Ej ur a S e ky ed um a si
Off ins o Se k ye re W est Se ky e re E es t
Kw ab re A sa nt e-A k im Nort h
A m a n si e We st Am a n sie Ee s t
Obua si
A da nsi S o ut h
1
1.0 INTRODUCTION
1.1 REGIONAL PROFILE
1.1.1 Location Ashanti Region has a land size of 24,390sq km, which is about 10.2% of the land area of Ghana. The region in its nodal structure share common boundaries, to the north with Brong Ahafo; to the south with Central Region, to the east with Eastern Region and to the west with Western Region. It lies approximately between longitude 0.15’ to 2.25’ west and latitude 5.50’ to 7.40’ north.
1.1.2 Demography
Ashanti is the most heavily populated region in Ghana, with a population of 4,415,554 for 2006 (Projection from the 2000 Housing and Population Census, Ghana Statistical Service). Kumasi has the highest population of 1,430,241 (32.4%) of the regional total. About 47% of the populations are in the rural areas. The region has a population density of 163.8 per sq. km. The region has a large proportion of hard to reach areas especially in the Afram Plains sections of Sekyere East, Ejura Sekyedumase, Sekyere West and Asante Akim North districts. Three new districts namely Adansi North, Atwima Mponua and Amansie Central were created in 2005. This has raised the number of districts to twenty- one (21) districts with 114 sub-districts.
1.1.3 Vegetation The vegetation is broadly classified into two: Semi deciduous forest and Guinea Savanna woodland. The average annual rainfall is about 166.7cm (66 inches) and the temperature is generally high, averaging over 27°C in the forest zone and 29°C on the northern fringes of the forest zone. The humidity is relatively high, averaging about 85% in the forest area and 65% for the Savannah belt.
2 1.1.4 Culture Ashanti Region has 33 traditional councils and each is headed by a Paramount Chief. All these Paramount Chiefs in turn owe allegiance to Otumfuo, the Asantehene. The region is often referred to as the seat of the country’s culture due to the fact that several items that portray the Ghanaian culture like pottery, kente weaving, wood carving, traditional sandals, beads, smithing and a lot more can be found in the Region.
The main economic activity in the region is agriculture. Major crops grown include cocoa, oil palm, plantain, maize, yam, cassava, vegetables and citrus.
1.1.5 Road Network Road network to major towns and villages is comparatively good. Kumasi, the regional capital, is centrally placed and easily accessible by road from almost all parts of the country. Parts of Sekyere East, Sekyere West, Asante Akim North and Ejura Sekyedumase districts are however inaccessible most of the time, especially during the rainy season.
1.1.6 Health Facilities There are five hundred and thirty (530) health facilities in the region. The Ghana Health Service operates about 32% of all health facilities in the region. Kumasi has the highest number of facilities of 38%. (Source: Service Availability Mapping Survey). Health Facilities by Ownership ¾Government : 170 ¾Mission : 71 ¾Private : 281 ¾Quasi Government : 08 Total 530
3 1.1 Key Priorities of the region at the beginning of the year To intensify child survival, Safe-motherhood and IDSR/DC intervention To improve the quality of health care through training To reduce maternal and neonatal deaths To improve outreach services especially in specialized services Dental, Eye and Obstetric Gynaecology. To develop capacity of sub district staff in financial management and improve audit response by BMCs. To improve data management
Key Challenges
Incomplete and late submission of reports.
Delay in payment of claims by NHIS
Long waiting time in the hospitals
Inadequate Human resource
High attrition of health staff
Poor Staff attitude towards work
Low motivation of staff
Inadequate budgetary provision
Irregular flow of funds
Non compliance to ATF rules and other government Regulations
Transport: Inadequate, Old fleet, lack of ambulance for accident prone areas
Infrastructure: Inadequate accommodation for office & staff
Inadequate infrastructure to cope with government policy
Increasing maternal deaths in the region
4 High still birth rate
Stagnation in some of the service indicators (EPI)
High Malaria disease burden especially in under 5 yr old
Strategies to address challenges
Quarterly data validation exercise and Feedbacks.
Regular meetings with Providers & Scheme managers
Instituted Financial Management Control Systems
Provided transport support occasionally to districts without vehicles
Intensify activities in specific interventions to improve coverage
5 FOLLOW UP ON ISSUES ARISING FROM IN-HOUSE REVIEW FOR 2006
ISSUE PERSON RESPONSIBLE 1. Investigation into high TB defaulter Regional TB coordinator rate at Atwima Nwabiagya 2. Strategies to strengthen community Guinea worm coordinator based surveillance on Guinea worm 3. Training in the diagnosis and DDPH and DDCC management of yaws 4. Follow up on the assessment of 31 Regional Nutrition Officer facilities trained in Baby friendly Initiative 5. Measures to ensure availability of Estate Manager approved designs for building projects to District Health Directorates 6. Mechanisms to ensure that all drugs DDPS are kept at the pharmacy at all levels 7. Establishment of a Regional SMC Monitoring unit 8. Awareness creation on cervical DDNS (PH) cancer screening. 9. Circular to headquarters on the SMC/Regional TB Coordinator effects of shortages of TB drugs. 10. Circular to headquarters on the SMC high cost of drugs at CMS as compared to the open market. 11. Ensure functioning of all SMC committees
6 2006 REGIONAL PERFORMANCE REVIEW ISSUES FOR DISCUSSION
• Human Resource • Transport • Service Delivery ¾ Still Birth ¾ Maternal Death ¾ TBAs • NHIS • Data Management • Infrastructure
Human Resource • Trainees to serve in Ashanti for 3 years
• Sensitise trainees to accept posting to rural areas
• Liaise with MoF for concession to employ staff
• Train CHNs in midwifery to man CHPS
• Keep Diploma midwives under supervision for at least a year
• Liaise with District Assembly for Incentive package for staff in deprived areas
• Dialogue with DAs to sponsor training of staff
• Policy to make transfer/movement mandatory
• Expansion of our training institutions
• Provide decent accommodation for staff when posted
7
Transport • Collaborate with GPRTU • Send concerns on jailing motor bikes to the RHD • Take advantage of tax waive to acquire personal vehicles capacity 1.8 litre
Service Delivery Still Birth - Need to develop guidelines on neonatal management Maternal Death - Training in Life Saving Skills - Intensify FP campaigns TBAs – Give percentage of delivery fees to TBAs to encourage them to send cases to hospital – Encourage ward assistants/orderly trained on job to practise midwifery – Specialist O&G visit to facilities Format for presentation • Quality Assurance issues to be added • Presentation skewed towards PH
NHIS • Policy on private participation in NHIS • Procedure for payment terms – 50% upfront before services are provided • Unified costing • Poor negotiation skills – Build up capacity to negotiate with scheme • Imposition of tariffs by scheme • Slow pace of renewals • Comprehensive Drug list needed (e.g.Quinine not on list)
8 Data Management - Sensitise staff to be interested in data management at all levels - Build up capacity in data management - Need to discuss and use data at the all levels - Scaling Up of DHIMS - Non Involvement of Health Info Officers in data management at district level - Institute regular Data Validation Exercise - Managers should use data to take decision
Infrastructure & Equipment • Package of Infrastructure and equipment • Use of IGF to replace basic equipment • Adhere to Policy on donation
9
2.0 PUBLIC HEALTH SERVICES
2.1 DISEASE CONTROL The main focus of activities was prevention and control of communicable diseases, especially those of National and International Public Health importance.
The objective of the reportable diseases were to: • Eradicate poliomyelitis and Guinea Worm • Eliminate Neonatal Tetanus • Control Yellow Fever, Tuberculosis, Yaws and Onchocerciasis • Accelerate control of measles
The primary objective of the EPI programme was to reduce morbidity and mortality of diseases that are vaccine preventable by immunization (. e.g.: Polio, Measles, NNT, TB, DPT-Hep B/Hib) and secondly, to improve immunization coverage for all antigens.
Activities: 1. Quarterly review meetings on TB, HIV-AIDS/STI, Buruli Ulcer, Leprosy, Yaws, Onchocerciasis, Guinea Worm, Malaria, Surveillance and Expanded Programme on Immunization.
2. Training on diseases of public health importance.
3. Conducted NID (mass immunization on measles, polio) distribution of ITN for under 2 years population.
4. Weekly/Monthly/Quarterly feedback on performance in surveillance and other diseases to Metro/Municipal and Districts.
5. Transportation of Acute placid Paralysis stool to Noguchi Lab, Legon, Yellow fever and Measles blood samples to PHRL, Korle-Bu for confirmation
6. Sensitization of health workers and traditional healers and spiritual centres to improve on disease surveillance system.
7. Distribution of Benzathine Peniciline for Yaws treatment, Tabs Mectizan (Ivermectin) for oncho treatment. ART for HIV/AIDS patients 8. Monitoring/Supervisions, Technical support visits to Metro/districts. 9. Monthly consultative meeting in Accra.
11
Achievement: 1. Documentation of EPI cold chain inventory. 2. Additional refrigerators were supplied to boost the performance of the EPI programme. 3. 100% completeness of submission of returns to National level in both Weekly Notifiable and Monthly Communicable Diseases. 4. Timely on Monthly Communicable Disease was 79% whilst Weekly was 70%.. 5. TB control programme saw remarkable improvement.
Constraints: • Cash flow for programmes not the best. • Weak response from, Metro, Municipal and Districts for all forms of meetings. • Poor quality of data submission • Poor timely submission of reports • Incomplete submission of reports
Surveillance: • Continuously monitoring and analysis Metro, Municipal and Districts reports submission rate. • Collecting/receiving and collating all data on disease reporting from 396 Health Institutions (both private and public) analyzing disseminating information of the various institutions/ Units for appropriate action to be taken.
TIMELINESS AND COMPLETENESS, WEEKLY NOTIFIABLE DISEASE (DISTRICTS SUBMISSION) The Regional average coverage (% score) on Timeliness of reporting from Metro/Municipal and Districts for the year under review was 95%. The Completeness was 100%.
Even though six districts including KATH, Sekyere East, Amansie East, Amansie Central, Amansie West, Adansi South scored below 90% all Metro/Municipal and districts performed above the target of ≥80%.
The same number of districts (6) failed to achieve the target of ≥80% in 2005. Whilst in 2005 the least performed district scored 33%, in 2006 the least performed district (Adansi South) scored 83%, an indication of 50% increase.
12 Weekly Notifiable Diseases, District Submission, % Score Timeliness. Jan-Dec 2006 Ashanti Region 120
100 100 100 100 100 100 100 100 98.198.198.1 100 96.296.294.294.2 95 90.4 88.587.386.5 85 83 83 80
60 % Score
40
20
0
N J M M S A F S G E AD AAN ATM ATN EJ AAS ASS EJ AFS BAK OF ATM SEE AME AD R KU OB SEW KW AMC AMW KATH Districts
% Score
Weekly Notifiable Diseases Timeliness and Completeness, Regional Reporting Ashanti 2002-2006
Year Timeliness Completeness ≥ 80% ≥ 90%
2003 89.2 89.2
2004 89.2 83.5
79.8 2005 94
2006 95 100
13 % Score Timeliness of Monthly Reporting in Ashanti by Districts for Year 2006 120
100 100 100 91 91 83 83 79 80 75 75 75 66 58 58 58 58 58
% 60 54 50 41 41 41 40 25
20
0
A S M G N J M F S E EJ EJ AFS ATM KW AAN AAS OB R AMC ATN SEE AD ASS KU OF SEW AME AD AMW BAK ASN Districts
Monthly communicable Disease Surveillance Reporting –Ashanti 2006
There has been much improvement in coverage in monthly CD surveillance reporting over the years from region to the national level in both Timeliness and Completeness.
The regional average coverage for Timeliness was 79%. Six (6) districts Atwima Mponua, Kwabre, Ahafo Ano North, Ejura Sekodumasi, Ahafo Ano South, Obuasi Municipality achieved the target of ≥80% whilst Adansi South, Amansie West, BAK and Asante Akim North could not even reach 50%. Asante Akim North achievement of 25% was the most disastrous in recent years.
Monthly communicable disease surveillance reporting from Municipal, Metro and Districts recorded a decreased in coverage (2% decreased). In 2006 the regional average coverage was 79% timely as against 81% in 2005. However, the region maintained the 100% Completeness recorded in 2005.
14 Monthly Communicable Disease Surveillance Submission, % Score Timeliness and Completeness, 2003-2006 Ashanti.
120
100 100 100 100 100 92.5
81 79 80 75
60 % coverage 40
20
0 2003 2004 2005 2006 Year
Timeliness Completeness
ACCUTE FLACID PARALYSIS (AFP)
Twenty-five (25) stool specimens were detected and sent to Noguchi Memorial Lab, Legon for confirmation. 24 out of the 25 stool specimen were collected within < 14 days of onset of paralysis (96% Timely). Afigya Sekyere, Amansie West, Asante Akim North, Atwima Nwabiagya, Ejura Sekodumasi, Ejisu Juaben districts failed to detect a case.
15 30 AFP STOOL COLLECTION BY DISTRICT - ASHANTI, 2006
25 <14 >14 24
20
15 NO. OF CASES 10
5 3 3 2 2 2 2 2 11 111 1 11 1 1 000000 00000 000000000 00000000 0
N S E J L N S S C N S M N K S M A F E H W M J W F T J A M S S T A F E T A A M U B D D E W M E E T A A A A A B A A A K O S A A O A A A K S D I S T R I C T K O T
The minimum expected case to be detected was 37 at the Regional level whilst Metro, Municipal and Districts were expected to detect at least 2 cases. The Region detected 44 cases in 2005 as against 25 in 2006, (43 % reduction).
16
AFP STOOL CO LLECTIO N BY D ISTRICT ASH A NTI 2006
Ejura S eky edum asi 0
Sek yer e E ast Of fins o Sek yer e W est 2 1 1
0 2 1 2 Kw abre A sante-A kim N o rth 0
0 3 0 1 3 2 0
Am ansie We st 2
NI L 2 Obuas i A da n s i N orth 1 1 C ASE 1
A dans i So ut h 1
Annualized non-polio rate in 2006 was 1.24 of the Regional target of 2.0. 17
OUTBREAK RESPONSE: Nine (9) major outbreaks were recorded in 2006: Six on Cholera from Asante Akim South, BAK, Ahafo Ano South, Kumasi, Afigya Sekyere and Adansi North districts, One chemical food poisoning (from Amansie West) and two whooping cough (from Amasie Central and Ejurs Sekojumasi).
Report on Chemical Food Poisoning in Amansie West shown that a total of 17 cases were treated and discharged after the people had taken banku. There were 4 males and 13 females.
MENINGOCOCAL MENINGITIS EPIDEMICS (MME)
Detection of meningitis by lumber puncture for lab examination to determine the bacteria for management of patients and prevention of close contacts (immunization) has not being the best. Cases were usually clinically diagnosed by the clinicians (except KATH), which resulted in 12 cases not classified.
Meningococcal Meningitis Epidemics (MME), 2006 Ashanti. High N. H. Strep. Neutrophiles Others Meningitides Influenzae Pneumonae Count
4 0 40 106 12
19 Cerebro Spinal Meningitis 1997-2006, Ash. 300 281
250
200 Deaths 162 150 133 of Cases/ 100
No. 92 78
50 55 34 29 25 20 14 17 15 7 12 0 3 4 22 2 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year
Cases Deaths
CHOLERA
The Region recorded a total of 211 cases with 16 deaths (CFR=6%) with Afigya Sekyere registering the highest number of cases (57 representing 23% with 8 deaths (CFR=14%).
Most reported districts were Afigya Sekyere, Ahafo Ano South, Adansi North, Kumasi and Asante Akim South.
The Region recorded 1966 cases with 11 deaths in 2005 as against 211 in 2006 with 16 deaths given a case reduction of 89%.
20 Trend of Cholera Cases and Deaths, 1997-2006 Ashanti.
2500
2000 1966 s h t 1500 ea D / 1270 ases C
f 1065 1000 . o o
N 823
500
211
0 40 19 40 40 16 161000033 16 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year
Cases Deaths
INTERGRATED DISEASE SURVEILLANCE AND RESPONSE – IDSR.
ACCELERATED MEASLES CONTROL A total of 65 suspected measles cases as against 96 in 2005 (32% reduction) were detected with blood samples (sera) sent to PHRL Korle-Bu for confirmation.19 Metro/Districts detected the 65 cases as against 13 districts in 2005. Asante Akim South and Sekyere East did not detect a case with Kwabre and Ejisu-Juaben detecting the highest cases of 7 each.
21 Trend of Suspected Measles Cases, Ashanti 1992-2006. 16000
Impact on 14000 14000 measles acceleration programme, 12000 CASE- 10900 BASED 10000 s e
s 9000 a
C 8000 f
. o 7000 7100
o 6500
N 6000 6000
4000 4000 4000 3600 2700 2000
479 403 0 86 65 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Susp Measles
Out of the 65 cases detected, five (5) samples proved positive, same number of positive cases in 2005.
Measles IgM Positive by Districts, Jan-Dec 2006, Ashanti Districts No. of Cases
Ahafo Ano South 1
Ejisu Juaben 1
Kumasi 2
Kwabre 1
Total 5
22 Trend of Measles IgM+ve Cases in Ashanti 2003-2006 25 22
20 s 15 13 ase C
f . o
o 10 N
55 5
0 2003 2004 2005 2006 Year
YELLOW FEVER The region detected 114 suspected Yellow Fever cases with blood samples sent to PHRL Korle-Bu for confirmation against 97 in 2005 (15% increase).
Suspected Yellow Fever Cases by District, 2006 Ashanti
40
34 35
30
25
Cases 20 f o .
No 15 11 10 10 8 6 6 5 5 5 4 5 3 3 3 33 2 2 1 0 0 0
N S C E N S M A M E A W S S T FF E W AFS M M M EJJ EJS W B E ADN ADS AA A A A A A A A ATN KUM K O O S S Districts
23 Two (2) districts (Asante Akim North and Sekyere East) failed to achieve the minimum target of 1 case.
TREND OF YELLOW FEVER CASES, 2004-2006 Year No. of Cases +ve
2004 61 0
2005 97 1
2006 114 0
YAWS CASES Out of the total 2,435 yaws cases treated in 2006, 1,139 were infectious of which 870 were < 14 years and 269 >15 years with 802 males and 337 females.
Yaws Cases (under 14years) by Districts, Ashanti 2006. 1000
900 870
800
700
600
500 of Cases 400 No. 292 300
200 147 91 100 61 65 43 30 49 40 1 19 2 4 0 12 00 1 4 0 9 0
J l N S J S A M M F a AFS E EJ AD AD AAN AAS AMC AME AMW ASN ASS ATM ATN BAK KW KU OB OF SEE SEW Tot g. e Districts R
Yaws Cases under 14yrs
24 NON-INFECTIOUS YAWS: 501 <14 years and 795 >15 years with 1,183 males and 413 females were treated as non- infectious.
Yaws Cases (15years and above) by Districts, Ashanti 2006. 300
269
250
200
150 of Cases No.
100
48 50 40 41 33 25 20 18 10 7 6 9 0 1 4 2 0 00 2 3 0 0
l N S N J S A M M F a D A AFS EJ EJ AD A A AAS AMC AME AMW ASN ASS ATM ATN BAK KW KU OB OF SEE SEW Tot g. e R Districts
Yaws Cases 15yrs and above
PROPLYLACTIC TREATMENT 5,236 contacts were given prophylactic treatment. 3,256 were <14 years whilst 1990 were > 15 years with 3,127 males and 2,109 females.
Most affected Districts are Adansi South, Ahafo Ano North, Asante Akim South, Atwima Nwabiagya, Ejisu Juaben, Obuasi Municipality and Offinso.
25 Trend of Yaws Cases, 2000-2006 Ashanti Region.
3500
3073 3000
2500
2113 2000 1962 2004 Cases f o . 1500 1424 No
1139 1000 1017
500
0 2000 2001 2002 2003 2004 2005 2006 Year
ONCHOCERCIASIS CONTROL PROGRAMME
Tabs mectizan (Ivermectin) were used to treat (dose) the affected communities by district. Training was conducted at the Regional and District levels after which tabs mectizan were released for the treatment.
Due to irregular/inadequate supply of the drugs, first line communities were tackled, Community Direct Treatment with Ivermectin was used. 13 out of the 21 Metro/Municipal and Districts did the dosing. Kumasi, Kwabre and BAK are non-endemic whist Ejura, Ahafo Ano North, Amansie East, Asante Akim North, and Atwima Nwabiagya districts did not dose.
The Regional % coverage was 37%.
26 % Coverage by District. Oncho Control Programme Ashanti, Jan-Dec 2006 120
98 100 86.5
80 e g
a 63.3 r 60 e
v 60 o C
% 36 37 40 32 33.5 27 22 20 13.2 15 6.4 3.2 000 00 000 0
N K E N AS ME SN SS TM BM FF E AFS A MC MW A ATN BA EJJ EJS UM O S EW IO ADN ADS AA A A A A A KWA K O S G RE District
% Coverage Onchocerciasis 2004-2006, Ashanti.
40 37
35
30
e 25
verag 20 Co
% 15 13.2
10 4.3 5
0 2004 2005 2006 Year
27 GUINEA W ORM ERADICATION
Seven (7) out of 21 districts recorded 52 cases in 15 communities in 2006 as against 50 in 2005.
Thirty-one (31) out of the cases recorded were indigenous and twenty-one (21) imported from Brong Ahafo Region (1), Northern Region (1) and MALI (19). Cases were captured by OBUASI MUNICIPALITY. All cases recorded were contained.
Guinae Worm Cases Reported by Districts in 2006
60 52 50
40
31 30
20
10 8 4 5 2 000000001 0000 00 1 0
N S C E N S N J A E G A W S S TM T J FF E W AFS M M M E EJS BM E ADN ADS AA A A A A A A A A BAK KUM KW O O S S RE
GWEP - Monitoring Chart by Month, Ashanti 2006.
35 29 30 s
g 25 n i r o
t 20 i n o
M 15
f o
. 10 8 o N 5 4 5 2 3 0 0001 0 0 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Month
28
Reported Guinea Worm Cases, Ashanti. 1600 1521 1400
1200
s 1000 982 e s a C
f 800 o
.
o 671
N 600
450 460 400
200 149 128 116 112 85 49 64 57 50 39 48 50 52 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
GUINEA WORM ERADICATION CASE SEARCH RESULTS
No. District No. of case search Cases 1 Adansi North 0 0 2 Adansi South 0 0 3 Afigya Sekyere 0 0 4 Ahafo Ano North 0 0 5 Ahafo Ano South 1 0 6 Asante Akim North 0 0 7 Asante Akim South 0 0 8 Amansie Central 0 0 9 Amansie East 0 0 10 Amansie West 0 0 11 Atwima Mponua 0 0 12 Atwima Nwabiagya 0 0 13 Bosomtwe-Atwima-Kwanwoma (BAK) 0 0 14 Ejisu-Juaben 0 0 15 Ejura-Sekyedumase 2 1 16 Kumasi Metro 0 0 17 Kwabre 0 0 18 Obuasi Municipality 0 0 19 Offinso 2 4 20 Sekyere East 2 0 21 Sekyere West 2 0 -+
29
WATER SUPPLY
The District Assemblies are doing well by providing boreholes to endemic communities in Offinso - 4 Atwima - 1
The underlisted districts with eleven (11) communities are yet to benefit from this package. Asante Akim South - 2 Adansi South - 1 Atwima Mponua - 4 Sekyere East - 4
Districts/ communities without safe drinking water are.
1. Asante Akim South • Densareso • Asampana
2. Atwima Mponua • Boakye Krom • Hiawoanwu • S.K. Nyame • Kekako
3. Sekyere East • Densi • Sabrewa • Kofui Dawu • Besore
WATER FILTER DISTRIBUTION
District No. Issued Comments Offinso 200 Sekyere East 400 Water filters were given to Sekyere West 300 endemic communities Ejura-Seko 300 reporting Guinea Worm Kumasi 100 Disease without potable water. Asante Akim South 100 Ahafo Ano South 100 Atwima Mponua 300
30
Buruli Ulcer
There has been a reduction of Buruli Ulcer new cases detected in 2006 from 673 in 2005 to 505 in the year under review. Out of this number 140 were nodular and 296 were Ulcerative cases. This is illustrated in the table below:
Buruli Ulcer Cases from 2004 to 2006
YEAR INDICATORS 2004 2005 2006
Nodules 150 171 140
Ulcers 323 345 296
Others 134 121 69
GRAND TOTAL 607 637 505
The reduction of ulcerative cases means we had a lot of health education conducted in most of the endemic areas.
The districts that had cases on Buruli Ulcers were Amansie West -107, Atwima Nwabiagya -99, Asante Akim North-82, Amansie Central-75, Ahafo Ano North-73, Ejisu Juaben-33, Atwima Mponua-14, Ahafo Ano South-11, Amansie East-3, Afigya Sekyere- 2, and Obuasi Municipality-1.
International Training Centre Agogo Presbyterian Hospital is now an international training centre for Buruli Ulcer Surgical Management. The inaugural ceremony was done by the sector minister Major (Rtd) Courage Quarshiegah in the first quarter of 2006 at Agogo. Surgical experts from France, Australia, Germany and Britain with local experts from KATH & Korle-Bu were present.
Sponsorship Training The American Leporsy Mission sponsored Buruli Ulcer Training for health professionals in Kwabre at Kaase Methodist Faith Healing Hospital, Mankranso Hospital and Apromase Hospital. Facilitators were drawn from KATH led by Consultant Dr. Pius Agbenorku.
31
Support Visit The National Programme Manager, Dr. Ampadu visited some treatment centres like Nkawie, Agroyesum, Agogo, Nyinahin, Konongo and St. Peter’s Hospitals to strengthen support for excellence in these facilities. There was free supply of dressings and other consumables from the National Buruli Ulcer Secretariat to the above institutions/Districts.
Challenges • Patients travel long distances for treatment • Free supplied dressing and other consumables are not separated from exemptions.
Way forward • To train health professionals to remove Nodules within their catchment’s areas • To visit treatment centres periodically to ensure that free supplied dressings / consumables to patients are separated from the facility stock. • Improvement of training of wound dressing among patients in their villages.
Leprosy Leprosy control in the region has been on elimination target of 1 per 10,000 populations since the last 8 years. All what we need to do is to sustain this and this means intensifying case search activities, adequate supply of chemotherapy to patients and good case holding practices.
72 new patients were registered and proportion of children under 15 years old among newly detected cases was 7%. Case detection rate was 7.05% and Prevalence rate was 0.5/100,000pop. Patients released from treatment were 99. Out of the 99 patients released from treatment 72 were multibacillary cases and 27 were paucibacillary
Trend in reported cases of Leprosy 2004 – 2006
Year 2003 2004 2005 2006 Cases 85 84 116 72
32 Three year trend of Leprosy cases, 2004-2006
Indicator 2004 2005 2006
Prevalence 80 107 52
New Cases 84 116 72
Discharged 70 83 99
Case Search • The entire districts embarked on case search activities. This time, more concentration was centered on training of community based health volunteers (CBS). • It is important to note that with the knowledge imparted to the CBS, they helped greatly to register 72 new cases (Passive approach). • It is interesting to note that Asante Akim North District which recorded most of the patients had consistently embarked on good case holding and this has resulted in total reduction of patients load from 43 in 2005 to 14 in 2006.
Challenges • Recycling of patients • Nerve assessment as component of case holding. • Low awareness among population under 15 years
Way forward • Periodic visit to update patient register and review to ensure that patients who complete the stipulated chemotherapy are released from treatment. • Training of prescribers on nerve assessment, so that patients who report with disability G1 would remain same after treatment. • Health education in schools and communities to create awareness among school children.
33 Malaria Control Programme
Objectives of the Programme
1. Implement new AMDP • Train relevant staff on AMDP (Artesunate Amodiaquine) • Monitor side effects of AMDP
2. Provide IPT to pregnant women • Train health staff on IPT • Carry out information, education &communication on IPT
3. Increase proportion of caretakers who are able to identify early signs and symptoms of uncomplicated malaria and severe malaria and seek prompt treatment • Undertake information, education &communication on home-based care
4. Monitoring and Evaluation
ITN ALLOCATION TO ASHANTI REGION
Quantity Received - 103,600PCS Quantity Issued - 99,200PCS Stock Balance - 4,400PCS
SULPHADOXINE PYRIMETHAMINE ALLOCATION
Quantity received - 640,000 Quantity issued - 92907 Stock balance - 547,093
Malaria Cases Total Number of Malaria Cases = 873,911 (46.3%) Malaria in Pregnancy = 16,330 (2%)
Total number of Malaria admissions = 34,568 Malaria admissions <5 malaria admissions - 12,382 <5 malaria deaths - 229 <5 malaria CFR - 1.8%
34 TUBERCULOSIS CONTROL PROGRAM
INTRODUCTION The Tuberculosis control program continues to implement DOTS in the management of cases. This has made the region to achieve very good successes in case management in the year under review. The Global Fund support received also injected a great deal of vigor in program management activities like supervision and monitoring, which is a major component for program success. If this momentum and commitment is maintained, the burden of TB in the region will be minimal.
AGENDA FOR THE YEAR In 2006, the region set itself to support all districts to organize refresher trainings and to incorporate new trends of Tuberculosis management with community involvement being piloted by Bosomtwe Atwima Kwanwoma district.
ACTIVITIES Training: There were refresher trainings four districts; Offinso, Asante Akim South, Ejisu-Juaben and Kumasi. The training covered 113 health care practitioners and 237 community based treatment supporters. Review Meetings: There were quarterly regional and district review meetings. The meetings were used to discuss case detection rate, inadequate microscopy services and the intermittent drug shortages. The new reporting forms (TB 07 and TB 08) were reviewed and institutionalized for use in reporting from the fourth quarter. The major comment on the TB07 was the column for defaulters that were placed under smear positives, since some defaulters return and are smear negative and yet must be re-registered. Data was also reconciled with the districts. Enablers Package: Districts disbursed the fund to care providers, which includes health workers, and community based surveillance volunteers. This was given to support their transportation for home verification before treatment commenced and lunch packs. Some districts also gave out T- shirts for propagation of TB messages and motivation. Most providers of care were greatly encouraged by the support and token given. Patients in the region received the package in the form of feeding supplementation (cooked food, provisions like Milo and mackerel), travel and transport allowance to health facilities for treatment and payment for other medications. Technical Support: Regional and District TB teams paid technical support visits to all districts and facilities treating cases to know at first hand the problems on the ground and institute remedial measures. Quality Assurance: External Quality Assurance (EQA) was carried out to review the performance of the laboratory in support if diagnosis. Details are covered in the diagnostic services report.
ACHIEVEMENTS Case Finding: The region detected 1931 (15.6%) out of its expected 12408 cases. Obuasi municipal consistently does well detecting 48.8% of its expected cases. Adansi North had the least case detection rate of 3.9%. See chart 1. Below is a table showing category of cases.
35 Table showing trend of total cases detected 2004 2005 2006 New Smear Positive 1256 1229 1283 New Smear Negative 448 527 489 Relapses 110 100 96 Extra Pulmonary 46 55 63 Total 1860 1911 1931
Chart 1: Case Detection Rate by Districts, 2006
50 49
45
40
35
30 30
25
21 20 20 19 17 16 16 1 16 15 5 15 15 14 13 12 11 10 9
7 7 6 5 5 4
0 OBS ASN AFS ASS ATN AD.S KWA AME EJJ KUM AAN SEW BAK OFF ATM AAS EJS AMC SEE AMW AD.N REG
Treatment Outcomes: For the first time all cases detected in 2005 were accounted for. Regional treatment success rate was 80% and adverse outcome rate was 20%. The adverse outcome is made up of 7% Default, 9% Death, 1% Treatment failure and 3% others. Kumasi, which sees a large number of the cases, maintains a zero defaulter rate. See charts 2 and 3.
36
Chart 2: Treatment Outcome by Districts, 2006 (Cases detected in 2005)
100 2 7 10 10 18 90 20 22 20 23 25 26 28 31 31 32 34 34 36 80 44
70
60
50 98 Adverse 93 90 90 Success 82 40 80 78 80 77 75 74 72 69 69 68 66 66 64 30 56
20
10
0 AFS KUM EJS AD.S EJJ BAK OBS AMW ASN OFF SEE ASS AAS SEW AME KWA AAN ATN REG
Chart 3: Trend of Regional Success and Adverse Rates, 2002 - 2005
100
22 20 90 25
37 80
70
60
Adverse 50 Success
78 80 40 75
63 30
20
10
0 2002 2003 2004 2005
37 DIAGNOSTIC SERVICES Laboratory service continues to improve over the years. The Central Tuberculosis unit supported the region with ten new Olympus microscopes to improve the microscope situation. Both public and private diagnostic facilities benefited. Quality assurance visits were made to selected public and private laboratories and 292 slides were picked for re-checking during the second and third quarters. Results gave an overall agreement of 92% and sensitivity of 100%. See chart 4 and table 2 below. Laboratories are not observing internal quality control measures may be accounting for the high false positive rate. Chart 4: Smear Preparation Assessments
38 Table 2: Correlation Table Result of Periphery Laboratory
Neg 1- 1+ 2+ 3+ Total 9AFB/100 Neg 181 6LFP 6HFP 5HFP 6HFP 204
Result of1-9AFB/100 0LFN 1 3 1 0 5 Assessor 1+ 0HFN 2 2 6 6 16
2+ 0HFN 0 2 13 11 26
3+ 0HFN 0 2 9 30 41
Total 181 9 15 34 53 292
Assessment of Reading ability: Overall agreement (Positive and Negative agreement) rate: 92% [(269 / 292) x 100] Disagreement: False Positive – 23 Sensitivity: Number of Positive agreement / Number of assessor’s total Positive x 100 = 100% [(88 / 88) x 100]
CHALLENGES Major challenges faced in our bid to improvement program management has been the low morale amongst microscopists who feel all the job is left for him yet does not receive any motivation and the intermittent short supply of logistics and medicines. Late reporting and poor data quality was also encountered.
NEXT STEPS Districts will be supported to re-train the staff to catch for the human resource gap caused by staff attrition and be abreast with new trends in Tuberculosis control featuring high will be TB / HIV collaborative activities to improve case detection.
39 Reported TB Cases by districts 2006
Extra-pulm Pulmonary Tuberculosis TB Smear- Smear-Positives negative New cases Relapses New cases New cases TOTAL DIST M F TOT M F M F M F M F T AD.N 9 2 11 2 0 2 0 0 0 13 2 15 AD.S 36 9 45 4 1 12 3 0 0 52 13 65 AFS 36 15 51 0 1 14 18 1 0 51 34 85 AAN 17 6 23 6 2 5 0 0 0 28 8 36 AAS 25 16 41 0 0 0 2 0 0 25 18 43 AMC 7 4 11 0 0 0 2 0 2 7 8 15 AME 44 26 70 7 1 5 1 1 1 57 29 86 AMW 7 3 10 0 0 6 2 0 0 13 5 18 ASN 40 28 68 3 2 35 12 7 1 85 43 128 ASS 29 11 40 2 2 10 10 1 1 42 24 66 ATM 14 3 17 0 1 9 6 0 0 23 10 33 ATN 44 28 72 1 1 9 1 5 4 59 34 93 BAK 28 11 39 0 0 16 8 0 0 44 19 63 EJJ 36 20 56 2 0 4 0 2 0 44 20 64 EJS 11 3 14 1 0 4 0 0 0 16 3 19 KUM 262 129 391 26 5 101 57 15 9 404 200 604 KWA 37 28 65 3 0 18 6 1 0 59 34 93 OBS 109 36 145 16 1 44 30 6 3 175 70 245 OFF 28 13 41 2 0 9 5 0 0 39 18 57 SEE 15 9 24 3 1 2 0 1 1 21 11 32 SEW 35 14 49 0 0 14 7 1 0 50 21 71 TOTAL 869 414 1283 78 18 319 170 41 22 1307 624 1931
40 Quarterly Report on Treatment Outcomes Trans Quarter Category M F Total Cured Comp Died Failure Default Out Total
Sm. Pos 195 94 289 199 21 29 2 26 12 289
Sm. Neg 89 55 144 118 17 0 2 7 144 1ST 2005 Relapses 18 4 22 17 3 2 0 0 0 22
Other RTR 3 3 1 2 0 0 0 0 3
Sm. Pos 184 90 274 220 10 24 2 14 4 274
Sm. Neg 79 55 134 101 22 0 4 7 134 2ND 2005 Relapses 18 4 22 8 8 3 0 2 1 22
Other RTR 2 2 0 2 0 0 0 0 2
Sm. Pos 217 115 332 250 15 31 3 19 14 332
Sm. Neg 75 39 114 92 16 2 3 1 114 3RD 2005 Relapses 13 7 20 16 1 1 2 0 0 20
Other RTR 7 7 1 3 0 0 1 2 7
Sm. Pos 217 117 334 249 15 21 5 33 11 334
Sm. Neg 88 54 142 123 11 0 5 3 142 4TH 2005 Relapses 23 6 29 18 5 6 0 0 0 29
Other RTR 0 0 0 0 0 0 0 0 0
Sm. Pos 813 416 1229 918 61 105 12 92 41 1229
ANNUAL Sm. Neg 331 203 534 434 66 2 14 18 534
Relapses 72 21 93 59 17 12 2 2 1 93
EPI
2006 EPI undertook series of activities but with a lot of challenges. Among them were routine static, out reach programmes and mops ups. Mass campaigns, support visits supply of logistics monthly feedback to the districts and training of staff were held during the year under review . Routine Static/Out reach Routine static and out reach programme were carried out daily, weekly or monthly in all districts at the institutional levels. Earlier on the Region was provided with some amount of fuel coupons to support the programme. Logistics support
41 The programme was successful due to logistics support which was regularly received from headquarters. The items supplied included cold chain equipment, vaccines, needles and syringes, etc.
Support Visit Support visits were made to the districts by the various officers including Deputy Director (PH) the programme coordinator and the cold chain managers. The visit was done together with the WHO Stop team member, Dr. Messeret. Records in the District and Metro Hospitals were reviewed for missed AFP, suspected yellow fever and measles cases. On EPI the teams were in the districts to assist in performance indicators, monitoring graphs drop out rates, missed opportunities, etc.
Mass campaign Combined measles, Polio, Vitamin A supplementation and bed net distribution campaign was organized from 1st to 5th November 2006. Even though the coverages compared to the previous years were low, it was quite successful.
Mop-up Mop-ups were carried out in all the districts following the fuel coupons provided by programme manager to increase coverage at the later part of the year.
Logistics support was adequately supplied from headquarters. These include cold chain equipment, vaccines, needles and syringes etc. Training of staff even though was not adequate it was done concurrently along side with other programmes
Challengers encountered. - Inadequate funds to support the programme. - Proposed mid level training could not be carried out because of funds. - Inadequate support visit at various levels. - Strike action of the staff.
EPI Performance 2006 Target 176281 Antigen/Year 2004 2005 2006 No % No % No % BCG 118795 72 148870 87 151852 86 Penta 3 117854 66 126799 74.2 125321 71 OPV 3 109193 66 133812 78.3 124948 71 Measles 112371 72.3 128832 75.4 126756 73 YF 55580 34 128472 75.2 127965 72
42 Chart 1 EPI trend 2004 to 2006
EPI Performance by Antigen 2004-2006 Ashanti 90%target for all antigens
100
90 87 86
80 78.3 74.2 75.4 75.2 73 72 72 71 71 71 70 68 68 66 64.8
60 57 e c
50 orman f
Per 40 34
30
20
10
0 BCG PENTA 3 OPV 3 MEASLES Y F TT2+ Antigens 2004 2005 2006
Besides the TT2+ all the antigens coverage fell below those of the previous year.
43 Chart 2 BCG by districts
100
91 91 90 90 87 83 83 83 83 81 80 79 75 74 74 74 72 72 72 71 70 70 65 63 60 59
50
40
30
20
10
0 AFS ATM AD.N AMW ADS AAS AMC OFF EJS EJJ OBS ASS KWA ATN AAN BAK SEE REG ASN SEW AME KUM
The best three performing districts are Offinso, Adansi North and Adansi South while Kwabre,Kumasi and Ahafo Ano North are the low performing districts
Chart 3: Penta 3 by districts
100 92 91 90 90 87 84 84 83 82 81 80 80 79 76 74 73 72 72 72 72 71 70 69
63 60 59
50
40
30
20
10
0 AFS ATM AD.N AMW OFF OBS AAS ADS EJS AMC EJJ ASS ATN KWA AAN SEW BAK SEE REG ASN AME KUM
44
Afigya Sekyere Atwima, Mponua and Adansi North are the best three performing while Kumasi, Amansie East andAsante Akim North are lowest.
Chart 4: OPV 3 by district 100
91 91 90 90 87 83 83 83 83 81 80 79 75 74 74 74 72 72 72 71 70 70 65 63 60 59
50
40
30
20
10
0 AFS ATM AD.N AMW ADS AAS AMC OFF EJS EJJ OBS ASS KWA ATN AAN BAK SEE REG ASN SEW AME KUM
45 Chart 6: YF by district
120
101 100 93 92 92 87 84 81 80 79 78 78 78 74 73 73 72 71 70 69 67 67 65 63 60
40
20
0 AD.N ATM AFS ADS AAS AMW EJJ ASS AMC SEE BAK ATN OFF REG EJS OBS AME KWA AAN ASN SEW KUM
Chart 7: TT2+ by district
120
105
100
85 84 81 80 79 78 77 75 73 72 72 70 70 68 65 63 61 60 60 57 56
50 47
40
20
0 AD.N ATN SEW ASN AFS KWA EJS SEE ATM OBS EJJ BAK AAS REG AMW ASS KUM AME ADS AAN OFF AMC
46
BCG & PENTA 3 drop out rate by districts- 2006
28.2 Campaign Results 26.0 23.0 23.5 22.1 21.2 Item Target Achieved % 20.1 17.8 18.0 17.8 16.6 e
t OPV 1,021,251 872594 85.4 a
r 13.6 12.2 11.5 12.0 Meas1l0.4es 868,0639.9 696,310 10.0 80.2 op out
dr 7.0
Vitamin A 919,126 784,2294.1 85.3
Bed-net 413,400 358,020 86.60.6
S S N S C E * S N K JJ S M A S F E * G .N D M W N S TM T A E U F W E A AF A M-1.8A A A A B EJ K OB O SE R AD AA A A AM AS KW SE
Recommendations
-Permanent labourer to be stationed at the regional cold room. -The regional cold room must be provided with a desk top computer. - Additional writing desk and shelf are required in the cold room
Outlook 2007 - Monthly feedback - Regular support visits - Data quality audit to be carried out in all the districts - Quarterly review meeting - Coverage survey to be carried out in Kumasi
47
HIV/AIDS/STIs Control
MAJOR HIV/AIDS /STIs ACTIVITIES
• HIV Sentinel Surveillance. • AIDS Surveillance. • Behavioural Surveillance Survey • Screening of Blood for transfusion • PMTCT/VCT Services • Management of AIDS – ART/OI • Training • Behavioural Change Communication • Inter-Sectoral Collaboration
OBJECTIVES
• To reduce further spread of HIV Infection in the Region. • To adequately manage AIDS and STD Cases in the Region. • To reduce the impact of HIV Positive status on the Individual, Family and Community.
SURVEILLANCE
Three Surveillance Surveys were conducted (as National/Regional activities by NACP) during the year: -
(a) HIV Sentinel Surveillance
Since 1990 HIV Sentinel Surveillance Survey has systematically looked at the trend of the infection in pregnant women between 15-49 years and has systematically seen a rise each year until 2004. The Prevalence results of the 4 sentinel sites, including the rural site at the St. Martins Hospital at Agroyesum in the Amansie West District are shown below in %
48 YEAR NATIONAL KUMASI - MAMPONG OBUASI AGROYESUM REGIONAL MEDIAN SUNTRESO 2000 2.3 3.8 1.6 - - 2.7 Average 2001 2.9 3.4 4.8 - - 4.1 Average 2002 3.4 4.2 2.4 6.0 - 4.2 Average 2003 3.6 5.0 5.4 3.7 - 5.0 Average 2004 3.1 2.4 3.2 3.4 2.8 3.0 Average 2005 2.7 3.4 2.7 2.8 3.0 3.0 Average 2006* 6.6 5.8 6.2 5.0 5.9 Average * SYPHILIS* 8.8 2.2 11.4 13.0 8.9 Average *
Suntreso STI - (200 maximum Samples collected) 15.0% HIV Positive * Preliminary Results
TREND OF HIV SENTINNEL SURVEY IN ASHNTI REGION, 2002 - 2006 7
6.6
6.2 6 6 5.9 5.8
5.4
5 5 5 SUNTRESO
MAMPONG 4.2 4 OBUASI 3.7 3.4 3.4 AGROYESU 3.2 M 3 REGIONAL 3 3 2.8 2.7 2.8 2.4 2.4 2
1
0 2002 2003 2004 2005 2006 Y E A R
The 2006 HIV/Syphilis Sentinel survey officially stated on the 25th September and ended on the 12th of Dec. 2006; the official authenticated results are yet to be released by the NACP. Each of the 4 sites was able to collect and screen the maximum number of 500 pregnant women for HIV and Syphilis. The main STIs Clinic at Suntreso - Kumasi was also able to collect and screen the required 200 samples of STD Patients for HIV.
49 (b) AIDS Surveillance
In line with the strategy of implementing Second Generation Surveillance in Ghana, the National AIDS/STI Control Programme (NACP) and the Regional Health Directorates (RHD) in the country under took Sentinel AIDS Surveillance Reporting Survey in the forty (40) sentinel sites in the country. The AIDS Surveillance Survey was conducted alongside the annual HIV Sentinel Surveillance Survey (HSSS) throughout the country; however the AIDS Surveillance was extended to early 2007.
In Ashanti the four (4) sites are Suntreso in Kumasi Metro, Mampong in Sekyere West District, Obuasi in the Obuasi Municipality and Agroyesum in the Amansie West District. Each site was given 100 AIDS Sentinel Surveillance Reporting forms to be administered by Clinicians. Clinicians were supposed to tick the Clinical Syndromes on the forms that a client might present and an HIV Test. AIDS Cases were still captured under the VCT (Diagnostic) though the old Questionnaire forms were sometimes used alongside with that of the VCT Questionnaire from NACP (Refer VCT Table).
(c) Behavioural Surveillance Survey
After a 4-day National training for Regional Coordinators, Field Supervisors and Data Collectors from Monday 24th February to Thursday 2nd March 2006 simultaneously in Kumasi for the Northern sector and Koforidua for the Southern sector, Behavioural Surveys started through out the country in March up to May 2006.
The General objective of this survey was: To obtain national baseline indicators related to HIV behaviour and prevention for developing a national database on HIV/AIDS in Ghana. In Ashanti, the survey covered the 4 Sentinel Districts and targeted at: - the general public, the JSS, SS, Polytechnic and one University - KNUST.
HIV AND BLOOD TRANSFUSION
To avoid HIV infection through blood and blood products Transfusion, blood for transfusion was screened in all Health Institutions before transfusion There are 27 sites for screening blood for transfusion. Table below shows incidence of HIV positive among blood donors in the Region between 2000 and 2006. BLOOD 2000 2001 2002 2003 2004 2005 2006
50 Donors 12476 13571 7,430 8,715 8715 7935
Screened
Donors 308 193 189 310 310 337
Positive 2.5% 1.4% 2.5% 3.6% 3.9% 5.3% 4.3%
TREND OF BLOOD DONAR POSITIVE IN ASHANTI REGION, 1995-2006
6
5.3
5
4.2
4 3.9 3.7 3.6
3
2.6 2.5 2.5 2.1 2 2 1.9
1.4
1
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Y E A R
51 PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV SERVICES
Prevention of Mother To Child Transmission (PMTCT) of HIV services were provided in most of the 34 Health Institutions. Summary result for 2005 and 2006 is shown below. 2005 2006 No. Of ANC Registrants 21,547 45670 No. Receiving Pretest Counselling 6,533 13337 Number Tested 3,335 9117 Number Positive 125 304 No. Receiving Positive Test 125 302 Results No. Rec. Post Test Counselling 3,332 8877 No. Of Pregnant Women Rec. 55 111 Nevirapine At ANC No. Of Pregnant Women Taking 41 60 Nevirapine In Labour No. Of Babies Receiving 38 62 Nevirapine No. Of Mother/Baby Pairs That 38 58 Took Nevirapine
In the course of the year, 14 Private Maternity Homes were accredited to provide both VCT and PMTCT Services in the Region after going through the training conducted by NACP in Accra.
VOLUNTARY COUNSELLING AND TESTING (VCT) SERVICES
Voluntary Counselling and Testing (VCT) is the process by which an individual undergoes counselling enabling him or her to make an informed choice about being tested for HIV. VCT is also one of the methods to limit the spread of the infection in the Region. VCT services were provided in almost all the 34 Health Institutions that provided PMTCT services. Summary report is shown below.
52 VOLUNTARY COUNSELLING AND TESTING RESULTS
2005 2006 No. Rec. Pretest Counselling Male 751 2042 Female 959 2704 Number Tested Male 732 1850 Female 911 2470 No. Receiving Results Male 732 1,844 Female 911 2468 No. Receiving Positive Test Male 277 594 Results Female 429 1007
No. Receiving Post Test Male 732 1,844 Counselling Female 911 2468
TYPES OF CLIENTS: Walk Inn: - 1848 Diagnostic - 2781 Other Specify (Visa) - 49 Referral from NGOs - 68
RESULTS OF HIV/AIDS FROM COUNSELLING AND TESTING AND OPD CASES
(a) HIV/AIDS CASES
Gender Counselling and Testing OPD cases sites 2005 2006 2005 2006
Male 227 594 992 728
Female 429 1007 1266 1016
Total 706 1601 2258 1744
53 (b) HIV/AIDS CASES (Morbidity)
YEAR Admission Deaths 2005 Male 132 34 372 92
Female 240 58
2006 Male 128 440 29 80 Female 312 51
PROVISION OF ART SERVICES By the end of the year the Region had 6 Centres in 4 of the 21 Districts providing ART Services to PLWHA. Below are the ART Centres in the Region
NO OF
NO ON DEATHS NO OF INSTITUTION ADHERANCE NO ON ARVs WHILE ON REGISTRANTS COUNSELLING ARVs M F M F M F M F
OFFINSO 17 39 8 17 6 6 1 0
ANGLOGOLD 67 75 18 21 17 17 4 0
OBUASI 2 4 2 4 1 2 0 0
BOMSO 37 49 1 1 14 26 4 3
PRAMSO 12 24 3 4 7 8 0 0
KSH 31 85 5 21 18 32 0 1 TOTAL 166 276 37 68 63 91 9 4
54 SEX DISTRIBUTION OF CLIENTS RECEIVING ARVs IN ASHANTI, 2006
35 MALE 32
FEMALE 30
26
25
20 18 17 17
15 14
10 8 7 6 6
5
2 1
0 OFFINSO ANGLOGOLD OBUASI BOMSO PRAMSO KUMASI SOUTH
STIs /STDs One of the factors that easily facilitate the transmission of HIV is the acquisition of STIs. As part of the effort to reduce the spread of the HIV in the Region, STI Clinic at Suntreso in Kumasi also conducted HIV Sentinel Survey along side with the HSSS. The purpose was to estimate HIV Prevalence among STI Clients.
Clients with STDs are managed in both private and Public Health Institutions using both the Etiological and Syndromic Approaches. However, there are three main STDs Clinics in the Region from where the bulk of the STDs Patients report for management. They are KATH, Suntreso, and Obuasi Hospitals. Additional STI Clinic was opened early in the year at the Maternal and Child Health Hospital (MCHH) in Kumasi- Kejetia under the WAPCAS/SHARP PROJECT.
55 STI Syndromic Management at CIDA Project Sites
SYNDROMES 2005 2006
Vagina Discharge 1617 965
Urethra Discharge 926 467
PID 551 390
Genital Warts 15 34
Genital Herpes 11 272
Genital Ulcers 716 239
MONITORING AND SUPERVISION
Two special Regional monitoring teams undertook monitoring and support visits to VCT, PMTCT, ART, HSSS, BSS and AIDS Surveillance sites in the second and third quarters of the year. Special visits were also paid to these sites by various National Monitoring and International Teams.
BEHAVIOURAL CHANGE COMMUNICATION
Seminars, symposia and other activities were organised in the Region by Stakeholders during the year. Some of the resource persons were from the Regional Health Directorate. For example the Regional Coordinator was involved in several HIV/AIDS/STIs Programmes during the period. Some of the Programmes were: • Organisation of workshops/facilitation in the Region and Outside the Regions. • Radio Presentations. • Delivering of Keynote Addresses. • Inauguration of the HIV/AIDS Committee for the KNUST by the Hon. Minister of Health in April • HIV/AIDS/STI Presentations for Tutors and Vice-Principals of Training Colleges in the country.
56 CARE AND SUPPORT FOR PLWHA IN THE REGION
Care and Support for People Living with HIV/AIDS (PLWHA) has been identified as priority area in the Prevention and Management of the HIV infection in the Region. The PLWHA Associations formed in 2003 grew to 70 by the end of 2006. A network of the Associations was formed (with 2 PLWHA and advisor from each of the Associations). The network met once a month (the 2nd Thursday of each month) at the Regional Health Directorate Conference room to discuss matters concerning the Associations, prevention of the spread of the infection etc. Some of the special people invited to talk at the meetings were the Regional Coordinator (on current issues); the Pharmacist at the ART Centre at KATH (on drug Compliance) etc
Out of the 70 Associations 42 have received various sums of support from the GLOBAL FUNDS INITIATIVE through the NACP for their monthly meetings and Income Generating Activities to support members. The Associations have a total number over 2,000 as at the end of 2006, with more Associations still registering.
COLLABORATION
The RHD worked in close collaboration with various HIV/AIDS/STDs Stakeholders like: The Regional Coordinating Council (RCC). The Ashanti Network of NGOS (ASAN). Ashanti Network of PLWHA Associations and Service Organisations. District Assemblies. Community Based Organisations (CBOs). Educational Institutions e.g. KNUST, Workers College (Distance Education) Faith Based Organisations. Ministries and Departments. The Press etc.
MEETINGS
(a) There was a two-day Advocacy Meeting on VCT / PMTCT for Health Managers in the Region on Thursday 27th and Friday 28th July 2006 at the Crystal Rose Hotel in Kumasi
57 The Objectives were: - - To brief Managers with detail information on PMTCT/VCT Services in the Region - To sensitize Health Managers to play advocacy role in the provision and scaling up of PMTCT/VCT - To update Managers knowledge on current HIV/AIDS/STI situation and - To discuss and plan the way forward. Funds were provided by the WHO-Ghana
(b) A one-day meeting for VCT/PMTCT Counsellors was held on 12th December 2006 at the RHD Conference room. One representative each from 49 counselling centres (including centres of the Private Maternity Homes) attended. The meeting was to afford assessment of performance and collaboration in the area of VCT/PMTCT Services in the Region.
TRAINING
(a) Regional There were three training workshops on Management of Opportunistic Infections in HIV/AIDS and other Diseases for:- - 23 Medical Officers and 2 M/As from the 21 Districts of the Region from Monday 7th – Friday 11th August 2006. - 25 Medical Assistants from Monday 23rd – Friday 27th October and - 25 Nurse–Prescribers from Monday 13th – Friday 17th November 2006 in Kumasi. Funds were provided by Global Funds through the NACP
(b) National There were series of trainings organised by the NACP for various staff in the Region e.g. - ART for Pramso, St. Michael, Offinso St. Patrick’s and Obuasi Government Hospitals - Care and Support for HIV/AIDS and Families - HIV Testing for Counsellors - Refresher training for Regional Trainers. - ART Data entry officers (2) etc.
SPECIAL VISITS
A team from ESTHER from France visited the Region in June and December 2006 to discuss HIV/AIDS activities and how they could support the Region.
58 WORLD AIDS DAY 2006
The Region joined the rest of the world in celebrating this year’s world AIDS Day, 1st December 2006, as declared by the UN with the Theme: -“ Stop AIDS; Keep the promise; with the sub theme the Time is now”. However, for genuine reason, the Regional celebration had to take place on the 8th of December 2006 at Fomena in the Adansi South District.
CHALLENGES
Translation of high levels of awareness to the desired behavior change Inadequate human resources at all levels Stigmatization and Discrimination of PLWHA Misconceptions about the epidemic False claims of cure Inadequate financial resources. Setting up a high quality comprehensive care package programme for HIV/AIDS in the region
PRIORITY AREAS FOR INTERVENTION IN 2007
¾Building staff capacity (Training) ¾Management of sexually transmitted diseases ¾Blood safety ¾Infection control ¾Improving Counselling and Testing (CT) skills ¾Regular meeting with Counsellors ¾Prevention of Mother to Child Transmission (PMTCT) of HIV. ¾Management of Opportunistic Infections in HIV and AIDS ¾ Scaling up of ART sites in the Region ¾Counseling and Home Based care ¾Support for PLWHA and OVC ¾Reducing Stigma and Discrimination against PLWHA ¾Behaviour Change Communication ¾Quarterly monitoring of HIV/AIDS Activities (CT, PMTCT, ART, OIS) ¾Strengthening intersectoral collaboration
59 COMMUNITY PSYCHIATRIC SERVICES – ASHANTI REGION ANNUAL REPORT, JANUARY – DECEMBER 2006
The Old Tafo Psychiatric Unit provided out–Patient care, Counseling, Domiciliary and Health Promotion activities while the Four Community Based Mental Health Units in the Region provided mainly community Mental services.
ACTIVITIES
(a) MEETINGS
The staff of the Tafo unit met twice a month for report readings (alternate Fridays). Discussions were held on home visits, client concerns, and problems; measures were formulated to improve the services in the region. Emergency meetings were held when the need arose to discuss issues concerning the region. There were also staff personal development meetings, where discussion and presentation on various topics pertaining to psychiatry were held on Thursday afternoons.
(b) CLINIC DAYS
Major clinic days for Tafo Hospital were Monday and Thursday, while Tuesday and Wednesday were maintained as minor clinic and home visit days.
Major clinical days for Bekwai and Mampong were Wednesdays (A staff from the Tafo Psychiatric Unit assisted the Mampong Unit every Wednesday).
(C) MENTAL HEALTH PROMOTION
In all 158 Health Promotion Talks were organized by the Tafo Psychiatric Unit. Some of the institutions that benefited were: 1. SDA Church 2. Assemblies of God Church – Tafo Ahenbronum, Ash Town and Gyenyinase 3. Buokrom Estate Presbyterian Church 4. Old Tafo Hospital – daily Some of the topics treated included Epilepsy, Drug Abuse and Mental Health / Illness.
(d) DOMICILLARY
During the period, 431 clients were visited as against 717 clients in 2005 by the Tafo hospital staff
60 Some of the clients were visited at least 2 times during the year. Home visits enabled staff to access how clients coped and integrated at home with family members and the public in general.
SPECIAL VISITS
As part of the effort by Basic Needs (an NGOs working to support Mental Patients) to improve Mental Health Situation in the Region Mr. Evans Oheneba Mensah visited the Tafo Psychiatric Unit on 27th of July 2006 to have discussions with the staff on how best they could work together to improve the conditions of Mental Patients in the Region.
MEETING ON NATIONAL MENTAL HEALTH BILL
During the year, a -3 day Workshop was held in Accra from 4th - 7th April 2006 to review the Mental Health Bill. The Region was represented by One Officer of the Tafo Psychiatric Unit
ROTATION NURSING
Eighty-Five (85) newly qualified General Nurses went through Community Psychiatric Nursing as part of their basic training requirements in Psychiatry as against 97 nurses in 2005.
PSYCHIATRIC CONDITIONS IN THE REGION
The main Mental Health conditions seen were mostly: -
- ANXIETY NEUROSES - DEPRESSION - HYSTERIA - MIGRAINE - SUBSTANCE ABUSE - SCHIZOPHRENIA - NEUROSIS - EPILEPSY
PSYCHIATRIC CASES IDENTIFIED AND REFERRED TO HEALTH INSTITUTIONS BY VOLUNTEERS FOR MANAGEMENT UNDER THE NATIONS FOR MENTAL HEALTH PROJECT (AMANSIE EAST, SEKYERE WEST, OFFINSO AND ASANTE AKIM N.
61 (a) AMANSIE EAST NEW CASES
2005 2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCH0SES 110 63 173 37 37 74
NEUROSES 19 38 57 9 14 23
SUBST. ABUSE 28 0 28 16 0 16
TOTAL 113 50 163 62 51 113
EPILEPSY
2005 2006 MALE FEMALE TOTAL MALE FEMALE TOTAL
199 125 324 24 29 53
(b) SEKYERE WEST DISTRICT STATISTICS - NEW CASES
2005 2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCH0SES 52 42 94 59 52 111
NEUROSES 13 11 24 14 6 20
SUBST. ABUSE 0 0 0 1 0 1
TOTAL 65 53 118 74 58 132
EPILEPSY
2005 2006
62 MALE FEMALE TOTAL MALE FEMALE TOTAL
159 204 363 80 115 195
C) OFFINSO DISTRICT STATISTICS
NEW CASES
2005 2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCHOSES 10 8 18 10 1 11
NEUROSES 0 0 0 0 2 2
SUBST. ABUSE 6 2 8 0 0 0
TOTAL 16 10 26 10 3 13
EPILEPSY 2005 2006
MALE FEMALE TOTAL MALE FEMALE TOTAL 76 25 101 13 12 25
C) ASANTE AKIM NORTH DISTRICT STATISTICS
NEW CASES
2005 2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCHOSES 16 13 29 11 7 18
NEUROSES 2 5 7 1 0 1
SUBST. ABUSE 0 0 0 0 0 0
TOTAL 18 18 26 11 7 18
63 EPILEPSY 2005 2006
MALE FEMALE TOTAL MALE FEMALE TOTAL 37 32 69 13 3 16
SUMMARY REPORTS OF STATISTICS FROM TAFO COMMUNITY PSY.
HOME VISITS AND ROTATION NURSES
YEAR 2005 2006
NO OF CLIENTS VISITED 717 415
NO OF ROTATION NURSES 97 85
NEW CASES
2005 2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
176 206 382 188 210 398 PSYCHOSES NEUROSES 60 133 193 66 122 188
SUBST. ABUSE 16 1 17 29 1 30
TOTAL 252 340 592 283 333 616
EPILEPSY
2005 2006 MALE FEMALE TOTAL MALE FEMALE TOTAL
257 210 467 225 179 404
64
OLD CASES (REVIEWS)
2005 2006 MALE FEMALE TOTAL MALE FEMALE TOTAL
6954 7803 14757 6428 7123 13551
PATIENTS REFERRED IN
2005 2006
71 79
PATIENTS REFERRED OUT
2005 2006
26 15
(Mostly Referred to KATH Psychiatric Dept., Ankaful, Accra Psychiatric Hospital and Pantang Psychiatric Hospital)
THE WAY FORWARD
- One Community Based Mental Health Project to be established in a District
- To hold Mental Health Review meeting with Prescribers in the management of simple mental conditions and record keeping.
- Mental Health Promotion activities to be intensified.
- To effectively monitor mental health activities in the Districts especially where the GHS/WHO’s Community Mental Health projects are in place.
65 ADOLESCENT AND REPRODUCTIVE HEALTH SERVICES
School Health School health activities provide opportunity to give messages about health disease prevention to children that can be spread to their families and communities in which they live. Supervision of school health activities in the region still remains a problem. There were training and retraining of school health coordinators in the course of the year since most people already trained have either left their schools or gone on transfer outside the region and this was affecting the service. School Health week was also organised and a number of durbars were held together with teachers to create awareness. This yielded a good result. 4350 schools were visited and
Table: 12 School Health Activities (2004-2006) 2004 2005 2006 Total School Enrolled 438,004 428,852 442,340 No of Children Examined 127,801 192,717 389,791 % of Children Examined 29.2 45.0 88.0 Schools with current Environmental Health Certificate. 4.4 4.6 9.0 No. of schools 5,943 5,948 11,835 No. of schools Visited 1,162 2,910 4,350
88% of the target group was covered.
Adolescent health Activities carried out included facility assessment, sensitisation and orientation of staff. Peer educator’s training is still on going in the region. There has been refurbishment of some adolescent health corners. Adolescent health services are provided in 13 facilities with 17 youth corners well established. The region has 44 abstinence clubs formed. Adolescent Pregnancy in 2006 was 16219 (12.4%) as against 17553 (13.4%) in 2005 with adolescent maternal deaths of 19 (11%).
66 SAFE MOTHERHOOD The goal of the safe motherhood programme is to improve women’s health in general and especially to reduce maternal morbidity and mortality and to contribute to reducing infant morbidity and mortality. Antenatal care over the past three years has seen a drastic decrease in coverage from in 83.6% 2003 to 74% in 2006. The total number of antenatal registrants for 2006 was 130698. Coverage for supervised delivery in 2006 was 54.3%, skilled deliveries were 72,062 (40.8%) and postnatal care coverage was 51.5% as illustrated in the table below.
Table 14c: Reproductive Health Outcomes, 2003-2006 Target Ante Natal Care Supervised Deliveries Post Natal Care YEAR population Registrants Coverage Number Coverage Registrants Coverage 2003 159766 133575 83.6 89829 56.2 92830 58.1 2004 165196 131778 79.8 92484 56.0 91947 55.7 2005 170814 130980 76.7 92829 54.3 87927 51.5 2006 176,622 130,698 74.0 94210 53.3 91,596 51.9
67 Table Reproductive and Child Health Performance by District, 2006
ANC PNC Supervised Target Deliveries Population DISTRICT Registrants % Registrants % Number %
Adansi North 5,492 3268 59.5 4713 85.8 2,655 48
Adansi South 5,343 3248 60.8 2525 47.3 3,015 56
Afigya Sekyere 5,822 3943 67.7 3673 63.1 3,341 57
Ahafo Ano North 3,517 2761 78.5 1645 46.8 2,016 57
Ahafo Ano South 6,533 4093 62.7 2406 36.8 2,486 38
Amansie Central 3,187 835 26.2 249 7.8 1,590 50
Amansie East 7,827 4495 57.4 3793 48.5 3,587 46
Amansie West 5,315 4623 87.0 3403 64.0 3,014 57
Asante Akim North 6,183 4509 72.9 2972 48.1 3,638 59
Asante Akim South 4,735 4135 87.3 3072 64.9 2,166 46
Atwima Mponua 4,456 3060 68.7 2109 47.3 1,726 39
Atwima Nwabiagya 7,160 6201 86.6 3959 55.3 3,741 52
B.A.K 7,139 5624 78.8 3531 49.5 4,422 62
Ejisu-Juaben 6,070 4831 79.6 3774 62.2 4,011 66
Ejura Seko 3,965 3829 96.6 2200 55.5 2,825 71
Kumasi 57,210 41,913 73.3 27629 57.6 30,262 53
Kwabre 8,050 7139 88.7 4634 55.8 4,849 60
Obuasi Municipality 7,142 6332 88.7 3983 54.6 3,726 52
Offinso 6,779 6279 92.6 3701 37.6 5,510 81
Sekyere East 7,694 3863 50.2 2891 67.6 3,084 40
Sekyere West 7,001 5717 81.7 4734 57.6 4,621 66 176,622 130,698 74.0 91596 51.9 94,210 53.3 Regional
68 FAMILY PLANNING
There was a marginal rise in FP acceptor rate from 14.15 in 2005 to 15.3% in 2006. District performance ranged from 6.1% in Sekyere East to 39.4% in the Kwabre district. Table 14a: Trend of Family Planning Acceptor Rate in Ashanti YEAR Target Population Number of Acceptor Rate Acceptors 2004 991,187 126,810 12.8% 2005 1,024,887 139,692 14.1% 2006 1,035,831 158,757 15.3%
Family Planning Performance by District 2006
Number of Districts Target Population Acceptor Rate Acceptors
31,854 4414 13.9 ADANSI NORTH 30,991 4089 13.2 ADANSI SOUTH 33,767 7146 21.2 AFIGYA SEKYERE 20,401 2845 13.9 AHAFO ANO NORTH 37,890 10034 26.5 AHAFO ANO SOUTH 18,485 1206 6.5 AMANSIE CENTRAL 45,399 6741 14.8 AMANSIE EAST 30,828 4399 14.3 AMANSIE WEST 35,861 5431 15.1 ASANTE AKIM NORTH 27,466 3771 13.7 ASANTE AKIM SOUTH 25,846 2126 8.2 ATWIMA MPONUA 41,525 5900 14.2 ATWIMA NWABIAGYA 41,405 7362 17.8 B.A.K 35,209 13333 37.9 EJISU-JUABEN 22,999 2029 8.8 EJURA SEKO
69 343,258 37211 10.8 KUMASI 46,690 18406 39.4 KWABRE 41,425 8570 20.7 OBUASI MUNICIPALITY 39,320 7148 18.2 OFFINSO 44,628 2718 6.1 SEKYERE EAST 40,604 3878 9.6 SEKYERE WEST TOTAL 1,035,851 158757 15.3
Couple Years Protection Oral Pills remained the most preferred method within the short term method range. Female sterilization also remained the most preferred method used by 59.3% of acceptors of long term contraceptive method.
Couple Year Protection by Method 2006 Contraceptive 2006 Oral Pills 17,185.93 Condoms 16,028.45 Spermicides 390.29 Norigynon 3,716.53 LAM 1,279.64 Depo Provera 25,830.34 Total 64,431.18 IUD 17,225.50 Female Sterilisation 58,853.52 Norplant 21,187.40 Natural 1,516.00 Vasectomy 417.80 Total 99,200.22 GrandTotal 163,631.40
70 INTEGRATED MANAGEMENT OF CHILHOOD ILLNESS (IMCI) ACTIVITIES
Growth Monitoring & Promotion
Data on the above is collected from child welfare clinics and the indicator of malnutrition based on weight for age, i.e. underweight.
The target for the year was 100%. For children 0-23 months there was a decrease in coverage from 66.50% in 2005 to 61.12% in 2006 and an increase in coverage from 13.81% in 2005 to 16.93% in 2006 for children 24-59months.
Over the past three years incidence of malnutrition in children under 5yrs of age has seen a marginal decrease from 3.40% in 2004 to 3.10% in 2006. However CWC coverage for under five increased by 10% (34.80% in 2004 to 44.50% in 2006). Amansie central recorded the highest incidence of malnutrition (7.3%) with Adansi North and Obuasi recording the lowest of 0.55% and 0.69% respectively. For children 0-23 months, Atwima Mponua recorded the highest incidence of 10.80% of malnutrition whiles Amansie East recorded the lowest of 0.15% for children 24-59 months of age.
CWC PARAMETERS
Children 0- 23 months Year 2004 2005 2006 Total Registrants 206144 221676 245287 W/A <80% 6762 6722 5591 Total population 326265 337359 348849 % coverage 63.20 65.71 61.12 % malnourished 3.30 3.03 2.89
Children 24- 59months Year 2004 2005 2006 Total Registrants 29770 50704 66091 W/a <80% 1878 1653 1880 Total population 355175 367251 379737 % coverage 8.40 13.81 16.93 % malnourished 6.30 3.26 3.34
71 CWC coverage for children aged 0 to 59months in 2006
7 6 5 4 3 2 1 0 2004 2005 2006
24-59 0-23
CWC PARAMETERS Malnourished Cases of Children 0- 59 months
Year 2004 2005 2006 Total Registrants 237407 275203 324354 W/a <80% 8096 9163 9947 Total population 681440 704610 728576 % coverage 34.80 39.10 44.50 % malnourished 3.40 3.30 3.10
Prevelence of malnutrition in children aged 0-59months attending CWC in 2006.
8 6 4 2 0 2004 2005 2006
24-59mos 0-23mos
72
BABY FRIENDLY HOSPITAL INITIATIVE PROGRAMME
Data on the above is compiled from all delivery facilities. However data on breastfeeding initiation is limited to only baby friendly facilities. The number of designated baby friendly facilities has not increased over the past 12 months. During the year under review none of the district undertook training in lactation management. Thirty - one (31) out of three hundred and thirteen (313) maternity facilities in the region are baby friendly. Additional 31 facilities were trained in 12 districts and ready for assessment since 2005. There is an urgent need to assess the back log of 31 facilities trained since 2005 to scale up the number of facilities designated as baby friendly in the region. An upward trend in the initiation of breastfeeding which started in 2003 reached its highest level in 2004 and a gradual fall was registered in 2005 and 2006 thus making it a call for concern.
KATH which delivers a substantial proportion of women in the region is not baby friendly and does not submit reports on maternal supplementation of vitamin A and other baby friendly activities Districts that have no breastfeeding facilities have to take steps to address this anomaly by the end of 2nd quarter 2007. Channels for vitamin a distribution and reporting at community level should be strengthen to capture data from TBAs. Mother support groups at local levels should be strengthened and improved.
BREASTFEEDING PROMOTION
Year 2004 2005 2006 Total Facilities 313 313 313 ( mat ) Designated as BF 31 Nil Nil % BF 9.9 0 0
An additional 31 facilities have been trained in 12 districts and ready for assessment since 2005.
BABY FRIENDLY PARAMETERS
Year 2004 2005 2006 Expected delivery 165195 170815 176622 B.F < 1hr 45979 37431 32672 % Initiation 49.6 40.3 38.80 % M. Vitamin 49.6 38.10 66.10
73 Community Based Growth Promotion (CBGP) Data on the above is compiled from 55 sites (communities) in the region where community growth promoters have been trained with PPTAP and BASICS II support. BASICS II supported 15 out of the 55 communities while PPTAP supported 40.
The programme which first started in Atwima district was extended to all the 21 districts in Ashanti region and scaled up to 40 communities with support from PPTAP (promoting partnership with traditional authorities’ project) under the auspices of the Asantehene. Districts were tasked to train additional communities each but none of them undertook the training. The year under review saw a highly unacceptable defaulter rate in all communities. Adequate weight gain did not meet the minimum target of 80% set for the year. Monthly reporting was on the low side; however Sekyere west did not submit a single report for the period under review. There is the need for districts to organize and conduct refresher training in the use of counselling cards for growth promoters and also promote quarterly community meetings as well as strengthening reporting system and institute rewards.
Community Based Growth Promotion (CBGP) Year 2004 2005 2006 District trained 1 21 Nil Community trained 22 40 Nil
Districts were asked to train an additional site each for year 2006 but none did. (Target: 21 communities; one community per district)
Micro Nutrient Supplementation
Iodated Salt Programme An upward trend in both the availability and usage of iodated salt was recorded during the year under review this is being attributed to the gradual increase in the number of functional iodated salt communities which are responsible at the local level to oversee the programme. Reactivation of the committee in Kumasi- metropolis also contributed significantly to the rise in both availability and usage. Kumasi being the capital of Ashanti region is strategically located and all commercial activity in the region and the Diaspora are carried out here and so reactivating the metropolis iodated salt committee has adversely affected availability and usage in the region. There is the need to intensify education at static points, outreach points, local fm stations and other social gatherings as well as reactivate iodated salt committee that are dormant or establish committees in districts that do not have. The following districts did not submit report for the November; market and household iodated salt survey. They were; Adansi north, Adansi south, Ahafo Ano north, Amansie
74 west, Asante Akim north, Atwima Mponua, Offinso, Atwima Nwabiagya and Sekyere West. Three sub metros Asokwa, Bantama and Tafo passed whilst two; Manhyia and Subin failed. Seven (7) districts and two sub metros out of the eleven- (11) districts, which carried out the survey, failed.
Iodated Salt Programme Year 2004 2005 2006 Availability 26.50 35.50 82.8 Use 38.40 43.12 79.3
Test kits for iodated salt monitoring for the year under review was not received. What is currently available expired in November 2005; this has been communicated to Accra nutrition unit but no feedback has been received.
Vitamin A Supplementation Vitamin A supplementation for children 0-59 months has over the years been scheduled to coincide with national immunization days and child health week. Coverage of 85.32% was recorded for the region in November 2006 indicating a decrease of 38.10% over the previous year's coverage. The downward trend of maternal supplementation of vitamin a (within eight (8) week of post partum) that started in 2005 reversed in 2006 showing a significant increase (28%) in maternal vitamin A supplementation, the figure however did not meet the target (70%) set for the year under review.
Vitamin A programme, Children aged 6-59 months Year 2004 2005 2006 Target 598840 619200 919127 Dosed 822154 865826 784229 % D. T. Card 137.29 139.83 85.32
Nutrition Rehabilitation The region recorded a marginal increase in the rate of rehabilitation of children with protein energy malnutrition. There was a drastic decrease in case fatalities by over 30% from the previous year's figures. Thus meeting the target set for the year. Rehabilitation centres in the region are facing dire problems with regard to funding. The issue has been raised twice at two meetings during the year under review (first at the national public health review at Wadoma hotel and second at RHMT meetings) There is the need to support rehabilitation financially to enable them run efficiently.
75 Nutrition Rehabilitation, 2004 - 2006 Year 2004 2005 2006 Cases 1836 3239 4774 RR 46 44.9 48.40 % CF 2.90 2.59 1.17
Target: To reduce case fatality by 30% in rehabs.
Anaemia Control No major activities in terms of training/durbars were carried out during the year. However, nutrition and health education in majority of facilities and outreach were centered on prevention of anaemia and the eating of fruits and green leafy vegetable to improve the nutritional status of pregnant women and children <5 years of age. Anaemia cases formed about 56.80% of the total admissions of nutrition rehabilitation cases for the year under review but contributed to about 32.50% of the total case fatalities.
Challenges • Lack of technical staff • Financial constraints • Lack of logistics • Data compilation, analysis and utilisation of results appear to be a major challenge in most districts • Non functional iodated salt committee in most districts.
Way forward • Liase with national assessment team for BFHI programme to assess the backlog of 31 institutions trained in 2005. • Revive/establish iodated salt committees in districts. • Conduct scheduled monitoring of iodated salt programme. • Train marching number of facilities per current designated number of baby friendly institutions. • Organize and conduct training session on rehabilitation for centre staff. • Organize and conduct two durbars per Subdistrict on GMP and conduct one on iodated salt/vitamin A. • See to the holistic management of diet related diseases. • Organize the distribution of vitamin A supplements for newly delivered mothers within 8 weeks post partum. • Distributive two rounds of vitamin A capsules for children 6-59months. • Capacity building in data management for technical officers.
76 PUBLIC HEALTH LABORATORY - KUMASI
INTRODUCTION The public health laboratory, Kumasi is situated on the premises of the Kumasi South hospital. It serves as the zonal laboratory for Ashanti and Brong-Ahafo regions in the investigation of diseases of public health importance. It has staff strength of five (5); two (2) Biomedical scientists, two (2) laboratory assistants and one (1) hospital orderly. The year under review has been challenging but routine activities were carried out with some success.
ACTIVITIES Training: There was no structured refresher training in the year but on-site corrective visits were paid to two (2) sub-district hospitals on infection prevention practices.
Technical Support / Monitoring: All HIV testing facilities were visited in the year under review twice to monitor test-kit usage and availability. The opportunity was used to ascertain the preparedness of the facilities to transport samples for investigation of diseases of public health importance. The facility also actively monitored the four (4) HIV sentinel survey sites and ensured adherence to protocols.
Quality Assurance: Quality Assurance was carried out in the 2nd and 3rd quarter of the year under review for Tuberculosis Sputum smear microscopy. The report revealed a sensitivity of 100% and overall agreement of 92.1%. Smear preparation abilities improved but 23 out of the 292 slides re-examined turned out to be false positives.
Routine Microbiological Services: The Public health Laboratory provides routine culture and sensitivity services to the Kumasi South hospital and other hospitals in the Kumasi metropolis and surrounding districts.
77 Table 1: Summary of samples and most common isolates, 2006 # Sample Cultured Isolates Urine 185 E. coli - 16, Klebsiella spp. - 10, Coliforms - 2 HVS 156 Candida - 18 Blood 16 Sputum 6 CSF 2 Wound 37 Pseudomonas- 10, Proteus spp.- 7, Klebsiella spp- 3 Stool 57 Pus 10 Klebsiella spp. - 2, Serratia - 1 Urethral S 6 N. gonorrhoea - 4 Ear 3 Pseudomonas - 1, Klebsiella spp. - 1 SF 1 Total 479
Disease Surveillance Support: There were reports of suspected outbreaks of cholera and other diarrheal diseases, which were all investigated.
Table 2: Three-Year trend of some serological tests: Test 2004 2005 2006 # Pos # Pos # Pos HIV 393 170 375 154 CSM 25 1 21 2 8 2 HBsAg 43 13 100 12 129 20 VDRL 4 0 13 1 62 5 Widal 1869 1624 1216 Cholera 5 0 142 49 Ogawa 176 54 Ogawa
Challenges/Constraints
78 Major challenges in the year included slow pace of maintenance of faults at the facility and the poor rate of report submission from the district hospitals. Lack of dedicated transport for frequent support visits is a big constraint.
Health Learning Material
Mission of NHLMC • To sustain a permanent national institution with the capacity to design, produce, distribute and evaluate the impact of HLM targeted at health service tutors, staff in service and trainees (students)
• To facilitate the organization and maintenance of well organized regional and health training institutions-based resource centres
• To create and increase awareness among the people of Kumasi on attitudes, perceptions and behaviours that will positively influence them towards improved health.
Major Activities for the Year
As part of the responsibilities towards the improvement of overall health status of people living in Ghana, the National Health Learning Materials Centre (NHLMC) continued with activities entrusted to the Centre. In pursuit of the responsibilities, the Centre worked on the following programme areas within the period under review.
• Health Learning Materials Production • Resource Centre Management • Sickle Cell Disease Education and Counseling • Health Education • Coordination of IE & C of TB Global Fund Activities • Administration and Support
HLM PRODUCTION i) Induction and Orientation/In-Service Policy Document The Unit completed works on Induction and Orientation manuals and In-service Training Policy which were being developed by HRD in collaboration with QHP. The manuals have been made camera-ready and submitted to QHP for printing. ii) Policy Documents
79 Four policy documents namely: postings, appointment, promotion, counseling underwent first level editing, formatting, layout and submitted to HRDD for technical review. The feedback was received and final editing and desktop works had commenced on them. iii) Mental Health and Research Manuals . Mental Health Manual This manual is an initiative of the Centre that was started some years back. This manual has gone through the various stages of production, up to the technical review stage. In May this year, a technical review team drawn from the Psychiatric hospitals, Training Institutions, HRDD and other stakeholders were put together to assess the content and the suitability of the manual.
During the review, the team realized that a major aspect of Mental Health was not included in the document, which is stress management. In this regard two members were tasked to write a chapter on the stress management. The chapter has been received and is currently being edited for inclusion into the manual. The next step for the manual is the pretesting stage, proofreading and final production, i.e, and printing. Currently, a proposal has been sent to Basic Needs International, a Non-Governmental Organization with their head office in Accra, which has expressed interest in the manual for printing sponsorship..
Research Manual The Research manual is also initiative of the Centre that was started in 2005. The scripts have been collated to form an acceptable manuscript. Currently the contents are being modified to suite the curriculum of nurse trainees who have been targeted as the primary audience.
iv) New Materials These are materials that are at the writing stage. The materials are on Radiography, Occupational Health and Laboratory Services. These manuals were developed based on a curriculum from the HRDD. Based on the curriculum a book plans were developed out of which the various chapters were allocated to writers. The writing started in 2004 and most writers have not completed their scripts in spite of persistent calls to complete the scripts. Currently contacts are being made heads of the respective groups to move these manuals forward. v) Materials Needs Assessment Survey A proposal to identify materials needs within the health sector was development in collaboration with the National Training Coordinator. The purpose was to identify priority materials for production based on needs. The proposal has been finalized and submitted to HRDD. vi) Ashanti Journal
80 The Unit continued with the collection of articles and pictures for inclusion into the Ashanti journal. The journal has been made ready for final editing by the editorial board. In a related development a National Service Person with journalism background was posted to the Unit to assist with the work of the journal.
Resource Centre and Library Management New equipments were purchased to enhance the work of the office. Notables amongst them are; PA systems, TV set and DVD player. These have been appropriately recorded in the inventory books.
Also items were bought in bulk quantities to make entry into the stores books easier. A storekeeper was engaged from the Metro Health Directorate to help with the writing of the numerous books. Routine maintenance of almost all the equipment was carried out within the period. Significant among these are the air-conditioners, generator, mower and anti-virus upgrading. There were frequent repairs of the computers including the laptops and the photocopies. All these equipment are functioning except one 2 laptops and 2 computers.
The library serves as a model for the regional resource centres and the institution based resource centres. The library has a wide range of books on health and related topics. Again we took stock of all the materials in the library. In view of this an up-to-date data base was updated to ensure proper monitory of the materials in the library. Reading materials that received the highest patronage were:
• Research reports • HIV/AIDS • TB • DRUG ABUSE • Malaria • Health System Management • Nursing • Family Planning • Pharmacology • HIV/AIDS • SCD Reports • Journals • Health Education • Medicine • Administration And Quality Assurance • Maternal and Child Health • Primary Health Care • Environmental Health • Other Health Reports
In all 2, 874Books were used and 14 Videocassettes were borrowed within the year.
81
Health Education The health education component continued to reach out to the people of Kumasi Metropolis on matters relating to their health. The health education programmes aimed at creating and increasing awareness among the people of Kumasi on attitudes, perceptions and behavoiur that will positively influence them towards improved health.
Based on this, proactive, responsive and reactive programme were planned and implemented. Most of the educational programmes were responsive, however, few proactive programmes were undertaken. Topics that received most attention were HIV/AIDS, STI’s, Tuberculosis, Menopause, Personal hygiene, Environmental Sanitation, Nutrition and Eating Habits. The sources of invitation included churches, schools, NGO’s and Communities. The team was able to embark on radio programmes at Nhyira FM.
The educational component together with the Ministry of Education and sponsorship from World Health Organization (WHO) carried out an educational awareness programme on Drug Abuse dubbed Youth Enter-Educate on Drug Abuse targeting second cycle institutions in some selected districts outside the Kumasi Metropolis. To assess the impact of the education, a quiz competition was organized for the schools in the participating districts on the 12th December 2006.
Coordination of IEC Activities of TB Global Fund The Centre also engaged in activities aimed at creating awareness on tuberculosis The activities carried out on awareness creation were mainly done in communities. Places visited included Adiebeba, Anwomaso, Domeabra, Apromase, Bantama, South Suntreso, North Suntreso, Adoato, Amanfrom, Ohwim, etc. Church group and school education programmes were also undertaken. Radio and Jingle broadcast were also done to promote the awareness creation. The FM stations contracted were Nhyira and GCR FM.
The following facilities were monitored for progress work as well as challenges confronting them. Tafo Hospital Suntreso Hospital Kumasi South Hospital Maternal and Child Health Hospital Central Prisons Technology Hospital 4 miles.
Some of the constraints that came up from the facilities were lack of PA system for Education and inadequate finance for T&T. The Unit engaged in TB educational campaign in JSS within the Bantama Submetro. This was the first phase of programme lined up to cover all JSS within the Kumasi Metro.
82 Drug Abuse Campaign Within the period, there was a drug abuse educational campaign in all second cycle schools dubbed, “Youth Enter Educate Programme” in the under listed districts in two phases. The campaign was a follow up to a research conducted by the Centre to ascertain the prevalence of substance use and abuse among the youth in Ghana in 2003. The programme was supported by the World Health Organisation (WHO) Reports on these programmes have already been submitted to WHO. The first phase covered these districts; Sekyere West Bosomtwe Atwima Kwanwoma Atwima Nywabyiaga Kwabre Ejisu-Juaben
The second phase covered the following districts; Atwima Mponua Sekyere East Ahafo Ano North Ahafo Ano South Amansie East Obuasi Municipal
As a follow up to the educational activities carried out in Second Cycle Schools on Drug Abuse, a quiz competition was organized among the schools that benefited from the programme on 12th December 2006 at KNAT hall Kumasi. The participating schools were grouped on district bases. The district and corresponding schools are enumerated below: • Sekyere East - T.I Ahamadiya Sec. Effiduase Sec Com. and Dadease Agric Sec. • Ahafo Ano South – Mankranso Secondary School • Ahafo Ano North – Tepa Secondary School • Obuasi Municipal – Obuasi Sec Tech, Christ the King Sec • Atwima Mponua – Mpasatia Sec Tech • Amansie East – Oppong Memorial Sec, Wesley High Sec, SDA Sec
Dignitaries present included the following: Mr. J.O. Adjei, Head of the Guidance and Counseling Unit of the Ghana Education Service, Ashanti Regional Office. Mr. Andrews Adjei Druye, head of the National Health Learning Materials Centre. Mrs. Sophia Twum- Barima, a representative from the WHO. Mr. Dan Briama, Ashanti Regional Pharmacist At the end of the three rounds Amansie East came first with 56 points, Obuasi Municipal was second with 40 points, with 37 points the third position went to Sekyere East. Ahafo Ano South came fourth with 35 points, Atwima Mponua was fifth with 32 points and the sixth position went to Ahafo Ano North with 23 points.
Awards made up of books were given to the various schools that represented the districts and the contestants received books and certificates as well. The first three districts received a shield each.
83 Sickle Cell Education and Counselling
The following were specific objectives set for the Sickle Cell Disease project; • Educate and counsel parents and patients at the sickle cell clinic • Continue create awareness about Sickle Cell Disease in the Kumasi metropolis • Support international students • Support Sickle Cell Association
i. Parents and Patient Education at the Sickle Cell Clinic Education and Counseling of parents and patients at the Sickle Cell clinic continued successfully for both first attendants and continuous education. At the end of the year under review the total number of first attendants registered at the clinic was 201. Among the topics discussed were; what is SCD, caring for SCD child, home management of pain and avoiding situations that will trigger the crisis, Septicemia and signs of infections, Penicillin Prophylaxis and Folic Acid, Managing fever and pain at home, Nutrition, Malaria, acute chest syndrome etc. The component has developed a new format for data collection at the first clinic. This new format was introduced in November 2006
ii. Awareness Creation Public education in churches was done together with the Sickle Cell Association based on request. Some of the churches visited were, Methodist ministers wives meeting at Mmofraturo Girls School Kumasi, Wesley Methodist Church, Amakom, Kwadaso Estate Methodist Church, Ahwia Methodist Church, Oforikrom Church of Christ, Corpus Christi Catholic Church, New Tafo, St. Theresa Parish, Asawase etc. In addition, radio education was given on the studios of Nhyira and Luv FMs. Public education was done in the following organizations: Kumasi Polytechnic and KNUST. iii. International Students During the year under review, only one student arrived from the USA to undertake a research in the country. She arrived in the latter part of June and stayed for six weeks. The title of her study was “Willingness of sickle cell parents to pay for National Health Insurance”. The Component supported her in the data collection. She was still at the analysis stage when she left for the US iv. Support to Sickle Cell Association The Component provided support to the Sickle Cell Association of Ghana both locally and nationally. The Component provides Administrative and Educational Support to the Association.
Monthly meetings were held on first Thursday of every month at KATH. The Component took the opportunity to give them talk on various issues and also invited resource persons to talk to the members on other relevant topics
The component has helped the association to open a branch at Koforidua, Eastern Region.
84
iv. Celebration of FALDA – 10TH MAY The celebration of Africa Day of Sickle Cell Disease took place at the Eastern Regional Capital, Koforidua under the Theme: “Sickle Cell Disease – A Need for More Regional Associations”. The programme was attended by all the existing branch members namely: Accra, Tema, Kumasi and Sunyani.
The occasion was chaired by Dasebre Nana Dr Oti Boateng, the Omanhene of the New Juaben traditional area and other dignitaries in attendance, were, the Regional Minister, Hon. Yaw Barimah, the Regional Director of Health Service, Dr. Ebenezer Appiah Denkyira, Dr. Fleischer-Djoloto, NPO- Family Health and Population of WHO and Dr. Taylor, Deputy Director, Clinical Care, Eastern Region. Others were Clinical Coordinator, NSSCD Project, Dr. Osei Yaw Akoto, the Medical Director of the Regional Hospital, Dr. Obeng Apori, and heads of departments within the GHS, National Executive of Sickle Cell Association of Ghana (SCAG) and members of the SCAG.
v. Genetic Counseling The education and counseling staff have been going to the SCFG every Wednesday to address the counseling needs of the people.
vi. Genetic Counseling Training One staff from the component attended a Genetic and Counseling Training for two (2) weeks in Nigeria. The training was organized from 30th July to 12th august 2006at the Sickle Cell Centre Idi-Araba Surulere, Nigeria. Forty-one (41) participants drawn from Ghana, Sierra Leone and Nigeria attended. The objective of the course was to equip participants with the requisite knowledge and skills to conduct effective counseling since genetic counseling is viewed as a cost effective means of addressing sickle cell problems among the populace. vii. Advisory Committee Meeting The 2nd advisory committee meeting for the year was held on the 17th October 2006. The principal investigator Dr. Kwaku Ohene Frimpong was around. All the component were represented and each component gave a report on their various activities covering the period January – June 2006
viii. Change in Cordinatorship During the year under review the coordinator Mrs. Stella Appiah left to pursue a master’s degree in philosophy at the University of Ghana, Legon. Her position is replaced by Mr. Andrew Adjei Druye
Finance and Administration The Centre received funds from the Government of Ghana for the following activities • Administrative Expenses • Service • TB Global • Donor Pooled Fund
85 Some IGF were also raised through the use hiring of equipment and use of the conference hall. All bills have been settled and there was a not outstanding bill
Transport The centre has four (4) official vehicle and these are; o Two land rovers o One Toyota Hilux Pick up o One Nissan Petrol
All the vehicles were repaired and serviced regularly. However, one of the Land Rovers (GV 982C) has been packed since 2005. The cost of maintaining the vehicles were very high and as such always exceeded budget set by the Centre.
The vehicles underwent major repairs and the details were as follows, Land Rover (GV 956C) was overhauled. The Toyota Hilux (GV7290C) Complete Home used engine was bought to replace the old one. New tyres and a battery were bought to replace the old ones. the Nissan Patrol, new battery was bought, new tyres bought and the tape Monthly vehicle reports were also submitted to the Regional transport manager for assessment during the period under review.
Achievements • Employees Handbook, Manual for Inducting Staff, and Instructional Guide have been completed and delivered to Director HRDD. • DTP work has begun on the following policy documents; Appointment, Promotion, Posting and Counseling. • DTP work on the Ashanti Health Journal has been completed and given to the editorial board for editing. • All request for health education programmes responded to • New computer purchased to enhance the Centre’s work.
Challenges The procurement of HLM for the health training institutions is long over due. Several calls to Director of supply Division did not yield any result. The old nature of some of the vehicles put serious financial burden on the Centre’s budget in terms of maintenance. Lack of funds to initiate health education programmes from the centre.
Recommendation • Need to solicit for funds to initiate health education programmes • Need to acquire new vehicle to replace the old Land rovers • New computers and Printers and other accessories need to be bought for the Centre • The need to procure new HLM for the Resource Centres and the training institutions in the country.
86 3.0 CLINICAL/INSTITUTIONAL CARE
3.1 Utilization of Hospital Services
FIG. 4: TREND IN OPD ATTENDANCE PER CAPITA (ASHANTI, 2002 – 2006)
0.51 0.50 0.50 0.50 0.50 0.50
A 0.50 T I 0.49 CAP R
E 0.49 0.48 D P 0.48 OP 0.48
0.47 2002 2003 2004 2005 2006 Y E A R
The total OPD attendance stood at 2,219,881 as against 2,129,973 in 2005. Out of this, the regional hospital, Kumasi South Hospital reported 71846 (80911 in 2005) representing 4%. This is an indication that patronage at the hospital is quiet low and therefore there is the need to increase accessibility and use of health services in the region. OPD attendance per capita remains at 0.5 meaning only about half of the population is consulting at our institutions per year despite the implementation of National Health Insurance Scheme in the region. The trend has been relatively stable for the past four years. Asante Akim North had the highest per capita attendance of 1.3 followed by Obuasi Municipality – 1.0 while Amansie Central had the lowest of 0.09.
3.1.1 Summary Statistics
Table 16a: Clinical Care Performance Indicators 2003- 2006 Indicator 2003 2004 2005 2006 OPD Attendance 1,987,184 2087720 2129973 2,219,881 Attendance Per Capita 0.50 0.5 0.5 0.5 Admissions 107,029 104,326 118,252 115,891 % Bed Occupancy 40.5 46.9 43.6 26.2 Turnover per Bed 37 53.3 43 42.9
87 Table 16b: Hospital Utilisation by Ownership GHS MISSION QUASI GOV’T PRIVATE OPD% 65% 20 9 6 ADMISSION/1000 42.6% 50.3% 6.5% 0.6% BED OCCUPANCY 20.8% 26.2% 5.7% 0.3% BED TURN OVER 22.5 28.5 4.1 0.2%
3.1.2 Causes of OPD Attendance Analysis on morbidity pattern shows that Malaria (47.3%), ARI (7.4%), Diarrhoeal Diseases (5.0%) were the leading causes of OPD Attendance. However, it is important to note that hypertension has been appearing in the top ten lists for the past four years, where as HIV/AIDS is still not included. Most of the leading causes of morbidity are conditions that can be most cost effectively treated or prevented through non-hospital interventions.
Table 17: Top Ten Causes of OPD Attendance (Morbidity 2004-2006) Diseases 2004 Diseases 2005 Diseases 2006
1 Malaria 682213(45.5%) Malaria 817,028 (49.1%) Malaria 873911
2 ARI 105827 (7.1%) Cough (IMCI) 101,980 (6.1%) Cough (IMCI) 136610
3 Diarrhoea 69897 (4.7%) Diarrhoeal Dx 75,058 (4.5%) Diarrhoeal Dx 92323
4 Skin 54534 (3.6%) Skin Diseases 63,003 (3.8%) Skin Diseases 76752
5 Hypertension 41588 (2.8%) Hypertension 44,622 (2.7%) Hypertension 57218 Accidents 35128 (2.3%) Home/Occp. Home/Occp. 6 43,302 (2.6%) 50118 Injuries Injuries UTI 31358 (2.1%) Acute Eye Rheumatic/Joint 7 29,851 (1.8%) 38312 Infection conditions Rheum 30932 (2.1%) Rheumatic/Joint Acute Urinary 8 29,557 (1.8%) 29879 conditions Tract Infections Intst. Worm 30587 (2.0%) Acute Urinary Intestinal 9 22,892 (1.4%) 26752 Tract Infections Worms Eye 25258 (1.7%) Intestinal Acute Eye 10 20,984 (1.3%) 25126 Worms Infection All other 391944 (26.1%) All other All other 414,903 (24.9) 441714 diseases diseases diseases
Total 1499266 Total 1663180 (100%) Total 1848715 (100%)
88 3.2 ADMISSIONS
Fig 5: TREND IN HOSPITAL ADMISSIONS PER 1000 POPULATION (ASHANTI, 2002-2006)
29 28 28
27 26 26.2 26
PER 1000 25 25 24 24 NUMBER 23
22 2002 2003 2004 2005 2006 Y E A R
Admission rate in health facilities in the region showed a slight decrease from 27.7 per 1000 in 2005 to 26.2 per 1000 in 2006. The Admission rate is highest in Asante Akim North District (74.9 per 1000), but lowest in Ahafo Ano South Districts (9.7 per 1000). Ahafo Ano South district has consistently being reporting of low admissions for the past five years.
3.2.1 Bed Occupancy Rate The average regional bed occupancy rate observed in the districts and regional hospitals has dropped from 43.6 in 2005 to 41.6 in 2006, a further decrease from 47.8% in 2004. Health facilities in the region are operating efficiently at a level far below the national target of 80-90 percent occupancy. Low occupancy rate in the region reflects inefficient use of hospital resources.
3.2.2 Causes of Hospital Admissions Malaria has retained its supremacy in term of causes of admission and accounted for 34568 of the total causes of admissions in the hospitals. It is worth mentioning that Accidents, which used to be among the top ten causes of admission for so many years is not included for the past three years.
89 The Table below gives the ten leading causes of hospital admissions for the period under review. Table 18: Ten Top Causes of Admission (Ashanti, 2004-2006) No. Diseases 2004 2005 Disease 2006
1 Malaria 21394 25111 Malaria 34568 2 Pregnancy Anaemia 4351 5391 Related 6538 Diseases 3 Hernia 2204 1824 Anaemia 5408 4 Diarrhoea 3122 2923 Diarrhoea 4986 5 Pregnancy Related Gynaecological 4929 5472 3168 Diseases Disorders 6 Gynaecological 2007 1776 Hernia 2342 Disorders 7 Typhoid Fever 1970 1944 Hypertension 2222 8 Hypertension 1817 1844 Pneumonia 2170 9 Pneumonia 1876 2365 Typhoid 1934 10 Cough/Cold 1636 1444 Cough/Cold 1370
3.2.3 Causes of Institutional Deaths Malaria and Anaemia are still the leading causes of hospital deaths in the region. HIV/AIDS still shuttles between the 4th, 5th and 6th Positions in the three-year trend. Strangely, Septicaemia has taken the 4th position as though it was not registered in the previous years. The Top ten causes of institutional deaths are shown in the table below; Table 19: Top Ten Causes of Death (Ashanti, 2004 – 2006) NO. Disease 2004 Disease 2005 Disease 2006 1 Malaria 309 Malaria 248 Anaemia 276 2 Anaemia 214 Anaemia 134 Malaria 254 3 Pneumonia 106 Pneumonia 120 Pneumonia 112 4 CVA 94 HIV/AIDS 92 Septicaemia 106 5 HIV/AIDS 88 Hypertension 76 HIV/AIDS 80 Related conditions 6 Hypertension 79 Malnutrition 72 Cerebro 78 Vascular Accident
90 7 Diarrhoeal Dis. 73 Cerebro Vas. 64 Hypertension 74 Accd 8 Typhoid Fever 62 Typhoid Fever 46 Cardiac Dx 72 9 Cardiac 60 Cardiac 46 Malnutrition 58 Diseases Diseases 10 Meningitis 54 Diabetes 38 Diabetes 42 Mellitus Mellitus
3.3 MATERNAL DEATHS
Total Maternal Deaths recorded from health facilities in the region was 178 with 115 deaths reporting from KATH. From the table below 77.5% of the deaths were audited. However KATH audited all their maternal deaths. The main causes of maternal death were attributed to Postpartum Haemorrhage, Sepsis, Eclampsia and Ruptured Uterus. The underlying contributory factors were delays at home, community and facility level. The region calls for improvement of road networks and improvement of transfusion services as a step to dealing with the problem.
Table 20a: Maternal Mortality (Ashanti, 2003-2006) FACILITIES 2003 2004 2005 2006 GHS Facilities 72 52 63 81 KATH 101 109 115 94 TOTAL 173 161 178 175 % AUDITED 100 76 (122) 76 (138) 71 (124)
Table20b: Summary of Major Causes of Maternal Deaths, 2004 - 2006 CAUSES 2004 2005 CAUSES 2006 Eclampsia 21 20 Haemorrhage 36 Haemorrhage 12 25 Eclampsia 26 Sepsis 20 21 Septicaemia 20 Obstructed labour 5 3 Unsafe Abortion 16 Abortion 16 6 Ruptured Uterus 3 Anaemia 6 14 Ruptured Ectopic 1
91 Ruptured Uterus 35 5 Others 73 Others 34 77 - - Total 161 178 Total 175
3.4 Quality of Care 3.4.1 Description of Quality of Care Activities Undertaking To upgrade the knowledge and skills of staff in order to provide quality service to clients the following programmes/workshops were organized for various categories of staff.
Table 22: No. of Trainings Organized - 2006 TOPIC STAFF CATEGORY NO. TRAINED Management of Opportunistic Infection Staff Mix 75 in HIV/AIDS and Other Diseases Reduction of Maternal Mortality Staff Mix 42 COPE Staff Mix 25 Neonatal Resuscitation Nurses and Midwives 60 Health Information System Health Information 35 Officers
3.4.2 Specialist Services Much was not done on outreach services because of breakdown of the Vehicle. It is still at the fitting shop.
Eye Care Services (Static) Institution General Cases Surgery
Agogo Hosp. 9278 405
St. Michael’s Hospital Pramso 8463 231
Westphalean, Oyoko 7746 114
Kumasi South Hospital. 5050 N/A
92 St. Patricks Hospital, Offinso 2386 141
Jachie Anglican Unit 2021 43
Maternal & Child Health Hosp 566 N/A
Total 35,510 1034
Dental (Static) Institution No. of Cases Suntreso Hospital 7707 Kumasi South Hospital 2442 Mampong Hospital 40
Total 10,189
Dental Care (Outreach Services) DISTRICT No. of days No. of cases % with satisfactory dental condition.
Amamsie East 3 232 66
BAK 3 196 62 Amansie Central 3 160 40 Obuasi Municipality 3 247 54
Dental care outreach services were carried out only in 4 districts. In all 835 cases were seen with 56% having satisfactory dental condidtion.
Recommendations were: 1. Sweets sold on school compound must be stopped. 2. Oral health education in school should be intensified 3. Mobile Dental Equipment needed by the team
93
4.4.3 Major Challenges in overall service delivery includes: - Long waiting time for clients - Ineffective Twenty four (24) hour service - Inadequate release of funds for exemptions - Poor Emergency Response at facilities - Polypharmacy and generic prescription (is not the best) - The use of antibiotics is still high (40% as against WHO 20%) - Frequent power outage at the Regional Medical Store - Poor waste disposal system - Inadequate staff and staff mix - Inadequate equipment/logistics for service delivery and/ or for storage of drugs and non-drugs consumables
3.4.4 CHPS Implementation All the 21 districts in the region have well demarcated zones for the implementation of CHPS. The number of CPHS zones demarcated is 281 with only 19 zones functioning well. Ahafo Ano South is doing excellence work on CHPS. The major setback on CHPS implementation is inadequate staff and motorbikes.
3.4.5 Improving Access Under this programme the under-listed activities shall be undertaking: 1. Strengthening the CHPS concept 2. Strengthening and improve outreach services in Eye, Dental, Obstetrics, ENT and Dermatology. 3. Upgrade facilities to meet NHIC accreditation status. 4. Upgrade New Edubiase, Juaso, Nyinahin, Obuasi and Nkenkasu Health facilities to meet emergency obstetric care. 5. Encourage domiciliary midwifery. 6. Ensure the availability of protocol, drugs and blood banks in all facilities especially emphasis on Kumasi Hospitals.
94 3.5 IMPLEMENTATION OF NHIS
3.5.1 Introduction The establishment and implementation of the National Health Insurance Scheme (NHIS) in the Ashanti Region has taken off as prescribed by the National Health Insurance Act, Act 650. There are high indications that the expected objectives would be achieved in the nearer future.
3.5.2 Scheme Establishment and Implementation 24 District Wide Health Insurance Schemes in full operation. The average % registered clients was 65% and average % of clients with ID cards is 38%. Payment of claims to providers were not regular and full payments were never made. Some of the Challenges and Concerns of Scheme Managers were as follows:
- Inadequate (“inappropriate”) MGT staff - Payment of premium by installment by informal sector clients - Vetting for payment not easy - no uniform tariff - Delays in refund of exempted fees - Inadequate logistics - No uniform tariff
3.5.4 Providers readiness All 36 hospitals and 158 health centers in the region have signed contracts with all schemes to provide services and are providing the services. Facilities have not undergone much change in terms of quality service delivery in context of the NHIS.
Facility utilization by insured and non-insured are shown in the table below:
Facility Insured Non-insured % insured
Bekwai Hospital 14,470 18,676 43.7
Obuasi Hospital 5,721 23,291 19.7
New Ed’bease Hos. 7559 18,353 29.2
Dominase SDA 8250 15,825 34.3
95 St. Martin’s Ag’sum 4,429 6,545 40.4
Tepa Hospital 7885 8234 48.9
Mankraso Hosp. 8901 8744 50.4
Presby. Hosp. Agogo 30012 46630 39.1
Konongo Hosp. 15524 10575 59.5
Juaso Hosp. 12036 11208 51.8
Nyinahin Hosp 5211 12653 29.1
Nkawie-Toase Hosp 10540 16637 38.8
St. Michaels Hosp 16151 48405 25.0
Mampong Hosp. 13455 23976 35.9
St. Patricks Offinso 16670 18799 46.9
Manhyia hosp 10348 65153 13.7
Suntreso hosp 8687 77403 10.1
Tafo hosp 9818 49994 16.4
Kumasi South hosp 6687 52112 11.4
Mat. Child Hosp 4235 27188 13.5
Effiduase hosp 21017 12486 62.7
Challenges • No uniform tariff for provider • Regular submission of claims to schemes but irregular delayed payment by schemes • Upgrading of facility to improve quality service delivery • Strengthen HR base of facility • Continuous education on HI for health care workers • Unclear vetting and short payments by schemes
96 Way forward • Assess and review management capacity of schemes to: o register and produce ID cards promptly o vet claims accurately and pay promptly • Strife to operate with a standard tariff • Improve quality delivery services in all context (inputs, process etc.)
97
4.0 SUPPORT SERVICES
4.1 General Administration
Main Priorities for 2006 - Opening of files for all categories of staff - Decongestion of the filing cabinets - Reducing misfiling to the barest minimum - Automation of the registry - Re-arranging of Personal and General Files
Key Challenges • Difficulty in storage and retrieval of letters • Misfiling of Letters • Lack of funds • Working with old computers at the Typing Pool • Frequent breakdown of photocopier machine in the registry
Correspondence
LETTERS RECIEVED AND DESPATCHED
2004 -2006
10000
S R 8000
E T
T 6000
E L 4000 F
O
o 2000 N 0 2004 2005 2006 YEAR
Letters Received Letters Despatch
98
Files
• Total No of General Files = 729 • Total No of Personal Files = 2,896 • Total No of Staff in the region = 3,153 • Percentage of staff with personal files = 92% • Total No of staff without personal files = 257 • Percentage of staff without personal files = 8%
Unexpected Performance • The sudden death of Mr Sampson Dwomoh, Senior Executive Officer made retrieval of personal files for general nurses very difficult • He was the schedule officer for several years
Meetings
Type Planned Held
RHMT 12 12
Staff Durbar 4 4
RSS Core 4 4
Reg Health Council 4 2 Meeting
Wednesday Monthly 12 12 Update
99 Wednesday Update by Regional Support Service
Topics handled were as follows • Leave • New Health Sector Salary Structure • Retirement Planning
Way Forward • Organise training on Administrative Practice and the use of computer for staff • Automation of the Registry • Provision of new computer for the typing pool
Estate Management
Key Priorities for 2006 To implement Preventive Maintenance at the Regional Health Directorate offices and Official accommodation unit and also offer support in Preventive Maintenance of Health Institutions in the Region.
To provide routine minor and major repair works on official accommodation unit, equipment and offices (RHS).
To carry out facility survey in the remaining 45 Health Facilities.
To Rehabilitate at least four (4) dilapidated buildings Completing the Accommodation unit at Abrepo Junction
Completing the O.P.D unit at Manhyia Gov. Hospital
Completing theatre and ward block at Kumasi South Hospital.
Completing the Pilot Accommodation unit at Kumasi South Hospital
Key Challenges Late release of funds for capital investment. Late release of approved Capital Investment for the year. National Level Allocating funds for specific projects which are not the priority of the Region. Non provision of Funds for maintenance Districts not informing region about works that have been going on and the haphazard way development projects are carried out
100
Work that were carried out in the year under review The Maintenance team completed a renovation work on Bungalow No.88 Danyame and this has been allocated to the Human Resource ManagerConstruction of Fence wall at Abrepo Junction-Cold room Work that were carried out in the year under review The unit worked on removal of old wooden Shelves to pave the way for installation of new metal shelves in the RMS.The unit also did internal painting in the affected areas in the RMS.
Property Acquisition The unit started with the processes of securing the Indenture on the Apampetia land. We requested for a new site layout this is because the Ring road designed by the Urban roads passes through the land The corrected one was sent to B.A.K for plotting onto the master layout. After which it will be send to Manhyia for the King’s Approval.
Training Programme In the year under review, Training Workshop on contract Management and Administration was organised for (75) participants. They included District Directors of Health Services, Health Services Administrators and Estate Managers.
Capital Investment The year under review, the Region had authority to procure the following works but did not have commencement certificate and so the works could not take off.
Description Allocation
Upgrading Kumasi South Hospital ¢1,3 billion
Const.of 4 Storey Block 3bedroom ¢600,000,000 Semi-detached at Abrepo
Completion of DHMT Block at Tepa ¢750,000,000
Completion of DHMT Block at Ejura ¢750,000,000
Construction of 10no.Chps Compound ¢2billion
Const. of Health Centre at Pankrono ¢1,4billion
Upgrading of Manhyia Health Centre ¢1billion
101
Projects in Districts without RHD knowledge
District No. of Project
1. Afigya-Sekyere 7 2. Adansi South 1 3. Asante Akim South 2 4. Amansie East 6 5. Ahafo-Ano South 2 6. Kwabre 6 7. Atwima Mponua 4 8. Offinso 3 9. Sekyere West 3 10. Sekyere East 4 11. Ejura/Seko 1 Total 39
• Project developments were generally at a standstill in the year under review. • Funds were not released for 2006 approved project. • Certificates on project completed and submitted in the year 2005 were paid at the end of 2006
Way forward Carrying out advocacy for the District to allot funds for maintenance. Carrying out advocacy for the release of project funds in bulk for the region to apportion along its own priority lines. Carrying out advocacy for the National level to publish approved projects on time.
4.3. Equipment Main Priorities • To improve equipment performance index. • Carry out equipment need assessment • To decommission all obsolete equipment. • To implement equipment revolving fund
Key challenges • Logistics support e.g. irregular supply of fuel. • Lack of spare parts • Lack of tools and test equipment • Poor communication between the unit and the districts/institutions
102 Unexpected performance • Training of safe use of medical gases for anesthetist in the region. This has been a planned programme since 2004, but due to lack of sponsorship from sponsors, it was not possible until 2006, when we secured funding from various organizations and the RHD .
Critical Equipment Needing Replacement The following were identified as critical equipment needing replacement. • Infection control equipment (autoclaves) • Surgical instruments (all types) • Laboratory equipment (microscopes, analysers etc) • Solar equipment • Monitoring equipment (vital signs monitors) • Maternity and delivery equipment (instruments and delivery tables) • Life support equipment (anaesthesia machines) • Theatre equipment (lamps, suction units, electro surgical units, operation tables) • Dental chairs and accessories
Table 26a: Repairs of Broken Down Equipment 2004 2005 2006 No that Broke down 220 78 186 No repaired 207 47 161 Repair Rate (%) 94 80.3 86.6
Equipment Achievement of the Unit • Attended all service calls • Benefited from various training programmes i.e. solar energy workshop at deng solar systems, cold chain equipment training at B.E.U, ophthalmic equipment training at eye center korle bu • All new equipment that were dumped in the district from medical stores, Accra were identified and installed • One gen set was installed at the regional cold room backup by an automatic change over switch.
Way forward 2007 • PPM for all hospital and health centre • Update regional inventory • Implementation of revolving fund • Carry out need assessment of equipment • Organized training for equipment users • Decommissioning of obsolete equipment
103 TRANSPORT
INTRODUCTION Transport is essential for the delivery of effective health services. Lack of transport, unreliable vehicles, and inability to pay for vehicle running costs have all been given as reasons to explain failure in service delivery.
MAIN PRIORITIES FOR 2006 • Acquisition of Land as Regional responsibility in the establishment of Regional Mechanical Workshop • Aid District motorbikes riders to acquire riding license in the region • Defensive Driving Training for all Drivers • Vehicular Support for newly created districts • Refresher Boat Confidence and Survival Training for BAK District • Disposal of old vehicles
KEY CHALENGES FOR 2006 • Ageing Fleet and broken down (Vehicles and Motorbikes) • No GHS mechanical workshop to enhance regular adherence to PPM • Inadequate drivers that give pressure to the few • Lack of funds to pay mechanics for work done and others
ACTIVITIES UNDERTAKEN • Site for Regional Mechanical discussed and proposed by management and effort being made to acquire • Newly created districts gained majority of new motorbikes allocated to the region • Support of vehicle extended to newly created districts at the Regional level in the carriage of consignments, outreaches activities and EPI activities
TRAINING OF STAFF DEV. No. Type of Training Group Number Period
1 Defensive Driving and Drivers 85 5 days Basic Life Support Skills 2 4 Stroke Maintenance Motorbike 23 3 days Technician 3 Ambulance Operations DDCC, RTM, 40 3 days and Emergency Care Mgt Med Supts. Nurses & Drivers
104 FLEET SITUATION
Vehicles
Age 2004 % 2005 % 2006 % Zone
1-5 yrs 34 33.3 27 28 37 34 Green 6-9 yrs 38 37.3 48 49 20 19 Yellow 10 yrs + 30 29.4 23 23 51 47 Red Total 102 100 97 100 108 100 Motor Bikes 1- 3 yrs 18 13.3 57 13.3 86 35.6 Green 4 – 6 yrs 21 15.6 68 15.6 47 19.5 Yellow 6 yrs+ 96 71.1 67 71.1 108 44.8 Red Total 135 100 192 100 241 100
New Vehicles TYPE NUMBER
Saloon 1
Pick- ups 2
Motorbikes 44
Tricycles 5
Ambulance 8
105
NEW AMBULANCES ALLOCATION
REGISTRATION NO. INST. ALLOCATED
GV. 701 W K’si Metro (Tafo Hospital)
GV 665 W K’si Metro ( Reg. Hospital)
GV 670 W Obuasi Mun. (Dist. Hosp.)
GV 624 W BAK (St. Michael Hospital)
GV 693W Asante A. South (Dist. Hospital)
GV 660 W Sekyere East (Dist. Hospital)
GV 690 W Offinso(Nkekansu Hospital)
GV 684 W Ahafo Ano North (Dist. Hospital)
ACCIDENT SITUATION • Two vehicles were involved in an accident. They are allocated to : • RHD- GV 174R • Amansie West District- GV 461U • No casualty recorded
DRIVER SITUATION Age Range TOTAL % of Total ZONES 50- 60 yrs 17 19 Red
40- 49 yrs 52 59 Yellow
39 and below yrs 19 21 Green
Total 88 100
• Driver Vehicle Ratio 1.4 • No. of casual drivers 9
106 CRITICAL NEED FOR VEHICLES • Districts and hospitals including Mankranso Hospital, Juaben Hospital, MCHH Hospital, Agona and Kokofu, Hospital are in critical need. • Atwima Mponua, one of the newly created districts is still not equipped with vehicle(s). • Accident prone areas that require urgent ambulance to aid referrals include Bekwai, New Edubiase, Nkawie, Nyinahin and Mankranso, Manpong, Ejura
KEY ACHIEVEMENT • Successful Defensive Driving and Life Support Skills for all drivers • Some DHMT taken keen interest in transport issues • The region being graded the best Transport Management Unit among the ten regions • Successful vehicular mobilisation of vehicles for EPI/ MEASLES activities • Participating in Developing of National Transport Policy for the country
OUTLOOK FOR THE YEAR 2007 • Piloting of Regional Mechanical Workshop/Acquisition of Land for regional mech. shop • Aid district motorbike riders to acquire riding license in the region • Expect new vehicles to replace old ones • Auctioning of disposable vehicles • Expect engagement of additional drivers • Provide refresher training for drivers on Basic Life support skills and HIV/AIDS • Provide Training for District Transport Officers on Transport Mgt. • Refresher training for Motorbike Riders • Undertake monitoring and supervisory visits • Refresher Boat Confidence and Survival Training for BAK District
107 PROCUREMENT
OBJECTIVES The Procurement Unit set for itself the following targets to be achieved by the end of the year 2006.
¾ Procure goods, works and services in accordance with the Public Procurement Act 663.
¾ Ensure the availability of goods works and services at the right time, right quantity, quality and at the right cost.
¾ Build up the capacity of the Procurement Unit.
¾ Monitor procurement activities in the districts.
¾ Sensitize supplier, Medical superintendents and district directors on the Public Procurement Act.
CHALLENGES
¾ The functioning and in some cases the non –existence of Procurement Committees at the districts
¾ The persistent procurement, storage as well as issues of drugs being handled by the same person in the person of the Pharmacist in charge which contradicts the procurement and supply guidelines of the Ghana Health Service.
¾ The massive indebtedness of the district hospitals to the Regional Medical Store in the area of Non Drugs Consumables present a major challenge to the Unit.
¾ Procurement of non-drugs consumable items by the district facilities without prior ascertainment of stocks at the Regional Medical Stores has also been the major concern of the Directorate.
REGISTRATION The Directorate updated its supplier’s database during the first quarter of the year under review. A total of 75 (seventy-five) potential suppliers registered with the Directorate for its 2006/7 procurement activities. The distribution is as follows: 1. Drugs - 39 2. Non- Drug Consumables - 20 3. Others, etc - 16 75
108
THE PUBLIC PROCUREMENT ACT 663 As part of efforts to comply with the provisions of the Public Procurement Act 663, especially with regards to the use of procurement methods and evaluation of tenders, the Directorate used National Competitive Bidding to procure its Essential Drugs and Non- Drugs Consumables requirements whiles shopping method was used for other items procured in the year under review. Evaluation panels were on a number of occasions set up to assist in the detailed evaluation of bids on all tenders.
WORKSHOP The acting Regional Procurement Manager was part of a team led by the Deputy Director Administration to participate in a 3day workshop on Procurement Planning organized by the office of the Stores, Supply and Drug Management Division of the Ghana Health Service from 1st –3rd October 2006 at the Marina Hotel (Dodowa)
EDUCATION The substantive Regional Procurement Manager in the person of Mr. Desmond A. Antwi has returned and assumed duty from a years study abroad
PROCUREMENT AT YEAR 2006 Procurement for the period under consideration started in the month of January 2006.Total Procurement made in the year amounted to ¢19,110,073,033 as against 21,052,992,193.08 in 2005 a decrease of 2% due to the near completion of renovation work at the Central Medical Store. Drugs continue to form the bulk of the procurement from the open market amounting to 14,596,208,658 followed by Eunice Ansah Asamoah Production Unit with 2,009,627,675 Non-Drugs consumables came third with 1,956,366,100 with the Regional Health Directorate (equipment, stationary and other items) taking the last position with 547,870,600 expenditure on procurement.
TABLE REPRESENTATION ITEM VALUE % OF TOTAL Drugs 14,596,208,658 76 Prod. Unit 2,009,627,675 11 Non Drug Cons. 1,956,366,100 10 RHD 547,870,600 3 TOTAL 19,110,073,033 100
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PROCUREMENT OF DRUGS & NON DRUGS CONSUMABLES FROM CMS BY YEAR 2005 & 2006
% Of % Of ITEM 2005 TOTAL 2006 TOTAL Drugs (op.mkt) 14,170,249,900 72% 12,444,812,660 75
Drugs (cms) 3,052,203,427 16% 2,151,395,998 13
NDC (op.mkt) 1,414,463,400 7% 1,645,417,500 10
NDC (cms) 900,208,000.08 5% 310,948,600 2
TOTAL 19,537,124,727 100 16,552,574,758 100
AUDITING 1.The books of the Procurement Unit were audited by auditors from Ernst & Young who were commissioned by the Ghana Health Service Among the facilities included in the auditing exercise were New Edubiase, Kumasi South Hospital, Midwifery Training School and Obuasi Municipal Hospital
2. There was also Year 2005 Ex-Post Procurement Audit conducted Messrs Benning, Anang & Partners, a private auditing firm contracted by the Ghana Health Service/MOH as part of the requirements of the Development Credit Agreement signed by the Government of Ghana and the International Development Association and agreed by the MOH and its Health Partners at the 2002 review of the programme of work under the Ghana Health Sector Support Programme.
BMCs included in the audit exercise were Kumasi South Hospital, Mankranso District Hospital and Kumasi Metro Health Administration.
WAY FORWARD
¾ Organize sensitization workshop for suppliers, Medical Superintendents and District Directors on the provisions of the Public Procurement Act.
¾ Strengthen supervision and monitoring of procurement activities of district facilities to ensure that they comply with the Procurement Act especially the institution of Procurement Committees and appointment of Procurement Officers at the facility level particularly the Regional and Mampong hospitals.
¾ Strengthen working relations with other units to ensure easy access to information
110 Human Resource Development
Introduction This report highlights on human resource activities within the Regional Health Service, Ashanti for the year 2006.
Staff Distribution The region’s total staff strength stood at 3453. A summarised detail of staff strength is provided in Table shown. The breakdown of staff distribution by staff category and district is set out in Annex 1.
Table Overview of Staff Distribution by category 2006 Staff Category In Service No on No on Total Study Leave Leave without pay Directors 14 1 15 Doctors/Dentist Medical Assistants Nurses/Midwives Pharmacist 29 2 1 32 Administrator 12 12 Anaesthetist Technical Officer Biomedical Scientist 10 10 Others Total 45 3 2 50
New Entrants Pharmacist` – 3 Accountants – 3 Medical Laboratory Technologist – 3 Administrators – 2 Health Aides -110
3. Wastage Seventy-Four staff (2005:91) separated from the service. The main mode of leaving was through retirement, which accounted for 70.3% as against 47.3% in 2005. This was followed by deaths 20.3% (2005:39.6%). We present a 3-year trend on wastage is provided in Table below: Table Mode of Leaving 2004 - 2006 Mode 2004 2005 2006 Retirement 30 43 52 Vacation of Post 23 9 4 Death 12 36 15 Resignation 5 3 2 Dismissal 0 0 1 Total 70 91 74
111 It appears that staff that left through vacation of post have reduced significantly and accounted for 5.4% of wastage as against 9.9% in 2005. We have however noted the problem of under reporting by BMCs. We would encourage BMCs to early reporting of staff vacation.
Staff DeathAs can be seen from Table 4 above, staff deaths reduced from an all-high figure of 36 in 2005 to 15. Sixty percent of deaths were female and the remaining 40% were male. Nurses/midwives category formed 33.3% (5) followed by Field Technician 20% (3) of the total deaths.
Staff death for a 4-year period is provided in Figure below.
Staff Death 2002 - 2006
40 35 36 30 f af
t 25 S
f 20 o 15 16 15 No 12 10 9 5 0 2002 2003 2004 2005 2006 Year
A plausible explanation for the reduction in deaths can be attributed to the mandatory medical examination for staff. The medical examination revealed hidden ailments of staff which lead to its management and treatment. The Nurses/Midwives category formed 34.2% of the total staff that separated from the service in 2006 (2005: Orderly – 27.4%), followed by the watchman and Technical officers categories each with 17.8%. See Annex 4
Appointment to Key Positions The following appointments were in the course of the year to fill the headship of the three regional BMCs Deputy Directors: Clinic Care – Dr Joe Bonney; Public Health – Dr Kyei Faried; Administration - Kofi Poku
112 Other Appointment DDHS – Francis Osei Medical Superintendent – Dr Kesse
Movement of Key Officers Mr. B.W. Quarshie the Regional Accountant was transferred to the Ministry of Local Government, Rural Development and Environment in April 2006.
Mr. Kwabena Ennin who took over as the Regional Accountant also moved over to Central Region Regional Health Directorate in August 2006.
Mr. Yaw Okyireh has taken over as the Regional Accountant
Dr S. Kyei Faried the Deputy Director, Public Health was transferred to the Northern Region
Ms. Abena Akuamoah Boateng, the Regional Nutrition Officer proceeded on leave without pay with effect from 1st October 2006.
Health Sector Salary Exercise The Unit collated data on health staff in the region for the Health sector Salary exercise. The exercise was however plagued with a lot of problems. List of Problems encountered are Inaccurate data - Wrong Staff ID - Wrong Grade Refusal of some staff to report when grades they were placed on favoured them Conflicting Date of Birth Non capture of some staff in the exercise Non receipt of salaries of some staff for some period Payment of salaries to wrong banks Discrepancies on payslip Distortion in calculations
Staff Durbars The Unit coordinated staff durbars, all 4 staff durbars as planned for the year were came off successfully. The durbars were used to discuss pertinent issues related to the service
Staff Development Sixty-six staff indicated their intention to purse further various courses in the course of the year.
113 Responded to intention to go to school – provide table NO PROFESSION NUMBER NUMBER FURTHER DECLARED EDUCATION INTENTION 1 Accountant 1 3 2 Community Health Nurses 10 17 3 Field Technician 7 6 4 Health Aides 5 4 5 Health Service Admin 1 0 6 Medical Asst 1 1 7 Medical Officer 5 8 8 Orderly 1 1 9 Pharmacy Technician 1 5 10 Principal Storekeeper 1 0 11 General Nurses 17 31 12 Nutrition Officer 1 2 13 Stenographer 1 2 14 Technical Officer 4 4 15 Ward Assistant 1 0 16 Total 57 89
Post graduate Seventeen staff left to purse various postgraduate courses as against 10 in 2005. A little of over a third (31.3%) of participants were female. The 4 staff in the residency programme are pursing course in Public Health, Child health and Obstetrics and Gynaecology respectively.
The breakdown of staff undertaking postgraduate course is in given below.
Table Postgraduate Training by Course Course Award No of Staff Place Course Type Epidemiology MSc 1 Overseas Long Residency 4 Nursing Mphil 1 Health Service Planning and MSc 1 Management Health Education MSc 2 Health Education Postgraduate 1 Diploma Population and Reproduction MSc 7 Health Total 17
114 This table shows staff pursing postgraduate course by staff category. Half (50%) of the staff pursuing postgraduate course are doctors
Table 5b Postgraduate training by Staff Category Staff Category 2006 No % Medical Officers 9 52.94 Pharmacists 3 17.64 Nurses 3 17.64 Clinical 1 5.88 Environment Technologist 1 5.88 Total 17 99.98
ADB Special initiative – Focus Bekwai Under the auspices of the Africa Development Bank, the region is benefiting from a training scheme as part of rehabilitation of the District Hospital.
Medical Examination/Treatment The Clinical Care Unit played the key role in arranging for staff of the Regional Health Directorate to undergo medical examination
The Regional Health Directorate footed the cost of plastic surgery carried on a staff, who was involved in a motor accident in the course of National Immunisation Day activities.
Staff Land Owning Scheme This scheme was started in 2004, under this scheme the Regional Health Directorate acquires large plot of land at various locations within the region and which are in turn sold to interested staff on a flexible payment system. This is to enable staff put up their personal residence (buildings) as it is one main concern on retirement.
Since its inception in 2004, 453 plots of land have been acquired at various locations within the region for sale to staff. ( Atwima Agogo – 129; Mamponteng 121; Afrancho-5 3 and Saaman- 100), Asenua (50)
The staff have continued to show keen interest in the scheme.
The Regional Personnel Officer plays pivotal role in the scheme as a member of The Staff Land Acquisition Committee
Award Total of 17 staff were awarded during the year under review’s annual party. 12 of the awarded staff were recognised for good performance, whilst two staff received the Regional Director’s Special Award. 3 retired staffs wer also awarded.
115 Pilot Project Select as one of the region to pilot the decentralization of salary management in the coming year 2007
Constraints • Three of the unit’ staffs were in school and this affected the output of the unit. • The only functioning computer of the unit was working for sometimes as results of virus infection. • The unit could not organized retirement planning workshop for the retired staff as planned due to financial constraints. • Embargo on promotion put much pressure on the unit. • One of the unit’s computers is not functioning. • Difficult to recruit, category D&E staff
Way Forward
• Develop Regional HR. Plan • 2 .Produce 2008 Retirement Schedule • Organize Retirement Planning Workshop • .Improve Upon HR information system • Recruitment HR officers for the districts
116 In Service Training (IST) A total number of 68 Training Sessions were organized during the period under review. The total number of staff who received in-service training has increased from 30% in 2005 to 34% in 2006. Majority of the staff trained were nurses and technical officers. Most of the topics treated centered on Public health, Clinical care and Management of Health services.
Course Areas
Clinical 22%
Public Health 56%
Management 22%
2004 2005 2006
No. of In-Service Training 61 75 68 Sessions Organized No. of staff trained 765 (21%) 1101(30%) 1080(34%)
Total cost of training 373,361,370 1,009,371,287 696,222,944
117 Post Graduate Training Eleven staffs are currently pursing various postgraduate courses. Three of the courses are being pursued outside the country.
Course No of Staff Place of Study
School of Public Health, Legon – Public Health 2 Ghana
Harvard University, USA
Health Service 4 Kwame Nkrumah University of Management Science and Technology (KNUST), Kumasi – Ghana
Procurement and 1 University of Birmingham, UK Strategically Management
Health Education 1 Leeds Metropolitan University, UK
Reproductive Health 3 Kwame Nkrumah University of Science and Technology
Total 11
118 COLLABORATION FOR HEALTH Private Sector Involvement Involvement of the private sector in public health service delivery was of utmost importance. Privately managed Maternity Homes were covered by the exemptions package. Information sharing sessions and training programmes organised during the year also included participants from the private sector. It is hoped that in the ensuing years greater attempts would be made to contract out services and provide logistics support to the sector Available information gathered indicates that students from the University of Ghana and Kwame Nkrumah University of Science & Technology undertook various studies in Kumasi Metropolis with the aim of improving service delivery.
119 Key Innovations and Best Practices the Region had undertaken
1. The region facilitated in the formation and development of the district wide mutual health insurance scheme.
2. Construction of four (4) semidetached units at Atwima Nwabiagya, Afigya Sekyere, Amansie Central and Adansi North through the initiative of the Director General of Ghana Health Service.
3. Installation of computer network to provide Internet access for all officers at the Regional Health Directorate.
4. In the course of the year under review, the region was concerned with the unusual high number of deaths among staff and instituted compulsory medical examination for all staff.
4. Renovation of Regional Vaccine storage depot (Cold Room) and installation of new Generator.
120 General Outlook for 2007
Scaling Up of District Health Information Management System (DHIMS) to all districts Programmes to reduce maternal and neonatal deaths – Training of Midwives - Improving All Safe motherhood Indicators eg. FP Piloting decentralization in payroll management Budgetary Control will be instituted at the various BMC level in the region Data management training for staff at various levels in the system Piloting of Regional Mechanical Workshop/ Acquisition of Land for regional mechanical shop. Advocate for the replacement of old vehicles Ensure the establishment of at least two completed CHPS compounds in every district Revamp Community Based Surveillance Intensification of monitoring and supervision at all levels Operationalise 80% quota for Ashanti in regional health training institutions
121
2006 PERFORMANCE REVIEW REGION: Ashanti Name of Regional Director: Dr. Kofi Asare Tel. Number:05123651 / 05122089 Postal Address of RHMT: P. O. Box 1908, Kumasi
PERFORMANCE INDICATORS 2004 Actuals 2005 Actuals 2006 Target 2006 Actual Comments AREA Number of Infants deaths - Institutional (0-11 months) 315 362 289 Number of Infants admissions - Institutional (0-11 months) 7590 8626 6704 Number of under five deaths - Institutional (0-4 years) HEALTH 670 740 649 STATUS Maternal Mortality ratio - 180/100,000 200/100,000 150/100,000 208/100,000 Institutional Number of Under five years who are under weight presenting under facility & Outreach 8096 9163 9947 % Under five years who are underweight - Institutional 3.4 3.3 3.1
ACCESS Clinical Care
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Utilization
Number of outpatient visits 2,087,720 2,129,973 2,219,881 Outpatient visits per capita 0.5 0.5 0.6 0.5 Number of cases seen and treated by the CHOs. - - - - Not Available Number of admissions 104,326 118,252 - 115,891 Hospital Admission rate 25.2 27.7 40 26.2
Specialist Outreach
Number of specialist visits received from the national - - - - level to region Number of patients seen by - - - - national team No reporting format Number of operations to collect data - - - - performed by national team Number of specialist visits made by regional team to - - - - district Number of patients seen on ACCESS - - - - specialist visits to the districts
Number of operations performed by regional team by - - - - specialty at the district
124
DISEASE SURVEILLANCE
No. of TB patients Detected 1860 1911 1931
No. of HIV positive cases 1840 2258 1957 diagnosed No. of AFP cases seen 43 31 25
Total number of malaria cases 682694 817028 873911
Diseases targeted for Elimination Number of guinea worm cases 85 50 - 52 seen Lymphatic filariasis treatment - - - - coverage Not Applicable
Reproductive & Child Health
Safe Motherhood
Number of Family Planning 126810 138692 158757 Acceptors 12.8 14.1 25 15.3 %Family planning acceptors
- - - - Same as % FP % of WIFA accepting FP Acceptors 131778 130980 130698 Number of ANC registrants
79.8 76.7 90 74 % ANC coverage
Proportion of ANC registrants - - - 1776 given IPT2 Started in 2006
125 91947 87927 91596 Number of PNC registrants
55.7 51.5 80 51.9 % PNC coverage
Total number of deliveries 92484 92829 94210 (including trained & untrained TBA) No delivery from Untrained TBA in 92484 92829 94210 Number of Supervised the region Deliveries (including trained TBA) % of Supervised Deliveries ACCESS 56 54.8 53.3 (including TBA) Number of deliveries by skilled attendants (excluding 65770 70728 72062 TBA) % of Deliveries by Skilled 71.1 76.2 76.5 Attendance (excluding TBA)
Fresh still births Proportion of fresh still births 1275/1951 661/1736 were not captured to total still births in 2004 No. of pregnant women given No reporting format - - - ITN Vouchers to collect data
CHPS
No. of CHPS zones 187 187 281 demarcated No. of functional CHPS zones 0 2 19
Child Survival
126 EPI coverage Penta 1 66.4 76 90 74.1
EPI coverage Penta 3 71.3 74.2 90 71.3
OPV3 66 78.3 90 71.1
EPI coverage Measles 68 75.4 90 73.5
Total number of Under five 167452 201842 219225 malaria cases - Outpatients
Total number of Under five 7717 14255 14340 malaria cases - Admissions
Exemptions Granted (No. of Patients by category)
Children Under 5yrs
Ante-natal
Deliveries Information Not Available Elderly (>70yrs)
Poor (Paupers)
All other Diseases number of maternal death QUALITY 122 138 124 audits Total number of maternal 161 178 175 deaths
127 % maternal death audits 75.5 77.5 100 70.9
Total number of Under five 725 272 - 179 deaths due to malaria
Under five malaria case fatality 0.74 1.61 <1 1.42 rate Number of drugs available out of the tracer drug list at the 56 57 61 56 Regional Medical Stores Number of drugs available out of tracer drug list at the 58 58 61 57 regional hospital Total Number of TB Cases 886 918 - - Cured Not due AFP non polio rate per 100,000 population under 15 2.05 1.33 1 1.24 years
EFFICIENCY HIV seroprevalence among
15 – 19 years - 1 2.6 Not due
20 – 24 years - 1.5 2.6 Not due
Clinical Care
Total number of beds 2334 2464 - 2578
Total number of discharges 98534 103013 - 108165
Total number of deaths 2608 2603 - 2405
128 Number of patient days 401330 39226 - 391232
% Bed Occupancy 46.9 43.6 80 41.6
Bed Turnover Rate 53.3 42.9 - 42.9
Doctor Ratio 1:23724 1:20679 - 1:23616
Nurse Ratio 1:1814 1:1443 - 1:1539
Resource Allocation
% total regional recurrent budget allocated to: Private sector providers - - - - PARTNERSHIP Missions - - - - Not Applicable NGOs and CSOs - - - -
Other government sectors - - - -
FINANCING Revenue Mobilization
Could not get data IGF - - - 71,157,594,443 for 2004 & 2005 due a computer that is Cash & Carry - - - - crashed NHIS - - - -
GOG Subsidy - - - 10,358,714,241
Health Fund - - - 9,861,821,586
129 MOH Programmes (Earmark - - - 29,233,877,042 Funds) District/Municipal/Metro. - - - - Assembly Common Fund
Other Sources - - - -
Exemptions
536,148,303 Total Exemptions Provided - - -
Total Exemptions Re-imbursed - - - - Not Available
Expenditure by Source
IGF - - - 62,229,835,205
GOG Subsidy/Operating Grant - - - 10,287,142,574
Health Fund - - - 10,954,271,836
MOH Programmes (Earmark - - - 26,043,470,422 Funds) District Assembly Common - - - - Fund Other Sources - - - -
FINANCING Expenditure by Item
PVs are sent directory to districts so Item 1: Personal Emoluments - - - information is not available at regional level
130 Item 2: Administration - - - 21,798,367,798 Expenses Item 3: Service Expenses - - - 14,532,245,198
Item 4: Investment Expenses - - - 531,688,215,
Number of doctors 88 103 - 94
Population to doctor ratio 46931:1 41460:1 - 46973:1
Number of nurses 1151 1476 - 1442
Population to nurse ratio 3588:1 2893:1 - 3062:1
Number of community - - - - resident Nurses (CHOs) HUMAN RESOURCE Proportion of staff appraised - - - -
Proportion of Drs & Midwives - - - - Trained in Life Saving Skills Total number of IST 61 75 68 programmes organized Total number of staff receiving 765 1101 1080 IST programmes % of clinical staff who 68 65 69 received IST Equipment, Nunber of vehicles 102 98 108 Transport & Procurement Number of vehicles road 85 81 57 worthy
131 Proportion of vehicles road 83.3 82.7 52.8 worthy Number of motorbikes 135 168 241
Number of motorbikes road 81 104 133 worthy Proportion of motorbikes road 60 62 55.2 worthy Proportion of non salary recurrent budget spent on buildings (PPM) Number of Facility Based 8 8 17 Ambulance
132
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