2005 GHS Annual Report, W estern Region

2005 ANNUAL REPORT

DR SYLVESTER D. ANEMANA REGIONAL DIRECTOR OF HEALTH SERVICE WESTERN REGION

1 2005 GHS Annual Report, W estern Region

Preface

The year 2005 was the fourth year of implementation of the second five (5) Year Programme of W ork of the Health Sector in .

The review of the 2005 POW shows a significant improvement over the 2004 performance for most programme areas. This improvement in performance has been possible despite the declining numbers of key health personnel such as doctors and nurses because of the zeal and dedication of our staff. I therefore wish to congratulate all health workers in the W estern Region for their continued dedication in rendering quality health care to the people of this region.

A number of issues and challenges have come up from the review of our 2005 performance. Key among these are the lack of accommodation to bring in young doctors and other core heath professionals into the regional hospital and the continued lack of improvement in some areas of Reproductive Health, notably Family Planning and maternal death audit.

The findings of the 2005 Review have been factored into the W estern Region 2006 Programme of W ork (POW ) provide a framework to guide BMCs in the Region to plan their activities for the year 2006. It is our hope that this will enable BMCs come out with good plans which, when properly implemented, will enable us further improve on our performance.

Thank you. Dr. Sylvester D. Anemana Regional Director of Health Services W estern Region

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Contents

Preface …………………………………………………………. 1 Appendices ……………………………………………………... 6 List of Abbreviations .…………………………………………… 7-8 List of Tables ………………………………………………………. 9-11 List of Figures ………………………………………………………. 12 Executive Summary ………………………………………………. 13-16 1.0. Introduction …………………………….………………. 17 1.1 Background Information ………………………………… 17 1.1.1 General Information ……………………………………… 17-20 1.1.2 Socio Economic …………………………………………… 20-21 1.1.3 Determinants of Health ………………………………… 22 1.1.4 Health Status …………………………………………………… 22 1.15. Health Infrastructure …………………………………………… 23 1.2 2004 Program of W ork ………………………………………. 24 1.2.1 Key Issues and challenges at the Beginning of 2005……. 24 1.2.2 Priorities & Key Activities for Year 2005……………. … 25-26 1.2.3 Key Activities & Achievement………………………………. 27-28 1.2.4 Challenges & Constraints……………………………………. 29 1.2.5 Outlook for 2005……………………………………………….. 29

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1.2.6 Collaboration for Health …………….…………………………. 30 1.2.7 NGOs and Areas of Activity……. ……………………………. 31 1.2.8 Ministries Departments and Agencies……………………… 31 2.0 Office of the Regional Director …………………………. 32 2.1 Governance …………………………………………………. 32-33 2.2 Health Information System …………………………………… 34-36 2.3 In-service Training ………………………………………… 36-38 2.4 Financial Management ………………………………… 38-46 2.6 Poverty Agenda ………………………………………………… 46-47 2.7 Health Systems Research ………………………………….. 48 3.0 Public Health Services ………………………………………… 49 3.1 Integrated Disease Surveillance …………………… 49 3.1.2 Epidemic Prone Diseases …………………… 49-52 3.2. Diseases Targeted for Eradication and Elimination …… 53-55 3.3 Guinea W orm…………………………………………………….. 56-58 3.4 Filariasis & Onchocerciasis………………………………………59-62 3.5-3.8 Priority Diseases …………………………………………… 63-74 3.9 Expanded Programme on Immunization ……………… 75-86 4.0 Reproductive Health Services …………………………… 87 4.0.1 School Health ……………………………………… 87 4.0.2 Adolescent Health ……………………………………… 87 4.0.3 Integrated Management of Childhood Illnesses (IMCI)… 88 4.1 Safe Motherhood ………………………………………… 88-100 5.0 Nutrition and Child Health ……………………………… 101 5.0.1 Growth Monitoring at Child W elfare Clinics …………… 101-104 5.2 Micro Nutrient Deficiency Control ……………………… 105-114 6.0 Health Promotion …………………………………… 115 6.0.1 Priorities for 2005 ………………………………………… 115 6.0.2 Achievements ………………………………………… 116

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6.0.3-4 Capacity Building and Support for District….……….. 117 6.0.5 Challenges/W ay Forward …………………………… 118 7.0 Special Initiative to Increase Access ………… 118-126 8.0 Clinical Care Services ……….…………………... 127 8.0.1 Regional Clinical Care …………………………………… 127-141 9.0 Regional Q uality Assurance Programme ………... 142-143 10.0 Regional Hospital …………………... 144-146

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11.0 Community Psychiatry Services …………………………… 147-149 12.0 Eye Care Services ………………………………………… 150-153 13.0 Oral Health Services ……………………………………… 153-155 14.0 Laboratory and Blood Transfusion Services …………… 156-158 15.0 Health Administration and Support Services ………… 159 15.1 Estate Management ………………………………………… 159-163 15.2 Clinical Engineering Unit….…………………………….…. 164-167 15.3 Transport Management ……………………………… 168-172 15.4 Human Resource…………………………………………… 173-175 15.5 Supplies and Stores Management …………………… 176-178 16.0 Health Training Institutions ……………………………… 179 16.1 Nurses and Midwifery Training College …………….…… 179-181 16.2 Community Health Nursing Training School …… 182-183 17.0 Conclusion …………………………………………………… 184

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Appendices 1. Population by Districts, 2. Health Infrastructure 3. Trend Analysis of Regional performance 2003-2005 4. Comparative performance by Districts 5. Top Ten Causes of OP Attendance 6. Top Ten Causes of Hospital Admissions 7. Top Ten Causes of Institutional Deaths 8. Trend in OPD Attendance Per Capita 9. Trend in Hospital Admission Rate 10. Trend in Bed Occupancy Rate 11. Manpower Distribution 12. Health Resources 13. MOH Initiated Projects 14. MOH suspended/abandoned Projects

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List of Abbreviations ADHA Additional Duty Hours Allowance AFP Acute Flaccid Paralysis ANC Ante Natal Coverage ATF Accounting Treasury and Financial (Rules) BMC Budget Management Centre BOR Bed Occupancy Rate CD Communicable Disease CDD Community Directed Distributors CHO Community Health Officers CHPS Community Health and Planning Services COPE Client Oriented Provider Efficiency CMS Central Medical Stores CSM Cerebro-Spinal Meningitis CYP Couple Year of Protection DCU Disease Control Unit DDHS District Director of Health Services DHMT District Health Management Team District W ide Computer Application Information management DIW CAIMS Systems DOR Drop Out Rate DPF Donor Pooled Fund EPI Expanded Programme on Immunization ENRH Effia Nkwanta Regional Hospital FICBY1 Fully Immunized Eligible Children Before Year 1 FP Family Planning GDHS G hana Demographic and Health Survey CHAG Christian Health Association of Ghana GHS Ghana Health Service GOG GPRTU Ghana Private Road Transport Union HASS Health Administration and Support Services IDD Iodine Deficiency Disorders

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IE&C Information Education and Communication IGF Internally Generated Fund IMCI Integrated Management of Childhood Illness IPT Intermittent Preventive Treatment IDSR Integrated Disease Surveillance and Response MHO Mutual Health Organization MMR Maternal Mortality Rate MNT Maternal and Neonatal Tetanus MOH Ministry of Health MPS Making Pregnancy Safer NCD Non Communicable Disease NID National Immunization Day ONCHO Onchocerciasis OPD Outpatient Department OPV Oral Polio Vaccine PCAB Prop. Of Children Protected At Birth RCH Reproductive and Child Health RED Reaching Every Child in District RHMT Regional Health Management Team RMS Regional Medical Stores SARS Severe Acute Respiratory Syndromes SHC State Housing Corporation SIA Supplemental Immunization Activities SMM Senior Managers Meeting SMO Senior Medical Officer STI Sexually Transmitted Infections TB Tuberculosis TBA Traditional Birth Attendant TUC Trade Union Congress U5 Under 5 years VCT Voluntary Counselling and Testing W IFA W omen in Fertile Age YF Yellow Fever

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List of Tables Table 1: Administrative Districts and Sub districts Table 2: Determinants of Health in the Region Table 3: Health Indicators – GDHS 1993/1998/2003 Table 4: Areas covered by Training Table 5: Categories of staff trained Table 6a: Inflows of IGF Table 6b: Outflows - Expenditure IGF Table 6c: Inflows GOG Table 6d: Outflows GOG Table 6e: Inflows GOG Services Table 6f: Outflows Services Table 6g: Inflows DPF Table 6h: Outflows DPF Table 7: Suspected Measles Cases Reported By Districts 2005 Table 8: Trend in Yellow Fever Cases 2003-2005 Table 9: Prevalence of Leprosy Cases Table 10: Summary of Ivermectin treatment coverage – 2005 Table 11: Albenzole and Ivermectin Coverage 2005 Table 12: Under 5 Malaria Case Fatality Rate(CFR) - 2005 Table 13: Voluntary Couselling & Testing Table 14: HIV SERO Prevalence (Donors) - 2005 Table 15: TB treatment analysis trend 2003, -2004 Table 16: Cases of Buruli Ulcer 2003-2005 Table 17: Penta 3 Coverage (%) By District 2003 – 2005 Table 18: BCG Coverage (%) By District 2003 – 2005 Table 19: Measles Coverage (%) By District 2003 – 2005 Table 20: Yellow Fever Coverage (%) By District 2003-2005 Table 21: Yellow Fever campaign Result

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Table 22: NID Performance Table 23: Exclusive Breastfeeding Table 24: Trend Ante Natal Coverage 2003-2005 Table 25: Supervised Deliveries by districts 2003-2005 Table 26: Post Natal Coverage by districts 2003-2005 Table 27: Maternal Deaths & Audits by District 2005 Table 28: Trend FP Acceptor Rate 2003-2005 Table 29: Couple Year Protection by Method Table 30: FP Acceptor by method, 2004-2005 Table 31: Malnutrition (Under W eight) Among Children 0 – 5 yrs. Attending Child W elfare Clinic Table 32: Prevalence of Under W eight among Children 0 – 5 yrs. Attending Child W elfare Clinic Table 33: Maternal vitamin A supplementation Table 34 Household Utilization of Iodated Salt Table 35: NHIS Targets Table 36: Status of Registration of Clients DNHIS Table 37: Exempt categories of NHIS Table 38; Summary of status of CHPS Implementation Table 39: Ten Top Causes of OPD Attendance Table 40: Ten Top Causes of Hospital Admission Table 41: Ten Top Causes of Institutional Mortality Table 42: Trend of OPD VISIT Per Capita 2003-2005 Table 43: OPD Attendance by Ownership 2004-2005 Table 44: Hospital Admission Rate 2003-2005 Table 45: Hospital Admission Rate 2004-2005 Table 46: Hospital Admissions and Deaths 2005 Table 47: Hospital Deaths Rate 2004 & 2005 compared

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Table 48: Trend in Bed Occupancy Rate 2003-2005 Table 49: Bed Occupancy Rate 2003-2005 Table 50: Trend Bed Turnover Rate 2003-2005 Table 51: Psychiatric Conditions Table 52: Piloting of quality control specimen Table 53: Estate Unit: Training & W orkshop Table 54: Statistical Data on exiting major equipment Table 55: Vehicle Indicators Table 56: Motorcycle Indicators Table 57: Serviceable & Unserviceable vehicles Table 58: Fleet inventory by Age block Table 59: Fleet allocation by districts Table 60: Licensure examination-NMTC Table 61: Current Student Population –ECHNTS Table 62: Comparative recruitment -2001-2005

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List of Figures

Fig 1: AFP Case Detection Rate Fig 2: Trend of Guinea W orm Cases Fig 3: Penta 3 Coverage, 2005 Fig 4: BCG Performance Fig 5: Measles Coverage Fig 6: Yellow Fever Performance Fig 7: Penta 1 & Drop Out Coverage Fig 8: ANC Coverage Fig 9: Supervised Delivery Fig 10: PNC Coverage Fig11: Trend in Maternal mortality , 2001-2005 Fig 12: Maternal Vitamin A Supplementation Fig 13: Trend in Vitamin A Supplementation 2003-2005 Fig 14: Trend of Anaemia Cases 2001-2005 Fig 15: OPD per Capita Fig 16: Hospital Admission Rate, 2005 Fig 17: Bed Occupancy Rate, 2005 Fig 18: Bed Occupancy Rate, 2005

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Executive Sum m ary

The 2005 Annual Report for the Health Sector in the W estern Region is based on an in-depth review of the 2005 Programme of W ork for the Region. The review started at the Budget and Management Centre (BMC) level, to a district review and culminated in a regional level review. Routine service data gathered from service delivery points throughout the Region was analyzed using the sector wide indicators agreed upon with health partners for the monitoring of the second five–year programme of work. For many of the service indicators, the Region achieved a remarkable improvement in the performance in 2005 compared to 2004 (see the table below). In the area of Public Health, there were improvements for virtually all the indicators except for Family Planning. Penta 3 coverage increased from 86% in 2004 to 92.8% in 2005. The coverage for measles remained the same at 86%. The coverage for NID’s remained high at 99-100%. The cure rate for tuberculosis increased from 53% in 2003 to 56% in 2004 and the defaulter rate dropped from 26% in 2003 to 23% in 2004. On reproductive health services, the coverage for antenatal care remained as high as over 90% whilst the average number of visits per client has gone up from 2.7 in 2004 to 3.2 in 2005. The overall supervised delivery rate has gone up from 45% in 2004 to 67.6% in 2005. Supervised delivery by skilled health personnel was 35.8% and by trained TBA’s was 17%. The proportion of maternal deaths audited increased from 67% in 2004 to 77% in 2005. Family planning however slumped from 17.6% in 2004 to 10.4% in 2005. The utilization of clinical services in 2005 virtually remained at the same level as 2004 with OPD attendance per capita being 0.51 and 0.50 in 2004 and 2005 respectively. The quality assurance programme in the

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Region had considerable support from Quality Health Partners (QHP) to train staff from the districts in Quality Assurance, Infection Prevention and on the Integrated Management of Childhood Illnesses. On Health Insurance, 24.9% of the Region’s populations were registered with District-wide Mutual Health Organizations as at 31st December, 2005. A total of 3.7 billion cedis was collected from premiums during the year and 12 out of 14 schemes in the Region attained the stage were registered, and paid up clients were receiving services in health institutions. The Community Health Planning and Services (CHPS) programme also saw improvements in 2005. The number of functional CHPS zones increased form 38 in 2004 to 67 in 2005. A motor-bike rider training was organized for 30 Community Health Officers at Sekondi and an additional 20 were trained at Juabeso. A total of 33 motorcycles were distributed to support the CHPS programme. Eight (8) CHPS compounds which were built under the Social Investment Fund in the Jomoro, Nzema East and W assa Amenfi districts were provided with furniture and equipment by the Regional Health Directorate. The Juabeso and Bia districts received support in the year 2005 from CHPS-TA for their development as CHPS demonstration districts. Study tours were conducted to Juabeso by the Regional Health Management Team and also by the District Health Management Teams from within and outside the Region. The Nurses Awards Scheme instituted by the W estern Regional Minister, Hon. Joseph Boahene Aidoo in 2004 was held for the second year on 1st November, 2005. The prize was a Rover Saloon car which was won by Miss Rose Vida Mensah of the W assa East district.

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The number of award winners increased from 59 in 2004 to 78 in 2005. The award winners were drawn from all over the Region and from both the public and private sectors.

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SECTOR WIDE PERFORMANCE

PERFORMANCE TARGET ACHIEVEMNET FOR INDICATOR 2003 2004 2005 FOR 2005 HEALTH STATUS Infant mortality rate 18.6 20.6 18 14.6 Under five mortality rate 32.9 40.2 40 28.2 Maternal Mortality ratio 210 170 160 289 % Under five years who are malnourished 26 18.1 15 9.8 ACCESS Population to doctor ratio 1:41539 1:31638 1:28,000 1:20,115 Population Nurse ratio 1:2261 1:2107 1:2,200 1:2,204 Outpatient visit per capita 0.44 0.51 0.6 0.50 Hospital admission rate 33.2 39.8 50 38.4 Total number of completed CHPS compounds 39 56 61 QUALITY % of maternal audits to maternal deaths 89 66 80 77.8 Under five malaria case fatality rate 0.4 3.1 3 3.4 % tracer drug availability 99 98 100 98 HIV seroprevalence (among reproductive EFFICIENCY age) 4.2 4.6 3.5 NA Tuberculosis cure rate 59 53 60 56 Number of guinea worm cases 32 4 0 2 AFP non polio rate 2.4 2.5 2 2.6 % Family planning accepts 18 23.8 25 10.4 % ANC coverage 124.4 97.7 99 91.1 % PNC coverage 50 33.9 40 35.6 % Supervised deliveries (skilled attendants) 63.8 45.3 50 67.6 Bed occupancy rate 50.6 46.9 50 47.7 EPI coverage Measles 109 86 90 86 EPI coverage Penta 3 109 84 90 92.8

FINANCIAL Total budget allocated 66,096,343,421 93,836,114,158 51,659,575,693

Total GOG recurrent budget 4,460,495,385 4,565,993,718 5,622,878,071

Total Health Fund 7,906,691,000 14,501,870,000 17,340,229,031

Total IGF 21,680,448,270 28,937,313,843 36,679,943,237

Total amount spent on exemptions 1,260,649,218 1,225,375,085 6,786,025,645

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1.0. Introduction

1.1. Background Inform ation of W estern Region

The W estern Region is situated in the southwestern part of Ghana. It shares borders with La Cote d’lvoire on the W est, the on the East, part of Ashanti and Brong Regions in the North, and the Gulf of Guinea in the South. It has an area of 23,760 sq, km, with a coastline of 192km

1.1.1. General Inform ation

Population The 2005 population of the region as projected from 2000 population census is 2,252,858. The breakdown of the population by districts is shown in Appendix 1.

Adm inistrative Districts There are thirteen (13) Administrative Districts in the region. All the District capitals have pipe borne water and electricity connected to the national grid. The region has seventy (70) Health Sub districts – refer Table 1

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Table 1: Adm inistrative Districts and Health Sub Districts District Population Area Of No. Of Districts Sq. Km . Health Sub Districts Shama Ahanta East 432,136 337 5 Mpohor W assa East 143,506 2,628 5 Ahanta W est 111,368 576 4 Nzema East 167,241 2,149 6 Jomoro 130,341 1,344 4 W assa W est 272,391 1,832 7 W assa Amenfi East 103,149 1,502 4 W assa Amenfi W est 171,215 3,164 5 139,454 2,699 5 Ahnwiaso 120,869 835 5 Sefwi W iawso 174,357 2,518 6 Juabeso 137,679 1,807 7 Bia 149,152 2,296 7 Region 2,252,858 23,760 70

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Geography

Clim ate The southern part of the region is the wettest part of the country. There are two distinct rainfall seasons, occurring in June and October. Temperatures are on the average about 270 C. Relief The region generally has low lying lands with heights below 222 metres above sea level except in the extreme northwest. The highest elevation is 660 metres at Atayemikrom.

Drainage There are ten (10) main rivers in the region. These are Bia, Sui, Tano, Tawya, Bonsa, Yannery, Butre, W hin, Ankobra, and Pra. Rivers Ankobra and Pra drain into the sea in the region.

Vegetation The region lies in the equatorial rainforest belt. It has a total forest area of 19,406 sq. km which constitute 25% of Ghana’s 77,625 sq. km forest area. The region has about 75% of its vegetation within the high forest zone of Ghana. Consequently, the region produces a large proportion of the country’s timber requirements for domestic use and export.

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M ineral Resource The W estern Region is probably the richest area in Ghana so far as mineral deposits are concerned. Some of the minerals found in the region and their locations are: Gold - , , , , Bibiani, Chirano and several other places. Diamond - Bonsa Basin Manganese - Bauxite - Awaso Limestone - Nauli () Iron Ore - Oppon Valley Glass Sands - Tarkwa

Forestry The concentration of high forest accounts for the large number of timber firms in the region. W estern Region leads in the production of timber in the country, producing an average of about 42% of Ghana’s timber annually.

1.1.2. Socio Econom ic Activities

Agriculture The region has soil types that are suitable for a wide range of crops – mainly Cocoa, Coffee, Rubber, Oil Palm, Coconut, Black Pepper and Rice.

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Industry The region is one of the three most industrialized regions in the country. According to industrial classification, there are three major groupings as follows: • Mining and Q uarrying • Manufacturing • Electricity, Gas and Steam

The industrial capacity of the region is due to the industrial centers namely Sekondi/Takoradi Metropolis and the Mining areas around Tarkwa. About 60% of all the industries are located in the Sekondi/Takoradi Metropolis.

Transport and Com m unication

It is estimated that about 40% of the trunk roads in the region are not tarred. The road network is however fast improving. A 1,272 km of railway line links the mining areas in the W assa W est District to the port cities of Sekondi/Takoradi in the Shama Ahanta East District. Other major infrastructure in the region includes the Takoradi Habour, Thermal Plant at Aboadze and the Sekondi Fishing Harbour (Bosomtwi Sam Fishing Harbour).

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Determ inants of Health in the Region Table 2: Determ inants of Health in the Region

Indicators National Regional Access to water 94.0% 96.7% Improved water source 74.1% 71.2% Safe Sanitation 55.0% 52.8% Has Electricity 50.6% 50.6% Adult Literacy Rate 53.4% 56.5%

Source: Core Welfare Indicators Questionnaire Survey, 2003 Ghana Statistical Services

1.1.4. Health Status Table 3: Health Indicators – GDHS 1993/1998/2003 Indicator 1993 1998 2003 Total fertility rate 5.54 4.70 4.50 Infant mortality rate/1,000 LB 76.3 68 66.0 Under 5yrs mortality/1,000 LB 131.8 109.7 109.0 Neonatal Mortality Rate/1,000 LB 47.3 38.3 37.0 Peri-natal Mortality Rate/ 1,000 LB 44.7 66.0 % of Under 5 Malnourished 33.1 25.6 17.0 Maternal Mortality Rate/ 100,000 LB 270 250 210 (institutional data)

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1.1.5. Health Infrastructure There are a total of 353 health facilities made up of 25 Hospitals, 2 Polyclinics, 57 Health Centres, 173 Clinics, 50 CHPS compounds, and 46 maternity homes. (See Appendix 2)

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1.2 2005 PROGRAM M E OF W ORK 1.2.1 Key Issues and Challenges At The Beginning Of 2005

The key issues and challenges at the beginning of 2005 were: • Shortage of various health professionals. • Inadequate office and staff accommodation. • Lack of essential equipment and supplies. • The high disease burden due to malaria and the contribution of ` HIV/AIDS to mortality. • Poor implementation of the exemption scheme. • Irregularities with the payment of Additional Duty Hour ° Allowances (ADHA). This de-motivated a lot of staff and was a constant cause of staff unrest in many BMCs. • The scaling up of the CHIPS programme in the Region was slow. • High maternal mortality rate in the region. • Bad road network affecting referrals, outreach and supervision. • Poor data quality. • Gaps in disease surveillance and control.

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1.2.2 Priorities and Key Activities For 2005 To address the above issues and others, the 2005 POW outlined certain priorities and key activities to be carried out during the year. These included:

IM PROVING ACCESS • Establish 20 CHPS zones • Open Juabeso hospital • Construction of new health centres • Streamline implementation of Exemptions • Facilitate health insurance set up • Health Promotion • Outreach services : dental, eye

IM PROVE QUALITY o Strengthen regional hospital towards accreditation o Staff to buy vision and values of GHS o Support Regional Clinical Care to build further on QA Programmes. o Collaborate with Q uality Health Partners (QHP) on quality o assurance, infection control and IMCI o Improve supervision and monitoring by Regional Clinical Care

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HUM AN RESOURCE • Orientation for over 170 new entrants and their posting, • absorption and salaries • Provide incentive to deserving staff • W ork for the accreditation of Effia Nkwanta Regional Hospital • Find accommodation to bring in staff • Request for staff – especially doctors • Conduct staff interviews and speed up promotions

IM PROVE EFFICIENCY BY • Improving team dynamics • Improving new logistic management system • Improving procurement/supplies (Regional Medical Stores) • Improving financial management • Stepping up supervision and monitoring • PRIORITY SERVICES - Malaria, TB, HIV/AIDS, RCH, Emergency Care

SPECIAL SERVICES • Scaling up of CHPS • Promotion of MHO/Health Insurance

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1.2.3 KEY ACTIVITIES AND ACHIEVEM ENTS

IM PROVING ACCESS • 30 CHPS zones were made functional • 30 motor bikes and sets of equipment distributed to functional CHPS zones • 10 CHPS zones received drugs and consumables • Juabeso district hospital still not completed • New health centres at Adabokrom, Nsawura, Asawinso, Boinzan, Akotombra and Sewum have beencompleted and handed over • Outreach for dental services were carried out

On National Health Insurance • Regional Task Team constituted and trained • Regional forum on NHIS took place • W orking group meetings were held • Training of Trainers for training health staff took place • 12 out of the 13 districts started benefit package

IM PROVING QUALITY CARE Strengthening of Effia Nkwanta Regional Hospital • Construction of Accident and Emergency centre on course • Equipment requested • Bungalows refurbished • Relocation of staff has been completed and an earmarked accommodation (white house) is being rehabilitated for housemanship programme

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° The Regional Clinical Care unit carried out the Quality Assurance programme with support from Quality Health Partners (QHP) ° New communication network operating in three districts ° Family Health Division (FHD) supported regional forum on safe motherhood and training of staff on safe motherhood

IM PROVING EFFICIENCY o Eleven (11) out of twelve (12) DHMT meetings were held o Three (3) out of four (4) RHMT/DHMT meetings were held o All four (4) Regional Health Committees meeting were held o Half Year performance review was carried out o Performance contracts were signed and monitored at half o year review o Training on facilitative supervision was done o Staff appraisals have improved o Promotion interviews and staff promotions greatly improved o Four (4) HND Statistics graduates from the Polytechnic were o absorbed in the region and posted to the district to improve o data management. o Installation of new computers and DIW CAIMS software at o Effiankwanta Regional Hospital, Takoradi hospital, the two Polyclinics and two pilot districts (W assa W est and Nzema East) for data capture, analysis and use. Training of sixty (60) staff on data management was organised.

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1.2.4 CHALLENGES / CONSTRAINTS Research Agenda could not be carried out • The Regional Health Committee members could not tour the districts to address issues on the corporate image for the GHS • The Public Health Division could not be supported with the mass public health education programme due to financial constraints

1.2.5 OUTLOOK FOR 2006 • Strengthen Community Based Surveillance • Conduct TB refresher training • Conduct needs assessment for effective institutional malaria • case management • Use RED Approach to improve EPI in priority districts • Intensification of routine Vitamin A supplementation • Zoning of the region into three (3) to facilitate efforts of reducing maternal death audits. • Strengthen financial management and revenue monitoring • Redistribute staff with focus on districts with inadequate staff • Improve clinical audits on medicine management • Scale-up DIW CAIMS from two to four districts • Improve staff knowledge and skills in data management

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1.2.6 Collaboration for Health The District Health Administrations collaborated with their respective District Assemblies, NGOs, and other agencies in various ways. Specific areas of collaboration and support are as follows: • District Assemblies sponsored Health Aides health training in the region. • The Districts Assemblies provided financial support and transport for health programmes such as National Immunization Days (NIDs) in all the districts and Maternal and Neonatal Tetanus campaign (MNT) in four districts. • Shama Ahanta East Metropolitan Assembly is constructing a new DHMT and Accident and Emergency W ard for Takoradi hospital. • Quality Health Partners (QHP), Ghana Sustainable Change Project (GSCP), CHPS-TA are in four districts ( Ahanta W est, Juabeso, Bia and Bibiani Anhwiaso Bekwai) supporting them to implement IMCI, Infection Prevention and Malaria through workshops.

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1.2.7 NGOs and their areas of activity are as follows: • W orld Vision International: Support various health programmes such as Onchocerciasis, Filariasis Control, HIV/AIDS and Eye screening in Ahanta W est and Mpohor W assa East districts, also sponsored the training of 20 TBA’s. • Rotary Club International supported the Polio Eradication Programme in the region. • Red Cross: They operate in 5 districts. They are involved in social mobilisations activities for Health programmes. • Mining and Timber companies are partners in the health delivery system in the region. • CHAG institutions in partnership with the Ghana Health Service have contributed enormously to providing quality health care to most people living in deprived areas of the region • GPRTU provide transport for pregnant women attending health facilities in the W assa W est district. • Care International: focuses on HIV/AIDS and Family Planning Education • Community W ater and Sanitation: Provision of boreholes in Guinea W orm Endemic communities. They also conduct hygiene education.

1.2.8 M inistries Departm ents and Agencies (M DAs) Decentralised departments such as Ghana Education Service, Ministry of Agriculture, Birth and Death, National Population Council and others provided personnel and transport for NIDs and other health programmes.

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2.0. Office of Regional Director 2.1. Governance The main issues confronting the Office of the Regional Director of Health Services at the beginning of the year were: • Shortage of various health professionals • Inadequate accommodation • Lack of essential equipment and supplies • High maternal mortality rate in the Region • Bad road network affecting referrals, outreach and supervision. • Numerous problems over ADHA • Poorly implemented Exemptions Scheme • Poor data quality • The high disease burden • Gaps in disease surveillance and control

To ensure that the above issues / constraints were addressed and that the 2005 POW would be properly implemented, the following priorities and key activities were drawn for the Office of the Regional Director. • Hold monthly meetings of Regional Health Management Team • Hold quarterly meetings of Regional Health Committee • District and sub-district health management teams were also to meet at least once each month. • Streamline ADHA payment and meet staff to explain payment modalities for ADHA • Carry out staff transfers where necessary to resolve conflicts and improve efficiency of teams • Disseminate protocols and standards. • Conduct training on financial management • Carry out reconciliation of financial statements with BMCs

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• Conduct internal audit checks • Build capacity to respond appropriately to audit queries • Provide feedback from Health Summit / SMM • Support HASS to introduce new logistic supply system • Celebrate W orld Days

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2.2. HEALTH INFORM ATION SYSTEM The current health reform and the changing health care environment require timely and reliable information for policy development and health planning, demanding innovative strategies to respond to efficiency and quality concerns. Routine service data for the period under review indicates a stagnating trend in service delivery and utilization. OPD visit per capita remained stagnated at 0.50 in 2005, not much different from 0.51 in 2004. Despite the stagnated OPD per capita, OPD attendance decreased from 68.8% in 2004 to 57.0% in 2005 for government institutions, whilst it doubled in private facilities from 11.0% in 2004 to 22.2% in 2005. Hospital Admission Rate (HAR) also did not show any improvement. It dropped from 38.9 in 2004 to 38.4 in 2005 per 1,000 population. Bed occupancy increased slightly from 46.9% in 2004 to 47.7% in 2005. Submission rate has shown a steady increase from 86.9% in 2003 to 95.2% in 2004 and 97.8% in 2005. The feedback system which was put in place last year has enhanced the submission rates of returns and more private health providers are now reporting. The Statement of Outpatient Returns was used as proxy indicator in determining the submission rates.

35 2005 GHS Annual Report, W estern Region

2.2.1 Capacity Building on Data M anagem ent During the year under review, a number of training/workshops were organized for staff at various levels in data management. In all these trainings, emphasis was placed on accurate data capture, compilation, analysis and usage. • Installation of computerised data entry systems were carried out in some facilities. • Quarterly validation of accounts to reconcile revenue and expenditure return was carried out for all BMCs. • Mapping of all health facilities under the Service Availability Mapping (SAM) Project was carried out in the region.

2.2.2 Constraints / Challenges • In-service training for Health Information staff could not be carried out due to lack of funds • Facilitative supervision could not be carried out • Evaluation of DIW CAIMS Software in two pilots districts could not be carried out • Data reconciliation (validation) could not be carried out

2.2.3 W ay Forward • To carry out regular facilitative supervision and monitoring of records staff at the district levels • To scale up DIW CAIMS Software from two to five districts • To conduct In-service training for District Health Information Officers. • To conduct quarterly data reconciliation (validation) at the district level. • To submit quarterly workload utilization performance to districts.

36 2005 GHS Annual Report, W estern Region

• To continuously update knowledge of staff in data management

2.3. In-Service Training Training activities undertaken, reported and recorded during the period under review were (19).

2.3.1 Type of Training Structured - 7 Remedial - 12

Table 4: Areas Covered By Training Area Training Courses Average Sessions Duration (Days) Public Health 4 Reproductive Health 2 Health Education & Promotion 3 Clinical Care 4 Nursing Care Practice 2 Case Management 1 Management 11 Computer Application 2 Financial Management 2

37 2005 GHS Annual Report, W estern Region

Table 5: Category of Staff Trained CATEGORY NO.TRAINED Doctors 7 Nurses 95 Public Health Nurses 4 Midwives 40 Medical Assistant 14 Pharmacist 5 Health Service 13 Administrators Technologists 50 CHP 0 OTHERS 150 TOTAL 378

COM M ENTS • Eight out of the thirteen districts have not submitted any training report for the year under review. • The only report from RHA is that of Preceptorship training for the Health Aides Program • No report from all program heads though records show that a number of structured IST have been conducted during the year.

38 2005 GHS Annual Report, W estern Region

2.3.2 KEY CHALLENGES • Incomplete submission of report forms • Non compilation and endorsement of logbooks • Health workers seldom make use of the training facilities available at the centre i.e library and equipment.

2.3.4 W AY FORW ARD • Program heads and IST Focal Persons to report on all trainings • Provide accurate data for analysis of in-service training programme.

2.3.5 Sources of Funding for the training: • Programme funds • IGF • Donor Pool Fund

2.4. Financial M anagem ent Health Financing 2.4.1 Key Activities • Quarterly Validation • Dissemination of GHS/MOH policies to Auditor General Staff • Monitoring of Exemptions • Training of Non-Finance Managers in Financial Management • Step up Financial Monitoring Activities • Produce more timely quarterly Financial Statements and improve reporting and analysis capacity at all levels. • Build capacity at all levels in Financial Records Management in order to cope with the possible tripling workload as a result of NHIS • Stocktaking at RMS on quarterly basis.

39 2005 GHS Annual Report, W estern Region

2.4.2 Achievem ent The Finance Division was able to carry out almost all the planned activities with the exception of Training of Non-Finance Managers. This was due to insufficient funds. Validation could also not be done on quarterly basis but rather bi- annually also due lack of funds. Because of change in our external auditors, stock taking was done only at the 3rd quarter and the end of year.

2.4.3 Resource Allocation. As usual resource in-flows came from three major sources; Government of Ghana (GOG), Donor Pooled Funding (DPF) and Internally Generated fund (IGF). The breakdown is shown in the tables 6a-6h. Sum m ary of Inflows and Outflows by sources of fund. Fund Type: Internally Generated Funds (IGF). Table 6a: Inflows

Fund Type: IGF

BMC CATEGORY 2004 2005 % Increase/Decrease

Regional Hospital 6,537,444,374.00 9,181,138,278.00 40%

Training Institution 561,075,707.00 775,869,799.00 38%

Districts Hospital 18,791,551,449.00 22,454,750,924.00 19%

Sub Districts 3,047,242,313.00 4,268,184,236.00 40%

Total 28,937,313,843.00 36,679,943,237.00 27%

40 2005 GHS Annual Report, W estern Region

The overall 27% and the impressive 40% percentage increases at the Regional Hospital and the sub-district facilities over 2004 performance could be attributed to a number of reasons:- Better controls in our revenue collection system as the percentages for the Regional and sub-district facilities have shown remarkable increases. The hospitals have also shown a positive improvement in IGF generation. Though not a very strong point, the effect of inflation on general prices cannot be ruled out. The general increase in intake into the training institutions has resulted in the increase in IGF from the schools.

Table 6b:Outflows IGF

Fund Type: IGF % Increase/ BMC CATEGORY 2004 2005 Decrease

Regiona Hospital 5,978,043,620.00 7,639,970,518.00 28%

Training Institution 419,649,444.00 848,230,447.00 102%

Districts Hospital 16,667,467,830.00 19,488,160,530.00 17%

Sub Districts 2,194,463,138.00 3,121,622,691.00 42%

Total 25,259,624,032.00 31,097,984,186.00 23%

There was a general increase in service charges. Consultation fees increased from ¢2000 to ¢5000 in health centres, and from ¢5000 to ¢10,000 in hospitals. There has been general increase in IGF at all the BMC categories. The over 100% increase at the Training Institutions can be explained in terms of the general increase in intake with its consequent expenditure increase.

41 2005 GHS Annual Report, W estern Region

The 42% increase at the sub-district level can be attributed to better control over revenue collection and hence increase in the available funds for expenditure.

Fund Type: Governm ent of Ghana (GOG) Adm inistration Table 6c: Inflows GOG Adm in. Fund Type: GOG Adm in % I n c r e ase/ BMC CATEGORY 2,004.00 2,005.00 Decrease Regional Health Admin 355,033,263.00 370,880,938.00 4% Regiona Hospital 225,562,745.00 200,908,543.00 -11% Training Institution 84,443,700.00 127,252,004.00 51% Districts Health Admin 503,645,947.00 1,073,802,227.00 113% District Hospital 1,064,393,063.00 524,249,166.00 -51%

Total 2,233,078,718.00 2,297,092,878.00 3%

Even though there is an increase of 3% to the Region as a whole, there is a remarkable decrease to both the Regional Hospital and the District Hospitals. The later experiencing a 51% decrease over 2004 inflows. The Training Institutions have rather gained 51%. The District Health Administrations have seen a tremendous inflow of funds -113%. The Regional Health Directorate had a minimal increase of just 4%.

42 2005 GHS Annual Report, W estern Region

Table 6d : Outflows GOG Adm in. Fund Type: GOG Admin BMC CATEGOR Y 2004 2005 % Increase/Decrease Regional Health Admin 196,052,207.00 370,880,938.00 89%

Regiona Hospital 177,521,550.00 200,908,543.00 13%

Training Institution 84,443,700.00 127,252,004.00 51%

Dist. Health Admins 329,930,335.00 1,073,802,227.00 225%

District Hospital 269,943,001.00 524,249,166.00 94%

Total 1,057,890,793.00 2,297,092,878.00 117%

There was a general increase, averaging 117%, in the amount accessed for Administration during the year under review. The high increase is due to the fact that in 2004 some of the BMCs did not access their GOG Administration expenditure warrants to enable them spend. The bulk of the increase 225% went to the District Health Administrations. However, there was a decrease in the warrant released for the last quarter to all BMCs and needless to mention that some of them could still not access the funds before the year end.

43 2005 GHS Annual Report, W estern Region

Fund Type: Governm ent of Ghana (GOG) Services Table 6e: Inflows Fund Type: GOG Services % Increase/ BMC CATEGORY 2004 2005 Decrease Regional Health Admin 438,827,000.00 553,873,000.00 26%

Regiona Hospital 313,061,000.00 459,031,447.00 47%

Training Institution 152,594,000.00 283,771,554.00 86% Districts Health Admin 883,315,000.00 1,287,564,991.00 46%

District Hospital 545,118,000.00 741,544,201.00 36%

Sub District - - 0%

Total 2,332,915,000.00 3,325,785,193.00 43%

All the BMCs had significant increases over the 2004 budgetary allocations. The overall regional increase is about 43%. The Regional Health had the least percentage increase. The highest increase of 86% went to the Training Institutions and this is due to the tremendous increase in intake.

44 2005 GHS Annual Report, W estern Region

Table 6f: Outflows GOG Services Fund Type: GOG Services % Increase/ BM C CATEGORY 2004 2005 Decrease Regional Health Admin 334,501,572 553,877,000 66% Regiona Hospital 307,948,408 391,386,383 27% Training Institution 99,385,412 232,799,417 134% Districts Health Admin 858,893,297 1,037,481,040 21% District Hospital 655,288,830 566,310,224 -14% Sub District 0 0 0% Total 2,256,017,519 2,781,854,064 23%

Apart from the District Hospitals that had a decrease of 14% in their budgetary expenditure under GOG for service delivery, there were increases in expenditure ranging from 120% to 234% and a regional net increase of 123%.

45 2005 GHS Annual Report, W estern Region

Fund Type: DONOR POOL FUND (DPF) Table 6g: Inflows Fund Type: DPF % Increase/ BM C CATEGORY 2004 2005 Decrease

Reg. Health Admin 1,900,227,000.00 3,052,748,228.00 61%

Reg. Hospital 2,087,278,000.00 1,946,703,356.00 -7%

Training Institution 901,884,000.00 952,508,000.00 6%

Dist. Health Admins 5,889,199,000.00 7,069,269,894.00 20%

District Hospital 2,723,282,000.00 4,318,999,553.00 59%

Sub District - 0 %

Total 13,501,870,000.00 17,340,229,031.09 28%

Budgetary allocation under DPF for 2005 increased by 28% to the region compared with the year 2004. The Regional Hospital suffered a reduction of 7% in its budgetary allocation over the 2004 allocation. The highest increase of 61% went to the Regional Health Administration. District Hospitals too had a remarkable increase of 59%.

46 2005 GHS Annual Report, W estern Region

Table 6h: Outflows DPF Fund Type: DPF % Increase/ BMC CATEGORY 2004 2005 Decrease Regional Health Admin 2,571,771,316 2,884,292,432 12% Regiona Hospital 2,135,977,500 1,930,399,865 -10% Training Institution 916,963,296 1,000,059,806 9% Districts Health Admin 4,860,000,000 7,554,403,245 55% District Hospital 3,123,000,000 4,399,178,418 41% Sub District 0 0 0% Total 13,607,712,112 17,768,333,766 31%

In exception of the Regional Hospital all thee other facilities had increases in expenditure. This could be attributed to the late release of funds at the end of 2004 which could not be used until the beginning of the 2005 financial year.

2.6 Poverty Agenda The poverty agenda for the Region covered the following activity areas: • Completion of the training of 65 Health Aides • Support the establishment of 30 functional CHPS zones • Training of 70 CHOs and supervisors • Supply of drugs and medical consumables • Procurement of equipment and furniture • Rehabilitation of accommodation units and provision of furniture to attract young doctors into the Regional Hospital. These doctors

47 2005 GHS Annual Report, W estern Region

are to complete their houseman-ship rotations prior to their posting to the rural district hospitals. • Support for the implementation of the National Health Insurance Scheme. • Formation and training of Regional Resource Team (RRT) • Study tour by the Regional Resource Team to and . • Preparation of Drug List and formulary for the Region for implementation of NHIS. • Training of Trainers workshop for staff of GHS to prepare them for implementation of NHIS. • District level training of staff of the GHS to prepare them for implementation of NHIS. • Start up financial support for new districts.

All the above activities were undertaken using funds allocated in 2004 for poverty and deprivation activities in the Region. All these funds could not be utilized in 2004 and were carried forward to 2005 to continue with the implementation of our poverty agenda in 2005. No allocation of funds was made to the region in 2005 for poverty and deprivation activities.

48 2005 GHS Annual Report, W estern Region

2.7 Health System s Research A number of operational research topics were approved but could not be carried out in 2005 due to financial constraints. However, three (3) operational researches were carried out in three (3) districts. These were: 1. A survey on ITN in the Mpohor W assa East district. 2. A research on why an increase in anaemia among children in Juabeso district? 3. High TB defaulter rate in W assa Amenfi W est district.

49 2005 GHS Annual Report, W estern Region

3.0. Public Health Services 3.1. Integrated Disease Surveillance Several diseases of public health importance remained under surveillance for early detection and prompt response. However, reporting from health institution was not timely, not accurate and not complete.

3.1.1 Key Activities • Monitoring of epidemic prone diseases: CSM, Cholera, Guinea W orm, Yellow Fever • Medical records review at health facilities. • Sensitization of clinicians, DHMTs and prescribers. • Community sensitization in Faith Based clinics • Providing quarterly feedback to districts.

3.1.2 Epidem ic Prone Diseases Cholera Cholera alert letters were sent to the districts early in the year before the onset of the rainy season. Reminders were sent when outbreaks were reported in other regions. In 2005, three suspected outbreaks were reported in W assa Amenfi East W assa Amenfi W est and Juabeso. However specimens collected for laboratory investigation were negative. Although there was no confirmed case in the year under review, all districts have been asked to monitor local pattern of diarrhoeal diseases.

50 2005 GHS Annual Report, W estern Region

CSM No case of CSM was reported during the period under review. The districts were sensitized to monitor weekly meningitis cases by districts and by thresholds and take appropriate action when the threshold is reached.

M easles There has been a significant improvement in the implementation of case-based surveillance for measles. Out of a total of 20 suspected cases reported, 19 were case-based representing 95% and one confirmed representing 5% were confirmed as measles. In 2004 47 cases were reported from 9 districts and only one confirmed as measles

51 2005 GHS Annual Report, W estern Region

Table 7: Suspected M easles Cases Reported - 2005 Districts Expected Reported Lab. Results Im m unization Status Sefwi W iawso 1 0 0 0 Bibiani A. Bekwai 1 0 0 0 Juabeso 1 3 Negative All not known Bia 1 0 0 0 W assa Amenfi E. 1 0 0 0 W assa Amenfi 1 2 Negative 1 known W est 1 unknown Aowin Suaman 1 1 Negative 1 known W assa W est 1 2 Negative 2 known Mpohor W assa E. 1 0 0 0 Ahanta W est 1 0 0 0 Shama Ahanta E 1 5 Negative 1 known 4 unknown Nzema East 1 4 Negative 3 known 1unknown Jomoro 1 3 1(Positive) 1 known 2 unknown REGION 13 20 9 known 11 unknown

52 2005 GHS Annual Report, W estern Region

Yellow Fever It is expected that every district reports and investigates at least one suspected case of Yellow Fever every year. Suspected Y/Fever Cases Reported by Districts 2003-2005 Compared Table 8: Trend in Yellow Fever Cases Districts 2003 2004 2005 Sefwi W iawso 1 1 6 Bibiani A. Bekwai 1 0 3 Juabeso 4 Bia 4 2 0 W assa Amenfi East 0 W assa Amenfi W est 0 3 5 Aowin Suaman 3 0 0 W assa W est 1 0 1 Mpohor W assa E. 0 2 0 Ahanta W est 2 3 1 Shama Ahanta East 6 0 4 Nzema East 0 0 0 Jomoro 3 1 5 REGION 21 12 29

The number of suspected cases of Yellow Fever reported in 2005 was more than twice what was reported in 2004. However 4 districts did not report any case in 2005. The increase in reporting suspected yellow fever was caused by the confirmation of a Yellow Fever from Ayanfuri in neighbouring Central Region.

53 2005 GHS Annual Report, W estern Region

3.2. Diseases Targeted For Eradication and Elim ination 3.2.1 Key activities AFP Surveillance • Training of District Directors and Disease Control Officers on Integrated Disease Surveillance as Local Stop Teams • Active Case Search in health institutions, prayer and healing camps • Supporting silent and weak districts to improve on case findings. • Investigating and following up cases detected in the districts.

Case Detection Based on the population of W estern Region it is expected that every year 9(now 18) AFP cases would be detected in children less than 15 years of age. However, during the period under review a total of 26 were detected from 12 districts. Out of the 26 cases of AFP in 2005 25(96%) were investigated within 14days of onset of paralysis compared to 76.2% investigated in 2004 and 33% in 2003 as shown in fig 1. Fig 1: AFP Cases Detection Rate

AFP Case Detection Rate, 2003-2005

100

n o i t c e e t t e a 50 D R

e s a C 0 2003 2004 2005 CDR 33 76.2 96 Year

54 2005 GHS Annual Report, W estern Region

60-day follow up was done for all the cases reported in 2005. 3.2.2 Key Challenges • Incomplete submission of monthly communicable Disease Form(CD2 Returns) • Improper filling of case-based investigation forms • No response to cases investigated • No reports from community based surveillance volunteers • Late submission of financial returns on surveillance activities

Leprosy 3.2.3 Activities undertaken • In-service training for technical officers • Case Search in Jomoro and Aowin Suaman districts. • Conducted facilitative supervision to the districts

There has been a downward trend in the prevalence rate within the 3 three year period from 0.42 in 2003 per 10,000 populations to 0.27 per 10,000 populations in 2005. There are however wide district variations.

55 2005 GHS Annual Report, W estern Region

Table 9: Prevalence Rate of Leprosy in W estern Region, 2003-2005 Districts 2003 2004 2005 Sefwi W iawso 0.2 0.3 0.3 Bibiani A. Bekwai 0.7 1.0 0.2 Juabeso Bia 0.1 0.2 0.1 W assa Amenfi East W assa Amenfi W est 0.8 0.6 0.4 Aowin Suaman 1.1 0.2 0 W assa W est 0.3 0.1 0.1 Mpohor W assa E. 0.4 0.2 0.8 Ahanta W est 0.7 0.4 0.8 Shama Ahanta East 0.04 0.1 0.2 Nzema East 0.4 0.1 0.1 Jomoro 0.2 0.3 0.1 REGION 0.42 0.31 0.27

• In 2005 the prevalence rate varied from 0.1/10,000 population in four East districts (Juabeso-Bia, Nzema East and Jomoro) to 0.8/10,000 population in two districts (Mpohor W assa East and Ahanta W est districts).

3.2.4 M ajor Challenges • Late submission of activity report and other returns. • Failure of some districts to conduct active case search. • Low priority given to Leprosy program in district

56 2005 GHS Annual Report, W estern Region

3.2.5 Achievem ents • Regular drug supplies for all year round • Effective Public Education resulting in more passive cases being detected early.

3.2.6 Recom m endations • Orientation on Leprosy for health workers should be pursued to facilitate early case detection to accelerate elimination of the disease. • District Technical Officers(Leprosy) should submit district plans on Leprosy activities to their respective DDHS for funding

3.3 Guinea W orm Guinea W orm is one of the diseases targeted for eradication 3.3.1 Key Activities • Meeting with DHMT members from Bia and W assa Amenfi W est on need to re – activate the CBS surveillance system. • Active case search in Asankran Breman in W assa Amenfi district. • Health Education/Community durbars in the affected communities. • Distribution of filters in all the hamlets where cases were reported. • Monitoring of filter usage and treatment of ponds

57 2005 GHS Annual Report, W estern Region

Fig 2: Trend of Guinea W orm Cases reported in W estern Region, 1993-2005

80

60

40

20

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

GW 74 60 36 24 19 4 15 6 6 1 32 4 2

The incidence of Guinea W orm declined remarkably in 2005 compared to 2004 and 2003. In 2002, a single imported case which was not well managed gave rise the following year, 2003 to an outbreak. 32 cases were therefore reported in 2003 as against 4 in 2004. In 2005 two (2) cases were reported from the W assa Amenfi W est districts. The 2004 and 2005 were all imported cases.

3.3.2 Challenges • Sustaining the interest of the CBS for good quality surveillance. • Continuous movement of migrant labour from highly endemic regions to remote and not easily accessible cocoa growing hamlet. Such people import Guinea W orm into the Region • Lack of transport for frequent and quality supervision

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3.3.3 W ay forward • Meeting with DHMTs in the 6 districts to review the performance of the CBS volunteers. • Refresher training for District Disease Control Officers in Abate application. • Supply of medical materials to sub- districts where cases will be reported. • Replacement of worn out filters to community members. • Active case search in endemic communities • Active surveillance to ensure early detection of cases

59 2005 GHS Annual Report, W estern Region

3.4 Filariasis and Onchocerciasis Filariasis and Onchocerciasis are of a major Public health concern in the W estern region. There is a program in place which distributes drugs to people in the endemic communities. The strategy for distribution is community directed. The target of this program is to achieve 80% coverage of total population in the endemic communities. • All thirteen districts are endemic with Onchocerciasis • Seven out of thirteen districts are co-endemic with Filariasis and Onchocerciasis • The W estern Region is supported by Sight Savers International(SSI) • W orld Vision International(W VI) is also supporting Ahanta W est and Mpohor W assa East

3.4.1 Specific Targets • Achieve treatment coverage of 75 per cent or more in the year 2006. • Train 900 community distributors and 24 health workers in: • Effective Information, Education and Communication in Ivermectin distribution. • Undertake an epidemiological evaluation to study the impact of treatment distribution.

60 2005 GHS Annual Report, W estern Region

3.4.2 Activities undertaken to m eet Objectives • Review meeting organized for District Director of Health Service Disease Control Officers and District Public Health Nurses to review activities in the past year. • Trained 24 health workers and 900 volunteers between the second and third quarters of the year. • Undertook support and monitoring visits to endemic communities.

3.4.3 Perform ance against Objectives: Treatment coverage of 75.3% (the highest in 4years) was achieved in the year 2005 as against 75% in 2004. Table 10: Sum m ary of Iverm ectin Treatm ent Coverage – 2005 Indicator Target Achievem ent Number of endemic 54 52 sub-district

Number of communities to treat 988 963

Population of endemic 860,815 648,125 communities

Treatment coverage 80% 75.3%

Geographic coverage 100% 97%

61 2005 GHS Annual Report, W estern Region

The table 11: shows coverage for Albendazole and Iverm ectin in seven districts

Albendazole & Ivermectin Coverage-2005

District Total Number 2005 TP* 2004 TP* Population Treated coverage. coverage (%) (%) Ahanta West 87,904 64,560 73.4 76.7 Aowin Suaman 139,388 92,236 77.9 80.8

Jomoro 114,748 88,281 76.9 84.3 Mpohor Wassa 124,323 94,239 75.8 78.6 Nzema East 98,198 71,945 73.3 74.6 Shama Ahanta 317,925 292,624 96.4 -

Wassa West 123,802 1100,408 81.1 81.8 REG 1,006,288 820,693 81.6 72.8

* TP=Total Population In 2005, W orld Vision International supported Ahanta W est and Mpohor W assa East to conduct 20 surgeries on cases identified during Mass Drug Administration. In 2004, 39 of the surgeries were done by a visiting surgeon in four districts. The costs of all the surgeries were borne by the Program.

62 2005 GHS Annual Report, W estern Region

3.4.5 Key Achievem ent • Good data capture in all district • Effective social mobilization in some district created demand for the drug • A slight increase in treatment coverage from 75% in 2004 to 75.3% in 2005 • Involvement of other partners and sectors in programme implementation

3.4.6 Key Challenges • Non-availability of vehicle hampering effective monitoring and supervision. • W eak supervision at all levels

3.4.7 Key Recom m endation • It is recommended that a vehicle be provided to ensure effective monitoring and supervision

3.4.8 Projections for 2006 • Review meeting for District Director Health Services, District Disease Control Officer and District Public Health Nurses • Training of health staff and community distributors • Support weak performing districts during distribution • Monitoring and support visit to selected districts • Epidemiological evaluation in 5 selected endemic communities • Post review meeting for District Directors of Health Services, District Disease Control Officers and District Public Health Nurses after distribution

63 2005 GHS Annual Report, W estern Region

3.5 Priority Diseases

M alaria Malaria is still the number one of cause morbidity and mortality in children less than five years and the commonest cause of outpatient visit and hospital admissions in health facilities in the region. It accounts for 45.8% of OPD attendances, 31.7% of admissions and 17.2% of deaths in the year 2005. Table 12: Under 5 M alaria Case Fatality Rate Districts 2003 2004 2005 Sefwi W iawso 2.47 3.35 2.60 Bibiani A. Bekwai 1.86 1.82 6.85 Juabeso 0 Bia 0 0 0 W assa Amenfi East 1.96

W assa Amenfi W est 2.11 1.52 2.68 Aowin Suaman 3.76 2.95 1.45 W assa W est 2.51 1.42 1.65 Mpohor W assa East 0 0 0 Ahanta W est 9.52 4.29 2.15 Shama Ahanta East 12.38 10.62 10.51 Nzema East 2.21 3.36 3.80 Jomoro 1.18 2.70 2.58 REGION 3.06 3.53 3.36

64 2005 GHS Annual Report, W estern Region

There was slight increase in case fatality rate from 2003 to 2004 and a marginal drop in 2005. Over the past three years Sefwi W iawso reported a comparative high case fatality rate. Aowin Suaman district showed a consistent decrease in CFR over the 3-year period. About 95% of the cases from Shama Ahanta East were reported from the Regional Hospital.

3.5.1 GLOBAL FUND M ALARIA PROGRAM M E Three districts in the region namely Mpohor W assa East, Aowin Suaman and Ahanta W est have piloted the Global Fund Malaria Programme. This has been scaled-up to include other ten districts. The Programme focused on three key areas and it essentially targeted at children less than 5 years and pregnant women.

3.5.2 The key areas were: • Increasing the availability, accessibility and use of Insecticide Treated Bednet (ITNs) in the population particularly among children under five and pregnant women. • Intermittent Preventive Treatment(IPT) using Sulphadoxine - Pyrimethamine in the prevention of malaria in pregnancy • Case Management at the facility and community level (Home- based care of malaria)

3.5.3 Key activities All the activities that were planned for the year could not be implemented due to the late release of Global funds to the Region. The activities undertaken were:

65 2005 GHS Annual Report, W estern Region

• Forty-two health staff of various categories were trained in Intermittent Preventive Treatment(IPT) • Distribution of 7,700 Insecticide Treated bednets in 2005 • Distribution of Sulphadoxine Pyramethamine(S-P) for the Intermittent Preventive Treatment of pregnant women for the prevention of Malaria. • Awareness creation on malaria in the communities and the local FMs in the districts

66 2005 GHS Annual Report, W estern Region

3.6 HIV/AIDS/STI

HIV/AIDS continues to be a major public health challenge because of its socio-economic impact on the region. The region in 2004 had 3 Sentinel site in Shama Ahanta East, Nzema East and Sefwi W iaso Districts. All these sites had a prevalence rate above 4%. The W estern Region in the 2004 surveillance prevalence rate of 4.6% that is far above the National Prevalence of 3.1% (2004). In 2005 W assa W est was added to the sites in the region to bring the number to Four (4) As part of efforts to control the spread of the disease, a number of activities were undertaken in 2005 with emphasis on behaviour change messages and the provision of clinical care to support those living with the disease.

3.6.1 Key issues at the beginning of Year • Establishment and operation of VCT/PMTCT sites in the districts. • Training of doctors/ Nurses in Syndromic Management of STIs / opportunistic infection management. • Establishment of PLW HA Association • Intensify Health promotion activities.

67 2005 GHS Annual Report, W estern Region

3.6.2 Strategies adopted to address issues • Training of health staff to man VCT/PMTCT sites • Secure funds from GHS/NACP for STI/ opportunistic infection training. • Linking- up with other NGOs to form Association of PLW HAs and support them. • Use of FM / Local TV and other organized groups i.e. churches, Associations

3.6.3 Achievem ents At the end of 2005, 16 Health facilities have trained staff for their VCT/PMTCT sites including 2 Mission Hospitals. A total of 72 Health Personnel were trained for the VCT/ PMTCT sites made up of: Midwives - 28 PHN - 11 CHN - 8 Gen.Nurses -24 Pharmacist - 1

68 2005 GHS Annual Report, W estern Region

3.6.5 Voluntary Counseling and Testing • 25 Health/Personnel made up of pharmacist, doctors and nurses were trained to start the ART clinic in Effia Nkwanta Hospital. • 32 Community Health W orkers and 20 doctors were trained in Syndromic Management of STIs in September and November 2005. Table 13: Voluntary Counselling and Testing Indicators Gender Male F emale Pre-test Counseling 170 203 Tested 167 200 Receiving Result 126 152 Positive Result 27 47

3.6.6 Prevention of M other to Child Transm ission of HIV The report on prevention of mother to child transmission of HIV covered the period of November to December 2005. Although 2 of the mothers tested were positive and received post test counseling, none of them was given Niverapine during labour.. • No receiving Pretest counseling 161 • No tested 28 • No positive 2 • No receiving post test counseling 2

69 2005 GHS Annual Report, W estern Region

3.6.7 STI / Opportunistic Infections M anagem ent • Urethral discharge 13 • Vaginitis 84 • Cervicitis 557 • Genital ulcer 3 • Genital wart 10 • Genital herpes 9 • PID 10 • Neonatal conjunctivitis 1 • HIV New cases 259 • Male condom 172,266 • Female condom 1,630 • Opportunistic infection 951

70 2005 GHS Annual Report, W estern Region

Table 14: HIV Sero Prevalence (Donors) 2004 2005 PHRL 2.3 3.2 Nzema East 4.0 6.1 Jomoro 9.6 7.6 W assa W est 8.9 10.6 W assa Amenfi 10.1 8.3 Aowin Suaman NA 0.7 Sefwi W iawso 3.0 5.4 Bibiani A. Bekwai NA 1.26 Mpohor W . East 0 0 Shama A. East 5.6 4.8 Juabeso-Bia 0 0 Ahanta W est NA 0 Regional 4.6 6.4

The proportion of blood donors with reactive blood sample increased from 4.6% in 2004 to 6.4% in 2005. In 2005 the highest proportion of reactive blood sample of 10.6% was recorded in W assa W est district and the lowest of 0.7% from Aowin Suaman district. There was no data from Mpohor W assa East, Juabeso-Bia and Ahanta W est districts in 2005.

71 2005 GHS Annual Report, W estern Region

3.6.8 Challenges • Lack of commitment on the part management in setting up of VCT/PMTCT Centres in their facilities • Non commitment of trained Personnel on HIV activities • Lack of transport for monitoring and supervision • High attrition rate / Turn over of staff (Nurses) • Lack of motivation of trained staff

3.6.9 Outlook for 2006 • Solicit the help/ support of senior managers to provide VCT/PMTCT centres • Liaise with other programme officers for transport for HIV/AIDS activities • Build capacity of service providers

3.7 Tuberculosis 3.7.1 Key Activities: • Monitoring of TB microscopy centres • Refresher training of 33 H/S in four districts (Shama Ahanta East, Mpohor W assa East, Ahanta W est & Nzema East) • Region supervised training in three districts (W assa Amenfi, Jomoro & Sefwi W iawso) • Four planned in 2005 POW • Celebration of W orld TB Day • Community meetings/Durbars A total of about 600 were sensitized in four communities in the Metro

72 2005 GHS Annual Report, W estern Region

3.7.2 Case Detection For every 100,000 population it is expected that 200 new cases of TB should be detected. W estern region with a projected population of 2,275,855 is expected to report 2,731 cases of tuberculosis. In 2005, the region recorded a total of 1191 cases representing a case detection rate of only 47.3% as against a National target of 55%.

Table 15: TB treatm ent analysis trend 2002, 2003 and 2004 2002 2003 2004 New Smear + 1099 1217 1265 Evaluated 884 849 1170 % Evaluated 80 70 92 Cure Rate 59 53 56 Combined Rate 66 58 65 Defaulter Rate 23 26 23 Failure Rate 2 5 3 Death Rate 4 7 3

The proportion of new smear positive cases evaluated increased from 70% in 2003 to 92% in 2004. Defaulter rate has also decreased from 26% in 2003 to 23% in 2004. This was as a result of most of districts declaring treatment outcome. The treatment success rate has (combined rate) also appreciated from 58% in 2003 to 65% in 2004.

73 2005 GHS Annual Report, W estern Region

3.7.3 Key Challenges • Stigmatization and the morbid fear of the disease • Poor documentation • Late and incomplete returns submission resulting in irregular supply of drugs • Some districts do not submit Cohort analysis even after training

3.7.4 Outlook for 2006 • Strengthening District & Institutional Management of TB Program • Quarterly joint review meetings with Region and districts • Refresher training for District TB Coordinators & Institutional TB Coordinators. • Train TB laboratory focal persons in each district to implement TB Q uality Assurance Program • Involve private practitioners in Regional TB Program • Develop region specific plans to improve case detection & treatment outcomes. • Public and Community Education on TB focusing on: • De-stigmatisation, • Seeking early and compliance of treatment • Institute quarterly TB awareness week at all levels in the region • Support for TB patients to complete treatment

74 2005 GHS Annual Report, W estern Region

3.8 Buruli Ulcer 12 suspected cases of Buruli Ulcer were reported from five districts in 2005 as against 23 from three in 2004. Table 16: Cases of Burli Ulcer reported, 2003-2005 District 2003 2004 2005 Sefwi W iawso 0 0 0 Bibiani A. Bekwai 0 0 0 Juabeso-Bia 14 11 0 W assa Amenfi East 5 W assa Amenfi W est 0 0 1 Aowin Suaman 0 0 3 W assa W est 3 0 0 Mpohor W assa East 0 0 0 Ahanta W est 0 12 2 Shama Ahanta East 0 0 1 Nzema East 0 0 0 Jomoro 0 0 0 Region 17 23 12

3.8.1 Action Taken • Dressings were supplied to Juabeso-Bia and Ahanta W est districts to manage the cases • Monitoring visits undertaken to the affected communities

3.8.2 W ay forward Active case search in affected districts • Liaise with National for financial and logistical support • Identify and set up treatment centres.

75 2005 GHS Annual Report, W estern Region

3.9. Expanded Program m e on Im m unisation(EPI)-2005 Expanded Programme on Immunization has progressed substantially. High levels of immunization coverage have been achieved for vaccine presventable diseases of childhood. At present the coverage for penta valent vaccine is above 80% in most of the districts (10 out of the 13 districts)

The following activities were under taken in order to improve upon coverage: • Routine immunisation against vaccine preventable disease • Cold chain inventory was conducted in all districts to determine the state of equipment • Implementation of four rounds National Immunisation Days against poliomyelitis • Monitoring of private midwives in EPI

76 2005 GHS Annual Report, W estern Region

3.9.1. Routine Im m unization Table 17:. Penta 3 coverage by districts in W estern Region, 2003-2005

Penta 3 Coverage

2003 2004 2005 Achievement Achievement Achievement Sefwi 114 95 99.3 Bibiani A. Bekwai 110 87 81.2 Bia Juabeso 170 125 135 Wassa Amenfi East 101.2 Wassa Amenfi West 96 90 100.4 Aowin Suaman 107 97 92.9 Wassa West 108 87 84.3 Mpohor Wassa East 89 69 93.3 Ahanta West 79 57 78.5 Shama Ahanta East 80 66 76.1 Nzema East 87 84 83.6 Jomoro 116 71 86 REGIONAL 109 84 92.8

Only three districts attained the target of 90% in 2005. Five other districts recorded coverage’s above 80% but below 90%. Sefwi W iawso, Ahanta W est and Shama Ahanta W est recorded coverages below 80%.

77 2005 GHS Annual Report, W estern Region

Fig 3: 2005 Penta 3 Coverage in ascending order

SAE

AW

BAB

Nzema East

Wassa West

t Jomoro c i r

t Aowin Suaman s i

D Mpohor Wassa East

Sefwi Wiawso

Wassa Amenfi West

Wassa Amenfi East

Bia

Juabeso

0 50 100 150 200 % Coverage

78 2005 GHS Annual Report, W estern Region

Table 18: BCG Coverage (%) By District 2003 – 2005 District 2003 2004 2005 Sefwi W iawso 130 102 106.4 Bibiani A. Bekwai 116 83 98.9 Juabeso-Bia 193 137 134.8 W assa Amenfi East 122 W assa Amenfi W est 131 109 112 Aowin Suaman 116 107 122 W assa W est 124 103 99 Mpohor W assa East 106 77 89.8 Ahanta W est 85 66 76.5 Shama Ahanta East 103 85 97.2 Nzema East 118 108 101.3 Jomoro 131 88 94.7 Region 126 100 105.7

Using 4% of the population as target for children under one in 2005, six districts recorded over 100% coverage. Ahanta W est recorded the lowest coverage of 76.5 %.

79 2005 GHS Annual Report, W estern Region

Fig 4: BCG perform ance for 2005 in descending order:

140 120

e 100 g a r 80 e v

o 60 C

40 % 20 0 WA WA W BA SA JO M JB AS SW NE AW E W W B E M WE BCG 135 122 122 112 106 101 99 99 97 95 90 77 District

Table 19: M easles Coverage (%) By District 2003 – 2005 District 2003 2004 2005 Sefwi W iawso 116 91 88.9 Bibiani A. Bekwai 114 83 77.9 Juabeso-Bia 191 137 122.9 W assa Amenfi East 95.9 W assa Amenfi W est 104 82 89.6 Aowin Suaman 105 95 95.6 W assa W est 119 103 86.2 Mpohor W assa East 87 65 84.4 Ahanta W est 74 54 59.6 Shama Ahanta East 75 62 70.9 Nzema East 86 75 73.1 Jomoro 106 67 80.8 Region 109 86 86

80 2005 GHS Annual Report, W estern Region

The Regional measles coverage stagnated over the two year period. However, five districts recorded coverages below the regional coverage of 86%. Ahanta W est recorded the lowest coverage of 56.6%.

Fig 5: M easles coverage in ascending order for 2005, W estern Region

Ahanta West Shama Ahanta

Nzema East

Jomoro

Mpohor Wassa East t c

i Wassa West r t s i Sefw i Wiaw so D Wassa Amenfi West

Aow in Suaman

Wassa Amenfi East

Bibiani A. Bekw ai

Juabeso

0 20 4%0 Co6v0erage80 100 120 140

81 2005 GHS Annual Report, W estern Region

Table 20: Yellow Fever Coverage (%) By District 2003 – 2005 District 2003 2004 2005 Sefwi W iawso 114 91 92.6 Bibiani A. Bekwai 110 83 77.8 Juabeso-Bia 171 137 126 W assa Amenfi East 95.7 W assa Amenfi W est 96 82 90.1 Aowin Suaman 107 95 95.2 W assa W est 108 109 87.3 Mpohor W assa East 89 65 84.8 Ahanta W est 89 54 65.7 Shama Ahanta East 80 62 62.3 Nzema East 87 75 71 Jomoro 110 67 77.6 Region 106 86 79.2

There was a fall in the regional coverage from 86% in 2004 to 79.2% in 2005. Five districts recorded coverages above 90%. Shama Ahanta East recorded the lowest coverage of 62.3%.

W assa W est recorded a drastic decline of 21.7% in coverage reported in 2004 as compared to 2005.

82 2005 GHS Annual Report, W estern Region

Fig 6: Yellow Fever : Perfom ance by districts: 2005

Juabeso

Wassa West

Aowin Suaman

Sefwi Wiawso

Wassa Amenfi West t c

i Wassa West r t s

i Mpohor Wassa East D Bibiani A. Bekwai

Jomoro

Nzema East

Ahanta West

Shama Ahanta East

0 20 40% Co6v0erage80 100 120 140

83 2005 GHS Annual Report, W estern Region

3.9.2. Yellow Fever M ass (YF) Cam paign

Mass Yellow Fever campaign was conducted between 14th and 15th July, 2005 as a result of a confirmed Yellow fever case in the Central Region. The districts where the campaign was conducted included: • W assa Amenfi East(the whole district) • Bibiani Anhwiaso Bekwai • W assa Amenfi W est (two sub-districts that share boundary with the first two district named above)

Table 21: Cam paign Result District Total num ber im m unized Coverage 1. W assa Am enfi East 85,470 79.4

2. W assa Am enfi W est 54,084 99.5 3. Bibiani A. Bekwai 112,854 97.3 Region 252,408 90.8

3.9.3 W ay forward • As part of IDSR, Yellow Fever surveillance is-going for early and prompt detection of cases which report at the health facilities • Community based surveillance volunteers have been sensitized to conduct active search in communities • Communities have also been sensitized to report to the nearest facility signs and symptoms of the disease

84 2005 GHS Annual Report, W estern Region

3.9.4 Access and Utilization

Figure 7: 2005 Penta 1 and Drop Out Rate (DOR)

Penta 1 and Drop Out Rate - 2005

e 200 20 g a

r 15 e

150 )

v 10 o %

5 ( C

100 R -

0 O 1

-5 D a 50 t

n -10 e 0 -15 P BA WA WA W MW SA JO RE SW JB BIA AS AW NE B W E W E E M G Penta 1 89 82 146 135 106 117 110 89 82 79 79 86 96 96 DOR -0.4 0.8 8.6 2.2 6.9 6.9 17 2.2 -1.6 0.6 -8.8 2 10 4.1 District

Figure 7 shows that access to immunization services (Penta 1 as proxy indicator) generally was good except in the Ahanta W est which has the least access to eligible children. This suggests weak outreach services. The district needs to strengthen outreach services in order to reach the hitherto un-reached area. The drop out rate (DOR) Shama Ahanta East -8.8%, an indication of influx of people into the metropolis or might be due to poor quality data.

Though access is not problematic in Jomoro districts, the drop out rate (DOR) of 10%. The highest DOR of 17% in the Aowin Suaman district is an indication a downward trend in outreach services in the district of low utilization due to compromise quality of service.

85 2005 GHS Annual Report, W estern Region

3.9.5. National Im m unization Days (NIDs)

Four rounds of national immunisation days were organised in 2005. The regional coverage for second round NID in December 2005 was 103 %, however an evaluation of the exercise recorded 98% coverage.

Table 22

NID PERFORMANCE-2005

NID Rds Chn vacc Zero Dose Zero % 0-59mhs <1yr Dose Cov >1yr Feb 653,859 4,767 26 100

April 644,783 5590 5 99

Oct 652,801 7,422 21 100

Dec 671,096 4,085 0 103

Generally, the coverage was good with all districts attaining more than 90%. Except in few districts evaluation result conducted by supervisors was close to those obtained by the districts.

86 2005 GHS Annual Report, W estern Region

3.9.6 Key Achievem ents • EPI coverage training and survey was successfully carried out. • Four rounds NIDs were conducted. • The region assisted 3 districts to implement (RED) approach. • There was no vaccine shortage during the period under review.

3.9.7 Issues / Challenges • Late submission of returns • Adverse Effect Following Immunizations not being reported • Poor data capture (immunisation returns, vaccines and logistics balancing etc) • Late submission of Cold chain Inventory • Data not analysed in some districts • Inadequate transport at sub-district level for outreach

3.9.8 Recom m endation • Data management training in EPI and Surveillance. • Monitoring of sentinel sites for vaccine wastage and use • Use of RED approach strategy in low performing districts to improve immunization coverage. • Acquire new motorbikes.

87 2005 GHS Annual Report, W estern Region

4.0. Reproductive Health Services 4.0.1 School Health

The target set for school health services was 30% and 33.4% was achieved in the period under review as compared to 26.6% in 2004 an increase of 6.8%. All the districts performed school health services. Five districts exceeded the regional target with the highest coverage of 71.3% recorded in Shama Ahanta East district.

Over 5,000 school children in Mpohor W assa East district were de- wormed in all communities in the district with Albendazole. W orld Vision International, an NGO in the district, provided assistance to the DHMTs.

4.0.2 Adolescent Health

There are only two functional adolescent corners in the region. These are located in Shama Ahanta East and Jomoro districts. The number of adolescents seen was 13,775 out of which 13,687(99.4%) were pregnant. There were 20 adolescents with sexually transmitted infections. Efforts will be made in 2006 to target adolescent in and out of schools that are not yet pregnant.

Two other districts namely W assa Amenfi and Aowin Suaman are in the process of establishing adolescent friendly facilities. Some of the health staff have been given training in adolescent health and health talks are given to youth groups in Junior and Senior Secondary Schools.

88 2005 GHS Annual Report, W estern Region

4.0.3 Integrated M anagem ent of Childhood Illness (IM CI) 4.0.3.1 Breastfeeding / Baby friendly Hospital initiative Twelve health facilities that were preparing to be designated baby friendly in the Bibiani and Jomoro districts were monitored and supported. These facilities will be ready for designation in 2006 Table 23: Exclusive Breastfeeding in Health Facilities District M other/ Infant pairs M other Infant pair % of m other /infant discharged exclusively BF at pair exclusively discharge BF at discharge SAE 7090 6985 98.5 AW 832 798 95.9 M W E 1287 1268 98.5 NE 2916 2916 100 JOM 1218 1218 100 W W 5616 5614 100 W AE 645 645 100 W AW 1375 1375 100 AS 1150 1150 100 BAB 2064 2064 100 SW 2247 1691 75.3 JB 973 944 97.0 BIA 1644 1606 97.7 REGION 29057 28274 97.3

Apart from Sefwi W iawso district the prevalence of exclusive breastfeeding among newly born babies is very high – above 95%. There is need to support Sefwi W iawso district to achieve a higher level of exclusive breastfeeding among the new born babies to promote proper growth and development.

89 2005 GHS Annual Report, W estern Region

4.0.3.2 Outlook for 2006 • Train 80 health workers in lactation management in Ahanta W est, Sefwi W iawso and Aowin Suaman districts. • Designate 15 health facilities baby friendly • Celebrate world breastfeeding month • Monitor 6 health facilities that are designated baby friendly • Carry out survey to determine exclusive breastfeeding in 2 districts.

4.1 Safe M otherhood

4.1.1 Ante Natal Care. The total number of antenatal registrants decreased from 85,314 in 2004 to 82,119 in 2005. This represent about 8% decline over the previous years performance. The overall coverage for 2005 was 90.8%. There were wide district variations in ANC coverage in 2005. W hilst seven district recorded coverage’s above the regional coverage, a few districts namely Mpohor W assa East and W assa Amenfi East had relatively low coverage’s of less than 70%.

4.1.1.1 Average Visit

It is expected that each pregnant woman make at least 4 Ante Natal Care visits. In 2004 the average visit made by each pregnant woman was 2.7; however the average visit per client increased to 3.2 in 2005

90 2005 GHS Annual Report, W estern Region

Table 24: Trend of ANC coverage in W estern Region 2003-2005 2003 2004 2005 Sefwi W iawso 135.1 132.4 107.4 Bibiani A. Bekwai 164.8 128.1 104.4 Bia 89.2 Juabeso 154.8 119.6 96.2 W assa Am enfi East 65.7 W assa Am enfi W est 118.4 80.4 92.9 Aowin Suam an 166.7 137.6 123.5 W assa W est 127.9 97.8 101.2 M pohor W assa East 86.4 59.9 58 Ahanta W est 92.4 71.2 72.9 Sham a Ahanta East 105.3 83.1 82.8 Nzem a East 128.5 103.8 99.5 Jom oro 103.3 72.8 84.3 Region 124.4 97.7 91.1

91 2005 GHS Annual Report, W estern Region

Fig 8: ANC coverage in 2005 by districts from highest to lowest 0 5 1 0 0 1 e g a r e v o C

0 5 % 0 AS SW BAB WW NE JBDisWtArWict BIA JOM SAE AW WAE MWE

92 2005 GHS Annual Report, W estern Region

4.1.2 Supervised Delivery

The introduction of free delivery service in the region did not impact significantly on the number of registered deliveries (Skilled health personnel attended) in the region. Although there has been gradual increase in supervised delivery coverage over the past three years, the proportion of pregnant women attended to by skilled health personnel is still far from the national target of 50%. (Refer Table 19 )

Table 25: Supervised Deliveries by districts 2003 - 2005

2003 2004 2005 Sefwi W iawso 38.0 54.5 40.4 Bibiani A. Bekwai 77.6 43.0 49.1 Bia 30.1 Juabeso 31.3 20.7 26.2 W assa Am enfi East 16.5 W assa Am enfi W est 26.5 24.8 24.5 Aowin Suam an 31.3 35.0 24.1 W assa W est 51.2 47.7 52.3 M pohor W assa East 25.2 24.8 26.9 Ahanta W est 17.3 29.6 24.1 Sham a Ahanta East 52.7 50.6 45.1 Nzem a East 47.3 50.6 45.8 Jom oro 26.5 25.7 24.3 Region 26.5 28.0 35.8

93 2005 GHS Annual Report, W estern Region

In 2005, trained TBA accounted for 31.8% of all deliveries in the region compared to 17% in 2004. The supervised deliveries conducted by both health personnel and trained TBAs is therefore 67.6% in 2005 as compared to 45% in 2004.

Fig 9:

Supervised Delivery 0 6 0 4 e g a r e v o 0 2 C

% 0 WW BAB NE SAE SW BIA MWE JB WAW JOM AW AS WAE District

4.1.3 Post Natal Coverage Post Natal Coverage for 2004 was 33.9% as against 35.6% in 2005. Bibiani A. Bekwai recorded the highest post natal coverage of 51.6% in 2005. Sefwi W iawso reported very low coverage of less than 10%.

94 2005 GHS Annual Report, W estern Region

Table 26: Post Natal Coverage by Districts, 2003, 2004 & 2005 Com pared 2003 2004 2005 Sefwi W iawso 21.5 19.2 6.7 Bibiani A. Bekwai 86.7 61.9 51.6 Bia 25.9 Juabeso 53.6 38.1 29.7 W assa Am enfi East 28.8 W assa Am enfi W est 45.6 24.4 36.7 Aowin Suam an 23.1 38.9 48.0 W assa W est 59.1 37.6 47.1 M pohor W assa East 63.5 25.5 22.1 Ahanta W est 53.2 43.6 44.3 Sham a Ahanta East 60.0 45.6 50.3 Nzem a East 26.7 13.7 23.9 Jom oro 33.4 12.1 16.7 Region 50.0 33.9 35.6

95 2005 GHS Annual Report, W estern Region

Fig 10: Post Natal Coverage by Districts, 2005 in ascending order

SW

JOM

MWE

NE

BIA

WAE

JB

WAW

AW

WW

AS

SAE

BAB

0 10 20 30 40 50 60

96 2005 GHS Annual Report, W estern Region

4.1.4 M aternal M ortality Institutional Maternal mortality has been declining over the past 4 years (from 2001 to 2004). In 2005 there was a dramatic increase in maternal mortality ratio as shown figure 12.

Figure 11: Regional Trend of M aternal M ortality Ratio 2001 – 2005

300 250 0 0 0

, 200 0 0

1 150 / R

M 100 M 50 0 2001 2002 2003 2004 2005 MMR 230 240 210 170 279 Year

97 2005 GHS Annual Report, W estern Region

Table 27: M aternal Deaths and Audit by Districts - 2005 District M aternal Num ber Audited % Death 2005 Audited Sefwi W iawso 13 13 100 Bibiani A. Bekwai 1 0 0 Bia 0 0 0 Juabeso 2 0 0 W assa Am enfi East 3 0 0 W assa Am enfi W est 2 2 100 Aowin Suam an 8 5 62.5 W assa W est 12 12 100 M pohor W assa East 0 0 0 Ahanta W est 1 0 0 Sham a Ahanta East 32 32 100 Nzem a East 12 3 25 Jom oro 1 0 0 Region 87 67 77

Shama Ahanta East District continues to record the highest number of maternal deaths in the region. This is due to the high number of maternal deaths from the regional hospital which is located in the district and the high population density in the metropolis. Most of the districts are not auditing their maternal death. A team from the Regional Health Directorate conducted a study tour to the Central Region to find out how the safe motherhood programme in that region was organised. A regional maternal audit task team has been formed to reorganise the W estern Region Safe Motherhood programme along similar lines.

98 2005 GHS Annual Report, W estern Region

4.1.5. Fam ily Planning

The regional coverage for family planning services for 2005 showed a dramatic decline compared to what was obtained in 2004. Four districts namely Ahanta W est, Nzema East, Jomoro and Sefwi W iawso have shown consistent increase in family planning acceptors. There was a drastic decline in the acceptor rate in Juabeso-Bia in 2005 compared to 2004. Table 28: Trend of FP Acceptor Rate by districts 2003-2005 District 2003 2004 2005 Sefwi W iawso 13.7 16.6 3.8 Bibiani A. Bekwai 13 13.2 8.6 Bia 5.9 Juabeso 42.3 29.1 10.4 W assa Am enfi East 8.5 W assa Am enfi W est 30.1 38.4 34.4 Aowin Suam an 15.2 24.2 17.9 W assa W est 12 10 7.4 M pohor W assa East 6.1 10.5 14.7 Ahanta W est 18 20.9 11.9 Sham a Ahanta East 12.3 27.5 6.4 Nzem a East 11.2 13.8 11.9 Jom oro 8.2 13.5 8.3 Region 18.1 17.6 10.4

99 2005 GHS Annual Report, W estern Region

4.1.5.1 M ethod Preference Depo-Provera still remained (3-monthly progesterone only injectable contraceptive) the highest and most preferred method, followed by combined pill. The total number of users declined drastically from 27,774 in 2004 to 8082 in 2005, the drop might probably be due to shortage of the commodity during the last quarter of 2005.

Oral Pill users also dropped from 21,722.1 in 2004 to 12,304 in 2005. There was no vasectomy performed in 2004 and 2005

4.1.5.2 Couple Year of Protection by m ethod The total CYP for 2005 was 25,109 as against 58,041 in 2005 showing a decrease of 32,932. There was also a decline in long term method in 2005 by 1,561. In 2004, Ghana Health Service had 63,205 representing about 94% of the total of 67,286 CYP for both Short and Long Term Methods.

100 2005 GHS Annual Report, W estern Region

Table 29: Couple Year Protection by M ethod For Public Health Sector 2004 & 2005 com pared 2004 2005 Contraceptive CYP Total CYP Total Short Term Method Orall Pill 21,722.1 12,304 Condoms 7407.4 3,412 Spermicides 151.1 135 Norigynon 987.2 1228 Depo Provera 27,774 58,041 8082 25,109 Long Term Methods IUD 898 602 Female Sterilization 2,713 1,804 Norplant 1614 1,257 Vasectomy 0 5,224 0 3,663

Table 30: Fam ily Planning – Acceptor by M ethod 2004 - 2005

Regional Achievement 2004 Achievement 2005 Figure Figure Male Condom 7,885 6727 Female Condom 49 210

There was a reduction in male condom whilst the female condom use also increased in 2005.

101 2005 GHS Annual Report, W estern Region

5.0. Nutrition and Child Health

5.0.1. Growth Prom otion Table 31: M alnutrition (Under W eight) Am ong Children 0 – 5 yrs Attending Child W elfare Clinic 2004

NO OF CHNN O < 80% OF STD. % < 80% STD DISTRICT W EIGHED SAE 18591 3.4 641 5078 9.6 AW 489 7171 NA MW E NA 15610 12.4 NE 1934 11795 14.9 JOM 1755 16823 5.1 W W 865 6998 19.9 W AE 1391 31006 2.3 W AW 718 9985 21.9 AS 2191 11355 16.3 BAB 1854 19202 26.2

102 2005 GHS Annual Report, W estern Region

SW 5025

29171 4.6 JB 1339 13832 8.4 BIA 1160 REGION 196617 19362 9.8

Overall about 10 % of preschool children attending child welfare clinics are underweight. Prevalence of underweight was highest in Sefwi W iawso district and lowest in Shama Ahanta East district. Mpohor W assa East did not do any further analysis on weight of children collected.

During the child health promotion week celebration in May 2005, the weights of children collected from 7 districts were analyzed using EPI Info programme.

103 2005 GHS Annual Report, W estern Region

Table 32: Prevalence of underweight am ong children under 5 yrs weighed during CHPW in M ay 2005

District No of chn No of % underweight weighed chn underweight SAE 161 14.7 1098 AW 507 136 26.8 M W E 446 59 13.2 NE 739 100 13.5 W W 1370 232 16.9 W AW 300 36 12 SW 1025 185 18.0

TOTAL 5485 909 16.6

Out of a total of 5485 children weighed, 909 representing about 17% were found to be underweight. Ahanta W est district recorded a disproportionately high prevalence of underweight compared to the other districts.

5.0.2. Key Issues • Nutritional status data generated from child welfare clinics tend to underestimate the level of malnutrition among preschool children • Prevalence of malnutrition among children under 5 years is high in most districts; yet nutrition programmes receive little or no support in the districts. • 6 out of the 13 districts do not have District Nutrition Officer.

104 2005 GHS Annual Report, W estern Region

5.0.3 W ay forward • Create sentinel sites in the region for reliable data generation on the nutritional status of children. • Advocate support for nutrition activities at the district level. • Build capacity of district / sub district staff to manage nutrition data effectively • Lobby for the recruitment of new nutrition staff

5.1 Breastfeeding / Baby friendly Hospital Initiative This programme which started in the region about 9 years ago has the aim of protecting promoting and supporting breastfeeding at both community and health facility level. Ultimately all health facilities in the region where maternity services are provided and deliveries are done should be designated baby friendly.

5.1.1 Activities carried out • Lactation management training was done in Bibiani and Jomoro districts. • There was monitoring of 12 health facilities preparing to be designated baby friendly in Jomoro and Bibiani districts. • A presentation on breastfeeding using Profiles was made to about 30 stakeholders in August as part of W orld breastfeeding awareness month. This programme was jointly organized with Ghana Sustainable Change Project • An officer from the region was trained on how to monitor health facilities that have already been designated baby friendly.

105 2005 GHS Annual Report, W estern Region

5.1.2 Outlook for 2006 • Train 80 health workers in lactation management in Ahanta W est Sefwi W iawso and Aowin Suaman districts. • Designate 15 health facilities baby friendly • Celebrate world breastfeeding month • Monitor 6 health facilities that are designated baby friendly • Carry out survey to determine exclusive breastfeeding in communities in 2 districts.

5.2. M icro Nutrient Deficiency Control 5.2.1 Vitam in A Deficiency Control Strategies to control vitamin A deficiency among children and lactating mothers include: • Twice a year mass dosing of children at 6 months interval • Providing vitamin A during routine immunization of children • Post partum vitamin A supplementation • Encouraging the production and consumption of vitamin A rich foods.

Targets: To achieve at least 90% coverage during m ass dosing of children and 80% during routine im m unization. Ensure that at least 60 % of m others who deliver are provided with vitam in A supplem ents.

106 2005 GHS Annual Report, W estern Region

5.2.2 Activities carried out: • There were 3 rounds of mass vitamin a supplementation for children in April and November alongside NID. Also in May, vitamin A was given to eligible children as part of child health week promotion. • Vitamin A capsules were administered to mothers within 8 weeks after delivery in all government health facilities.

5.2.3 Achievem ents • The coverages of vitamin A supplementation for children in April and November were 93% and 99.2% respectively. ( fig 12 )

Fig 15:

Vitamin A supplementation coverage for chn 6-59 mths in April & Nov 2005

120.0

100.0

80.0 e g a r e

v 60.0 o c

%

40.0

20.0

0.0 SAE AW MWE NE JOM WW WAE WAW AS BAB SW JB REG Apr 86.0 103.1 92.2 104.6 88.6 92.2 95.5 94.0 81.9 111.0 90.4 93.8 92.3 Nov 100.8 102.7 102.8 101.6 102 104.1 80 94.9 98.7 107.9 101.8 94.4 99.2 Districts

107 2005 GHS Annual Report, W estern Region

The regional coverage of vitamin A supplementation increased by 6.9 percentage points between April and November 2005. Only 3 districts ( Ahanta W est,Nzema East& W assa Amenfi East) showed a decline in coverage in November compared to April.

Fig 13:

Trend of VAS coverage for children 6- 59 month during Nov./ Dec supplemetation. 2003-2005

100

99 99.2

98

97 e g

a 96 r e v o C 95 %

94 94 93.9

93

92

91 2003 2004 2005 Year

Between 2003 and 2004 the coverage of vitamin A supplementation for children was around 94%. However in 2005, there was an increase in coverage to 99.2% due to better micro planning at sub district level and improved monitoring and supervision during field work

108 2005 GHS Annual Report, W estern Region

Table 33: M aternal Vitam in A supplem entation, 2003-2005 District 2003 2004 2005 Sham a A. East 21.3 42.4 36.6 Ahanta W est 8.8 19.1 18.1 M pohor W .East 52.6 33.1 22.2 Nzem a East 49.8 45.7 28.9 Jom oro 12.9 25.3 24.5 W assa W est 23.1 44.0 44.3 W assa A. East NA NA 20.1 W assa A W est 15.6 26.1 22.1 Aowin Suam an 15.1 32.6 22.7 Bibiani 29.5 50.7 43.1 Sefwi W iawso 20.5 39.2 33.1 Juabeso 6.8 27.5 26.1 Bia NA NA 15.5 Region 22.0 35.8 29.6

All districts recorded a decrease in coverage in post partum vitamin A supplementation in 2005 compared to 2004. Furthermore there is gap of 6.6% between supervised delivery (36.2%) and post partum vitamin A supplementation (29.6%)

109 2005 GHS Annual Report, W estern Region

5.2.4 Challenges • Slow / non implementation of routine supplementation for children in most districts • Data on the use of vitamin A capsule for the management of malnutrition and measles not captured at facility level. • Impact of vitamin A supplementation on the vitamin A status of children not assessed after about 7 years of vitamin A supplementation for children. • Maternal Vitamin A supplementation still limited to government health institutions in some districts.

5.2.5 Projection for 2006 • Accelerate the implementation of routine vitamin A supplementation for children • Improve data capture on vitamin A supplementation at all levels • Extend maternal vitamin A supplementation to private care providers • Lobby at the national level for impact assessment of vitamin A supplementation programme • Narrow the gap between maternal vitamin A supplementation and supervised delivery.

110 2005 GHS Annual Report, W estern Region

5.3 Iodine Deficiency Control Program m e 5.3.1 Iodine Deficiency Disorders (IDD) Consumption of iodised salt has proven to be the most cost effective method for the control of iodine deficiency disorders. Therefore the goal of programme to control IDD is to achieve universal salt Iodization (USI) in Ghana and 70 % household consumption by the end of 2005

5.3.2 Strategies/ Activities • In collaboration with the Food and Drugs Board about 100 officers from the law enforcement agencies (CEPS, MTU& MOLG) were trained on how to monitor the quality of salt at road check points and border posts. • Awareness creation on the importance of iodised salt in controlling IDD on the local FM stations • Two districts ( Shama Ahanta East & W assa W est) have been trained to iodise non iodised salt in markets. About 500 bags of salt has been iodised in Takoradi and Tarkwa markets • Regional iodised salt survey was conducted in November 2005.

5.3.3. Achievem ents The household utilization of iodised salt in the W estern Region is about 68%. Although the target of 70 % in 2005 could not be achieved coverage increased by 14.3 % from 2003 to 2005.( Table ) Most districts recorded increases in performance in 2005 compared to 2003.

111 2005 GHS Annual Report, W estern Region

Table 34: Household Utilization of iodated salt in 2005 com pared to 2003 Household Household Utilization of Utilization of Rem arks Districts iodated salt iodated salt in in 2005 2003 Sham a Ahanta East 49.1 63 Increase Ahanta W est 45.5 65 Increase M pohor W assa East 50.0 35 Decrease Nzem a East 59.1 55 Decrease Jom oro 81.8 55 Decrease W assa W est 45.5 75 Increase W assa Am enfi W est 33.0 80 Increase W assa Am enfi East Not 72.5 Available Aowin Suam an 37.9 73.3 Increase Bibiani Anhiawso Bekwai 61.4 65 Increase Sefwi W iawso 65.2 81.7 Increase Juabeso 76.1 55 Decrease Bia Not 76.7 available Total (Region) 53.2 67.5 Increase

112 2005 GHS Annual Report, W estern Region

5.3.4. Key Issues • A lot of the salt traders complain that the coarse salt that is iodised melts rapidly thereby making them loose a lot of money. • Some of the brands of iodised salt have inadequate levels of iodine. • Awareness about the importance of iodised salt is comparatively lower in the rural areas compared to the urban areas. • Commitment of the Environmental Health Division of the Ministry of Local Government in monitoring salt in sentinel markets is still low.

5.3.5 W ay Forward: • Intensify education on iodised salt especially in the rural settings. The difference between iodised and non iodised salt should be demonstrated. • Liaise with the Foods / Drugs Board Ghana Standards Board and the District Assemblies to ensure adherence to standards in the production of iodised salt. • Support the iodization of salt in markets

5.4 Anaem ia Control Program m e Anaemia ranks among the top ten causes of morbidity and mortality in most of our health institutions. People who are mostly affected are children under 5 years, pregnant and lactating women. Hence during the last 3 years of programme implementation the focus has been on preventing / controlling anaemia among children and during pregnancy.

113 2005 GHS Annual Report, W estern Region

5.4.1 Activities carried out. • Three radio talks on control of anaemia in pregnancy and among children were given in the second and third quarters of the year. • Monitoring of implementation of the programme in 5 districts was undertaken in May and November, 2005. • Training of sub district staff on integrated strategy for the control of anaemia

Fig 14: Trend of anaem ia cases in the region

Trend of anaemia cases reported from health institutions in the region 2001-2005

25000

20000

d 15000 e t r o p e r

s e s a

C 10000

5000

0 2001 2002 2003 2004 2005 Cases 19873 13952 10146 14651 14007 Year

Cases of anaemia reported from health facilities in the region declined from 2001 to 2003 but rose in 2004 when the integrated anemia programme started. The increase experienced in 2004 and in 2004 might be attributed to increased awareness and improved reporting. However there is the need for vigorous implementation of the integrated strategy for the control of anaemia especially at sub district levels for a sustained reduction in cases of anemia in the region

114 2005 GHS Annual Report, W estern Region

5.4.2. W ay Forward • Organize training on integrated strategy for control of anaemia for sub district health staff especially the midwives and Medical Assistants. • Implement malaria control programme – IPT for pregnant women • Emphasize the management of side effects of iron folic acid supplements during ANC • Conduct research to link ANC attendance, iron folic acid supplementation and Hb. status.

115 2005 GHS Annual Report, W estern Region

6.0. Health Prom otion 6.0.1 Priorities For 2005 • Create awareness on the following: • Malaria/TB/HIV/AIDS • Safe Motherhood • Celebration of National/International Health Days • Education on infection with epidemic proportions-cholera, Cerebro-Spinal Meningitis & Yellow Fever • Prevention and control of micronutrient deficiencies-Vitamin A & Iron • Prevention of Non Communicable Disease (Diabetes, Hypertension, Sickle cell) • EPI-Polio

116 2005 GHS Annual Report, W estern Region

6.0.2 Achievem ents 6.0.2.1 Health Com m unication/Public Education • Cholera awareness created on local FM on causes, prevention and early reporting of any unusual diarrhoea to health facility. • Four (4) Radio discussions on Diabetes, Hypertension and Epilepsy. • Teachers and pupils educated on causes, prevention and home based care of simple malaria in the Shama Ahanta East. • Radio discussion on local FM on NIDs. • W eekly radio discussion on local FMs on Home Based Care, promotion of use of ITN and IPT. • Radio discussions on Malaria were organized on local FM. • Community Durbars on Malaria at Ahanta W est, Mpohor W assa East and Aowin Suaman. • Radio discussions on the causes and prevention of anaemia especially in children and pregnant women • All District Assemblies formed District HIV/AIDS Response Initiatives and CBOs in the various communities to educate members on causes and prevention of HIV/AIDS. • Launching of Safe motherhood programme at • Durbar of Queen mothers at House of Chiefs on Saving W omens life

117 2005 GHS Annual Report, W estern Region

6.0.3 Capacity building & Support for Districts

Training of 42 health personnel were trained on Intermittent Preventive Treatment(IPT) in Malaria took place in November 2005

6.0.4 Distribution of support m aterials The following IE&C materials covering priority disease control areas were distributed to the districts. • Sexually Transmitted Infections • Audio Cassettes on Anaemia • HIV/AIDS • Hypertension • Polio • Lymphatic Filariasis • Onchocerciasis • Rational Drug Use • Malaria

6.0.5. Challenges / W ay Forward • No Health education staff at the district level • Non submission of Health Education Report from districts • National level workshops interrupt the implementation of scheduled work plans • Misinformation on the radio stations on cure of one herbal preparation for so many diseases • No funding of health education activities in the districts

118 2005 GHS Annual Report, W estern Region

6.0.6 W ay Forward • Strengthening districts by appointing IE&C Coordinators • Collaboration with NGOs working on Health related programmes • Train thirteen (13) district IE&C Coordinators • Provision of reporting formats to all health facilities • Strengthen IE&C on priority health problems in the five (5) year programme of work.

7.0. Special Initiative To Increase Access 7.0.1 Im plem entation of National Health Insurance

The region has 15 MHOs made up for fourteen( 14)) District Mutual Health Insuarance Schemes and one(1) Private Mutual Health Organization, The Private MHO is APOW - MU-PAH which means Appropriate Programme for womens Mutual production and Health. It is affiliated to ATW W AR (Advocates and Trainers for W omen’s W elfare Advancement and Right) APOW -MU-PAH has developed 5 schemes in Jomoro, Nzema East and SAEMA. The scheme has enrolled 4000 clients.

7.0.2. Key Activities • Development of Regional Health Insurance Scheme Formulary and Service Charges • Increase in the range of medicines and non-medicine consumables stocked at Regional Medical Stores to meet requirements of the NHIS. • Training of providers at all levels on the NHIS

119 2005 GHS Annual Report, W estern Region

• Organized stakeholders meeting on NHIS – RM, RCD, RHD, DDHS, DCES’, SMs etc. • Sensitization workshop for the Press – (Print and Electronic Media) on NHIS. • Declared the 1st – 30th October as the NHIS month in W estern Region • Sensitization of general public on NHIS through– radio presentations and jingles

Table 35: TARGETS SET FOR 2005 INDICATOR TARGET FOR 2005 ACHIEVEM ENT AS OF 31ST TARGET FOR DECEM BER 2005 2006 1. Registration 547,495 (25% of projected 545,083 (24.9%) of 50% of coverage (formal population) population Population and informal) (National target = 10% of pop)

2. Benefits eligible 437,996(20% of population) 263,973 (12.1% of 20% of coverage (upfront + population or 48% of Population NHIF t o t a l registered clients) premium payment clients)

3. Benefits offering 10 schemes (70% of 12 Schemes (85% of All 14 schemes Schemes) Schemes) Schemes (Probably 15 if establishes own scheme)

120 2005 GHS Annual Report, W estern Region

Table 36; STATUS OF REGISTRATION OF CLIENTS W ITH DM HIS IN W ESTERN REGION-2005

DISTRICT/ POP TOTAL NO OF % OF POP NO OF FULLY TOTAL PREM IUM CLIENTS W ITH CURRENT STATUS OF SUB-M ETRO REG CLIENTS REG PAID UP COLLECTED VALIDATED SSNIT IM PLEM EN- CLIENTS (INF ) NUM BERS (FORM AL TATION SECTOR) W ASSA A. 115,000 26000 22 750 54m 729 Photo ID EAST W ASSA A 160,114 43,404 27 3542 255m 3992 Benefit. W EST BIBIANI A 121,869 21,824 17 4209 416m 2149 Benefits BEKW AI JUABESO 262,487 23,937 9 5,902 425m 1219 Photo ID

SEFW I 178,322 79,588 44 6,944 560m 3139 Benefits W IAW SO

245,940 137169 55..8 2984 315 4782 Benefits W ASSA W EST AOW IN 139,184 20,118 14 2118 152 622 Benefits SUAMAN

AHANTA 104,500 42,689 47 705 175 4521 Benefits W EST

167,241 10,920 6 1030 105 1576 Benefits NZEMA EAST 111,351 22,343 20 1743 184m 1028 Benefit JOMORO MPOHOR W 122,595 22,970 22 917 68m 3,000 Benefits EAST 205,876 33,020 16 2337 298m 7192 Benefits TAKORADI 93,380 23,001 24.6 1506 173m 950 SHAMA Benefits 162,123 38,100 23 7,015 536m 7954 SEKONDI Benefits TOTAL 2,189,982 545,083 24.9% 41,702 3.7bn 42,853

121 2005 GHS Annual Report, W estern Region

Table 37: EXEM PT CATEGORIES OF NHIS-2005

DISTRICTS/ < 18 70yrs + INDIGENTS PENSIONERS SUB-METRO YEARS (Core Poor)

W ASSA A. EAST 6300 400 100 50

W ASSA A W EST 10,645 1514 162 170

BIBIANI A BEKW AI 11,049 1457 9 176

JUABESO 15,264 961 512 79

SEFW I W IAW SO 20,832 1,892 759 364

8300 2798 11 463 W ASSA W EST AOW IN SUAMAN 10,438 567 5 44

AHANTA W EST 19,458 2690 275 295

6789 874 154 120 NZEMA EAST 5229 120 750 50 JOMORO MPOHOR W EAST 14,573 813 301 177

6893 917 26 282 TAKORADI SHAMA 10,486 984 210 77 9745 1,486 133 190 SEKONDI TOTAL 156001 17473 3407 2537

122 2005 GHS Annual Report, W estern Region

7.0.3 Key Challenges • Increase in utilization levels o Utilization almost tripled with increase in floor patients o Increased workload – Dispensing Technician collapsed with mild CVA due to work overload(Bibiani Government Hospital) o Overstretched infrastructure o Increase in consumption of medicines and non-medicine consumables. o Professional staff of all categories inadequate.

o Insured clients given prescriptions to buy basic medicines that are normally stocked in GHS facilities. • Prescribing of Medicines outside the official formulary/Medicines List for insured clients • W rong dispensing of medications on prescriptions by some chemical sellers eg. dispensing tabs. Amodiaquine instead of Tabs. Ancoloxin; • Lack of suitable office accommodation for some schemes. • Complaints by private providers of non-assessment for accreditation by the NHIC despite submission of applications and payment of prescribed fees. • Large number of partly paid registered clients. • Irregular release of funds by the NHIC to Schemes to meet administrative expenses. • Inadequacy of logistics and other inputs to facilitate the work of the various schemes. • Absence of clear cut conditions of service for scheme administration staff resulting in de-motivation.

123 2005 GHS Annual Report, W estern Region

7.0.4 Outlook for 2006 • Increase registration coverage and Benefits from the current 24.9 to 50%. • All Health providers to join the crusade in educating the general public on the benefits of NHIS. Platforms to include Churches, Mosques, Health talks at OPDs and social meetings etc.

7.0.5 Recom m endation • Advocate the appointment of National Health Insurance Fund Administrator (as with District Assemblies Common Fund. • DCEs to provide suitable accommodation for scheme Administrations. • All providers to get committed to the success of the implementation of the NHIS. • Amendment of ACT 650 to restrict NHIC to its core regulatory functions.

124 2005 GHS Annual Report, W estern Region

7.0.6 Status of Im plem entation of Com m unity Health Planning and Service delivery (CHPS) Table 38: Sum m ary of Status of CHPS Im plem entation by Districts - 2005

District No. of State of Service Com m unity District Assem bly Num ber of Dema Im plem en- provided Involvem ent Involvem ent functional rcated tation zones CHPS Zone Sefwi W iawso 6 4 CHO Supported Compound Family planning Construction of Completed services Volunteers Compound 4 All functioning Immunization Growth Monitoring

Aowin 19 1 CHO Immunization Suaman Compound Family planning completed services Volunteers Supported 1 Funcctional Treatment of Construction of malaria Compound 12 10 CHPS Immunization Zones F a m i l y p l a n n in gP r o v is i o n o f C H P S Functioning services Compound Supported 10 Treatment of Construction of malaria Compound Bia 12 12 CHPS Immunization Zones F a m i l y p l a n n in gP r o vision of CHPS Functioning services Compound Supported 12 Treatment of Construction of malaria Compound W assa Amenfi 6 CHO Immunization Provision Supported W est Compounds Family planning of CHPS Construction of completed services Compound Compound 6 All funcioning

125 2005 GHS Annual Report, W estern Region

W assa Amenfi 13 4 CHO ImmunizationP rovision of CHPS Supported East Compounds Family planning Compound Construction of completed services Compound 4 All funcioning W assa W est 7 6 CHO Immunization Volunteers Supported Compounds Family planning Construction of 6 functional services Compound Home visit

Mpohor 20 Immunization W assa East 2 CHO Family planning Volunteers Supported 2 Compounds services Construction of Completed Home visit Compound

Shama 16 Immunization Ahanta CHO Compound Family planning Volunteers NA 0 East earmarked services Home visit

Ahanta 4 1 CHOs Immunization Provided Involved in W est Compound Family planning CHOs Community 1 completed services compound Sensitization Home visit

Nzema 12 3CHO Immunization Provided East Compound Family planning Volunteers Polytank 3 completed all services functional Home visit Jomoro 5 6 CHO Immunization Supported Compound Family planning Volunteers Construction of 6 completed and 6 services Compound functional Home visit

126 2005 GHS Annual Report, W estern Region

Bibiani 107 functional CHPS A.Bekwai zone Immunization Proposed 4 new Family planning Volunteers Supported 7 zones Treatment of Construction of common Compound ailments Home visiting

127 2005 GHS Annual Report, W estern Region

8.0 Clinical Care Services

8.0.1. Regional Clinical Care Table 39: Ten Top Causes of OPD Attendance No. Condition No. of Cases % 1 Malaria 405,141 45.8 2 Other Acute Respiratory Infection 60,046 6.8 3 Diarrhoeal Diseases 30,738 3.5 4 Skin Diseases and Ulcers 27,336 3.1 5 Pregnancy & Related Complications 26,520 3.0 6 Acute Eye Infection 18,736 2.1 7 Hypertension 18,518 2.1 8 Rheumatism & Joint Pains 16,108 1.8 9 Home/Occupational Accidents 15,933 1.8 10 Intestinal W orms Infestation 15,531 1.8 All Other Diseases 249,470 28.2 Total New Cases 884,077 100

Malaria continues to be the number cause of morbidity, accounting for about 45.8.4% of OPD attendance. In 2004, 401,684 cases were reported as against 405,141 in 2005, an increase of about 10,289. This relative increase is against the background of the intensification of the Roll Back Malaria programme and also, the use of Insecticide Treated Nets (ITN) among others. The number of reported cases of Diarrhoeal Diseases increased slightly from 29,667 in 2004 to 30,738 in 2005. As compared to last year, these were incidentally the same conditions which were reported at the OPD despite the change in rankings in 2005 as compared to 2004 dropped in absolute figures of the cases reported in 2005.

128 2005 GHS Annual Report, W estern Region

Table 40: Ten Top Causes Of Hospital Adm ission No. Condition No. of Cases % 1 Malaria 16,246 31.7 2 Anaemia 4,762 9.3 3 Diarrhoeal Diseases 3,864 7.5 4 Pregnancy Related Complications 2,448 4.8 5 Hypertension 2,186 4.3 6 Pneumonia 1,529 3.0 7 Hernia 982 1.9 8 Typhoid Fever 653 1.3 9 Gynaecological Disorders 642 1.2 10 Road Traffic Accidents 610 1.2 All Other Diseases 17,366 33.8 Total New Cases 51,288 100

Malaria continues to be a leading cause of admission, accounting for about 31.7% of all admissions. About 48.6% of the malaria admissions are children under 5 years of age. The data was extracted from about 63% of expected returns from admitting institutions.

129 2005 GHS Annual Report, W estern Region

Table 41: Ten Top Causes Of Institutional M ortality No. Condition No. of Cases % 1 Malaria 524 17.2 2 Anaemia 372 12.2 3 Congestive Cardiac Failure 157 5.2 4 Hypertension 147 4.8 5 Pneumonia 128 4.2 6 Septicaemia 126 4.1 7 HIV/AIDS 119 3.9 8 Cerebro Vascular Accident 114 3.7 9 Diarrhoeal Diseases 105 3.4 10 Diabetes 77 2.5 All Other Diseases 1,185 38.8 Total New Cases 3,054 100

Malaria continues to be the leading cause of mortality, accounting for 17.2% of all deaths. Non-communicable diseases, notably cardiovascular diseases and diabetes are significant among the top ten causes of mortality in the Region accounting for about 16.2% of all institutional deaths. Diabetes Mellitus is now among the top ten conditions, according for 2.5% of all deaths.

130 2005 GHS Annual Report, W estern Region

Figure 15:

OPD visit per Capita 2005: District Performance

1.20

1.00 a

t 0.80 i p a c

r e p

0.60 Series1 t i s i v

D

P 0.40 O

0.20

0.00 NE WW SAE BAB SW AW JOM JB AS MWE WAW WAE BIA REG Series1 1.10 0.70 0.70 0.65 0.43 0.42 0.39 0.37 0.35 0.28 0.27 0.21 0.12 0.50 District

Figure 18 shows the performance of the districts in terms of utilization of health facilities. It is highest in Nzema East district (1.10) and the lowest in the two newly created districts, Bia (0.12) and W assa Amenfi East(0.21)

131 2005 GHS Annual Report, W estern Region

Table 42: Trend of OPD Visit Per Capita 2003 – 2005 DISTRICT 2003 2004 2005 Achievem ents Achievem ents Achievem ent Sefwi W iawso 0.40 0.48 0.43 Bibiani Anhwiaso Bekwai 0.46 0.60 0.65 Bia 0.12 Juabeso 0.18 0.3 0.37 W assa Amenfi East 0.21 W assa Amenfi W est 0.17 0.26 0.27 Aowin Suaman 0.40 0.44 0.35 W assa W est 0.53 0.61 0.70 Mpohor W assa East 0.26 0.28 0.28 Ahanta W est 0.33 0.43 0.42 Shama Ahanta East 0.53 0.68 0.70 Nzema East 0.95 1.11 1.10 Jomoro 0.30 0.38 0.39 Region 0.44 0.51 0.50

The OPD per capita remained relatively constant from 2004 to 2005. Four out of the thirteen districts were well above the regional average of 0.50. The performance of Nzema East district could be attributed to influx of people from other places to seek medical care in the district, specifically at Eikwe Catholic hospital. Bibiani-Anhwiaso-Bekwai and W assa W est districts showed significant increase in 2005 as compared to 20004. There was significant drop in OPD per capita in Aowin Suaman district from 2004 to 2005.

132 2005 GHS Annual Report, W estern Region

Table 43: Outpatient Attendance By Ownership, 2004 And 2005 Com pared

Institution Attendance Attendance % Coverage 2004 2005 2004 2005 Government 771,310 635,380 68.8 57.0 facilities Mission facilities 136,706 144,335 12.2 12.9 Private facilities 123,036 248,186 11.0 22.2 Regional Hospital 89,131 87,641 8.0 7.9 Region 1,120183 1,115,542 100.0 100.0

There was significant drop in OPD attendance in Government health facilities, with no significant change for mission facilities. OPD attendance in private facilities more than doubled in 2005. The increase could be attributed to a number of factors, notably among them are: (i) more private health facilities are now reporting, (ii) attitude of some GHS staff to clients thus driving away clients to private practitioners.

133 2005 GHS Annual Report, W estern Region

Fig 16: Hospital Adm ission Rate By District: 2005

Hospital Admission Rate 2005 Performance by districts

90

80

70

60

50

40

30

20

10

0 NE SW BAB WW AS WAW WAE JOM ENRH SAE AW JB MWE BIA REG HAR 85.4 77.6 49.8 49.5 31.2 31.2 28.1 27.9 27.4 18.6 14.4 7.4 3.8 0 38.4

The above figure shows the performance of the district in terms of admission per 1000 population. It ranges between 3.8 in Mpohor W assa East to 85.4 in Nzema East. There is no admitting institution in the Bia district.

134 2005 GHS Annual Report, W estern Region

Table 44: Hospital Adm ission Rate: 2003 - 2005

DISTRICT 2003 2004 2005 Achievem ents Achievem ents Achievem ent

Sefwi W iawso 65.3 66.3 77.6 Bibiani Anhwiaso 23.6 64.6 49.8 Bekwai Juabeso 7.4 Bia N. S. N. S. N.S. W assa Amenfi East 28.1 W assa Amenfi W est 21.5 26.3 31.2 Aowin Suaman 22.2 36.1 31.2 W assa W est 43.5 57.4 49.5 Mpohor W assa East 3 12.7 3.8 Ahanta W est 13.4 12.7 14.8 Shama Ahanta East 16.5 17.7 18.6 Nzema East 83 97.2 85.4 Jomoro 21.9 27.2 27.9 ENRH 23.7 26.2 27.4 Region 33.2 38.9 38.4

Hospital Admission rate has stagnated over the last two years. Four (4) districts performed well above the regional average of 38.4. Sefwi W iawso district recorded a significant increase from 66.3% in 2004 to 77.6% in 2005. Mpohor W assa East district recorded a significant decrease of 12.7% in 2004 to 3.8% in 2005, possibly implying less admission and more patients being treated and discharged. Nzema East district recorded a significant decrease from 97.2% in 2004 to 85.4% in 2005, having similar explanation to that of Mpohor W assa East

135 2005 GHS Annual Report, W estern Region above. The hospital admission rate is highest in Nzema East and lowest in Mpohor W assa East.

Table 45: Hospital Adm ission - 2004 AND 2005 Com pared

Institution Adm issions % Coverage 2004 2005 2004 2005 Dist. Hospitals 34,675 34,052 40.8 39.9 Other Hospitals 7,985 8,125 9.4 9.5 Private Hospitals 9,734 8,047 11.5 9.4 Mission Hospitals 21,523 23,342 25.4 27.3 Regional Hospital 10,991 11,841 12.9 13.9 Regional Total 84,908 85,407 100 100

The regional coverage showed a marginal increase of 0.6% from last year. There was an improvement in admission at mission hospitals. A marginal increase was also recorded at the regional hospital.

Table 46: Hospital Adm issions and Deaths 2005 Institution Adm issions Death Death Rate % District Hospitals 34,052 1,131 3.3 Other Hospitals 8,125 90 1.1 Private Hospitals 8,047 232 2.9 Mission Hospitals 23,342 799 3.4 Regional Hospital 11,841 862 7.3 Regional 85,407 3,114 3.6

The regional hospital had quite a high proportion of death rate (7.3%) as compared to the regional figure of 3.6%. The rest of the facilities had rates below the regional average.

136 2005 GHS Annual Report, W estern Region

Table 47: Hospital Death Rates : 2004 and 2005 Com pared Institution 2004 2005 District Hospitals 3.2 3.3 Other Hospitals 1.4 1.1 Private Hospitals 1.8 2.9 Mission Hospitals 3.0 3.4 Regional Hospital 8.2 7.3 Regional 3.5 3.6

There was not much difference in the hospital death rate from 3.5% in 2004 to 3.6% in 2005. However, there was significant increase from 1.8% in 2004 to 2.9% in 2005 in Private Hospitals. There was a marginal decrease recorded at the regional hospital from 2004 to 2005. District and Mission hospitals showed slight increases in 2005 as compared to 2004.

137 2005 GHS Annual Report, W estern Region

Fig 17: Bed Occupancy Rate: Perform ance by districts in 2005

BED OCCUPANCY RATE: 2005 PERFORMANCE BY DISTRICT

90

80

70

60 Y C

N 50 A P

U BOR C C 40 O

%

30

20

10

0 NE SW AS BAB ENRH WAW SAE AW WAE JOM WW MWE JB BIA REG BOR 81.1 64.6 51.2 48.6 48.3 45 40.5 36.7 33.6 29.6 27.3 25.2 0 0 47.7 DISTRICT

The bed occupancy was highest in Nzema East district (81.1%) and lowest in lowest in Mpohor W assa East district (25.2%). Seven (7) out of the thirteen (13) districts performed below the regional average of 47.7%. Juabeso has no data available whilst Bia district has no admitting institution.

138 2005 GHS Annual Report, W estern Region

Table 48: Trend in Bed Occupancy Rate 2003 – 2005

DISTRICT 2003 2004 2005 Achievem ents Achievem ent Achievem ent Sefwi W iawso 54.8 68.0 64.6 Bibiani Anhwiaso Bekwai 66.5 58.6 48.6 Juabeso NS Bia NS NS NS W assa Amenfi East 33.6 W assa Amenfi W est 57.4 46.2 45.0 Aowin Suaman 41.2 52.7 51.2 W assa W est 43.2 44.2 27.3 Mpohor W assa East NS 13.4 25.2 Ahanta W est 26.3 37.1 36.7 Shama Ahanta East 33.7 41.7 40.5 Nzema East 77.9 82.1 81.1 Jomoro 32.4 32.1 29.6 Effiankwanta Reg.Hospital 48.0 49.6 48.3 Region 50.6 46.9 47.7

The Regional average showed decline in occupancy rate from 2003 to 2004 with a marginal increase in 2005. W ith the exception of the Mpohor W assa East district which recorded an increase in bed occupancy rate from 2004 to 2005, all the remaining reporting districts recorded decreases in occupancy rate in 2005.

139 2005 GHS Annual Report, W estern Region

Table 49: Bed Occupancy Rate 2003 - 2005 Institution 2003 2004 2005 District Hospitals 51.0 46.7 45.9 Mission Hospitals 65.5 69.0 69.0 Private Hospitals 36.8 21.8 22.6 Other Hospitals 28.6 27.5 38.9 Regional Hospital 48.0 49.6 48.3 Regional Total 50.6 46.9 47.7

The performance for district hospitals over the three year period is on the decline. The trend for the mission hospitals showed an improvement in 2004 but stagnated from 2004 to 2005. Other hospitals showed a decline in 2004 but improved significantly in 2005 from 27.5% to 38.9%. The mission hospitals recorded 69.0% which was higher than the regional average of 47.7%.

140 2005 GHS Annual Report, W estern Region

Fig 18: Bed Turnover Rate: 2005

BED TURN OVER RATE : 2005 PERFORMANCE BY DISTRICT

80

70

60

E 50 T A R

R E

V 40 BTO O

N R U

T 30

20

10

0 AS NE SW BAB WW JOM WAE ENRH SAE AW WAW MWE JB BIA REG BTO 69.9 55.1 49.2 46.7 42.3 41.6 35.6 35.6 35.2 31.8 30.2 7 0 0 42.3 DISTRICT

The bed turnover rate is highest in Aowin Suaman district (69.9)and lowest in Mpohor W assa East district (7.0). The regional hospital recorded 35.6.

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Table 50: Trend of Bed Turnover Rate : 2003 - 2005

DISTRICT 2003 2004 2005 Achievements Achievement Achievement Sefwi W iawso 50.7 45.0 49.2 Bibiani Anhwiaso Bekwai 74.2 53.0 46.7 Juabeso NS Bia NS NS NS W assa Amenfi East 35.6 W assa Amenfi W est 28.3 18.4 30.2 Aowin Suaman 51.7 72.6 69.9 W assa W est 52.0 43.8 42.3 Mpohor W assa East NS NS 7.0 Ahanta W est 22.9 27.5 31.8 Shama Ahanta East 33.6 33.4 35.2 Nzema East 36.4 58.1 55.1 Jomoro 34.3 38.4 41.6 ENRH 32.0 33.4 35.6 Region 43.5 41.0 42.3

Only four (4) out of the thirteen (13) districts performed above the regional average. The turner over rate is as low as 7.0 in Mpohor W assa East district to as high as 69.9 in Aowin Suaman. Five (5) out of the thirteen (13) districts had rates above the regional average.

142 2005 GHS Annual Report, W estern Region

9.0 Regional Quality Assurance Program m e

A number of activities were carried out during the year under review.

9.0.1 Key Activities • Supportive monitoring and supervision in six (6) districts • Quality Assurance T.O.T. was organized for forty four (44) participants • Training of staff on Infection Prevention. • Monitoring infection prevention and control. • Clinical conferences. • IMCI training was organized for staff • The training of staff on Quality Assurance, Infection Prevention and IMCI were supported by Q uality Health Partners(QHP)

9.0.2 Specialist Services • G.U. outreach services from EffiaNkwanta Regional hospital to the districts has not taken off • O.& G. outreach services from Effiankwanta Regional hospital to the district has been suspended • E.N.T. outreach from to Effiankwanta Regional hospital came off, and a total of one thousand and forty (1,040) patients were seen in 2005.

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9.0.3 Achievem ents • Improvement in in-patient care • Improvement in emergency preparedness • Improved adherence to prescriptions using the treatment guidelines.

9.0.4 Constraints • Non-availability of vehicle • Failure of staff to comply with transfer instructions • Staff shortage – culminating in work overload.

9.0.5 Outlook For 2006 • Improve clinical audits on medicines management. • Strengthen QA activities in all health facilities • Improve monitoring and facilitative supervision • Strengthen Infection Control Committees in all facilities.

144 2005 GHS Annual Report, W estern Region

10.0 Effia Nkwanta Regional Hospital

10.1. Staffing Position of the Hospital

Doctors - 33 (3 on contract, 4 on study leave) Medical Assistants - 2 (1 on contract) Nurses - 211 (4 on contract, 28 on study leave) Clinical Support Services - 36 Non-Clinical Support Services - 194 Casual W orkers - 78

Grand Total - 554

M edical Doctors Medical Director (P.M.O.) - 1 Specialists - 5 (1 on contract) P.M.Os - 3 S.M.Os - 10 (2 on contract, 2 study leave) M.Os - 12 (2 study leave)

Total - 31 Bed Com plem ent - 416

145 2005 GHS Annual Report, W estern Region

10.2 Key Activities • A four day in-Service training organised for 64 staff on infection prevention • A four day programme was also organised for 51 middle level managers on Data Management • A day’s workshop was held for all Health aides and W ard Assistants on Current Issues in Clinical Care Practice • Eight (8) Maternal Audits and Clinical Conferences were held during the period • Eight (8) Clinical meetings were held for Medical Doctors, W ard Managers and Pharmacists on Treatment Guidelines and Protocols.

10.3 Challenges and Constraints • Inadequate office and residential accommodation for staff • The need to provide a W elfare Bus for the Hospital still remains a challenge • Most of the vehicles are over 10 years • Inadequate personnel of all categories • The Medical and Dental Council have accredited the Obs and Gynae and Surgical Units but yet to get the requisite equipment and personnel for the Medical unit to be accredited as well

146 2005 GHS Annual Report, W estern Region

10.4. W ay Forward • Re-orientation of staff on management procedures and techniques • Establishment of professional protocols • Training of staff on emergency preparedness • Computerisation of the whole hospital • Full automation of the Records Unit • Sustaining the 24 hour emergency service • Sustaining the specialist outreach services • Strengthening of the Blood Bank Unit to carry out campaigns for blood donations • Introduction of the sub-BMC concept • Establishment of Spare Parts Revolving Fund

147 2005 GHS Annual Report, W estern Region

11.0 Com m unity Psychiatry Services

There are nine (9) reporting units in the region serving six (6) districts and the regional hospital. The six districts covered by this service are Shama Ahanta East, Bibiani Anhwiaso Bekwai, Jomoro, Mpohor W assa East, W assa W est and Sefwi W iawso

11.1 Key Activities • Daily consultation carried out in all the units to identify new clients and to review old cases. • Home visits undertaken to monitor the progress of clients • Health education talks given to relatives, clients and the public. • Hospital Visitation of the mentally ill • Counseling of patients • Responding appropriately to mental health emergencies • Orientation of students on Community Psychiatry • Assessment of mentally retarded patients

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11. 2. Com m unity Psychiatric Conditions Table 51: Com m on Psychiatric Conditions -2005 No. Condition NEW OLD TOTAL 1 Epilepsy 350 3,176 3,526 2 Schizophrenia 103 1,842 1,945 3 Depression 42 771 813 4 Drug Abuse 55 373 428 5 Psychosis 94 1,464 1,558 6 Convulsion 56 433 489 7 Headache 26 324 350 8 Anxiety Neurosis 20 43 63 9 Alcoholism 20 222 242 10 Dementia 17 229 246 11 Mental Retardation 31 175 206 12 Puerperal Psychosis 9 42 51 13 Enuresis 1 64 65 TOTAL 824 9,158 9,982

11.3 Key Achievem ents Three (3) clients with psychiatric problems were managed successfully to complete their University education Eighty three (83) qualified nurses had their orientation in Psychiatry Ten (10) drop out with mental disorders went back to school after recovery

149 2005 GHS Annual Report, W estern Region

11.4. Constraints • Lack of transport for Community outreach • Shortage of antidepressant drugs. • Inadequate Psychiatric nurses. • Exodus of Psychiatric nurses to the U.K. and U.S. • Poor collaboration with traditional healers • Lack of funds for outreach programmes

11.5 Outlook For 2005 • Integration of Community Psychiatry activities into District action plans. • Intensify health education on drug abuse and epilepsy • Celebration of Mental Health W eek

150 2005 GHS Annual Report, W estern Region

12.0 Eye Care Services

Eye care services are available in only six (6) out of the thirteen (13) districts in the region. These districts are Sefwi W iawsi, Aowin Suaman, W assa Amenfi East, W assa W est, Ahanta W est and Shama Ahanta East. The services provided by the unit include daily OPD activities, outreach services, and school screening services, public education, training and surgery. A total of twenty two thousand, one hundred and seventeen (22,117) patients were seen during the year under review.

12.1. Objectives • To control diseases that cause avoidable blindness • To develop and deploy human resources for eye health delivery • To develop and strengthen the infrastructure and the technology for eye delivery

12.2 Key Activities • Static Eye Care Services run at the OPD • School health screening • Surgeries • Outreach services • Health Education

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12.3 Com m on eye problem s seen during the year under review at the OPD included: • Ophthalmic Neonatorum • Conjunctivitis (infection/allergic) • Blinding Cataract • Non Blinding Cataract • Glaucoma • Corneal Opacities • Ocular Tumors • Refractive Errors • Major injuries • Minor injuries

152 2005 GHS Annual Report, W estern Region

12.4. Outreach Services

A total of nine hundred and twenty three (923) patients were seen.

OPD - 20,771 OUTREACH - 923 SCHOOL SCREENING - 150 SURGERIES - 273

12.5 School Screening Services The ophthalmologist, optometrist and ophthalmic nurses, visited schools within the catchment’s areas of the units. Minor eye cases were treated and those, which needed further investigations, were referred. A total of one hundred and fifty (150) patients were seen.

12.6 Surgeries Two hundred and seventy three (273) surgeries were carried out in the region. 37.4% (102) of the cases were cataract.

Human Resource Ophthalmologist - 2 Optometrist - 1 Ophthalmic Nurses - 5

153 2005 GHS Annual Report, W estern Region

12.7. Constraints • Inadequate staff • Inadequate instruments and equipment • Lack of transport for outreach services

12.8. Outlook For 2006 • Training more Ophthalmic Nurses • Need for an Optometrist • Intensify Health Education talks. • Scale up outreach services • Orientate service providers on eye diseases • Improve eye equipments and surgical instruments supply

13.0 Oral Health Services

13.1 Key Activities • Outreach services were carried out in Bibiani Anhwiaso Bekwai district only. • Major and minor surgeries carried out during the year under review.

13.2 Dental Health Facilities • There are five (5) reporting dental units in the region. • Effia Nkwanta Dental Unit • Essikadu Dental Unit • Kwesimintsim Dental Unit • 2MR Military Dental Unit • Tarkwa Dental Clinic • Axim Dental Unit (Outreach Services)

154 2005 GHS Annual Report, W estern Region

13.3. OPD Attendance A total of 12,360 cases were recorded from five out of the six dental units for year under review. Figures from 2MR Military Dental Clinic were not available as at the time of writing the report. The summary of treatment of dental cases is shown below: Extractions - 7,404 Filings - 1,016 Root Canal Therapy - 22 Dentures - 296 Miscellaneous - 3,622

13.4 Outreach Services Outreach services were carried out in only Bibiani Anhwiaso Bekwai district where communities and school children were visited. The summary of activities carried out were : Total Patients screened - 914 Number treated - 256 Number of extractions performed - 218 Number with Dental Caries - 180 Referrals - 63 Others - 197

13.5 Constraints • Inadequate staff • Lack of dental facilities in some of the district hospitals. • Inadequate equipment. • Inadequate funds to carry out more outreach.

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13.6 Outlook For 2006 • Intensification of extended outreach programmes. • Provide dental services to schools. • Train auxiliary dental personnel to augment the existing staff.

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14.0 Laboratory and Blood Transfusion Services The laboratories conducted investigations of specimens and diagnosis of clinical conditions. The blood bank also provided safe blood and blood products for transfusion to save lives.

Figure 18: Public Health Reference Laboratory, Sekondi W estern Region

14.1 Key Activities • Supervisory visits and micro-teaching at facility level. • In-Service training for selected technical staff on TB Microscopy • Piloting of quality control specimen as part of Q uality Assurance programme. • Training of Interns • Blood Transfusion

157 2005 GHS Annual Report, W estern Region

14.2 Piloting of Quality Control Specim en This was carried out in selected health facilities to test the quality of reagents and also to ascertain the state of the equipments being used. Haemoglobin was chosen as the analyte. The results are displayed in the table 56 below: Table 52: Piloting of Quality Control Specim en

Facility Low Norm al High Rem arks Essikadu Polyclinic 9.3g/dl 15.2g/dl 16.8g/dl Very Good Takoradi Hospital 11.9g.dl 15.7g/dl 16.7g/dl Good Antenatal Clinic- 9.5g/dl 15.1g/dl 17.4g/dl Fairly Good ENRH Hospital 8.7g/dl 14.9g/dl 15.1g/dl Excellent W assa 7.6g/dl 11.2g/dl 13.6g/dl Low value Hospital

14.3 Blood Transfusion Most of the activities were confined to individual facilities. Effia Nkwanta Regional Hospital and Tarkwa Government hospital were the two major sources from where voluntary blood donation was carried out.

14.4 Staff Situation

Technologist - 4 Technician - 18 Biochemist - 3 Lab.Assistant - 12 Interns Technologist - 7

158 2005 GHS Annual Report, W estern Region

14.5 Constraints • Inadequate laboratory staff • Obsolete laboratory equipment in some district hospitals. • Budgetary allocation must be made available for training activities all year round. • Lack of transport for blood collection activities

14.6 Challenges • Standardizing the procurement of equipments and reagents for the various laboratories. • Increasing the current test profiles in laboratory investigations to include Biochemisrty and Microbiology tests. • Regular supervisory visit and microteaching at facility level. • Set up second Sub-Transfusion centre at Sefwi W iawso • Step –up production of blood products (especially FFP)

14.7 W ay Forward • To collaborate with District Assemblies to support blood collection activities • Intensify the supervisory visits • Increasing the number of qualified staff at the various facilities.

159 2005 GHS Annual Report, W estern Region

15.0 Health Adm inistration and Support Service

This unit comprises : • The Estate Unit • Equipment Unit • Human Resource Unit • Stores and Procurement Unit • Transport Unit

15.1.0 THE ESTATE UNIT 15.1.1 Health Facilities Database Sum m ary Of Survey Of Health Facilities

Total no. of facilities - 146

Facilities surveyed - 145

Facilitiy to be surveyed - 1

Facilities keyed into database - 145

Facilities drawn to scale - Nil

The only health facility not surveyed is the Tarkwa Government Hospital. This is because plans are far advanced for the construction of the new hospital to start. The region now has a data base of all 145 health estates in the region

160 2005 GHS Annual Report, W estern Region

15.1.2 Training/W orkshop Table 53: Estate Unit, Training/W orkshop Title of Training Num ber Categories Trained Trained PPM for Southern Sector Maintenance Persons 18 PPM for Northern Sector 23 Maintenance Persons PPM Trg in Environmental Orderlies & W ard Sanitation 86 In-Charges Trg. In Contract Adm., DCEs, DCDs, Project Mgt. & W orks Procurement DDHSs, for selected Districts 51 Procurement Officers, & Medical Officers PPM in Environmental Sanitation DCEs, DCDs, 45 DDHSs, Procurement Officers, & Medical Officers

Trg. In Computer application for District Estate Managers - District Estate Managers

161 2005 GHS Annual Report, W estern Region

15.1.3 Im pact of Training

• Improvement in waste management practices at the various health facilities.

• Improvement in the knowledge of Estate Managers in project estimation

• Improved collaboration between the District Assemblies, other NGO’s and the Ghana Health Service.

15.1.4 Projects 15.1.4.1 M OH Initiated Projects

A total of seven (7) projects were started in the region. Three (3) have been completed; with the rest (4) at various stages of completion. Percentage completion of the 4 ranges between 40%- 75%. Refer to appendix 14 for details.

15.1.4.2 M OHH Suspended / Abandoned Projects

Three (3) projects have been suspended/abandoned over the past years. They have reached various stages of completion, between 50%-60%. Refer to appendix 15 for details

162 2005 GHS Annual Report, W estern Region

15.1.4.3 Pilot Project Rehabilitation of Maternity and OPD of Mpohor Health Centre Start Date: - 29th November 2004

Completion Date - 30th September 2005

Level of Completion - 98%

Name of Consultant - Messrs Architectural Spring

Name of Contractor - Messrs Francis Asante Construction Limited

Contract Sum: - ¢394,512,488.70

Payment to Date - ¢375,659,580.00

Retention - Yet to be released

163 2005 GHS Annual Report, W estern Region

15.1.4 Achievem ents • Trained select staff at the various districts in contract administration and works Procurement • Pilot Rehabilitation of Mpohor Health Centre completed • Six bungalows were renovated • All civil work projects awarded. • Monitored the conduction of 24 civil works projects in the region

15.1.5 Constraints

• Frequent breakdown of vehicle affecting the progress of the project monitoring and PPM programme. • Inadequate given to health facility maintenance focal persons to enable them carryout planned preventive maintenance effectively • Inability to draw to scale sketches of facilities from facility survey

164 2005 GHS Annual Report, W estern Region

15.2 Clinical Engineering Unit 15.2.1 KeyActivities • Equipment Installation and Commissioning of W orks • Acceptance Testing of Equipment • Planned Preventive Maintenance (PPM) Servicing • Corrective Maintenance Servicing (Repair W orks) • Response to Service Calls • Conducted Training for working Health Staff in the use of Equipment

15.2.2. Equipm ent Installation Two hundred and ten (210) pieces of equipment were installed and commissioned in eight (8) health institutions in 2005. The beneficially health institutions are: Tarkwa Hospital, Takoradi Hospital, Prestea Hospital, Health Centre, Tikobo No1. Health Centre, Tikobo No.2 Health Centre, Apowa Health Centre, and Oppon Valley Health Centre.

15.2.3. M aintenance and Repair Services Two (2) Planned Preventive Maintenance visits were made to the District Hospitals. For the Health Centres, one (1) PPM Service was carried out. Repair Activities Total No. of faulty Equipment sent in for repair - 38 No. of Equipment repaired and returned to the users - 24 No. of Equipment repaired at facilities by outreach travel - 71 Total No. of Equipment awaiting spares - 14

165 2005 GHS Annual Report, W estern Region

Total Broken Down - 123 M ajor breakdowns were: Blood Pressure Measuring Instrument - 65 Sterilization Machine - 35 Suction Machine - 10

15.2.4 Supply and use of Equipm ent • Medical Equipment supply to the region has been on the decline. Equipment in short supply includes: • Laboratory equipment • Diagnostic Ultrasound Scanner • Infant Incubator • Laundry Equipment, • Doppler Unit, • Monitors and Surgical Instruments • W eighing Scales and Instrument.

166 2005 GHS Annual Report, W estern Region

Statistical data on existing m ajor equipm ent Table 54: Statistical data on existing m ajor equipm ent

TOTAL FUNCTIONING BROKEN% FUNCTIONING NEW DOW N REQUIREM ENT Large Vertical 17 14 3 82.4 4 HP Steam Autoclave Static X-Ray Unit 12 10 2 83.3 3 Ultrasound 6 5 1 83.3 8 Scanner Dental Unit 5 5 0 100 0

Stand By 15 13 2 86.7 3 Generating Set Mechanized 2 2 0 100 9 Laundry Mortuary Unit 9 7 2 77.8 2

15.2.6 User Training Program m es Held Four Trainings W ere Held:- Use of Table Top Autoclave at two (2) Health Centres in the Jomoro district Use of Hydraulic Beds at Tarkwa Gov’t Hospital. Use of Surgical Diathermy and Table Top Autoclave at Dixcove Hospital. Use of Baby Incubator at Prestea Gov’t Hospital

167 2005 GHS Annual Report, W estern Region

15.2.7 Constraints Broken vehicle affecting the smooth operation of the Unit. Lack of spare parts for maintenance and repair of Medical Equipment.

15.2.8 W ay Forward To impress upon the Regional Health Administration to create a revolving fund for the unit where spare parts could be purchased in bulk and used by the various institutions to repair their equipment.

168 2005 GHS Annual Report, W estern Region

15.3 Transport Unit 15.3.1 Key Activities • Registered twenty two (22) Jailing GY100 motorcycles. • Assembled one (1) Jailing GY100 motorcycle. • Distributed eight (8) Jailing motorcycles to two (2) districts (Aowin Suaman and Ahanta W est-Four (4) each.) and twenty five (25) Yamaha Access AG100 motorcycles to all the districts • Assembled Twenty (20) new Jailing JH125GY motorcycles. • Refurbished five (5) ambulances. • Received and transferred one (1) Fibre Glass Reinforced Plastic Boat and its accessories to Jewi W harf in the Jomoro District (i.e. Half Assini Health Directorate). • Carried out an audit of all motorcycles in all the districts and facilities.

15.3.2 New Vehicles Six new pick-ups, 80 motorcycles and 1 boat were received from the national level in 2005.

15.3.3. Accident / Incident Seven (7) accidents occurred in the year involving six (6) vehicles and One (1) Motorbike with one (1) death.

169 2005 GHS Annual Report, W estern Region

15.3.4. Indicators Table 55: Vehicle Indicators

Total Total No. of% of Vehicle Total Km % % Km /L M aintenance Average No. of Vehicle reported Travelled Availability Utilization Cost/km Running Veh. reported cost

87 49 56% 3019544 94% 61% 1.6 ¢166.7* ¢505.00

Table 56: M otorcycle Indicators

Total Total No%. No. of Veh. Total Km % % Km /L M aintenance Average No. of of Veh reported Travelled Availability Utilization Cost/km Running Bikes reported cost

115 58 50% 136439 90% 50.4% 15.6 260.8* ¢1,074.6

Com m ents: *Some districts and facilities did not provide the maintenance cost whilst some speedometer of the vehicles and the motorcycles and not working

170 2005 GHS Annual Report, W estern Region

15.3.5 Serviceable and Unserviceable Vehicles Table 57: Serviceable and Unserviceable Vehicles INSTITUTION/DISTRICT SERVICEABLE VEHICLES UNSERVICEABLE VEHICLES Regional Health 16 7 Directorate Effiankwanata 4 3 Reg.Hospital Nursing &Mid.Training 1 2 College Shama Ahanta East 3 1 Mpohor W assa East 3 1 Ahanta W est 2 2 Nzema East 5 1 Jomoro 4 - W assa W est 4 2 W assa Amenfi W est 1 1 W assa Amenfi East 1 1 Aowin Suaman 3 2 Juabeso Bia 4 1 Bia 1 0 Sefwi W iawso 5 2 Bibiani Anhwiaso 2 2 Bekwai TOTAL 59 28 % 67.82 32.18%

171 2005 GHS Annual Report, W estern Region

DIST./INST.V EHIC MOTORCYCLE BICYCLE BOAT TRICYCLE LE

15.3.6 Fleet Inventory by Age Block Table 58: Fleet Inventory by Age Block Type AGE GROUP TOTAL 1 – 5 yrs. 6 – 9 yrs. 10+yrs. Vehicles 45 23 19 87 1 – 3 yrs. 4 – 5 yrs. 6 yrs. M otorcycles 31 35 49 115 1 – 5 yrs. 6 – 9 yrs. 10+yrs. Boat 2 2 0 4

15.3.7 FLEET ALLOCATION – BY DISTRICT / INSTITUTION

Table 59: FLEET ALLOCATION – BY DISTRICT / INSTITUTION Regional 23 6 - - - Health Directorate Effiankwanata 7 5 - - - Reg.Hospital Nursing & 3 1 - - - Mid.Training College Mpohor W assa 4 9 - - - East Ahanata 4 8 - - - W est Nzema East 6 6 - - - Shama Ahanta 4 11 - - - East

172 2005 GHS Annual Report, W estern Region

Jomoro 4 9 - 4 - W assa W est 6 15 - - - W assa Amenfi 2 7 - - -

East W assa Amenfi 2 8 - - 1 W est Aowin 5 9 - - - Suaman Juabeso 5 6 - - - Bia 1 6 - - - Sefwi W iawso 7 6 - - - Bibiani Anhwiaso 4 3 - - - Bekwai TOTAL 87 115 0 4 1

15.3.8 CONSTRAINTS • No proper maintenance schedules • Planned preventive maintenance (PPM) not followed. • Inadequate stock of spare parts • Very poor driver/rider skills in handling emergency situations and road traffic system • Inadequate staff

15.3.9 W AY FORW ARD

• To conduct monthly vehicle parade with drivers/riders to assess neatness and control of vehicle • To organize training for regional maintenance staff • Erect transport movement, key and notice boards and regularly visit parking premises to check on vehicle instrumentation. (Fuel levels, odometer reading and oil levels log sheets.)

173 2005 GHS Annual Report, W estern Region

15.4. Hum an Resource

The shortage of health professionals at all levels continues to pose challenges to efficient health delivery in the region. However frantic efforts were made by the human resource unit to attract qualified health professionals into the region. The staff strength as at end of 2005 stood at 2,504 as against 2489 in 2004. Refer to appendix 11 for details

174 2005 GHS Annual Report, W estern Region

15.4.1 Recruitm ent

Category Num ber Recruited

Medical Doctors 5

Professional Nurses 7

Pharmacist 0

Auxiliary Nurses 5

Dispensary Technicians. 1

Technical Officers. 4

15.4.2 Fellowship Training

Category No. Sponsored Type Of Course Rem arks

Medical Doctors 1 Long Not approved

Prof.Nurses 2 Short Approved

Tech.Offrs. 1 Short Not approved

175 2005 GHS Annual Report, W estern Region

15.4.3. Post Basic Training

Course No. Enrolled

Midwives 34

Public Health 3

Critical Care 1

Medical Assistant 6

E.N.T. 1

SRN 3

Anaesthesia 2

Diploma In H/Srv. 3

15.4.4 PROM OTION OF STAFF CATEGORY NO. PROM OTED Med.Offrs. 2 Pro.Nurses 25 Aux.Nurse 37 Pharmcist 2 Lab.Techn. 2 Techn.Offrs. 14 Accountants 12 All Others 70

TOTAL 168

176 2005 GHS Annual Report, W estern Region

15.5. Supplies and Stores M anagem ent

15.5.1 Procurem ent

The Central Medical Stores (CMS) continue to be the first point of call for all procurement intended by the Regional Directorate. However, due to the on-going rehabilitation at the CMS most of our requisitions could not be met.

Below is the state of affairs of the operations at the Regional Medical Stores for the period under review.

15.5.2 Breakdown of Non-Drug M edical Consum ables For 2005. ¢ 1. Procurement Plan 2005 3,200,000,000 2. Total Purchase from Open Market 2,993,128,600 3. Total Purchase from CMS 228,682,298 4. Total Stock as at 31st Dec. 2005 2,403,657,450 5. Total Value of supplies to the BMCs. 2,940,127,649 6. Total Receipt from BMCs 2,175,367,942 7. Outstanding Payment (Creditors) 675,971,785 8. Outstanding Payment (Debtors) 2,018,150,948.

177 2005 GHS Annual Report, W estern Region

15.5.3 DRUGS ¢

1. Procurement Plan (2005) 7,820,000,000 2. Requisition from CMS 3,382,415,000 3. Total Purchase from Open market 6,848,226,634 4. Total Purchase from CMS 1,391,452,214 5. Total Stock as at 31st Dec. 2005 3,509,999,339 6. Total Value of Supplies to the BMCs 7,938,047,115 7. Total receipt from BMCs 6,884,208,372 8. Outstanding Payment (Creditors) 2,655,461,550 9. Outstanding Payments (Debtors) 2,720,660,205

15.5.4 General Procurem ent Other procurements made during the year are as follows:- ¢ 1. Office Consumables and Stationery 130,022,715 2. Printing 481,250,000 3. Hardware for maintenance of building 67,541,000 4. Tyres, Vehicle Spare parts etc. 157,665,868

15.5.5 Constraints/Challenges. • Most facilities are not adhering to the Procurement procedures and standard operating procedures on logistics management of health commodities. • Central Medical Stores could not honour most requisition from the RMS owing to on-going rehabilitation works. • Some of the items supplied by the CMS were very close to their expiry and therefore were rejected.

178 2005 GHS Annual Report, W estern Region

• Requisition from BMCs are always late. • BMCs do not settle their indebtedness to the Regional Medical Store there locking up the revolving capital of the latter. Total indebtedness of BMC to Regional Medical Stores as at 31st December 2005 was 4,738,811,153.00

15.5.6 The W ay Forward. • Continue education on the procurement procedures (Act 663) • Still continue the education on standard operating procedures on logistics management of Health Commodities. • Assist Commodity Managers to determine the various levels of stock minimum re-order levels, maximum, re-order and emergency stock point.

179 2005 GHS Annual Report, W estern Region

16.0. Health Training Institutions 16.1. Nurses & M idwifery Training College - Sekondi 16.1.1. M ajor Concerns for 2005 • Discipline among staff and students • Improved academic performance • Preparation and organisation of licensure examination • Planned preventive maintenance on boy’s hostel and dinning hall • Cleanliness on campus and improved water supply • Completion of hostel renovation and construction of classroom block • Improved exposure of students to learning • Refurbishment of library towards accreditation

16.1.2 Students& Tutors Students Population 445 General Nursing - 361 Direct Midwifery - 84

Females - 332 Males - 113 Tutors 14 Tutor/student ratio - 1:32

180 2005 GHS Annual Report, W estern Region

16.1.3. Academ ic Activities and Perform ance • 202 new students admitted in October 2005 • End of semester examination and referral exams conducted and marked • Clinical practice for students was carried out in districts within the region and at Korle-Bu • Rotation for students (D4 & D1) was taken over by the institution. • Revision / remedial classes started but discontinued due to postponement of licensure examinations.

16.1.4 Academ ic Perform ance Table 60: Licensure Exam inations Year Group No of No of Referred Referred Referred Referred % Pass candidates passes 1st tim e 2nd Tim e 3rd tim e 4th tim e ** D1 55 30 25 - - - 54.5 D2 51 19 15 17 - - 37.2 D3 75 37 25 8 5 - 49.3 D4 83 48 26 5 3 1 57.8 DM 1 12 8 4 - - - 66.8

181 2005 GHS Annual Report, W estern Region

16.1.5 Challenges & Constraints • Inadequate tutors to cover subjects especially for basic nursing and anatomy • No librarian to satisfy accreditation requirements • Nurses and Midwives Council (NMC) recommended books difficult to obtain • Inadequate clinical areas and accommodation at sites for students • Inadequate funds to cater for students’ T&T during clinical sessions due to increased numbers • Mini bus in a poor condition • Inadequate tables, benches in dining hall • No incinerator for effective disposal of refuse • No fence wall , security post and site plan for the institution

16.1.6 W ay Forward for 2006 • Dialogue with Directors of clinical areas for additional accommodation to help absorb more students • Procure more computers( including lap tops) for the computer laboratory to enhance use of LCD projector • Lobby for an incinerator to manage waste • Press for continuation of constructional works of classroom block and completion of hostel renovation • Solicit support for construction of wall and security post for college • Carry out body works and replace engine of mini bus • Prepare for graduation ceremony.

182 2005 GHS Annual Report, W estern Region

16.2. Essiam a Com m unity Health Nursing Training School 16.2.1. Intake and Output Table 61: Current Student Population Year M ale Fem ale Total 1 29 194 223 2 34 117 151 Total 63 311 374

There are 5 full tim e nursing tutors giving a tutor/ student ratio of 1:75

Table 62: Com parative recruitm ent from 2001 to 2005 Year Intake No of increase % increase 2001 25 - - 2002 50 25 100 2003 70 25 50 2004 154 84 120 2005 223 69 54

The student population increased from 25 in 2001 to 223 in 2005. The greatest yearly increase in intake of student occurred between 2003 and 2004.

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16.2.2. Key Activities & Achievem ent The school hosted His Excellency President John Agyekum Kufour in August 2005. The president inspected the Government project of classrooms and hostel The school conducted her maiden graduation ceremony of 55 students The school received an award of a colour TV during the W estern Regional Nurses Awards Day. The Principal also received an award. Two tutors are pursuing a degree course at the Department of Health Science Education at .

16.2.3 Key Issues and Challenges • Two more tutors are needed to enable effective teaching and learning • Inadequate residential accommodation for tutors. • Conflict between the Principal of the school and the Director of Missions. • Inadequate transport for the school. The school needs a pick –up and a 61 seater bus.

16.2.4 Outlook for 2006 • Construction of accommodation for staff at project site • Complete work on female hostel for occupation by end of February. • Prepare 79 students for licensure examination and achieve 90% success. • Resolving conflict between the Director of Missions of W ord Alive Church and the Principal of the school.

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17.0. Conclusion

The performance of the Region in 2005 has improved significantly over the 2004 performance for many of the Public Health indicators; family planning was exception. Utilization of the hospitals and clinics has gone up marginally for both out- patient and in-patient admissions

The slight improvement in the human resource situation in the Region in 2005 enabled us to start sending a second doctor to each of the major districts hospitals in the Region. It has also enabled us identify some community health nurses to be trained as community health officer for the CHPS programme. The output of all these staff, who will be operating in peripheral, previously un-served areas, will be manifest in 2006 and beyond. Those portions of the 2005 POW which could not be implemented either due to lack of funds or time constraint have been rolled into the 2006 POW . The 2006 POW for the W estern Region provides an excellent framework to guide BMCs in the Region to plan their activities for the year.

W ith the improving staff situation, coupled with the elaborate planning and the signing of performance contracts with our BMC Heads, we are optimistic that we will have better implementation of our activities and increased performance in 2006.

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