhum 103170 73.9 61.4 13.2 59.1 14877.2 0.81 40.6 98 21.3 17.8 23.3 30.1
Upper Manya-Krobo 81943 67.2 43.7 18.7 33.6 6530.3 3 0 78.7 29.2 48.6 24.9 29.7
Upper West Akim 100141 59.3 37.8 17.5 20.8 12968.4 0.36 0 74.7 32.3 46.4 26.5 30.8
West Akim 124425 72.5 83.7 9.8 46.1 24151.7 2.1 174.8 88.2 35.2 32.9 34.7 37.4
Yilo-Krobo 100155 71.5 70 15.6 30.8 7234 0.08 0 70.8 46.9 31.2 42.4 53.1
Eastern 3028398 71.8 70.5 14 50.4 303362.6 1.6 158.9 83.9 31.1 26.4 30.5 31.8
FHD | Annual Report 2 0 1 6 61 | P a g e
GREATER ACCRA
Percentage Percentage Percentage Pregnant Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Total Still Women Annual ANC Maternal whose Hb Women Coverage Coverage Organisation unit clients adolescents skilled couple year birth Anaemic Population Coverage Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries protection rate at 36 Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration Accra Metro 1936836 78.8 104.2 5.3 57.2 272494.1 2.2 262.2 75.8 30.6 19.3 17.2 18.8 Ada East 80740 71.5 57.2 14.9 53.7 6106.9 0.85 114.1 90.5 59.3 44.7 24.0 22.3 Ada West 66742 84.5 33.8 17.1 29.6 1647.7 0.25 0 40.1 45.6 28.6 21.3 25.1 Adentan 87646 66.9 46.4 3.8 26 6769.9 1.2 0 90.7 31.7 16.9 56.2 62.2 Ashaiman 216482 146.1 61.2 6.6 85.5 29174.7 0.29 13.7 99.2 24.2 18.8 27.3 28.7 Ga Central 132379 45.2 61.3 5.5 20.7 2097.8 0.81 0 91.6 38.6 41.6 22.8 26.4 Ga East 167715 86.1 42.9 4.5 43.3 26647.4 0.74 70.5 93.2 23.1 9.4 19.7 34.9 Ga South 488678 70.5 54.8 7.1 34.8 42620.8 0.35 29.5 91.2 36.8 21.6 15.8 22.0 Ga West 250915 103 67.9 6.1 66.4 12025.3 0.56 14.9 99.5 37.0 22.0 27.0 30.5 Kpone-Katamanso 123978 72.9 74.3 6.5 36.7 12261.5 0.51 0 96 39.0 24.6 35.7 37.7 La-Dade-Kotopon 207473 80.1 140.4 4.2 83.9 55536.8 2.4 173.9 90.9 30.5 13.0 21.2 19.9 La-Nkwantanang-Madina 126490 191.6 83.6 6.8 118.8 26838.6 1 83.2 92.1 41.9 19.2 36.9 25.5 Ledzokuku-Krowor 257973 69.6 74.2 5.5 50.8 51899.6 1.5 96 94.1 35.7 18.3 27.7 28.2 Ningo Prampram 80098 89.7 48.8 13.5 48.7 3686.6 0.56 63 79.8 49.5 25.1 38.2 35.6 Shai-Osudoku 58429 169.7 55.8 11.3 136.5 5065.9 1.3 31.3 92.9 41.5 20.3 34.2 44.2 Tema 331063 112.2 122.5 4.8 92.2 40593.7 2.9 403.4 99.8 28.6 29.6 20.4 25.3 Greater Accra 4613637 87.6 86.8 6.2 59.4 595467.2 1.7 180.4 86.8 33.0 21.2 21.9 24.4
62 | P a g e FHD | Annual Report 2 0 1 6
NORTHERN REGION
Percentage Percentage Percentage Pregnant Total Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Still Women Annual ANC couple Maternal whose Hb Women Coverage Coverage Organisation unit clients adolescents skilled birth Anaemic Population Coverage year Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries rate at 36 protection Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration Bole 71446 186.7 52.1 17.7 92.3 4127.7 2.1 75.8 43.5 62.7 59.9 40.7 45.6 Bunkpurugu-Yunyoo 139942 73.4 65.4 12.9 31.7 4228.6 1.4 0 71.8 6.8 8.0 28.5 66.2 Central Gonja 99981 125.8 58.3 9.8 36.8 902.9 0.74 67.9 67.2 47.2 34.4 29.0 47.0 Chereponi 62831 135.4 51.5 11.5 39 963.1 2.7 199.2 79 39.4 26.8 40.8 49.0 East Gonja 157098 78.5 62.4 11.7 40.3 2645 2.8 180.4 82.2 51.5 31.3 29.1 61.9 East Mamprusi 139941 135.4 50 13.5 82 4516.2 2.1 256.2 91 31.0 27.3 41.1 56.7 Gushiegu 128501 123.6 40.7 10.1 43.7 2791.5 1.8 134.2 53.7 60.6 40.5 18.4 44.6 Karaga 88538 112.8 57.8 11.9 35.2 2276.1 1.9 0 80.5 62.1 48.6 36.2 111.5 Kpandai 125660 100.8 54.6 16.9 53.6 2536.6 1.5 0 44.4 48.8 54.6 27.1 60.4 Kumbungu 45700 187.6 92.3 7.4 73.5 245.9 1.1 75.9 62.4 65.6 43.8 62.2 93.6 Mamprugu-Moagduri 54263 89.4 40.6 11.7 24.8 588.4 0.94 0 19 68.9 57.5 21.6 28.6 Mion 94248 75.2 43.2 8.6 27.7 1030.4 0.38 0 94.2 40.5 22.9 43.6 36.3 Nanumba North 162765 106.6 54.9 8.2 40 3251.7 2.4 198.3 87.7 62.9 52.4 21.2 41.2 Nanumba South 108526 79.2 69.9 11 24.8 1891.3 1.4 0 93.2 50.2 35.0 27.5 73.5 North Gonja 51410 75.4 45.9 15.9 24.2 397.7 0.4 0 59.6 36.0 14.5 25.8 36.4 Saboba 77113 125.4 32.6 9.5 39.1 2287 1.7 0 82.8 46.4 34.1 39.6 36.9 Sagnarigu 168441 73.4 81.6 9.2 18.2 3359 0.26 87.2 90.6 36.6 26.2 26.6 34.0 Savelugu-Nanton 159924 102.2 71.2 7.2 63.9 1076.1 0.95 23.3 66.2 64.1 51.4 38.3 54.7 Sawla-Tuna-Kalba 114238 80.6 46.7 19.4 30.6 2917 1.2 148.4 37.3 35.7 38.6 26.5 53.3 Tamale 257039 228.3 102.1 7.5 175.2 9405.1 2.4 419.8 95 24.7 24.6 45.5 110.8 Tatale-Sangule 68547 95.4 44.9 11.4 42.3 1467.5 0.51 0 92.5 42.5 31.0 44.0 55.7 Tolon 82825 158.8 61.1 6.8 48.3 322 0.74 0 57.8 54.4 41.8 31.5 29.0 West Gonja 48544 97.2 54.4 14.5 67.5 1671.2 1.5 165.6 72.8 43.9 48.5 36.7 54.7 West Mamprusi 139946 95.5 69.6 16 47.3 3654.4 2.9 315.8 99 54.5 30.1 21.8 41.2
FHD | Annual Report 2 0 1 6 63 | P a g e
Yendi 137100 118.7 54.8 10.3 84.7 2093.5 2.2 281.4 95 45.0 16.5 52.8 38.9 Zabzugu 74263 114.1 74.3 13.6 40.6 991.9 2.2 245.9 37.2 58.0 43.7 27.1 41.6 Northern 2858830 116.7 65.7 10.9 57.5 61637.8 1.9 207.3 76.3 43.0 32.4 33.5 56.6
UPPER EAST
Percentage Percentage Percentage Pregnant Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Total Still Women Annual ANC Maternal whose Hb Women Coverage Coverage Organisation unit clients adolescents skilled couple year birth Anaemic Population Coverage Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries protection rate at 36 Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration Bawku 111635 109.1 91.7 11.5 113.3 5443.2 2.6 279.1 79.3 40.8 0.4 33.3 37.1 Bawku West 106885 91.5 123 18.4 86.4 6909.1 1.6 0 96.8 52.2 45.3 34.4 32.2 Binduri 70073 47.6 67.8 18.4 25.4 2446.2 0.83 0 96.9 37.5 24.8 36.1 32.9 Bolgatanga 151159 86.1 88.7 12.8 96.3 10175.7 2.4 172.3 93.3 47.5 56.2 34.9 28.8 Bongo 96199 72.7 74.6 19.8 74 7090.4 0.93 34.7 100.1 34.9 39.3 28.9 34.6 Builsa North 64143 52.2 78.3 15.2 58.4 4017.3 2.2 201.1 95.7 53.5 43.2 18.2 20.7 Builsa South 41566 58.9 78.3 19.5 44.2 2481.3 0.67 0 51.1 64.7 45.0 23.5 20.8 Garu-Tempane 147263 70.7 88.5 12.4 65.8 6503.3 0.54 25.7 63.4 36.2 31.3 40.3 31.9 Kasena-Nankana 124694 55.2 77.2 14.9 49.2 5597.8 1.8 327.6 62 31.3 15.0 27.1 25.2 Kasena-Nankana West 80754 75.3 68.9 16.8 55.5 5884.5 0.61 0 90.2 36.2 24.7 33.4 31.0 Nabdam 38012 67.4 111.8 21.1 60.2 2503.9 1.1 0 99.4 47.2 29.2 50.2 34.1 Pusiga 65320 116.8 74.8 14.6 88.6 2619.2 0.98 0 66.8 23.6 33.5 39.3 30.6 Talensi 92630 62.4 86.3 19.1 44.8 4335.9 0.65 0 92.1 36.2 33.4 24.6 22.3 Upper East 1190333 76 87.4 15.4 70.1 141797.4 1.6 110.9 83.2 41.0 3.4 32.7 29.8
64 | P a g e FHD | Annual Report 2 0 1 6
UPPER WEST
Percentage Percentage Percentage Pregnant Total Institutional of clients Pregnant Vitamin A Vitamin A of ANC of Percentage Still Women Organisation Annual ANC couple Maternal whose Hb Women Coverage- Coverage- clients adolescents skilled birth Anaemic unit Population Coverage year Mortality was tested Anaemic at 6-59m 6-59m making 4th attending deliveries rate at 36 protection Ratio at Registration (Jan-June) (July-Dec) visit ANC 10-19 weeks registration Daffiama-Bussie- 37139 75.7 65.4 14.2 50.6 2242.7 0.94 0 50.6 35.6 37.2 46.5 34.7 Issa Jirapa 99565 62.5 59.8 13.6 59.5 5362.5 1.8 84.5 61.9 44.2 37.6 43.0 36.2 Lambussie-Karni 58477 68.3 69.4 12.2 34.3 2320.3 0.13 0 61.4 51.5 46.0 49.1 31.5 Lawra 61640 60.3 61.2 12.7 49.9 2874 0.64 80.3 64.6 54.3 64.9 38.3 34.4 Nadowli-Kaleo 69528 78.2 87.3 15.4 75.5 3831.1 0.74 46.9 69.3 45.8 31.9 50.7 45.4 Nandom 52155 63.2 87.2 8.4 86.1 2407 1.1 0 86.8 46.8 44.3 32.1 31.9 Sissala East 64001 104.6 141.6 11.5 86.7 5420.2 0.89 44.7 57.6 29.9 18.9 80.8 43.6 Sissala West 56101 80.5 65.7 15 43.4 2696.3 0.2 0 47.4 33.6 33.3 40.4 42.6 Wa 120885 131.2 73.9 8.8 127.3 8011.1 2.4 308.9 97.3 37.0 35.4 58.4 41.6 Wa East 81381 91.3 68.7 17 34.8 4670.1 0.44 0 26.4 44.3 35.0 41.1 44.0 Wa West 91665 84.3 69.5 15.9 40.8 4315.4 1.3 68.2 25.9 53.5 33.0 49.9 42.7 Upper West 792537 85.4 78.1 12.8 66.3 50862.9 1.4 118.6 62.3 41.2 36.5 49.0 39.6
FHD | Annual Report 2 0 1 6 65 | P a g e
VOLTA REGION
Percentage of Percentage of Percentage of adolescents Percentage Total couple Institutional clients whose Annual ANC ANC clients attending ANC skilled year Still birth Maternal Hb was tested Organisation unit Population Coverage making 4th visit 10-19 deliveries protection rate Mortality Ratio at registration Adaklu 41301 39.5 59.2 17 19.2 2247.3 1.2 0 24 Afadjato South 109468 34.8 60.3 18.7 13.6 3422.4 0.17 0 88.7 Agortime-Ziope 31620 94.1 57 17.4 42.4 4388.1 0.56 0 72.4 Akatsi North 36300 42.2 48.4 13.8 10.3 2023.5 0 0 18.9 Akatsi South 113570 57.7 84.6 15.3 40.5 2921.4 1.1 107.2 94.4 Biakoye 75415 92.8 42.4 17.6 62.7 6494.4 2.2 158.2 97.4 Central Tongu 68116 86.6 45.8 19.3 43.9 8795.3 2.1 336.1 57.4 Ho 204353 54.8 96.8 10 54.7 23399.9 2.7 293.6 88.6 Ho West 109469 31.8 72.2 16.6 15.8 16506.2 0 0 39.6 Hohoe 192188 37.4 72.6 16.1 34.1 5844.1 1.6 272 79.1 Jasikan 68115 58.6 59.3 16.7 35.5 3736.5 1.7 102.1 79.6 Kadjebi 68125 94.3 47.1 15.6 61.4 3076.8 2.4 120.3 67.3 Keta 170295 71.4 76.9 12.9 61.7 10679.3 1.7 93 83.1 Ketu North 114379 54.1 66.2 15.7 36.2 4407.4 2.2 123.4 69.4 Ketu South 184894 83.3 68.7 13.2 53.4 9152 1.8 50.4 76.4 Kpando 60822 97.9 56.3 12.9 77.3 8102.9 1.9 211.1 84.3 Krachi East 133806 78.7 40.8 18.4 28.3 4296.3 2 0 60.3 Krachi Nchumuru 82717 67.6 59.3 16 29.1 3188.5 0.83 0 13.5 Krachi West 55951 102.4 238.3 15.6 59.9 1941.8 3.4 380.8 85.2 66 | P a g e FHD | Annual Report 2 0 1 6
Nkwanta North 72980 165 41.8 14.1 37 3320.5 1.4 0 40.7 Nkwanta South 136368 83.3 46.6 16.3 36.5 29476 1.9 202.1 29.9 North Dayi 46221 50.9 48.4 16.5 44.6 3349 1.9 362.8 35.7 North Tongu 102173 57.3 85.2 15.5 59.4 4128.8 3 412.7 79.3 South Dayi 53530 82.7 53.9 18.9 52.8 6073.3 0.99 181.7 44 South Tongu 102173 79.3 158.6 16.1 63.6 12068.3 2 115.4 78.5 Volta 2434349 68.8 72.4 15.3 43.7 183040.2 1.9 167.7 67.1
WESTERN REGION
Percentage of Percentage of Percentage of adolescents Total couple Institutional clients whose Annual ANC ANC clients attending ANC Percentage year Still birth Maternal Hb was tested at Organisation unit Population Coverage making 4th visit 10-19 skilled deliveries protection rate Mortality Ratio registration Ahanta West 129919 77.3 81.5 17.6 53.9 11216.2 1.2 178.4 96.6 Aowin 144344 72 68.5 13.7 30.8 7293.9 1.9 56 71.5 Bia East 34640 109.5 37.5 16.5 47.9 3481.5 1.4 0 38.4 Bia West 103942 122.2 69.2 14.3 83.1 4212 1.8 144.4 86.2 Bibiani-Anhwiaso-Bekwai 150132 104.2 114.7 13.5 76.8 7022.9 1.3 85.8 74.9 Bodi 63512 63.9 51.1 15.3 21.6 3412.6 1.4 0 81.8 Ellembelle 106820 123.8 91.2 13.9 105.1 7179.4 3.2 67.6 37.8 Jomoro 181842 68.7 56.1 16.6 31.2 16138.3 2.6 220.9 96.2 Juaboso 72167 125.6 84.3 12.8 93.2 2516.1 1.9 37.1 82.8 Mpohor 51974 65.1 72.9 18.2 36.3 2798.3 0 264.2 89.2 Nzema East 75107 110.6 54.2 17.7 46.5 3389.8 2 0 80.5 Prestea-Huni Valley 193433 90 52.5 13.5 44.5 23945.1 2 58.3 80.7 FHD | Annual Report 2 0 1 6 67 | P a g e
Sefwi-Akontombra 101046 54.1 30.7 14.3 20.7 2555 0.82 118.6 20.3 Sefwi-Wiawso 170347 75.1 65.2 11.1 68.2 6956.9 1.4 106.3 96.2 Sekondi-Takoradi 678459 47.8 78 7.3 39.7 31258.3 2.2 373.6 92.2 Shama 98166 104.8 48.7 12.7 59.3 6967.8 1.9 86.5 95 Suaman 25983 123 68.1 15 52.1 1505 0.37 186.2 92.7 Tarkwa-Nsuaem 109711 155.3 71.5 9.9 122.9 7793.6 1.9 204.7 96.2 Wassa Amenfi East 101053 140.6 36.4 17.5 58 9056.8 1 42.1 26.1 Wassa Amenfi West 112599 128.5 76.3 14.6 75.9 5596.1 2.6 146.7 72.4 Wassa East 98160 78.9 60.1 17.1 40.2 4897.5 0.13 0 87.3 Wassa-Amenfi Central 83720 101.5 43.7 16 41.5 4499 0.57 0 50.4 Western 2887076 85.4 68 13.5 53.8 179216.4 1.8 151.5 77.3
68 | P a g e FHD | Annual Report 2 0 1 6