AREAS OF CONCERN TO IMPROVE HEALTH SERVICE IN THE -2019

District Profile

The Wa West District is one of the eleven administrative districts of the of . It is located in the North Western part of the region and stretches from longitudes 40°N to 245° and from latitudes 9"W to 32°W, covering an area of approximately 5,899.3 square kilometers. To the South, North-West and East, it has a common boundary with the , District and Wa Municipal respectively, and to the West with .

The district lies within the general prevailing semi savanna vegetation and tropical climatic conditions in the region. There is a single rainfall pattern that falls between May and October, followed by the prolonged dry season (harmattan) extending from November to April. This is a period characterized by reduced availability of food items (lean season) and also a high preponderance of CSM.

Lying in the Sahel belt makes the district prone to other epidemic prone diseases such as yellow fever, meningitis, anthrax, measles, cholera etc. There are eighteen border communities with Burkina Faso which makes it prone to diseases from that country as well. Sharing boundary with Sawla-Tuna-Kalba district in the Northern Region is another challenge as it is also a new district and even more less endured with health facilities. Therefore the people of that district use the Wa West district facilities at times.

The district has a population of 95984 people and is predominantly rural. There is not a single urban population in the district. The youthful population (0-17) constitutes approximately 47% of the total population, whilst the aged (65 and above) accounts for a legible proportion of 4.3%. The economically active population (18-64 age groups) accounts for 48.7% of the district’s population and dependency ratio is approximately 1:1. This implies that every economically active person has an additional mouth to cater for. Also, the low population density coupled with the state of the roads in the district makes wide coverage of health services to all communities a difficult task.

The district has 40 health facilities spread across with 6 sub districts and these include 7 Health centers 30 CHPS compounds, 2 Private facilities and 1 District Hospital. The Map below shows the distribution of the various facilities in the district

Map of Wa West District

Health Target Population Categories 2018

Total Expected Sub districts Population pregnancies 0-59 mths WIFA 0-23 mths 3-59 mths Dorimon 20,635 825 3,818 4,952 825 3,962 Eggu 6,145 246 1,137 1,475 246 1,180 Gurungu 16,893 676 3,125 4,054 676 3,243 Lassia 13,437 537 2,486 3,225 537 2,580 Poyentanga 17,085 683 3,161 4,100 683 3,280 21,789 871 4,031 5,229 871 4,183 District 95,984 3,838 17,757 23,036 3,838 18,429

SOCIO-CULTURAL STRUCTURE

The people of the district are mainly of two tribes; the Dagaaba and Brifor. There are Christians, Moslems and Traditionalist evenly distributed amongst the population. Also, there exists a consecrated chieftaincy institution with two Paramoncies namely Dorimon and Wechiau. The paramount chiefs and their sub-chiefs are recognized as major tools in improving and sustaining community participation in health and other development related activities in the district.

Wa West is considered as one of the deprived districts in Ghana with majority of the people being predominantly peasant farmers with low income generation. This is due to erratic rainfall and bad farming practices. Others also engage in traditional craft such as weaving of cloth pottery, basketry and woodcarving with limited market for their products. Few are engaged in fishing and as civil servants.

People live together mainly in rural compound dwellings with men generally being the bread winners for most households. Acute shortage of accommodation for civil servants in the district is an issue of major concern.

According to the district environmental health 2009 report, there are 232 boreholes located throughout the district out of which 182 are functioning and producing low yield.

Less than 10% of the population in the District has access to sanitary facilities 2244 households with latrines. These are only few KVIPs constructed through community initiative. Drainage is almost non-existent in the communities. The District has problems with her institutional structures to deal with waste.

Infrastructural development in the district is at low ebb especially the road network, communication facilities and power supply. Much of the road network is very poor arid inaccessible especially during the raining season. Besides, poor communication network is another challenge in the district. Out of the six sub-districts health centres, only three are covered by MTN and partially Airtel mobile network. The rest of the communities are without any network telephone facilities. Five out of the six sub-districts are connected to the national electricity grid leaving the rest in darkness.

The Wa West District has a great tourism potential in terms of natural, cultural, historical and man- made attractions. The tourist attractions include the following Wechiau Hippo Sanctuary which brings both local and foreign visitors to the district; Unique Lobe Architecture and Crocodile pond around Ga

Another nagging issue in the district is illiteracy, which is rated to be about 83%, especially among women. The in-depth household survey has not been conducted to determine the exact illiteracy rate. School enrolment for ages 6-25 in the district is very low. The numbers of schools are 11 nurseries, 48 Primary, 26 Junior Secondary and 2 Senior High schools.

Health status is low as mirrored by childhood and maternal mortality. Infant mortality is 62 deaths per 1,000 live births and the under-five mortality rate is 127 deaths per 1,000 live births. Neonatal mortality is estimated at 32 deaths per 1,000 live births; this means that for children who die before their first birthday, nearly one out of two die within the first month of life. It also has a Maternal Mortality rate of 0/100,000, the incidence of HIV/AIDS rate of 1.7 and Malnutrition rate of 43. The doctor-patient ratio is 2:95983 and Nurse-patient ratio is 1:628

These indicators have generally fallen below the national rates. The people have a strong belief in medicine prepared from the barks, leaves, seeds, and roots of trees which are considered efficacious for the caring of many ailments. Only a small proportion of the total population lives within the 8km radius and most clients are able to seek health care only on market days when they can have access to transport.

The District Health Services has identified some major challenges confronting the District which when addressed would be able to reduce morbidity, Mortality and the general wellbeing among the Population in the District. Below are some of the Topics or challenges outlined with suggested solutions.

A. HIGH TEENAGE PREGNANCY CASES

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20. Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods. In well- nourished females, the first period usually starts around the age of 12 or 13. Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth. For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age. Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.). Teenage pregnancies are associated with social issues, including lower educational levels or school dropout and poverty as well as death which can occur in the process of delivery or other complications. The Wa West District has recorded as much as 274 cases for the first half of 2018 which is a worry to the entire district as well as the region.

Expectations for improvement • Educating teenagers on Dangers Associated with the condition • Supporting female teenagers further their education • Engaging stakeholders to reduce the incidence • Sex education and reproductive health • Formation of adolescent health clubs

B. POOR MALARIA CASE MANAGEMENT

Malaria is a mosquito-borne infectious disease affecting humans and other animals caused by parasitic single-celled microorganisms belonging to the Plasmodium group. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death. Symptoms usually begin ten to fifteen days after being bitten by an infected mosquito. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria.

Mostly affected are the pregnant women and children less than five years of age resulting in thousands of death though out the world with most cases occurring in the Sub Saharan Africa. Wa West has not been an exception due to poor nature of the District.

Unfortunately management of malaria cases has been a great problem leading to increased number of cases in the district. As at mid-year 2018, the district recorded 20387 and tested 20268 with a gap of 119 and also recorded 11493 positive cases.

Expectations for improvement

• Provision of enough Anti Malaria Drugs • Education of Population on Prevention of Malaria • Provision of malaria Test Kits • Stakeholder engagement • Early detection and reporting of malaria cases

C. LATE ANTENATAL CLINIC (ANC) REGISTRATION AND HOME DELIVERIES

Pregnancy is very critical moment in a woman life as she passes through total change in the whole system which sometimes comes with different conditions and reactions.

Every Pregnant woman is supposed to visit the Clinic or Hospital to be assessed within the first three months and eventually deliver in the health facility to save the lives of the mothers and their children. Some women visit the health facility as late as month seven, eight and nine when conditions are so worse that it becomes difficult to manage. It is partly sometimes due lack of education, lack of means of movement, lack of closer facilities etc. The district has seen 172 pregnant women registering as late as third trimester and 81 mothers delivering at home for mid-year 2018 which is not a good thing to write about.

Expectations for improvement

• Education of women of child bearing age on the need to visit health facility after conception • Motivation of pregnant women who visit the facility early to entice other people to do same • Getting health facilities closer to the people • Making the materials for pregnant women available at all times • Stakeholder engagement

D. LOW FAMILY PLANNING UPTAKE

Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved”. Family planning may involve consideration of the number of children a woman wishes to have, including the choice to have no children, as well as the age at which she wishes to have them. These matters are influenced by external factors such as marital situation, career considerations, financial position, and any disabilities that may affect their ability to have children and raise them, besides many other considerations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre- conception counseling and management, and infertility management. Family planning as defined by the United Nations and the World Health Organization encompasses services leading up to conception and does not promote abortion as a family planning method, although levels of contraceptive use reduce the need for abortion. The Wa West District has had as low as 42.8% recorded for the year 2017 family planning services rendered leading to huge numbers of unwanted pregnancies eventually causing unwanted deaths. This could be lack of the family planning commodities, lack of trained personnel to render the services, Lack of nearby facility to render the services etc.

Expectations for improvement

• Making family planning devices available and free • Educating women of child bearing age on the importance of Family Planning Services • Training more health workers on how to use the devices • Making family planning available at all facilities • Role Play on early and late ANC registration

E. COMMUNITY EMERGENCY TRANSPORT SYSTEM (CETS)

This is an initiative in the remote areas or communities to help transport critically ill persons to the nearest health facility for care. Due to the lack of proper roads as well as means of transport in the remote communities it is imperative to get means to convey people in critical need. It is than so that when such a person becomes stable the cost of transport is paid back to keep the system running

The system can be in the form of car, motorbike, tricycle, bicycle, horse etc. depending on what is available in a particular time in a community

The district has just 72 communities being able to implement the initiative in their communities out of the 226 communities which is does not permit the smooth running of the system.

Expectations for improvement

• Beginning capital to acquire the means to be used • Educating community members on the importance of CETS • Formation of additional CETS in communities without CETS • Role Play on Emergency on CETS • Stakeholder engagement

F. DORMANT AND INADEQUATE FATHER TO FATHER SUPPORT GROUPS (FTFSGS) Over the past period there has been low fathers support in the upbringing of children and even in areas relating to the health of the woman or the wife. And therefore the need to create a platform where fathers or men can discuss health issues concerning the whole family and the community

After each meeting, the men pledge to try new behaviors that will contribute to the health and wellbeing of their households, especially pregnant and lactating women and children under two years. This might mean taking on more cleaning tasks around the house to free up time for their wives to rest during pregnancy; providing nutritious food for the family; learning to identify signs of illness in their children; and providing safe transportation for their wives and children to attend health clinics. The men also bear witness to one another’s commitments, reporting on the success of their peers and helping them is accountable for their pledges. The Wa West District has 14 functional Father to Father Support Group spread across which is woefully inadequate as a district.

Expectations for improvement

• Following up on the existing groups to educate members in other to strengthening them • Establishing new FTFSGs in other communities without the groups • Involvement of men on Health activities

Other Challenges confronting health service delivery

The average distance to a health facility in the district is believed to be above the National target of 5-kilometer maximum distance in accessing health services. This is indicative of poor physical accessibility to health services notwithstanding the increased outreach stations and static health facilities in the district. Many people are also unable to access health services due to the prevailing poverty among the people.

The existing health facilities are poorly equipped and staffed. Patient and staff accommodation is inadequate to meet current demands and communication between communities and health delivery outlets remains poor. There is also one Ambulance service in the District to facilitate movement of emergency referral cases to the regional hospital for special services. These are all critical issues, which needs immediate attention by the DA and the District Health Directorate as they could threaten the ability of the district to provide good quality health services and negatively affect the achievement of SDGs’ especially child and maternal health care.

Other challenges include;

• High incidence of minor surgical cases requiring surgical attention in the district • High teenage pregnancy rate over the past 4 years. Below is a graph showing the trend of teenage pregnancy in the district

Figure 2: Trend of teenage pregnancy 2012 - 2017

600 537 493 500 456 428 391 400 376

300

200

100

0 2012 2013 2014 2015 2016 2017 No.of Teenage Preg. 391 376 428 456 493 537

• Old and dilapidated health facilities requiring renovation • Week and broken furniture for service delivery • Inadequate data capturing equipment (Laptop and desktop computers, printers) for data entry and report writing • Inadequate delivery items. Some facilities deliver women on the bear floor • Week transport for community based projects resulting in low coverage in some indicators (Out of 80 motors only 25% of them are on road impacting negatively on service delivery especially outreach programmes

Conclusion

In conclusion, it is our hope that with all the above listed suggested solutions will help to deal with all the challenging issues bedeviling the district if the necessary support is gained. Researches/survey could also be conducted to reveal facts on the areas listed above.