GHANA HEALTH SERVICE 2014 ANNUAL REPORT
GHANA HEALTH SERVICE
2014 ANNUAL REPORT
JULY 2015
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GHANA HEALTH SERVICE 2014 ANNUAL REPORT
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GHANA HEALTH SERVICE 2014 ANNUAL REPORT
FOREWORD
The Ghana Health Service has very elaborate review processes that culminate in the writing of the Annual Report.. Each year, the GHS conducts performance reviews beginning at the District level and ending with the Health Summit at mid-year. These reviews apprise and appraise Health Sector comparative performance overtime, based on the six define objectives of the sector. Achievements in the year form the baseline to set the targets of the following year.
The 2014 Annual Report of the GHS highlights the implementation activities, and health service initiatives in the Health Sector Medium Term Development Plan (HSMTDP 2014-2017).
Ghana has continued to maintain a ‘polio-free’ status since 2008 and a progressive TB success rate of 86% over 2012 and 2013. Elimination of Maternal and neonatal tetanus (MNT) status has remained at zero since 2011. Mortality from measles has also remained at zero since 2003. Efforts to eradicate Guinea Worm have remained on course in 2014.
Topical in our efforts to reduce maternal and newborn deaths are measuring institutional maternal mortality ratio (IMMR) and stillbirth rate (SBR). IMMR in 2014 was 143.8/100,000 live births in comparison to IMMR of 153/100,000 live births in 2013. Stillbirth rate stagnated at 1.8 in the 2014, as was in 2013.
Total outpatient department (OPD) attendance in 2014, comprised 83.5% insured clients and less than 17% being out-of-pocket clients. This coverage is comparable to 2013 where 83% of OPD attendants were insured. The proportion of malaria cases tested before treatment at the OPD continued to improve from 42.9% in 2011 to 74.3% in 2014. The malaria case fatality in the under-fives reduced from 0.6% in 2013 to 0.51 in 2014. The proportion of pregnant women who were registered and were administered a second dose of Intermittent Preventive Treatment (IPT2) declined, falling from 55.4% in 2013 to 38.8% in 2014. This is drastic fall back compared to 60.9% coverage achieved in 2011.
In 2014, the continued poor financing of the Service produced noticeably adversely effects on health care services across districts and regions. The inability to address issues of inadequate financing and the pattern of erratic fund flow over successive years is hampering service delivery efforts as well as maintaining and running district, regional and national offices within the GHS. The majority of funds disbursed in 2014 were earmarked for implementing only particular programmes. This is reflected in the inability of the Service to progressively achieve desired service delivery targets.
Despite these setbacks, we as a national health service have remained focused and undeterred in our efforts to provide healthcare for all people living in Ghana and contribute to national development and productivity. In the coming year 2015, we would reflect on combined efforts and initiatives that have been implemented to enable Ghana achieve its health-related Millennium Development Goals (MDGs).
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GHANA HEALTH SERVICE 2014 ANNUAL REPORT
I am grateful to all the staff of the Ghana Health Service, first of all for their resilience in a particularly challenging year, and for their hard work and commitment to achieving the vision of the Ghana Health Service and the accomplishments of the Health Sector.
I am also grateful to our health and development partners as I acknowledge their continued collaboration, capacity-building, technical and financial assistance to the Ghana Health Service.
I would also like to acknowledge collaboration efforts of other Sectors: Finance, Agriculture and Local Government working with health to make Ghana a better place for all Ghanaians.
I say Ayeekoo!
Although I acknowledge that Ghana will not be achieving three out of its five MDGs next year, I urge all of us to put our shoulder to the wheel to make the positive change we all want to see in 2015.
Thank you.
Dr. Ebenezer Appiah-Denkyira Director-General
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EXECUTIVE SUMMARY
The Ghana Health Service has the primary mandate to ensure a healthy Ghanaian population by providing quality healthcare services to all people living everywhere in Ghana. This is a priority achieved through a seamless access to health service from community level to the district level.
The Ghana Health Service 2014 Annual Report is organized into ten chapters. Chapter One describes the Ghana Health Service as an organization and its mandate. Chapter Two elucidates its structure, governance and leadership. In Chapter Three we review financial reporting and in Chapter Four, human resource. Chapters Five, Six and Seven cover support services for health, Disease Surveillance and Control, and reproductive and family health activities, respectively. In Chapter Eight we cover activities in clinical and institutional care and highlight some of the community engagements and partnerships in Chapter Nine. Chapter Ten concludes with research activities and reporting, and the role of the District Health Information Management System (DHIMS2) in strengthening health information management in the GHS. Sector wide indicator figures are covered in the Annexes.
Key performance indicators for 2014 are discussed in comparison to previous years. In 2014, 368 additional functional CHPS zones were made operational across all ten regions. This is a slight increase compared to 354 CHPS being made operational in 2013. This brings the total number of functional CHPS zones in 2014 to 2,948; a 14% increase (368 CHPS zones) over the 2,580 figure reported in 2013. Out of this total number, 1,260 CHPS have compounds.
In 2014, 2,743 CHPS (93%) were seen to be directly reporting into the DHIMS2, in comparison to 2119 CHPS (82%) reporting into DHIMS2 in 2013. For CHPS not directly reporting, health service data are reported on their behalf by the supervising health centres. CHPS contribution to OPD attendance increased from 6.1% of the total OPD attendance of 2,549,859 in 2013 to 2,407,966, which is 10.2% of total OPD in 2014.
The proportion of total OPD attendance that was insured in 2014 was 83.5%, which is almost the same as what was recorded in 2013. Out of the total OPD attendance 62.7% were females.
As the efforts to ensure improved maternal and neonatal health continue, there was an observed increase in the proportion of pregnant women achieving the minimum 4 antenatal care (ANC) visits in 2014. Approximately 76.1% pregnant women made at least 4 ANC visits in 2014 in comparison to 66.3% in 2013. The supervised delivery rate slightly improved from 55.3% in 2013 to 56.7% in 2014. Family Planning coverage increased from 24.7% in 2013 to 29.1% in 2014. These improvements in maternal care although not conclusive, could be a reflection of the increase in critical workforce, particularly midwives in many districts across the regions. The midwife: WIFA ratio has been slowly improving over the last three years. In
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the last two years, the midwife: WIFA ratio improved from 1:1,400 in 2013 to 1: 1,374 in 2014.
Improvement in childhood immunization is measured using the proxy Penta-3. National average of Penta-3 coverage increased from 86% in 2013 to 90% in 2014, however 29% (63) of the 216 districts in Ghana, could not achieve the 80% coverage target for Penta 3 coverage in 2014. The Greater Accra region recorded the highest number (44,487) of unimmunized children. Regional immunization performance is detailed in Chapter Six.
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TABLE OF CONTENTS
FOREWORD ...... 3
EXECUTIVE SUMMARY ...... 5
CHAPTER ONE ...... 15
1.0 INTRODUCTION ...... 15 1.1 GHANA HEALTH SERVICE ORGANIZATION AND MANDATE ...... 15 1.2 CHALLENGES IN THE GHS: END OF 2013/BEGINNING OF 2014 ...... 15 1.2.1 HEALTH SYSTEM ...... 15 1.2.2 HEALTH INFORMATION SYSTEM ...... 15 1.2.3 HUMAN RESOURCES FOR HEALTH ...... 15 1.2.4 HEALTH FINANCING AND FINANCIAL ARRANGEMENTS ...... 16 1.2.5 INFRASTRUCTURE AND EQUIPMENT ...... 16 1.3 SUMMARY OF KEY PRIORITIES ACTIONS FOR GHANA HEALTH SERVICE FOR 2014 ...... 16
CHAPTER TWO ...... 18
2.0 LEADERSHIP AND GOVERNANCE ...... 18 2.1 THE GHANA HEALTH SERVICE COUNCIL ...... 18 2.2 DIRECTORS’ MEETING ...... 18 2.3 HEALTH SUMMIT ...... 19 2.4 GHANA HEALTH SERVICE STRATEGIC PLAN ...... 21 2.5 GAVI HEALTH SYSTEMS STRENGTHENING (HSS) ...... 21 2.6 CHPS OPERATIONAL POLICY AND GUIDELINES ...... 21 2.7 PROGRAMME OF WORK ...... 21 2.8 PERFORMANCE MANAGEMENT PROCESSES ...... 21 2.9 MONITORING AND EVALUATION ...... 22 DATA COLLECTION AND REPORTING: ...... 22 2.9.1 IMPROVING THE DISTRICT HEALTH INFORMATION MANAGEMENT SYSTEM (DHIMS2) ...... 22 2.9.2 INTEGRATED MONITORING VISITS ...... 23 2.10 AUDIT OF BUDGET MANAGEMENT CENTRES (BMCS) IN GHS ...... 24 2.10.1 FORMATION OF AUDIT REPORT IMPLEMENTATION COMMITTEE (ARIC) ...... 24 2.10.2 PERFORMANCE OF REGIONAL INTERNAL AUDIT UNITS ...... 25 2.10.3 AUDIT RECOMMENDATIONS IMPLEMENTED ...... 25 2.10.4 AUDITS FINDINGS ...... 25
CHAPTER THREE ...... 26
3.0 FINANCE ...... 26 3.1 PERFORMANCE IMPROVEMENT ...... 26 3.2 2013 FINANCIAL REPORT ...... 27
CHAPTER FOUR ...... 28
4.0 HUMAN RESOURCES FOR HEALTH ...... 28 4.1 ANALYSIS OF PAYROLL DATA ...... 28
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4.2 NOMINAL ROLL AND PAYROLL RECONCILIATION ...... 34 4.3 REVIEW OF STAFFING NORMS ...... 34 4.3.1 SUMMARY OF STAFFING NORMS OUTPUT ...... 35 4.3.2 HUMAN RESOURCES (HR) GAP ANALYSIS BASED ON THE STAFFING NORMS ...... 36 4.4 HUMAN RESOURCE DATA ...... 36 4.5 RECRUITMENTS ...... 36 4.5.1 MEDICAL OFFICERS ...... 36 4.5.2 DENTAL SURGEONS ...... 37 4.5.3 GENERAL NURSES ...... 37 4.5.4 REGISTERED MENTAL HEALTH NURSES ...... 37 4.5.5 REGISTERED MIDWIVES ...... 37 4.5.6 COMMUNITY HEALTH/ ENROLLED NURSES ...... 37 4.6 HEALTH ADMINISTRATION AND MANAGEMENT (HAM) PROGRAM ...... 38 4.6.1 EVALUATION OF THE HAM PROGRAM ...... 38 4.7 TRAINING/DEPLOYMENT OF MEDICAL PERSONNEL TO FIGHT AGAINST EBOLA VIRUS PANDEMIC ...... 38
CHAPTER FIVE ...... 40
5.0 ADMINISTRATION AND SUPPORT SERVICE ...... 40 5.1 TRANSPORT ...... 40 5.0.1 CONSTRUCTION OF CHPS COMPOUNDS AND HEALTH CENTRES ...... 41 5.0.2 UPDATING AND VALIDATING DATA ON HEALTH FACILITIES IN THE REGIONS ...... 41 5.0.3 REVAMPING BOAT FLEET AND MANAGEMENT ...... 41 5.0.4 INCREASE FLEET SIZE AND IMPROVE VEHICLE AVAILABILITY ...... 41 5.1 EQUIPMENT ...... 42 5.1.1 ESTABLISHING THE EQUIPMENT MAINTENANCE FUND ...... 42 5.2 ADMINISTRATION ...... 42 5.2.1 DEVELOPMENT OF ADMINISTRATORS DASHBOARD ...... 42 5.3 ESTATE ...... 42 5.3.1 UPDATING THE PROGRESS AND STATUS OF GHS CIVIL WORKS ...... 42 5.3.2 GHS 2014 CIVIL WORKS BUDGET ...... 43 5.3.3 APPROVED BUDGET ...... 44 5.3.4 GHS CIVIL WORK PROJECTS ...... 44 5.3.5 TREND OF PROJECT IMPLEMENTATION FROM 2012 – 2014 ...... 45 5.3.6 PROCESSING AND PAYMENT OF CLAIMS ...... 45 5.3.7 SECTOR BUDGET SUPPORT ...... 45 5.3.8 CHPS PROJECTS ...... 45 5.3.9 CERTIFICATES PROCESSED ...... 46 5.4 CLINICAL ENGINEERING ...... 46 5.4.1 ACCE/HTF 2014 INTERNATIONAL ACEW AWARD ...... 46 5.5 PROCUREMENT ...... 46 5.5.1 COMPETITIVE TENDERING / SOLE SOURCING CONTRACTS ...... 46 5.5.2 FUNDING SOURCES FOR PROCUREMENT FOR YEAR 2014 ...... 47 5.6 STORES AND SUPPLY ...... 47 5.6.1 EARLY WARNING SYSTEM ...... 47 5.6.2 INTRODUCTION & TRAINING OF SUPPLY CHAIN MANAGEMENT IN PRE-SERVICE INSTITUTION ...... 48
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5.6.3 INVENTORY MANAGEMENT SOFTWARE ...... 48
CHAPTER SIX ...... 49
6.0 DISEASE SURVEILLANCE AND CONTROL SERVICE ...... 49 6.1 DISEASE SURVEILLANCE ...... 49 6.1.1. ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE ...... 49 6.1.2. MEASLES-RUBELLA SURVEILLANCE ...... 52 6.1.3. NEONATAL TETANUS SURVEILLANCE ...... 55 6.1.4 YELLOW FEVER ...... 56 6.1.5 MENINGITIS SURVEILLANCE ...... 57 6.1.6. CHOLERA SURVEILLANCE ...... 59 6.1.7. INFLUENZA-LIKE ILLNESS (ILI) SURVEILLANCE ...... 60 6.1.8. NATIONAL VIRAL HEPATITIS SURVEILLANCE AND CONTROL PROGRAMME (NVHCP) ...... 60 6.2 NATIONAL MALARIA CONTROL PROGRAMME ...... 63 6.2.1 KEY ACTIVITIES ...... 63 6.3 GUINEA WORM ERADICATION PROGRAMME ...... 68 6.3.1 MAJOR ACTIVITIES ...... 68 6.3.2 MAJOR ACHIEVEMENTS ...... 68 6.3.3. SOCIAL MOBILIZATION AND HEALTH EDUCATION ...... 68 6.3.3. CAPACITY BUILDING (TRAINING, MEETINGS) ...... 68 6.3.4 LOGISTICS SUPPORT ...... 69 6.3.5. WATER INVENTORY IN FORMERLY ENDEMIC COMMUNITIES ...... 69 6.3.6 GUINEA WORM PROGRAMME REVIEW MEETING ...... 70 6.3.7 GUINEA WORM FREE PRE-CERTIFICATION: ICT VISIT TO GHANA ...... 70 6.4 NON COMMUNICABLE DISEASE CONTROL PROGRAMME ...... 71 6.4.1 POLICY REVIEWS ...... 71 6.4.2 MONITORING ...... 71 6.4.3 ESTABLISHMENT OF ADDITIONAL WHO-PEN SITES ...... 71 6.4.4 CERVICAL CANCER SCREENING IN ASHANTI AND GREATER ACCRA REGIONS ...... 71 6.4.5. PARTNERSHIP FOR CERVICAL CANCER ...... 71 6.4.6. TRAINING ON WHO-PEN PROTOCOLS AND TOOLS ...... 72 6.4.7 SUPPORT SERVICES ...... 72 6.4.8. DISEASE BURDEN ...... 72 6.4.9. HEALTH RESEARCH ...... 74 6.5 NATIONAL YAWS ELIMINATION PROGRAMME ...... 74 6.5.1 ACTIVITIES ...... 74 6.5.2 RETURNS AND INDICATORS ...... 74 6.5.3 REMARKS ON ENDEMIC COMMUNITY BASELINE SITUATION ...... 75 6.5.4 INNOVATIONS ...... 76 6.6 NEGLECTED TROPICAL DISEASES ...... 76 6.6.1 LYMPHATIC FILARIASIS ...... 76 ONCHOCERCIASIS ...... 77 6.6.2 ...... 77 TRACHOMA ...... 79 6.6.3 ...... 79
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6.6.4 SCHISTOSOMIASIS ...... 79 6.6.5 SOIL-TRANSMITTED HELMINTHS ...... 79 6.7 NATIONAL TUBERCULOSIS CONTROL PROGRAMME ...... 80 6.7.1 KEY ACTIVITIES ...... 80 6.7.2 PERFORMANCE INDICATOR TRENDS ...... 80 6.7.3 COMPLETION OF NATIONWIDE TUBERCULOSIS PREVALENCE SURVEY ...... 82 6.7.4 DEVELOPMENT OF NEW STRATEGIC PLAN ...... 82 6.7.5 ON SITE COACHING FOR LABORATORY STAFF AND QA ASSESSORS ...... 82 6.7.6 CONTINUOUS ON SITE DATA VALIDATION AND DATA QUALITY AUDITS ...... 82 6.8 THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI) ...... 82 6.8.1 EPI-RELATED HEALTH INDICATORS ...... 82 6.8.2 GLOBAL COVERAGE GOALS FOR NATIONAL IMMUNIZATION PROGRAMME ...... 83 6.8.3 PROGRAM OBJECTIVES FOR 2014 ...... 83 6.8.4 KEY STRATEGIES FOR 2014 ...... 83 6.8.5 MAIN INTERVENTIONS CARRIED OUT IN 2014 ...... 84 6.8.6 SERVICE DELIVERY STRATEGIES ...... 84 6.8.7 EQUITY IN VACCINATION COVERAGE ...... 86 6.9 OCCUPATIONAL HEALTH ...... 88 6.9.1 ACTIVITIES ...... 88 6.9.2 POISON CONTROL ...... 89 6.10 NATIONAL LEPROSY ELIMINATION PROGRAMME ...... 90 6.10.1 LEPROSY ENDEMIC DISTRICTS IN GHANA ...... 90 6.10.2. PRIORITY INTERVENTIONS ...... 91 6.11 NATIONAL YAWS ELIMINATION PROGRAMME ...... 91 6.11.1 ACTIVITIES ...... 91 6.11.2 INNOVATIONS ...... 92 6.12 NATIONAL AIDS CONTROL PROGRAMME (NACP) ...... 92 6.12.1 HIV TESTING AND COUNSELING SERVICES (HTC) ...... 92 6.12.2 PMTCT SERVICES ...... 92 6.12.3 EID SERVICES ...... 93 6.12.4 CLIENTS ON ANTIRETROVIRAL THERAPY ...... 93 6.12.5 CONDOMS ...... 93 6.12.6 HIV TEST KITS AND ACCESSORIES ...... 93 6.12.7 INFORMATION AND COMMUNICATION MATERIALS ...... 93 6.12.8 CAPACITY BUILDING FOR HEALTH CARE WORKERS ...... 94 6.12.9 CDC COLLABORATION ...... 94 6.12.10 MONITORING & SUPERVISION ...... 95 6.12.11 RESEARCH ...... 95 6.12.12 RESOURCE MOBILIZATION ...... 95 6.13 PUBLIC HEALTH LABORATORIES ...... 95 6.13.1 BACTERIOLOGY, MEASLES/RUBELLA/YELLOW FEVER BENCH ...... 95 ACTIVITIES UNDERTAKEN ...... 95 6.13.2 ...... 95
CHAPTER SEVEN ...... 97
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7.0 REPRODUCTIVE HEALTH, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH) ...... 97 7.1 ADOLESCENT HEALTH AND REPRODUCTIVE HEALTH SERVICES ...... 97 7.1.1 POLICY AND PLANNING IN ADHD PROGRAMMING ...... 97 7.1.2 ADOLESCENT HEALTH SERVICES ...... 97 7.2 FAMILY PLANNING ...... 98 7.3 SAFE MOTHERHOOD AND CHILD HEALTH ...... 99 7.3.1 ACCELERATED REDUCTION OF MATERNAL MORTALITY ...... 99 7.3.2 NEWBORN CARE ...... 99 7.4 NUTRITION ...... 100 7.4.1 VITAMIN A SUPPLEMENTATION ...... 100 7.4.2 DEVELOPMENT OF GUIDELINES & PROTOCOLS ...... 100 7.4.3 INFANT AND YOUNG CHILD NUTRITION PROGRAM (IYCN) ...... 100 7.4.4 NMCCSP/GROWTH PROMOTION ...... 100 7.4.5 COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM) ...... 100 7.4.6 NUTRITION ASSESSMENT COUNSELING AND SUPPORT (NACS) FOR PLHIV ...... 101 7.5 HEALTH PROMOTION ...... 101 7.5.1 HEALTH PROMOTION SUPPORT FOR PROGRAMMES ...... 101
CHAPTER EIGHT ...... 103
8.0 CLINICAL CARE SERVICES ...... 103 8.1 EBOLA CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL TRAININGS ...... 103 8.1.1 EBOLA CASE MANAGEMENT SIMULATION EXERCISE ...... 103 8.2 DEVELOPMENT OF DRAFT POLICY ON ANTIMICROBIAL USE AND RESISTANCE ...... 103 8.3 CATARACT SURGERIES ...... 104 8.4 FIGHT AGAINST EPILEPSY INITIATIVE ...... 104 8.5 CUSTOMER CARE PROGRAMME (PHASE 2) ...... 104 8.6 GUIDELINES ON THE DISPOSAL OF DEAD BODIES ...... 105 8.7 DISTRIBUTION OF SEVERAL QA DOCUMENTS ...... 105 8.8 PATIENT SAFETY SITUATIONAL ANALYSIS ...... 106 8.9 TRAINING OF TRAINERS IN PAEDIATRICS IN DISASTERS ...... 106 8.10 QUALITY IMPROVEMENT WORK WITH PROJECT FIVES’ ALIVE ...... 106 8.10.1 DESIGN AND IMPLEMENTATION ...... 107 8.10.2 SOME RESULTS ON THE INTERVENTIONS MADE BY HEALTH STAFF ...... 107 8.11 NEONATAL MORTALITY RATES ...... 108
CHAPTER NINE ...... 112
9.0 COMMUNITY ENGAGEMENT AND PARTNERSHIPS ...... 112 9.1 COMMUNITY-BASED HEALTH PLANNING SERVICES (CHPS) ...... 112 9.1.1 CONTRIBUTION OF CHPS TO SERVICE DELIVERY ...... 113
CHAPTER TEN ...... 114
10.0 HEALTH INFORMATION, ICT AND HEALTH RESEARCH ...... 114
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10.1 DATA MANAGEMENT AND INFORMATION TECHNOLOGY TO IMPROVE HEALTH INFORMATION MANAGEMENT AND SERVICE DELIVERY ...... 114 10.1.1 DATA QUALITY IMPROVEMENT ...... 114 10.1.2 GHS PERIODIC PERFORMANCE REPORTS ...... 114 10.2 HEALTH RESEARCH ...... 115 10.2.1 ACTIVITIES ...... 115 10.2.2 DATA MANAGEMENT SUPPORT FOR RESEARCH STUDIES ...... 115 10.2.3 RESEARCH CENTRES ...... 115
ANNEX ...... 116
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ACRONYMS & ABBREVIATIONS ACTs Artemisinin-based Combination GWEP Guinea Worm Eradication Therapies Programme ACSM Advocacy, Communication and HASS Health Administrative Support Social Mobilization Services Division AEFI Adverse Events Following HIA Health Impact Assessment Immunization HMM Home Management of Malaria AFRO African Regional Office of WHO HPV Human Papillomavirus AMFm Affordable Medicines Facility for RDD Research Development Division Malaria HRDD Human Resource and ANC Antenatal Care Development Division AusAID Australian Agency for HSMTDP Health Sector Medium term International Development Development Plan BCC Behavior Change HTC HIV Testing and Counseling Communication Services BMCs Budget Management Centers ICD Institutional Care Division CBAs Community-based Agents ICOH International Commission on CDR Case Detection Rate Occupational Health CDTI Community-directed Treatment ICT Information Communication with Ivermectin Technology CFR Case Fatality Ratio/Rate IDSR Integrated Disease Surveillance CHO Community Health Officer and Response CHPS Community-based Health IE&C Information Education and Planning and Services Communication DANIDA Danish International IHR International Health Regulation Development Agency IGF Internally Generated Funds DFID UK Department for IMCI Integrated Management of International Development Childhood Illness DHIMS District Health Information IPHU International Public Health Unit Management Systems IPT Intermittent Preventive DHMT District Health Management Treatment Teams IRS Indoor Residual Spraying DHS Demographic Health Survey ITNs Insecticide-treated bed nets DTS Dried Tube Specimens JHU CCP Johns Hopkins University EmONC Emergency Obstetrics and Centre for Communication Neonatal Care Programs EMD Epidemic Meningococcal KATH Komfo-Anokye Teaching Disease Hospital EPI Expanded Programme on KBTH Korle-bu Teaching Hospital Immunization CoHS KintampoCollege of EQA External Quality Assessment Health Sciences and Wellness GAVIHSS Global Alliance for vaccines LDP Leadership Development and Immunization Health Program Systems Strengthening LF Lymphatic Filariasis GHS Ghana Health Service LLINs Long-lasting insecticide treated GIS Geographical Information bed nets System MAF MDG 5 Acceleration Framework GMA Ghana Medical Association MDA Mass Drug Administration GoG Government of Ghana
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MDAs Ministries Department and RDTs Rapid Diagnostic Test kits Agencies SBS Sector Budget Support MDBS Multi-Donor Budget Support SCD Sickle Cell Disease MDSC Multi-Disease Surveillance SCFG Sickle Cell Foundation of Centre Ghana MICS Multiple Indicator Cluster SHEP Social Health Education Project Survey SOP Standard Operating Procedure MNT Maternal and Neonatal Tetanus SP Sulphadoxine–Pyrimethamine MSD Measles Second Dose SSDM Stores, Supply and Drugs NACP National AIDS Control Management Division Programme SSTH Schistosomiasis and Soil- NCD Non-communicable Diseases Transmitted Helminthes NFP National Focal Person STH Soil-transmitted Helminthes NGOs Non-Governmental TBCAP Tuberculosis Control Assistance Organizations Program NHIA National Health Insurance ToT Trainer of Trainers Authority TTH Tamale Teaching Hospital NHIS National Health Insurance U5 Under Five year olds Scheme UNICEF United Nations Children’s Fund NHRC Navrongo Health Research USAID United States Agency for Centre International development NIDs National Immunization Days WHO World Health Organization NMCCSP Nutrition and Malaria Control WIFA Women in the Fertile Age for Child Survival Project NMCP National Malaria Control Programme NPHRL National Public Health and Reference Laboratory NSSCD Newborn Screening for Sickle Cell Disease NTB National Tuberculosis Control Programme NTDs Neglected Tropical Diseases OHS Occupational Health and Safety OHS Occupational health strategy OPC Onchcocerciasis Control Programme for West Africa OPD Out Patient Department PCR Polymerase Chain Reaction PMDT Programmatic Management of Drug Resistant TB PMTCT Prevention of Mother to Child Transmission POD Prevention of Disease PoW Programme of Work PPME/D Policy Planning Monitoring and Evaluation Division QA Quality Assurance
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CHAPTER ONE
1.0 INTRODUCTION
1.1 Ghana Health Service Organization and Mandate
The Ghana Health Service (GHS) was established in 1996 as a Public Service body under Act 525 as required by the 1992 constitution. The GHS is an autonomous executive agency of the Ministry of Health (MoH) and responsible for the implementation of all national health policies. GHS’ independence is designed primarily to ensure that the agency has greater degree of managerial flexibility to achieve its responsibilities, in contrast to what would be permissible within the civil service. The GHS is also independent of the Teaching Hospitals, Private and Mission Hospitals but collaborates to ensure the health of the nation.
The Ghana Health Service is mandated “To provide and prudently manage comprehensive and accessible quality health services with emphasis on Primary Health Care in accordance with approved national policies.” The Ghana Health Service has the shared vision to ensure “A Healthy population with Universal Access to Quality Health Service.”
1.2 Challenges in the GHS: end of 2013/beginning of 2014
1.2.1 Health System
a) Weak sub-district structures .There are inadequate public health programmes both at the sub-district and community levels resulting in weak community engagement for routine health activities, particularly EPI and operating CHPS. Progress made in improving immunization coverage in previous years was not maintained in 2014. Progress in CHPS implementation also slowed in 2014.
b) Inadequate sector collaboration The weaknesses at the sub-district level were more evident during the cholera outbreak early in 2014 and the inadequate collaboration with other sectors, particularly transport and sanitation, that contribute significantly to the health of Ghanaians contributed in an immense way to the care of cholera cases in the country.
1.2.2 Health Information System
There is low commitment among some senior managers at the district, regional and national level in supporting the use of the DHIMS data for reporting and decision-making. This apathy by managers poses a challenge to improving the data quality at all levels.
1.2.3 Human Resources for Health
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There has been the gradual improvement in the increasing the numbers of skilled staff nationwide in efforts to close the ever-widening equity gaps. Despite these efforts, there has been little impact on rural and remote facilities. Many rural areas lack the minimum number of skilled staff needed to enhance service delivery and quality of care.
1.2.4 Health Financing and Financial Arrangements The withdrawal of Government of Ghana funds to the Service over the last few years continues to adversely affect service delivery, particularly public health promotion and prevention activities across the country. This is further exacerbated by the continued delayed reimbursement of health facilities by the Nation health Insurance Scheme at all levels. There has been some efforts to collaborate with the National Health Insurance Authority, but this has not yielded much improvement in the late reimbursement of all facilities. Many facilities are unable to sustain their drugs component of the health financing as a result of severe funding constraint.
1.2.5 Infrastructure and Equipment
The health sector has a backlog of uncompleted projects that not only hampered the provision of adequate office space and accommodation for staff across all regions, but also efforts to draw in more clients because of overcrowding in facilities. There is inadequate and in some case a lack of means of transport at health facilities to undertake outreach services into hard-to-reach communities and for health service monitoring activities. In cases where vehicles are available these are either overage or carry a high burden of cost to repair or operate. In some regions there is notably a a poor culture of planned preventive maintenance (PPM) of equipment and facility buildings. This may be in part due to little or no funding for PPM activities.
1.3 Summary of Key Priorities Actions for Ghana Health Service for 2014
There are six broad health sector objectives that underscore the implementation of priority actions in the Sector Programme of Work for 2014:
Table 1.0 Health Sector Objectives of the Health Sector Medium-Term Development Plan (HSMTDP) 2014-2017
HO1 Bridge Equity Gaps in Geographical Access to Health Services
HO2 Ensure Sustainable Financing for Health care Delivery and financial protection for the poor HO3 Improve Efficiency in Governance and Management of the Health System
HO4 Improve Quality of Health Service Delivery including Mental Health Services
HO5 Enhance National Capacity for the attainment of health-related MDGs and sustain gains 16
GHANA HEALTH SERVICE 2014 ANNUAL REPORT
HO6 Intensify Prevention and Control of Communicable and Non-communicable Diseases
These Health objectives require certain priority actions by the Ghana Health Service. Below is a summary of the priorities for 2014 that will cover report of activities in Chapters Six to Nine.
Table 2.0 Summary of Priorities for 2014
1. Accelerate scale-up of Community-based Health Planning and Services (CHPS) under the ‘close-to-client’ service delivery policy;
2. Continue implementation MDG 5 Acceleration Framework and related emergency services.
3. Finalize staffing norms and implementing the Human Resource for Health (HRH) deployment plan to provide skilled middle-level health workers for deprived areas
4. Increase strategic use of Information Communication and Technology to improve health outcomes, especially related to DHIMS2
5. Step-up disease control activities, particularly surveillance.
6. Explore avenues for alternate source of funding for implementing key activities in the 2014 Programme of work
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CHAPTER TWO
2.0 LEADERSHIP AND GOVERNANCE
Leadership and Governance within the Ghana Health Service involve several partners, with differing roles depending on their level of authority. One of the most important players in the governance of the GHS is the Ghana Health Service Council established by the Act 525 with key duties, which are to:
ü Ensure the implementation of the functions of the Service; Submit recommendations on health care delivery policies and programmes to the Minister for Health ü Promote collaboration between the Ministry of Health, the Teaching Hospitals and the GHS ü Advise the Minister on qualification for post in the Service; and on such matters as the Minister may request.
2.1 The Ghana Health Service Council
A new GHS Council was sworn into office in 2014 chaired Dr. Paul Enin, a private Consultant Gynaecologist. This new Council succeeds the previous one that was chaired by Professor J. Oliver-Commey.
The Council held a briefing with Divisional Directors and Programme Managers at the Headquarters. Among some of the activities it undertook during the year were: to clear the backlog of staff promotions in the Service and appoint Divisional Directors to the Family Health and Public Health Directorates.
The Council has tasked itself to address issues of professional misconduct, negligence and unethical behavior of certain staff of the Service. As part of these activities there were punitive actions taken against individual who were guilty of financial malfeasance reported by the Internal Auditors of GHS, the Auditor-General’s Department and Special Forensic Audits. Named individuals at various levels were found guilty of theft, misappropriation and embezzlement of funds and appropriate disciplinary action taken against them according to the GHS Code of Conduct and Disciplinary Procedures. There are measures in place to retrieve the embezzled funds. In 2014, there were fewer reported cases of payroll irregularities.
In the coming year the Council will make visits to the regions to hold briefings with the regional management teams.
2.2 Directors’ Meeting
GHS Divisional Directors hold weekly meetings to update the Office the Director-General on their implementation activities under the agreed programme of work for the year. In 2014, 18
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43 of such meetings were held at the Headquarters and a Directors’ Retreat to summarize the holistic progress over the year, while planning for the next year 2015. The Directors’ Retreat provides a forum to discuss implementation of the health sector policies and strategic direction, and is attended by all Divisional and Regional Directors, and Deputy Directors. The theme for the 2014 directors’ retreat was: “Thinking Strategically and Acting Tactically: the Last Push for Achieving the Health MDGs.” At this meeting the Director- General reaffirmed his vision and engaged the directors to build consensus on performance management in GHS and to deliberate on the best approaches to engage with the Coalition of NGOs in Health, to achieve Ghana’s MDGs.
The Director-General reiterated the motto of the GHS: “Your health – Our concern.” he enumerated his vision for the GHS as: 1. All children shall survive beyond five years 2. All Pregnant women shall have a safe delivery and healthy babies 3. All people shall be educated to live healthy life style and avoid unwanted pregnancies, Communicable and Non-communicable diseases
2.3 Health Summit
The Health Summit is the zenith of annual performance reporting in the Health Sector. It presents a holistic assessment of the progress made or deficits in the Health Sector. In 2014, the health summit was held in May from 12th to 16th at GIMPA-Legon. Among key issues from the holistic assessment are summaries presented in Table 3.0.
Table 3.0 Holistic Assessment: 2014 Health Summit
1 LEADERSHIP AND GOVERNANCE Timeline Responsibility 2 1 FDA to look for GSA’s draft Bill, identify areas of conflicts and inform the Aug. Sept. . FDA/ MOH Parliamentary Select Committee on Health through MOH 2014 2014
MoH will review the formats for presentations to bring out strategic and 3 2 Aug. Sept. policy issues during reviews and business meetings. This will be shared at PPME, MOH . 2014 2014 the Sept. sector working group meeting for consensus. 4 3 Aug. Dec. MOH to work and complete the LI for HIFRA by end of year 2014 PPME, MOH . 2014 2014 5 4 MOH to identify and earmark specific funds towards the completion of Aug. Dec. . MOH the uncompleted and abandoned projects within the sector. 2014 2014
6 5MOH to submit the required information to the Office of the President to Aug. Sept. . facilitate the transfer of monies accrued from salary cuts of the MOH 2014 2014 Executives for the construction of CHPS compounds. 7 6 MOH to finalize all requirements and sign the MOU with DANIDA for the Aug. Sept. . MOH SBS before September sector working group meeting 2014 2014
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8 7 MOH to constitute the adjudication committee for the National Health Aug. Dec. . MOH Insurance Scheme by end of December 2014 2014 204
9 8MOH to work with Parliamentary Select Committee on Health to amend Aug. Dec. . the NHIS Act, Act 856 to allow direct transfer of the NHIL to the NHIA MOH 2014 2014 through MOH
10 9 MOH should earmark funds to support KATH’s IGF for the completion of Aug. Dec. . MOH/ KATH KATH’s Maternity and Children’s Block by December 2015 2014 2015
11 1 MOH to make provision for funding primary health care in the 2015 Aug. Sept. 0 PPME, MOH sector budget 2014 2014 . 12 1 MOH to work with NHIA and make provision for funding preventive health Aug. Dec. 1 MOH/ NHIA care 2014 2014 . MOH to organize a meeting in September to brainstorm on ways of 13 1 Aug. Sept. mobilizing financial resources internally. This will be presented at the PPME, MOH 2 2014 2014 September HSWG meeting 14 1 MOH should coordinate the Ebola Preparedness and Response, bring all Aug. Sept. 3 MOH stakeholders along esp. NAS, THs, NBS, Private Practitioners 2014 2014 . 15 1 MOH to work with MOF to secure Financial Clearance for the training of Aug. Jan. 4 MOH/ NAS 200 EMTs by January 2015 2014 2015 . 16 1 NBS to share a concept paper on the NBS and its contribution towards Aug. Sep. NBS 5 the country’s Ebola preparedness. 2014 2014 . FDA and TMPC to sign MOU in areas of safety testing and safety 17 1 MOH, FDA, monitoring herbal preparations. The two agencies will jointly develop a Aug. Dec. 6 TMPC framework for safety testing and monitoring of such products. MOH will 2014 2014 . facilitate the process 18 1 MOH to address all the issues causing the delay in implementing the Aug. Dec. 7 MOH/ PS Supply Chain Master Plan and roll out the plan by Dec 2014 2014 2014 . 19 1 DG - GHS to develop a re-deployment plan for the re-distribution of Aug. Sept. DG, GHS 8 health staff through out the country. 2014 2014 . 20 1 The plan and analysis of current distribution of staff will be presented at Aug. Sept. HRHD, MOH 9 the September HSWG meeting 2014 2014 . 21 2 MOH to identify critical HR needs by December 2014. This will be the Aug. Dec. HRHD, MOH 0 basis for Recruitment and Training of Health staff going forward. 2014 2014 . 22 2 Wk.2 MOH to always arrange for MOF to participate in the review and Aug. 1 Feb. business meetings 2014 . 2014
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2.4 Ghana Health Service Strategic Plan
The Ghana Health Service Strategic plan outlines key interventions under the sector objectives. This begins with the preparation of the Service’s plans and budgets at district and regional level and summarizing these into a single composite plan for the Service that will be submitted to the Ministry of Finance (MoF) through the Ministry of Health (MoH). In 2014, funding constraints did not permit this procedure, as such all plans and budgets for 2015 were molded on the 2014 plans and budget.
2.5 GAVI Health Systems Strengthening (HSS)
Immunizations in Ghana have been immensely supported by the Global Alliance for Vaccines and Immunization (GAVI). GAVI has also supported health systems strengthening through its GAVI-HSS component. In 2014 Ghana submitted a new proposal for GAVI support, having completed the activities under the previous funding support. The proposal has been accepted and funds are to be disbursed over the course of next year. Ghana however has begun preparations towards graduation off GAVI support, because of the attainment of middle-income status. The Ghana of Ghana will as such be fully responsible for funding vaccine procurement and management of the EPI programme.
2.6 CHPS Operational Policy and Guidelines
The CHPS Operational Policy was reviewed to intensify capacity building at the community (CHPS) level and to advocate for accelerated CHPS implementation by re-orientation of DHMTs, MDAs, Area Councils, Sub-districts, Community Health Committees and Volunteers on CHPS concept.
2.7 Programme of Work
Preparation of the Ghana Strategic plan continued throughout the year in 2014. The strategic objectives for the plan were agreed upon. These have been aligned to the sector objectives in the new Health Sector Medium Development plan (2014-2017) and also aligned to the 9 health systems strengthening pillars of the Ouagadougou Declaration.
2.8 Performance Management Processes
Performance Appraisal All managers within the service signed performance agreements with their supervisors to deliver on some set objectives during the year under review. They were assessed on these objectives during the half-year. It is expected that in the early part of the year 2015, all managers will give an account of their stewardship. The performance appraisal was cascaded down to the other staff of the service during the year under review.
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2.9 Monitoring and Evaluation
2.9.1 Data Collection and Reporting: Improving the District Health Information Management System (DHIMS2) a) Orientation and training DHIMS2 regional, administrators, regional focal persons and MOH staff were introduced to the newer version of the analysis module and the tracker in DHIMS2. Some staff were also trained to support the management of DHIMS2 at the regional and district level to sustain the gains of DHIMS2 in the GHS. Although this is in place, facilities, regions and districts are still reaching out directly to the National Technical team for troubleshooting, bypassing the district and regional administrators and DHIMS2 focal persons. Some of this was attributed to inadequate orientation on the current versions of DHIMS and has since been addressed by the Technical team. A five-day workshop was organized for the GHS HQ DHIMS2 regional focal persons and staff of MOH. CHNS/CHOS, midwives, and maternity in-charges were trained on the DHIMS2 mobile application for data management and tracking of the MAF (MDG5) indicators.
The MDG Acceleration Framework (MAF) – Ghana Action Plan developed by the Ministry of Health and Ghana Health Service in collaboration with development partners focuses on improving maternal health (MDG 5) at both community and health care facility levels through the use of evidence-based, feasible and cost-effective interventions to accelerate the reduction of maternal and new born deaths. The MAF key priority activities include;
− Procurement of smart phones for data capture at the community level and in health facilities, and reporting on the family planning programme using the DHIMS2 mobile application. − Training of CHNs/CHOs, midwives, and maternity in-charges in the use of these smart phones for data management and supportive supervision − Development of an MDG5 indicator dashboard on the smartphones for CHNs/CHOs, midwives, and maternity in-charges to support monitoring and supervision
A total of 560 smartphones (Samsung Galaxy Tab 3) were procured through the Procurement Department of MOH with specifications provided by the Ghana Health Service – Policy Planning Monitoring and Evaluation Division and ICT Department.
Training on the use of the DHIMS2 mobile application on the smartphones was done jointly by the DHIMS2 technical team, the ICT departments of GHS and MOH, staff of the Family Health Division and the Regional Health Directorates. The training covered 60% of sub- districts in across all regions. The target participants were the health centres at the sub- district level that were submitting their health service reports to their respective districts for entry into DHIMS2 and health centres with limited internet connectivity.
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The outcome of the training was that these target groups were now conversant with the DHIMS2 mobile app and were given the Samsung Tablets to use in their respective facilities.
b) DHIMS2 Governance and Data Access DHIMS2 Governance and data access structure for users and system administrators has been and developed and approved for adoption by the Service. Upon consensus, the PPME and Family Health Divisions, and the EPI Programme tasked the DHIMS2 technical team to develop and deploy an electronic register for capturing individual child health case management data. This is now known as the DHIMS2 eTracker system, a system designed to collect, manage and analyze transactional case based records at the community level.
c) Ghana Health Service Report The periodic reports of the GHS published on the organization’s website at: www.ghanahealthservice.org/publications or upon request from the PPME-GHS. Publications include GHS Annual Reports, Ethics Guidelines, GHS Quarterly Performance Bulletin and GHS Half-year Reports, Regional and Programme reports.
2.9.2 Integrated Monitoring Visits The GHS instituted an integrated monitoring system to undertake monitoring and oversight of the implementation activities in the regions. An Integrated Monitoring Tool is developed for this purpose and a league table updated to reflect individual regions’ performance at the end of the year. The first integrated visit was held from May 13 to July 5 2013. Some general observations from the visit are summarized below:
a) Monitoring Plan with Access Coverage and Poor Information Dissemination Culture Only one (1) region i.e. UER, has some data on access coverage for health care, clinical care and outreach services. Some regions do not have capacity in using the GPS to capture the coordinates of their facilities
b) Infrastructure The old asbestos roofing sheets on staff residential accommodation which needs replacement in Ashanti Region; RHD office block in Ho which is made up of 70% wood in this era of rampant fire outbreak; Sea effect on equipment in the Central Region e.g. air conditioners, ceiling, hospital beds; Poor sewerage system in Sunyani Hospital
c) Operational Research Poor generation of information through relevant Operational Research
d) NHIS reimbursement Delays in reimbursement with an average of 4 months arrears; Errors on claims forms leading to arbitrary claim cuts; High accreditation fee; Inability to recover cost; Low Tariffs; Cheques not separated into drugs and services.
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e) Occupational Health and Expired Drugs in some of the regional stores Occupational Health activities are not regularized in the regions. Regions will have to operationalize the DHIMS 2–based OHS surveillance system to provide data for decision making.
2.10 Audit of Budget Management Centres (BMCs) in GHS
In 2014, three hundred (300) health facilities were scheduled for auditing. Out of these 78% (233) were audited. The facilities audited were Regional Health Directorates, District Health Directorates, Regional Hospitals, District Hospitals, Polyclinics, Health Centres and some CHPS compounds. The number of audits conducted in 2014 in the Central region fell in comparison to numbers in 2013. The Brong-Ahafo, region maintained similar audit coverage in 2014 as for 2013. Audits increased in all the other regions with the highest being in the Volta and Eastern regions. (Figure 1.0)
Figure 1.0 Audits of BMCs by Region (Regional Coverage)
2.10.1 Formation of Audit Report Implementation Committee (ARIC) All Regional Health2014" Directorates2013" have formed2012" Functional Audit54 Report Implementation Committees (ARIC). 100"At the District Health Directorates, 38Regional Hospita4446 ls and 31other category of BMCs, 80% of health28 facilities 27 23 16 visited 18 16 in17 2014 had23 16 also formed 28 their 27 Audit Report 18 16 Implementation Committees (ARIC). Of these ARICs13 14 formed at the District level, 1261 12% 11 are 13 13 12 12 15 14 13 active.
24 ge"(%)""
Covera 0"
GHANA HEALTH SERVICE 2014 ANNUAL REPORT
2.10.2 Performance of Regional Internal Audit Units
All ten Regional Internal Audit Units were assessed in the areas of Annual Plan, Functional ARICs, Submission of reports and BMCs audit coverage. Six regions comprising Eastern, Ashanti, Northern, Upper East, Greater Accra and Western scored above the set average (9/12) while remaining four regions –Volta, Central, Upper West and Brong-Ahafo performed below average.
2.10.3 Audit Recommendations Implemented
There was improvement in the implementation of audit recommendations made in both internal and external audit reports. Out of one thousand, one hundred and twelve (1,112) observations raised in the 2011/2012 Ghana Audit Service report to Public Accounts Committee of Parliament (PAC), one thousand, and seventy four (1074) were resolved, representing (97%) with thirty eight (38) representing (3%) are still pending.
2.10.4 Audits Findings
Though there was improvement in compliance with laws and regulations in respect of financial operations, there were few other areas that were a source of concern. The following were the observations made at the BMCs visited in 2014: − 61% reduction in misappropriation of funds by the Health facilities visited. − 23% decrease in overdue staff advances over 2013. − 9% decrease in unretired advance. − Non-remittances of advances however increased by 23%. − 11% reduction in unearned salaries over 2013 − 17% decrease in non-acquitted PVs as compared with 2013. − 16% reduction in items not routed through stores.
The above occurrences may be attributed to the weaknesses in the internal control environment that includes; − Weak budgetary control system − Management override of laid down procedures − Weak monitoring and supervision at all levels
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CHAPTER THREE
3.0 FINANCE
3.1 Performance Improvement
A number of activities were carried out in in 2014 that resulted in the implementation of a Resource Tracking Tool (RTT), which was developed in 2013. A training of trainers was held for of some regional managers and selected district managers on the RTT in all ten regions. This will enable a regional cascade of training on the RTT for finance and non-finance managers in all BMCs to ensure full utilization of the tool. However because there was no release of MAF funds in 2014, the rollout of RTT is limited.
The transaction model of the ACCPAC accounting software implemented at the Greater Accra Regional Health Directorate (GRHD) was monitored and any challenges encountered were documented to provide learning for a smooth rollout in the other regions. There was the need to build capacity of regional finance managers (2 per region) to provide constant and sustainable support for smooth implementation.
There were quarterly validations of BMCs financial statements across all ten regions. The first was to validate the 2014 financial data for the 2013 financial statements. The last three were to validate the financial data for first three quarters of 2014. There were no visits by the Headquarters to the third quarter validation exercise at the BMCs.
An excel-based transactional tool has been developed for BMCs below the Region to minimize paper-based financial transactions, processing and reporting. A hospital transactional tool was been developed in 2014. The tool was piloted in the Volta Region in November 2014 after a series of stakeholder acceptance tests. If the pilot is successful the there will be scale up to other hospitals in the country.
The feasibility of utilizing the Accounting model in the Logistics Management Information Systems (LMIS) software being used in the Volta, Greater Accra and Eastern Regions was conducted. The outcome so far shows that the Accounting module can be used with some tweaking of the system.
There was the audit of the 2013 financial statement by the Ghana Audit Service and Ernst & Young as part of the cycles in Public Financial Management. There were fewer observations on procurements, incompleteness of fixed asset register, unearned salaries and some recommendations to strengthen internal controls in 2014 in comparison to 2013. These cleared by both auditors after deliberations.
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There was a review meeting with all regional accountants, financial monitors and other senior finance managers of the Service. There was financial monitoring and supervision visits in Greater Accra, Eastern and Volta Regions.
The numbers of accounting staff are inadequate; there are a total of 1000,although the estimated adequacy is 5000 accounts staff. However, even for the number available, there is an issue of inequitable distribution. Compilation of a comprehensive data on all finance staff in the Service has been planned to facilitate the redistribution of staff. At the end of 2014 data has been obtained on 9 regions. A re-distribution exercise will be scheduled for 2015 based on the outcome.
3.2 2013 Financial Report
Ghana Health Service un-Audited Financial Reports for year ending 31st December 2014
Ghana Health Service Consolidated Balance Sheet (Ghana Cedis) As At: 12/31/2014 Current Assets Cash and Bank Balances 104,685,416.25 Accounts Receivable 237,373,958.98 342,059,375.23 Current Liabilities Accounts Payable 86,696,555.07
NET CURRENT ASSETS 255,362,820.16
Consolidated Statement of Revenue and Expenditure For the year ending 12/31/2014 Income Net Operating Income 542,568,606.93 Non Operating Income 770,654,512.17 TOTAL INCOME 1,313,223,119.10
Expenditure Employee Compensation 674,120,617.13 Goods & Service 463,826,877.44 Assets (Purchases) 12,850,891.92 Programme Expenses 128,787,549.06 TOTAL EXPENDITURE 1,279,585,935.55
INCOME SURPLUS 33,637,183.55
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CHAPTER FOUR
4.0 HUMAN RESOURCES FOR HEALTH
4.1 Analysis of Payroll Data
Analysis of data from Integrated Personnel and Payroll Database (IPPD) indicates that as at December 2014, the total number of health workforce on the MOH payroll was Eighty-Four Thousand and Eight (84,008) which is about 25% increase over the previous year. The corresponding Net Salary of the Health Workforce is Seventy-Three million, Two Hundred and Forty-Six Thousand, Seven Hundred and Seventy Ghana cedis (GH¢73,246,770.07) representing about 14.5% increase over the previous year. This figure excludes trainees within the health training institutions. The distribution of the health workforce by staff category and agency is presented below.
Figure 4.1 Distribution of Health Workforce by Agency, 2014
Ghana Health Service (GHS) has the NAS, 962 , 1% PsyHosp, 1,901 , 2% TH, 9,260 , 11% highest number of health workforce MOH, 133 , 0% CHAG, 11,579 , of Fifty-Five Thousand and Eighty-Two MDC, 917 , 1% 14% HTIs, (54,082) representing 64% of the 5,174 , 6% total workforce in the sector. This represents a 4% increase in GHS staffing level over the year 2013. The GHS, 54,082 , 65% Christian Health Association of Ghana (CHAG) also has 14%, followed by the Teaching Hospitals with 11%.
Trend analysis of Health Workforce distribution by Agencies revealed that all Agencies except Health Training Institutions and Health Trainees are making steady increase in the number of health workforce. The number of Health Trainees on payroll has reduced significantly because trainees allowance has been curtailed even though the intake into Health Training Institutions has rather witnessed massive increases over the years.
The Human Resource for Health (HRH) situation on payroll as at December 2014 stands at 84,008 (excluding Health Trainees). Of this, Greater Accra Region has the highest number of HRH (20.77%) with Upper West and Upper East Regions having the lowest.
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Figure 4.2 Regional Distribution of HRH (Per cent) - 2014 (All Agencies)
25.00
20.77
20.00 18.17
15.00
9.95 9.31 10.00 8.49 8.55 8.62 7.85
Percentage Distribution 5.04
5.00 3.25
- UWR UER WR BAR VR CR NR ER AR GAR
Regions
Trend analysis of HRH distribution of health workforce by region indicates that Greater Accra region maintained similar proportion of HRH from 2010 to 2012 with an increase of 0.81% in 2012 but reduced by 1.2% in 2013. In 2014, the region made a net gain of 0.24% in in their HRH strength. On the other hand, Brong Ahafo, Eastern and Volta Regions recorded declines in the number of HRH. Northern and Ashanti Regions have shown steady increases over the years. The increase in Northern Region is due to massive production of enrolled nurses in the region and expansion of the Tamale Teaching Hospital, which continues to attract significant number of HRH into the region.
Figure 4.3 Trend of Distribution of HRH by Region (All Agencies)
25.00
20.00
15.00 2010 2011 2012 10.00 2013
Percentage Distribution 2014 5.00
- UWR UER NR WR CR BAR VR ER AR GAR Regions
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Figure 4.4 Trend of HR Distribution in GHS, 2010 – 2014
12,000
10,000
8,000 2010 6,000 2011 2012 4,000 2013 Number of Workforce 2014 2,000
- AR BAR CR ER GAR NR UER UWR VR WR Regions
Trend analysis shows that all regions with the exception of Central and Greater Accra, all regions had steady rise in health workforce over the last five years. Even though Greater Accra experienced a decrease in their staff strength, the region continue to be the most endowed in terms of HRH followed by Ashanti, Eastern, Western, Volta, Northern, Central, Brong-Ahafo, Upper East and Upper West Regions in descending order. Even though the three regions in the north recorded some increases in the HRH due to the numerous initiatives to bring about equity in HR distribution, they are still below expectation.
Figure 4.5. Trend of Midwives Distribution by Region in GHS, 2010 – 2014
800
700
600
500 2010 2011 400 2012 300 2013 Number of Workforce 200 2014
100
0 AR BAR CR ER GAR NR UER UWR VR WR Regions
In 2014, Ashanti region recorded the highest increase in the number of midwives even though Greater Accra Region still has the highest number of midwives in the GHS having consistently over 600 Midwives at post in the five-year period. There has been some improvement in the number of midwives across the regions even though Central and Volta regions are yet to fully recover the net losses of midwives over the last five years due to 30
GHANA HEALTH SERVICE 2014 ANNUAL REPORT
retirements. In line with the target set by MDG 5 to reduce maternal mortality ratio by ¾ in 2015 the Health Sector in Ghana has over the years embarked on various interventions and programmes to improve access to quality health services with special emphasis on maternal, neonatal and adolescent health services. The midwives to Women in Fertile Age (WIFA) ratio have recorded some improvement as a consequence increased production of midwives.
Figure 4.6 Trend of Midwives to WIFA Population, 2009 – 2014
Figure 4.7 Trend of Midwives to WIFA Ratio by Region, 2010 - 2014
The figure above shows the trend of Midwives to Population ratio by year and region. The trends show that Western Region has the worst Midwives to Population ratio above 2,000 over the four (3) years period but witnessed improvement in 2013 and 2014. Northern Region also witnessed Midwives to Population ratio above 2,000 for 2013 and 2014. All the regions recorded improvement in the Midwives to Population ratio in 2014. The national Midwife to WIFA population ratio has improved from 1:1,400 in 2013 to 1:1,374 in 2014.
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Figure 4.8 Distribution of medical officers in GHS, 2013 & 2014
As shown in figure 4.8 above, all the regions recorded slight increases in the number of medical officers except Central and Brong-Ahafo regions where many medical officers were upgraded to specialists. Furthermore, doctor to population ratio has improved in many regions but the issue of inequity in doctor distribution continues to linger. There has been a marginal improvement in the Doctor population ratio from 1:10,000 in 2013 to 1:9043 in 2014.
Figure 4.9 Trend of Doctor to Population Ratio by Region, 2010 - 2014
Distribution of the skill-mix of nurses
Figure 4.9 depicts the current skill mix of professionals and enrolled nurses. Grossly, the GHS has 44.8% of clinical nurses being professionals as against 55.2% who are auxiliary. There are huge inter-regional variations with the widest in northern region where only 22% of the nurses are professionals. No region except Greater Accra region meets the norm of 60% professional nurses to 40% auxiliary nurses. The situation has huge implications for
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quality of care and therefore requires a critical look at the number of enrolled nurses being produced.
Figure 4.10 Skill-Mix of Clinical Nurses by region 2014
Age distribution of health workforce on payroll: Analysis of the age distribution of the health workforce on payroll shows that those in the 25 to 35 age bracket constitute 66.24% of the total workforce. This indicates that the health workforce is largely young. This has implications for training and capacity development. On the other hand, those in the 56 – 60 age bracket constitute only 6.22% and would be retiring from the within the next 5 years, majority of whom are nurses and midwives. Mentorship and succession planning need to be strengthened to ensure that few experienced staff who would be retiring enhances the competencies to take up the mantle of leadership and service delivery without compromising quality.
Figure 4.11 Age Distribution of the total Health Workforce
12,000
2010 10,000 2011 2012 8,000 2013
6,000 2014
Number of RGNs 4,000
2,000
- <25 25 - 35 36 - 45 46 - 50 51 - 55 56 - 60 60+ Age Intervals
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Figure 4.12 Trend of age Distribution of Midwives, 2010 - 2014
2,000 2010 1,800 2011 1,600 2012 1,400 2013 1,200 1,000 2014 800 600 Number of Midwives 400 200 - <25 25 - 35 36 - 45 46 - 50 51 - 55 56 - 60 60+ Age Intervals
4.2 Nominal Roll and Payroll Reconciliation Figure 4.13 Nominal/PayRoll Reconciliation, December 2014
During the year under review 12,000 the Department collected 10,000 Nominal Rolls from all the regions and analyzed. The 8,000 nominal roll and payroll were 6,000 compared to determine the
4,000 gap between the two. Brong-
Number of Workforce Ahafo, Eastern and Greater 2,000 Accra Regions have very low
- difference between the UWR UER BAR CR ER WR VR NR GAR AR Nominal Roll and Payroll Regions Nominal Roll whereas the rest of the Payroll regions have huge difference between the Nominal Roll and Payroll (difference ranges from 33% to 10%). The difference may be attributed to workers who are at post but not yet on Government’s mechanized payroll. It could also be partially due to inclusion of staff of CHAG, Health Training Institutions and Health Interns.
4.3 Review of Staffing Norms
The health sector has over the years been confronted with inadequate numbers of staff and unbalanced skill mix of the available health workers. Part of this problem has been due to inequitable distribution of the health workers, which have led to gross understaffing in many facilities and overstaffing in some facilities. 34
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There has therefore been a compelling need to review the 1992 Facility Staffing Norms, which was deemed to have outlived its usefulness. Both the WHO Population Ratio Staffing Norms and 1992 Facility Staffing Norms do not take into account local variations and workload characteristics such as the different levels and patterns of morbidity in different locations, the services provided by health facilities among others. This brought about the need to use a more empirical and evidenced-based approach to the establishment of a dynamic and realistic staffing norm.
Consequently, the Ministry of Health and its agencies in 2011 decided to develop an evidenced-based Staffing Norm using the WHO’s Workload Indicator for Staffing Needs (WISN). The process to develop a new staffing norm was then started with a capacity building workshop on WISN through the collaboration of WHO. WISN is a human resource planning tool which uses actual workload to determine the number of health workers of a particular cadre required to cope with the workload of a given health facility; and to assess the workload pressure of the health workers in the given facility.
A steering committee and technical working group were constituted to undertake the staffing norms development. The Workload Indicators of Staffing Needs (WISN) approach was adopted and contextualized for the development of the staffing norms. For effectiveness and also due to erratic availability of resources, the process was divided into two phases. So far the first phase which covered the development of the staffing norms for clinical staff and some support staff has been completed. However, the second phase, which comprised mainly of support staff, directorates and training institutions has been started and progressing steadily.
4.3.1 Summary of Staffing Norms Output
A Staffing Norm has been developed which covers most clinical staff and some support staff in Health Centers, District Hospitals, Regional Hospitals and Teaching Hospitals based on workload. Workload components (tasks performed by staff) and their service standards (time spent in performing the tasks) have also been developed for these staff categories covered. Health facilities have also been categorized according to their workload level to aid equitable staff distribution. The Staffing Norms developed together with the activity standards may serve as both a human resource planning tool and a monitoring tool. Stakeholders’ input has been sought and incorporated in the Staffing Norm, which the Technical Working Group recommends for adoption and implementation. The draft staffing norm has been discussed in many forums and has received highly levels of endorsements.
For phase two, baseline data have been collected and analyzed; draft activity standards have been developed for the staff categories that were not covered during the first phase. This is however, yet to be validated before it is applied for WISN and statistical analyses for norms setting
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4.3.2 Human Resources (HR) Gap Analysis Based on the Staffing Norms
The ultimate aim of the staffing norms is to determine the required staffing levels based on workload and also to be used as a tool to address distribution challenges.
Following completion of the first phase of the staffing norms in May, 2014 which covered most of the critical staff as well as some support staff, there has been compelling need for a comprehensive human resource gap analysis using the norms to facilitate staff redistribution where necessary and strategic HR decision making.
Consequently, the Human Resources Directorate (HRD) undertook a preliminary HR gap analysis which revealed critical shortages in some areas and excesses in others, requiring recruitment, training, some level of staff redistribution and effective performance management
4.4 Human Resource Data
Internet Human Resource Information System (iHRIS) is a web-based, server based, fully developed HR system designed for the health sector. The Capacity Project developed it with the sponsorship of USAID. The system was proposed by WAHO. IHRIS Software is free and the system has the capability of accepting and storing large quantities of HR data generated in the country. It provides a means of tying the data in it to hard copy information on employees. It safe from virus attacks and security of the data in the system is assured. The system allows the user the flexibility to design and create customized reports.
After successful pilot implementation of the system in the Northern Region in 2010, it is being scaled up to host the Public Health Workforce database. In view of this the system was customized and installed on a server at the Tamale Teaching Hospitals. The year under review has witnessed capturing of Bio-Data of the Health Workforce of Volta, Brong-Ahafo and Upper East Regions into the iHRIS. The percentage data capture coverage for the regions are as follows: Volta Region: 44%; Brong-Ahafo Region: 13% and Upper East Region: 59%. Regions are encouraged to mobilize resource to complete the capturing of Bio-Data of the Health Workforce into iHRIS.
4.5 Recruitments
During the year under review, a total of seven thousand one hundred and eighty one (7,181) appointments were processed. The number excludes those processed at the various regional health directorates following the decentralization of appointments of lower level cadres to the regional health directorate.
4.5.1 Medical Officers
The source of appointment of officers in the above category was assumption of duty letters received from the various regional health directorates. Even though records available at the 36
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postings unit indicate that about one hundred and fourteen (114) medical officers were posted during the year under review, reports from the regions appear to suggest that about twenty (20) of them did not report at their regions of postings.
4.5.2 Dental Surgeons
The eleven (11) Dental Surgeons whose appointments were processed in the year under review were distributed..
4.5.3 General Nurses
This category of staff was mainly from the various Ministry of Health Nursing Training Institutions who were either retained by the region of training in line with the train and retain policy or released to the Human Resource Directorate as an excess quota. The one thousand four hundred and sixty six (1,466) appointments processed were distributed as depicted in the figure below.
4.5.4 Registered Mental Health Nurses
These officers were trained by the three Psychiatric Nursing Training Schools and were released to the Ghana Health Service for placement in the various district hospitals as Psychiatric Nurses. The two hundred and eighty nine (289) appointments represented the total number contained in the various reports on assumption of duty received from nine regions as well as those retained by the psychiatric hospitals.
4.5.5 Registered Midwives
During the year under review, a total of six hundred and twenty two (622) Registered Midwives were recruited for the Ghana Health Service. The total number came from the various diploma awarding midwifery training schools.
4.5.6 Community Health/ Enrolled Nurses
A total of four thousand one hundred and ninety two (4,192) Community Health and Enrolled Nurses were recruited during the year under review. One thousand six hundred and fifty four (1,654) out of the total number were Community Health Nurses out of which fourteen (14) were Diploma holders. The table below shows the distribution across the ten regions.
Table 4.1 Regional Distribution of CHNs and ENs Recruited in 2014
Region GAR AR VR WR NR CR ER BAR UER UWR Total
Dip. CHN 12 0 2 0 0 17 14 2 0 0 47
Cert. 179 157 264 83 61 130 314 188 137 94 1607 CHN
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389 443 157 318 375 143 109 335 178 91 2538 En. Nurse 580 600 423 401 436 290 437 525 315 185 4192 Total
4.6 Health Administration and Management (HAM) Program
The Health Administration and Management course, one of the standardized in-service training programs offered by GHS in collaboration with GIMPA to adequately prepare senior health professionals who assume senior management roles continued in 2014. There were three (3) HAM courses in 2014 with various topics ranging from Managerial Principles and Processes to Project Planning and Management, Gender issues in Health and Research Methods and Techniques. A total of 505 personnel from the service has benefitted from the HAM program over the last three years.
Table 4.2 HAM Training Sessions and participants 2011-2013
HAM 2012 2013 2014 Total Feb-March 68 43 42 153 July –August 69 40 52 161 Nov-Dec 45 40 30 115 Total 182 123 124 429
4.6.1 Evaluation of the HAM Program
There have been suggestions that the HAM program be upgraded to certificate awarding level with required examinations taken at the end of the program. A distance learning to be promoted to encourage self-directed learning across geographical locations to benefit staff that cannot leave their posts vacate to attend taught courses.
4.7 Training/Deployment of Medical Personnel to Fight against Ebola Virus Pandemic
As parts of efforts to rid the sub-region of the Ebola Viral Disease (EVD), the West African Health Organization (WAHO) in collaboration with the Ministry of Health (MOH) embarked upon the training and deployment of medical staff as volunteers to Liberia and Sierra Leone to serve for three months. The volunteers were offered competency-based training on EVD; to equip them with the proficiency to holistically manage the clients and families infected with the disease. The volunteers were adequately prepared for the mission and it is hope that they would be good ambassadors of our dear nation. In all 42 personnel were trained; 30 from GHS, 3 from KBTH, 2 from Police, 1 from CHAG, 1 from NAS, and 1 from NSS. The figure below provides details of the staff categories trained and deployed.
Figure 4.14 Health Volunteers deployed to Liberia and Sierra
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Leone
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CHAPTER FIVE
5.0 ADMINISTRATION AND SUPPORT SERVICE
5.1 Transport
Currently the Service has 13 types of transport vehicles. 1 Saloon cars: Used by Directors for their administrative rounds 2 Pick-ups: Used by districts, hospitals and institutions for general service delivery (e.g. Stores, administration, outreach services, monitoring etc.) 3 Bus (small & medium): Used primarily by training schools for field studies 4 Ambulance: Used by hospitals for the conveyance of critically ill patients on transfer 5 Station wagons: Used by HQ, RHA, Teaching Hospitals and other Institutions for monitoring and trekking 6 Haulage Trucks: Used by Stores to convey stores and supplies 7 Water Tanker: Used for the supply of water to health institutions lacking water 8 Forklift: 9 Cold Van: Used for the distribution of vaccines and medicine needing transport under prescribed temperatures 10 Hearse: Used by hospitals for the conveyance of corpses 11 Boat: Used for service delivery in hard-to-reach areas (e.g. Afram Plains) 12 Motorcycles: Used by Sub-districts for rural outreach programmes 13 Bicycles: Used by volunteers for disease surveillance
Table 5.1 Transportation at levels of healthcare
Level Dominant Transport Type Status of Transport Situation
Sub District Bicycle, Motorbike, Boat Motorbikes available but challenge with operational (Including reliability CHPS)
District Motorbike, Boat, Vehicle (Pickup) River-worthiness of a number of boats poor; Health inadequate and aging vehicles; Challenge with Directorate operability of Bikes (Nanfang)
District Vehicle (Pickup), Bus (Mini), Newest vehicles are Great Wall Vehicles some having Hospital Ambulance maintenance Problems; few have buses, Ambulances are phasing out to NAS
Regional Vehicle (Pickup), Bus (Mini), Newest vehicles are Great Wall Vehicles some having Hospital Ambulance, Truck (Mini) maintenance Problems; few have buses, Ambulances are phasing out to NAS
Regional Vehicle (Saloon, Pickup, Station Saloons provided for Reg. Directors under hire HD Wagon, Bus (Mini/Maxi), Truck purchase; internal Allocation weaknesses of pick-ups; (Mini/Maxi) Aging vehicles
Head- Vehicle (Saloon, Pickup, Station Fairly good vehicles, over supply, however there are quarters Wagon, Bus (Mini/Maxi), Truck internal allocation deficiencies
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5.0.1 Construction of CHPS Compounds and Health Centres
Work on 25 CHPS Compounds under the Phase II of ongoing CHPS Project and the remodeling of 6 health centres procured in collaboration with the MoH in 2012, which was suspended in 2013, resumed following the payment of Advance Mobilization to the contractors. Reports from monitoring visits show that there was active work at all the sites, with some buildings at the roofing level. The overall progress of work was 10% at the close of 2014. Two ongoing CHPS Compounds under Phase I of the CHPS Compounds programme, remained uncompleted during the year due in large part to non-performance by contractors. These compounds are in the Central and Volta regions.
The construction of the 25 CHPS compounds is under GOG funding. The construction of 42 CHPS compounds is under Phase I of JICA Support in the Upper West Region. The overall progress of work was estimated at 56% completion level as at the end of 2014. It is expected that Phase II comprising 38 compounds will commence in 2015. In all, 80 CHPS compounds are to be constructed under JICA Support in the Upper West Region.
5.0.2 Updating And Validating Data On Health Facilities In The Regions
The list of health facilities in four regions (Ashanti, Western, Central and Volta) was updated in 2014. Facility data in the Northern and Upper East Regions was validated and updated as part of efforts to improve data on the spatial distribution of health facilities across the regions.
5.0.3 Revamping Boat Fleet And Management
A survey was conducted to assess the river worthiness of the existing boats of GHS and assess other transport needs of riverine communities. Five ports of commissions were visited in the Greater Accra and Western Regions as at the close of 2014 and preliminary findings revealed that the majority of the boats were weak and not river-worthy.
Two ambulance boats were obtained for Donkorkrom and Dambai in the Eastern and Volta Regions, respectively. These will support service delivery in these riverine communities. There is one boat ambulance under construction for Jewhi Wharf (Jomoro District in the Western Region) with support from ENI Ghana Foundation. It is expected to be ready in 2015. There were bids launched in 2014 for the procurement of 2 boats and accessories under the GAVI fund, which will be delivered in 2015.
5.0.4 Increase Fleet Size And Improve Vehicle Availability
There was no significant increase in the vehicle fleet size to meet the demand and expansion of services. The majority of vehicles received were ad hoc and designated to specific programmes and projects. A number of used vehicles were from external donor project phase-out (USAID, others). Motorcycles received in 2009 are the main means of transport at the periphery (sub-district) of the health service delivery system and due for replacement. Bids were launched to procure 200 motorcycles under the GAVI Fund and will 41
GHANA HEALTH SERVICE 2014 ANNUAL REPORT
be received and distributed in 2015 to the districts. The detailed statistics on transport status at the end of 2014 in Appendix 1.
5.1 Equipment
5.1.1 Establishing The Equipment Maintenance Fund
There are plans to create revolving funds for maintenance and replacement of medical equipment. There were initial stakeholder meetings to establish a Equipment Maintenance Fund and draft framework and guidelines was developed. The draft framework and guidelines will be finalized and disseminated in 2015 to operationalize the Fund.
5.2 Administration
5.2.1 Development of Administrators Dashboard
A standard Excel data capturing format has been developed to help capture and maintain an integrated database for administrative and support services including utilities, transport, estate and equipment maintenance, mortuary, procurement and stores, catering, laundry, human resource, in-service training, etc. The software is expected to: • Improve data visibility and management information system for administrative and support services in the health facilities • Standardize data collection and reports generation across various administrative and support service departments/units across BMCs • Enhance timeliness of data and reports for administrative and support services to facilitate timely management decision making in health care delivery • Facilitate data analysis and effective monitoring of operational performance of the broad spectrum of departments/units which the Administrators supervise in the health facilities • Improve administrative cost-effectiveness and institutional efficiency
5.3 Estate
5.3.1 Updating The Progress And Status Of GHS Civil Works
The Directorate continued to maintain oversight responsibility and monitored and updated the progress and status of the following GHS civil works in 2014: • The construction of the new Greater Accra Regional Medical Stores. This project was suspended at 70% completion level in 2013 due to funding constraints by the National Aids Control Programme, which was funding the project. In 2014, the funding situation did not improve and so the project was transferred to the Greater Accra Regional Health Directorate for completion using their IGF. • The construction of 4-storey office block for the Centre for Disease Control at Korle- bu. The project was 60% complete at the close of the year under review. • Construction of GHS Learning Centre at Pantang in Accra. Work on the project remained suspended since 2012. Preliminary discussions were initiated with the
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National Investment Bank for financial assistance to complete the project. Similar collaboration is to be initiated with CAL Bank early 2015. • The remodeling of workshop into offices for Family Health Division at Limb Fitting Centre, GHS Headquarters. The office block was completed and handed over. The block is currently in use. • Construction of 2 No. Offices and a Refuse house for LEKMA Hospital. It was 100% completed but was yet to be handed over as at the close of 2014. • Preparation of estimates for the painting of the entire LEKMA hospital was in progress. • Construction of 3-storey classroom block for Nurses and Health Assistants' Training School at Teshie for Ministry of Health - The progress of work of the Phase I (Construction of Ground Floor to Completion) was 50% completed. • The construction of the Operating Theatre and Staff Accommodation at Anloga Health Centre reached 55% completion at the close of 2014. The contractor was the cause of delay in completing the project during the year under review. • Work on the completion of 1 No. Semi Detached Quarters at Kpeve was abandoned by the contractor during 2014. All attempts to get them back to site failed. We have therefore advised the Volta Regional Health Directorate to terminate the contract. Similarly, the contractor stalled work on the completion of the Female Ward at Asamankese District Hospital due to the non-performance. We have again advised for the termination of the contract.
5.3.2 GHS 2014 Civil Works Budget
The Capital Budget submitted by GHS to MoH in 2014 amounted to GH¢91.005 million comprising GH¢75.345 million for ongoing projects and GH¢15.360 million for new projects as was requested by MoH. The budget covered GHS foremost priority activities being the completion/rehabilitation of ongoing projects and the CHPS programme. A budget of GH¢2.5 million for the construction of 2000 CHPS Compounds was made by MoH as a new project. This did not include the ongoing CHPS project Phase II comprising 25 CHPS Compounds and the expansion of 6 Health Centres for implementation by GHS. The regional breakdown of the GHS budget is as follows:
Table 5.2 GHS civil works budget and releases by Budget Management Centres Entity 2014 GHS % 2014 % Amount of % Budget Allocation Approved Approved Approved GHS Released (GH¢) GHS Budget Budget Budget Released Head Office 29,400,000 32.3% 0 0 0 0 Volta 4,575,000 5.0% Eastern 18,015,000 19.8% *3,300,000 3.6 2,079,418.41 2.29 Brong-Ahafo 3,580,000 3.9% for all Greater Accra 3,880,000 4.3% regions Central 4,320,000 4.8% Western 3,985,000 4.4% Ashanti 3,425,000 3.8% 43
GHANA HEALTH SERVICE 2014 ANNUAL REPORT
Upper East 1,085,000 1.2% Upper West 3,175,000 3.5% Northern 2,815,000 3.1% Accra Pysch 150,000 0.2% Hosp. 0.2 0 0 Pantang 12,800,000 14.1% 200,000 Psych Hosp. Ankaful 500,000 0.6% 0 Psych. Hosp. Total 91,005,000 100.0% *3,500,000 3.8 2,079,418.41 2.3 * GH¢2,500,000.00 of the amount was from MoH Budget for the implementation of a new CHPS Compound project. That project did not take off as the close of 2014.
From the above budget, a provision of 32.3% of the GHS Budget was available to the GHS Head Office to undertake certain national projects such as the GHS Corporate Office Building, Centre for Disease Control Office and GHS Learning Centre projects at Pantang, Kumasi and Tamale. Similarly. Another 14.9% of the budget was designated for Psychiatric Services while 52.8% was provided for projects in the regions and districts.
5.3.3 Approved Budget
An amount of GH¢3.5 million (3.8% of the budget) of GH¢91.005 million submitted by the GHS was approved. Thus, while the projects presented by the GHS were largely set aside or overlooked, the approved budget saw the dominance of projects undertaken by the MoH in the regions. Even though funds were approved for some selected projects, remarkably, only GH¢2,079,418.41 was released for the payment of claims on the construction of Doctors Bungalow at Ho and the construction of CHPS Compounds under the GHS budget in 2014.
5.3.4 GHS Civil Work Projects
In 2014, there were 139 projects: 29 new and 110 ongoing and suspended projects. These were planned for implementation in the 2014 Capital Budget and other Infrastructure Investment programmes. Included in the list are ongoing projects under CHPS Phases I and II comprising 28 CHPS Compounds and 6 health expansion projects. They were to be financed mainly from the national level. The projects did not include those under any of the MoH PIUs. The EMD also implemented 38 new projects with funding from the Global Fund/National TB Programme while the Ministry of Roads & Highways was implementing 7 health projects under the Fufulso-Damango-Sawla Highway Project. These projects were outside the 2014 GoG Capital Budget. Thus, there were 184 projects in total, 74 were new and 110 were either ongoing or suspended.
Active work took place in 79 project sites. In all, 45 projects were completed at the close of the year. These were made up of 6 under the GoG funding, 33 from Global Fund/ NTP and
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6 from Ministry of Roads & Highways. The details of the projects completed in 2014 are indicated in the Appendix 2.
5.3.5 Trend of Project Implementation from 2012 – 2014
The table below shows that the number of planned projects, on-going projects and active projects stayed relatively stable. However, new projects and completed projects dropped between 2012 and 2013 but rose in 2014.
Table 5.3 Project implementation status (2012-2014) Year Planned GHS New Old/ Ongoing Active Completed Projects Projects Projects Project Sites
2012 175 69 106 71 51
2013 189 39 136 61 24
2014 184 74 110 79 45
5.3.6 Processing And Payment Of Claims
During the year, many contractors on GoG projects abandoned their project sites due to lack of payment of outstanding claims. The outcome was the submission of a relatively small number of certificates by the regions for processing.
5.3.7 Sector Budget Support
In 2012, the MoH made available GH¢2,350,000.00 from the Sector Budget Support for the completion of 19 suspended projects in 6 regions: Volta (7), Eastern (2), Brong-Ahafo (1), Ashanti (2), Northern (4) and Upper East (3).
In 2014, 7 certificates for work done on 6No. projects (3No. completed) totaling GH¢200,675.75 were received and processed. Out of this GH¢100,404.50 was paid. There were 4 projects under SBS funding that are ongoing: Ashanti (1), Eastern (1) and Volta (2).
5.3.8 CHPS Projects
In 2014, 2 CHPS compounds remained uncompleted in the Volta (1) and Central (1) regions, out of the original 19 CHPS Compound projects started in 2011 under CHPS Phase I.
A release of GH¢2,037,303.19 was made from the MoH Budget for the payment of mobilization for all the 25 CHPS compounds and 6 Health Centre projects under CHPS Phase II started in 2012. A status report on the ongoing CHPS projects including financial forecast and request for funds for the next batch of interim payment certificates was submitted to MoH for approval and release of funds. However, no response was received before the close of the year.
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5.3.9 Certificates Processed
During the year under review, a total of 115 payment certificates and claims due contractors and consultants working on GHS projects across the country were received and processed. The breakdown of the claims is as follows:
• GoG/SBS 46 Certificates & Claims processed GH¢1,663,824.88 • GoG/CHPS 31 Certificates processed GH¢2,037,303.19 • Global Fund 38 Certificates & Claim processed GH¢2,255,578.37
Of the bills processed, 44 GoG bills totaling GH¢1,621,709.66 remained unpaid by the close of the year.
5.4 Clinical Engineering
5.4.1 ACCE/HTF 2014 International ACEW Award
In 2014 the American College of Clinical Engineers (ACCE) awarded the Head of the Clinical Engineering Department, Dr. Nicholas Adjabu and his Deputy, Mr. John Zienaa. The award was the American College of Clinical Engineers Health Technology Foundation 2014 International Advanced Clinical Engineering Workshop Award (ACCE/HTF 2014 International ACEW Award) and happened to be the first time the ACCE has ever given such an international award to any country or organization on the African continent
SUPPLIES, STORES AND DRUGS MANAGEMENT
5.5 Procurement
Total procurement in 2014 amounted to GHC 6,106,714.23 in comparison to GHC9, 444,427.97 in 2013. This was a reduction of 35.34% in the procurement spend relative to previous years. Shown in Table 5.4. Table 5.4 Analysis Of Procurement Spent From 2012-2014 Year 2012 (GHC) Year 2013 (GHC) Year 2014 (GHC) Annual Procurement 34,134,072.90 9,444,427.97 6,106,714.23 Spent 1,000,871.59 2,313,057.56 1,023,808.58 Shopping (2.93%) (24%) (17%) Competitive Tendering 22,965,091.48 3,177,060.91 909,259.74 (NCT& ICT) (67.28%) (34%) (15%) Sole Sourcing 10,168,109.83 3,954,309.50 1,999,363.78 /Restrictive Tendering (29.79%) (42%) (33%)
5.5.1 Competitive Tendering / Sole Sourcing Contracts 46
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There was no International Competitive Tendering in 2014. The value of procurement through National Competitive tendering amounted to GHC 909,259.74 representing 15% of the annual procurement spending in 2014. Request for Quotation (Shopping) totaling GHC 1,023,808.58 representing about 17% of the annual spend in 2014. Sole Sourcing and Restrictive Tendering procedure with concurrent approval from the Public Procurement Authority totaled GHC 1,999,363.78 representing 33% of the 2014 annual spend.
5.5.2 Funding Sources for Procurement for Year 2014
Out of the total Procurement Spend for year 2014 of GHC 6,106,714.23 Global Fund related procurement totaled GHC 2,665,234.79 accounting for about 42% of total Procurement spend. GAVI funds totaled GHC 907,917.95 accounting for 14% of the total Procurement spend. GOG related procurement totaled GHC 305,410.63 that represents only 5% of the total procurement spends. MAF procurement and related activities totaled GHC 666,285.03 representing 11% of the totals Procurement spend. UNICEF funded activities totaled GHC 148,552.37, which represents 2% of the total Procurement, spends. CDC related activities totaled GHC 235,171.75 representing 4% of total Procurement. PATH related activities totaled GHC 70,133.10 which represents 1% of total procurement spends. Ebola Heath Found activities totaled GHC 663,499.66 which represents 10% of total procurement spends. IGF and other Fund activities totaled GHC 721,541.39 which represents 11% of total procurement spend
5.6 Stores and Supply
5.6.1 Early Warning System
The Early Warning System is currently operational in 527 health facilities including the central medical stores, the 10 regional medical stores, 3 teaching hospitals, districts hospitals, health centres and CHPS.
During the year under review there were re-training on Early Warning Systems throughout the country. About 500 staff were trained in the country.
The Early Warning System (EWS), a stock reporting system uses a mobile technology to enhance logistics data reporting, visibility, and utilization for improved supply chain functions. Through the use of mobile phones, health facility staff reports on stock levels of selected tracer commodities (HIV, malaria, family planning and TB) via SMS to a dedicated short code on a weekly basis. Information from the EWS helps managers to intervene when there is problem in respect of product availability and implement appropriate interventions to address any stock imbalances (low stocks, stock outs and overstocks) at the service delivery point. 47
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5.6.2 Introduction & Training of Supply Chain Management in Pre-service Institution
The Ghana Health Service contributed to the introduction of basic Supply Chain Management in Pre-service Health Institutions and the training of Trainers programme. Two Tutors in each Pre-service Institution was trained. The integration of this course into curriculum of pre-service health institutions ensures health professionals graduate from school with knowledge in commodity management.
5.6.3 Inventory Management Software
During the year under review, inventory management software was developed and deployed in seven (7) Regional Medical Stores.
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CHAPTER SIX
6.0 DISEASE SURVEILLANCE AND CONTROL SERVICE
6.1 Disease Surveillance
6.1.1. Acute Flaccid Paralysis (AFP) Surveillance
Table 6.1 AFP Surveillance Performance Indicators, Ghana, 2014 Annualize % Popul’n % Expect’d Report’d Confirm’d d Non- Timel Region Under 15 Compatible Discard’d Adequate AFP AFP Polio Polio AFP y yrs Stools Rate Stools
Ashanti 2,233,539 45 34 0 4 29 1.29 82 79
Brong Ahafo 1,063,037 21 97 0 3 92 8.76 95 95
Central 1,044,899 21 33 0 1 28 2.67 85 85
Eastern 1,201,790 24 23 0 1 21 1.75 83 83
Greater Accra 1,902,980 38 32 0 3 28 1.47 78 75
Norther n 1,167,530 23 42 0 3 38 3.30 90 88
Upper East 461,030 9 24 0 1 22 4.89 92 92
Upper West 317,944 6 19 0 0 19 6.33 100 100
Volta 982,025 20 25 0 1 23 2.30 88 88
Western 1,080,190 22 47 0 7 38 3.45 79 74
Ghana 11,454,964 229 376 0 24 338 2.95 88 86
A total of three hundred and seventy-six (376) cases were detected in all ten regions. The non-polio AFP was 2.95 and stool adequacy was 86%. Six regions achieved the two golden indicators of AFP surveillance. However, the Ashanti, Greater Accra, Eastern and Western regions did not achieve both indicators.
There was a good geographic spread of reported non- Polio AFP cases throughout the country as depicted on the Fig. 6.1; and isolated cases of AFP compatible with polio in some districts. Fig. 6.2 below: 49
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Fig 6.1: Distribution of AFP Cases by Fig 6.2: Distribution of AFP cases District in Ghana, 2014 compatible with Polio, 2014
Sixty percent (60%) of AFP cases were followed up; 3% of cases were not due for follow-up while 37%, which had not been followed, were overdue. Central region followed up only one out of the 33 AFP cases detected (Table 6.2)
Table 6.2: AFP Sixty-day follow-up report by Region, 2014
No Residual Lost to Not Not Region residual Died TOTAL paralysis Follow-up Done due paralysis Ashanti 3 13 2 1 13 2 34
Brong-Ahafo 9 51 2 2 33 0 97
Central 1 5 0 0 25 2 33
Eastern 7 13 1 1 1 0 23
Greater Accra 6 21 1 0 4 0 32
Northern 9 15 0 0 16 2 42
Upper East 1 9 0 0 13 1 24
Upper West 1 15 0 1 2 0 19
Volta 3 16 0 0 5 1 25
Western 6 10 0 0 28 3 47
TOTAL 46 168 6 5 140 11 376
Table 6.3 shows vaccination status of AFP cases, 2014. Overall, 83% had records on vaccination status. Of these, ninety-three percent had at least three doses of Oral polio vaccine (OPV). 50
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Table 6.3 Vaccination Status of AFP cases, 2014
OPV doses Received Number of Cases Percent Cumulative Percent 1 12 3.2 3.2 2 11 2.9 6.1 3 67 17.8 23.9 4 163 43.4 67.3 5 53 14.1 81.4 6 9 2.4 83.8 Not Stated 61 16.2 100 Total 376 100
Table 6.4 AFP Surveillance Indicators, Ghana 2012-2014
Indicator 2012 2013 2014
Number of cases detected 199 334 376
Non Polio AFP rate 1.57 2.71 2.95
% Timely stools 86 85 88
% Adequate stool 84. 82 86
Number of Wild poliovirus isolated 0 0 0
Number compatible with Polio 18 31 24
Number discarded as non-Polio 174 303 338
Table 6.4 shows AFP surveillance indicators in Ghana, 2012-2014. There was an improvement in the two ‘golden’ indicators in 2014 compared with 2013.
Activities undertaken for AFP surveillance
1. Printing and distribution of posters on AFP surveillance to regions 2. Distribution of AFP specimen collection kit to regions 3. Monitoring visit to Greater Accra Region by the Chairman of NCC 4. National Polio Expert Committee (NPEC): Three meetings were convened during the year where AFP cases were classified into compatibles, discarded and ‘not an AFP’. 5. National Polio Certification Committee (NCC): Three meetings were convened to discuss AFP surveillance performance indicators. The committee offered useful advice and made recommendations for improvement. Greater Accra, one of the poor-performing regions were summoned to attend their meeting so they could prevail on them to improve 6. National Task Force on Containment of Wild Poliovirus (NTC): The national taskforce on containment of WPV was reconstituted and two meetings were held during the year under review.
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Key issues from the 3 advisory committees
1. Procurement of AFP specimen carriers in progress 2. List of all public and private laboratoriess have been updated 3. Regional Biomedical Scientists would be invited to Accra for orientation on the survey questionnaire 4. Survey of labs will be undertaken to find out those storing potentially infectious materials. A proposal to that effect has been submitted to WHO and is receiving attention 5. Whilst Ashanti, Eastern and Western regions have achieved one indicator each, Greater Accra is yet to accomplish these goals. 6. It was observed that vaccine-associated poliovirus was isolated from 22 of the AFP cases. The EPI program was asked to investigate all these cases and report at the next meeting. 7. One vaccine-associated paralytic polio (VAPP) was identified during the classification. A VAPP case is one in which vaccine strain virus is isolated and there is residual paralysis during 60-day follow up. 8. There were other cases with adequate stools, negative results but with residual paralysis.
Data Validation Meeting
Three meetings were held in 2014. Participants included staff from DSD, Polio Lab, Public Health and Reference Lab and EPI. Surveillance and Lab data were harmonized as missing dates and epidemiological numbers were all corrected. There were also presentations on the achievements and challenges from the various programmes.
6.1.2. Measles-Rubella Surveillance
An estimated 10 million cases and 164,000 deaths from measles occur worldwide each year. Measles is a leading cause of vaccine-preventable deaths among young children. Ghana has not reported any confirmed death from Measles since 2003, however focal outbreaks are reported in a number of districts each year. Measles SIAs were conducted in 2006, 2010 and 2013.
Measles Surveillance Performance Indicators and Targets
1. At least one suspected measles case detected and investigated in a district in a year. 2. At least 80% of reported cases with blood specimen after mass campaign, 3. 80% of blood specimens arrive at PHRL within 7 days of collection 4. 100% outbreaks investigated and reported with line-listing 5. Less than 10% suspected cases investigated are confirmed IgM positive after SIA
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In 2014, a total of 1,039 suspected measles cases were reported in 179 (82.8%) districts. One hundred and twenty one (121) (that is, 11.6%) were confirmed positive cases for measles, 13 (11%) were AEFI/vaccine related. 76% of specimen arrived the NPHRL within 7 days of collection. Five (50%) of the regions attained above the 10% Measles positive after SIA. Thirteen (10.7%) of the positive cases were vaccine related/AEFI. No Measles death was reported.
Measles Outbreaks Five districts in 3 regions: Brong-Ahafo, Northern and Western had measles outbreaks in the first quarter of 2014. The districts were: Central Gonja, West Gonja, Techiman, Zabzugu, and Wassa-Amenfi West. An outbreak investigation and reactive campaign were conducted. The investigations revealed that there was a population of Fulani migrants making up a large unvaccinated group, however, the isolation of affected persons was not done at the health facility level.
Table 6.5 Achievement of Measles Surveillance indicators by Regions, 2014
No of Districts % No. of No. Rubella No. of that report at ≥ Districts % Region cases Confirmed IgM Districts one suspected that Positive Reported Positive Positive case reported Ashanti 30 25 83.3 86 3 3.4 1 Brong Ahafo 27 26 96.2 339 41 12.1 17 Central 20 17 85 53 1 1.8 3 Eastern 26 23 88.4 166 2 1.2 8 Greater Accra 16 11 68.7 33 0 0 0 Northern 26 14 53.8 43 21 48.8 0 Upper East 13 12 92.3 65 24 38 0 Upper West 11 10 90.9 59 15 25.4 0 Volta 25 20 80 81 0 0 2 Western 22 21 86.3 114 14 12.8 7 TOTAL 216 179 82.8 1039 121 11.6 38
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Figure 6.3: Annual Trend of Suspected and Confirmed Measles Cases, Ghana, 2009-2014
Table 6.6 Age Distribution of Confirmed Measles Cases, Ghana, 2014
Age Group No. Confirmed Positive % Confirmed Positive Less than 9 mths 33 27.3 9 mths to 11mths 24 19.8 1 yr to 4 yrs 26 21.5 5 yrs to 9 yrs 14 11.6 10 yrs to 14 yrs 7 5.8 15yrs and above 17 14.0 Total 121 100.0
27% of the patients were less than 9 months old and that not due for Measles vaccination. Over 14% were above 15 years. [Table 6.6]
Table 6.7 Confirmed Rubella from Measles Negative Tests, 2009 - 2014
Total Measles Negatives & Year Rubella Confirmed % Rubella Confirmed Indeterminate 2009 585 135 23 2010 654 160 24 2011 1472 552 38 2012 1282 372 29 2013 759 168 22 2014 909 39 4.3
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Fig 6.4 Trend of Rubella Positive Cases, Ghana, 2006 -2014
1000 2006 2007 2008 2009 2010 2011 2012 2013 2014
596# 500 459# 372#
175# 133# 160# 168# 0 31# 39# 2006 2007 2008 2009 Years#2010 2011 2012 2013 2014 No.#Rubella#positive#
Table 6.8 Positive Rubella Cases by Age group, Ghana, 2014
Age group Number of Cases Less than 9 mths 1 9 to 11 mths 8 1 to 4 yrs 16 5 to 9 yrs 7 10 to 14 yrs 5 15 yrs & above 2 Total 39
6.1.3. Neonatal Tetanus Surveillance
Strategies for the elimination are as follows: 1. Routine Immunization § Mass immunization Target group – WIFA and School immunization 2. Clean Deliveries § At Health facilities and Communities
Table 6.9 Reported NNT cases and Deaths, Ghana, 2008 - 2014
Year Cases Deaths CFR/% 2009 8 5 62.5 2010 1 1 100.0 2011 5 3 60.0 2012 9 4 44.4 2013 1 0 0.0 2014 1 1 100.0 Total 25 14 54.2
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Fig 6.5 Annual Trend of NNT Cases, Ghana, 2007 -2014
Districts That Suspected and Investigated NNT, 2014 Two (2) suspected cases of NNT were reported in 2 regions (Greater Accra and Eastern). Districts that reported are Ga West and Lower Manya Krobo. Ages of babies are 4 and 8 days old. All 2 cases were investigated. One case was not confirmed NNT, and the investigation report indicated Bilirubin encephalopathy and Neonatal sepsis, ruling out NNT. The second case from Eastern was confirmed. Mother received 5 doses of TT, attended by a trained TBA/Midwife. The baby was well, able to suck, normal cry for first 2 days. The baby’s cord was dressed with Kpokpa ointment. However, baby died after 3 days.
6.1.4 Yellow Fever
Indicators and targets 1. Every district is expected to report at least one suspected case with blood specimen every year target of 80% 2. Blood specimen taken should arrive in the lab within 3 days of being taken 3. YF IgM lab results should arrive at the district within 3 days of arriving in the lab. 4. Timeliness and completeness of reporting should also be at least 80% and 90% respectively.
Achievements for 2014 A total of 464 suspected cases were reported from 127 districts, giving a national district- reporting rate of 58.8%. The Brong-Ahafo and Upper East were the only regions to achieve the 80% target. Brong-Ahafo region reported the highest number of suspected cases (186 cases); in contrast Greater Accra reported the least number of suspected cases (2 cases). Table 6.10 below shows the performance by regions in 2014.
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Table 6.10 YF Performance Indicator Achievements by Regions, 2014
Region Total no. of No. of dist. % district No. of districts reporting reporting suspected cases Ashanti 30 21 70 65 Brong Ahafo 27 26 96.2 186 Central 20 9 45 13 Eastern 26 13 50 45 Greater Accra 16 1 6.3 2 Northern 26 7 26.9 10 Upper East 13 11 84.6 26 Upper West 11 5 45.4 29 Volta 25 17 68 43 Western 22 17 77.3 45 National 216 127 58.8 464
Figure 6.6 Districts Reporting Suspected YF Cases with Blood Samples (%), 2012-2014
120% 2012% 2013% 2014% 100% 100% 100% 96.2% 100% 95.5% 88.9% 88.9% 85.2% 84.6% 80% 77.8% 77.3%
80% 71.2% 70% 68.2% 68% 66.7% 64.1% 61.9% 58.8% 55.6%
60% 52.9% 50% 50% 45.4% 45% 41.2% 41.2% 41.2% 40% 40% 30% 26.9% Reported(Cases( 20% 6.3%
0% ASH% BAR% CEN% EAS% GAR% NOR% UPE% UPW% VOL% WES% NAT%
6.1.5 Meningitis Surveillance
Epidemic meningococcal disease (EMD) or meningococcal meningitis is a major public health challenge in the meningitis belt. The disease occurs more commonly in children and young adults (2 – 29 year old group), and more in males than females and in crowded conditions. The risk of epidemic meningococcal disease differs between sero-groups.
From the beginning of the 2001/2002, – meningitis season, the country adopted the response strategy of enhanced meningitis surveillance; rapid and effective case management to control any outbreak. The intervention has since transitioned to meningitis case-based surveillance (CBS). Strong case-based surveillance is critical to demonstrate the field efficacy of MenAfriVac after its introduction and measure its short, medium and long-term impact on disease burden. 57
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Activities undertaken: 1. Trained Regional and district staff on Meningitis surveillance 2. Distributed quantities rapid test kits and other logistics to the regions by National Public Health and Reference Laboratory (NPHRL 3. Weekly monitoring of Meningitis cases especially from the three Northern regions in the country. 4. Reports and data from the meningitis update was used to brief the Director (PH) GHS 5. Assessed gaps in case-based surveillance implementation and provided orientation for the team in the regions.
Fig 6.7 Annual Trend of Meningitis Cases and Death, Ghana 2009 - 2014
1400$ Cases$ Death$ 1164$ 1200$ 956$ 1000$ 790$ 800$ 477$ Cases% 600$ 454$ 364$ 400$ 128$ 104$ 200$ 68$ 90$ 41$ 39$ 0$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$ Years%
Table 6.11 Meningitis Cases and Deaths by Region, 2014
Region Cases Deaths Ashanti 16 3 Brong Ahafo 13 1 Central 0 0 Eastern 7 0 Greater Accra 18 2 Northern 144 5 Upper East 86 6 Upper West 191 21 Volta 0 0 Western 2 1 Total 477 39
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Table 6.12 Pathogens isolated from CSF Tested by Latex Agglutination and Gram stain, 2014
Pathogen Number Nm A 0 Nm B 0 Nm C 0 Nm X 0 Nm Y 1 Nm W135 47 S. Pneumoniae 35 H. Influenzae 1 Other Meningitidis 15
6.1.6. Cholera Surveillance
Table 6.13 Reported Cholera Cases and Deaths, Ghana 2014
No. of Districts Region Cases Deaths CFR (%) reporting
Ashanti 287 3 1.05 27 Brong-Ahafo 1056 26 2.46 16 Central 3846 60 1.56 16 Eastern 1875 6 0.32 19 Greater Accra 20219 121 0.60 16
Northern 282 2 0.71 5 Upper East 294 9 3.06 10
Upper West 36 1 2.78 3 Volta 651 8 1.23 7 Western 429 7 1.63 11 Total (Ghana) 28,975 243 0.84 130
Response Measures a) National Level The National Cholera Emergency Preparedness and Response Plan was updated and activated. A series of Inter-Ministerial and National Technical Coordinating Committee (NTCC) meetings were held to review the cholera situation. Cholera alert was sent to all regions and districts. Support visits were conducted to the affected regions and districts. Copies of the Standard Operative Procedures (SOPs) on surveillance and case management were sent to all regions.
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b) Regional level and below The regional, district and health facility health staff were trained on cholera surveillance and clinical management of cholera cases. Medicines and supplies were dispatched to the affected regions and districts. Trends and spread of outbreak were monitored at district, regional and national levels.
c) Collaborations There were series of Media engagement-TV and Radio discussions. Posters and flyers were distributed to all regions and districts. The WHO Mission provided Technical support for cholera risk assessment. Aqua-tabs donated by USAID were distributed to regions and districts. A cholera expert from UNICEF visit to support response measures in the area of WASH. WASH Emergency Technical working group, mainly Environmental Health Officers were trained.
6.1.7. Influenza-Like Illness (Ili) Surveillance
Surveillance on ILI is by IDSR and sentinel surveillance. There is at least one influenza sentinel site in each region. The list of influenza sentinel sites in the country is in Annexes. Reports from routine IDSR indicated that, 4 890 cases were reported throughout the country. However only a total of 2,713 influenza specimens were received from the sentinel sites and other facilities that suspected outbreaks out of which 2,357 (86.8%) were processed with 254 (10.7%) being positive. Forty-three Influenza A (H1N1), 62 Influenza A (H3N2) and 149 Influenza B were confirmed.
Table 6.14 Lab Results of ILI from Influenza Sentinel Sites, 2013 & 2014
Number 2013 Percent Number 2014 Percent Pathogen (N= 2,738) (2013) (N= 2,738) (2014) A (H1) 0 0.0 0 0.0 Pandemic A (H1N1) 19 7.6 43 16.9 A (H3) 191 76.7 62 24.4 A (H5) 0 0.0 0 0 A (Not subtyped) 0 0.0 0 0 B 39 15.7 149 58.7 Total Influenza Positive 249 100.0 254 100.0
6.1.8. National viral hepatitis surveillance and control programme (NVHCP) Key Activities 1. Development and finalization of Viral Hepatitis National Policy. 2. The first edition of the National Policy on Viral Hepatitis have been developed and accented by the Hon. Minister of Health, Dr. Kweku Agyemang-Mensah
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3. Collaboration with Stakeholders: An NGO desk has been established to register all NGOs in Viral Hepatitis control in Ghana. For the period under review, the Hepatitis Society of Ghana (HEPSOG) was inaugurated. 4. Strengthening of surveillance: Clinical surveillance on Acute Viral Hepatitis is ongoing. There are already existing surveillance case definitions at the Districts/Regions with the introduction of the 2nd Edition IDSR. A database of Viral Hepatitis cases and deaths has been created to monitor reported cases and deaths from regions and districts. 5. Prevention and Control Measures a) Vaccination The EPI is carrying out routine vaccination of children less than one year with pentavalent vaccine (Penta) that includes hepatitis B vaccine. During the year under review, 981,952 (90%) children under one year were vaccinated (See EPI report). b) Awareness creation The NVHCP carried out health education talks on eTV Media house, Adabraka, Accra. Meetings held with NGOs and prepared plans for celebrating World Hepatitis Day. A press statement was prepared for the Honorable Minister of Health who issued it during the World Hepatitis day celebration on 28 July 2014. 6. Research In collaboration with EPI a proposal to conduct research into Hepatitis B Seropositive among Pregnant Women in Ghana was finalized. The research will determine the prevalence rate of hepatitis B virus among pregnant women in the population, which will consequently inform health service planning in the introduction of Hepatitis B vaccination at birth. 7. Viral Hepatitis Treatment Guidelines There was collaboration among the Programme, HESOG and Roche Pharmaceutical Company Ltd to start the development of National Viral Hepatitis Treatment Guidelines.
Reported acute viral hepatitis cases and deaths A total of 51,052 suspected acute viral hepatitis cases with 108 deaths (CFR 0.2%) were reported from 9 out of the regions in Ghana. No report was received from northern region. Out of these suspected cases, 7,581 were confirmed positive, however the various types of Viral Hepatitis were not specified.
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Table 6.15 Reported Acute Viral Hepatitis Cases and Deaths by Region, Ghana, 2014
Region Suspected Cases Lab Confirmed Deaths CFR Ashanti 6117 698 3 0.0 Brong-Ahafo 2413 1339 47 1.9 Central 8003 902 7 0.1 Eastern 171 52 0 0.0 Greater Accra 14791 878 14 0.1 Northern No report No report No report - Upper East 1583 212 11 0.7 Upper West 8812 1784 17 0.2 Volta 3963 654 0 0.0 Western 5199 1062 9 0.2 Ghana 51,052 7,581 108 0.2 Data source: GHS DHIMS2, 2014
Fig 6.8 Annual Regional Trends of Suspected Acute Viral Hepatitis Cases, Ghana, 2009-2014
Data source: GHS DHIMS2, 2014
1. Train health staff at sentinel sites on surveillance tools and treatment guidelines on Viral Hepatitis 2. Request for reagents to test suspected cases and classify by type of viral hepatitis 3. Selection and training of regional focal persons to coordinate programme activities at regional levels 4. Treatment and care for positive Viral Hepatitis cases in high-risk population 5. Develop and Disseminate to all regions key messages on Viral Hepatitis 6. Advocate for funds to conduct research into Hepatitis B Sero-positivity among Pregnant Women in Ghana 7. Selection and training of regional focal persons to coordinate programme activities at regional levels.
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6.2 NATIONAL MALARIA CONTROL PROGRAMME
6.2.1 Key Activities
1. Malaria case management Comprises Diagnosis and Treatment, Malaria in Pregnancy (MIP) and integrated Community Case Management (iCCM). The majority of planned activities under malaria case management were carried out. There was the impact study on IPTp and research in the reasons for dropouts although there has been an increase in IPTp doses from three (3) to five (5), among others. Commodities such as RDTs, SPs, community registers, etc. were distributed.
2. Integrated Vector Control Continuous Distribution of LLINs and Point Distribution of LLINs and In-door Residual Spraying (IRS) with continuous distribution of bed-nets at Child Welfare Clinics (CWCs) and Ante-Natal Care (ANCs) units of facilities. Over 1.1 Million bednets were distributed to facilities, the majority given to pregnant women and children under-5 years. There was a school distribution of over 1.3 Million bednets to school children in Primary 2 and 6 in all ten regions of Ghana. There were point distributions during which over 2.9 Million bednets were given to households using a coupon system. These were in the Eastern (over 1.3 Million) and Volta regions (over 1.6 Million).
There were series of meetings held by the Malaria Vector Control Coordinating Committee MaVCOC, which is a multi-sectoral committee with membership of Insecticide Regulatory Bodies (FDB, EPA), Research Institutions (NMIMR, GAEC), other agencies of MOFA and MOH, Partners (PMI, WHO), Vector Control Implementing Bodies (AGA, Abt, VCC, Labiofam) and Commercial Partners (Vestergaard Frandsen and recently admitted, Bayer, Zoomlion and Calli Ghana).
Under the New Funding Model, activities were planned including finalizing the Programmatic Gap Analysis, the National Strategic Plan as well as the M&E Plan. External consultants were also brought in to conduct a joint assessment of the National Strategic Plan (NSP). The programme successfully submitted concept note for year 2015-2016.
There was Private Sector Copayment Mechanism (PSCM) under which the Copayment Task Force was formed and Task Force Meetings were also held. First Line Buyer Assessments were undertaken as well as Port of Entry Monitoring and FLB Spot Checks undertaken. A committee was formed to undertake Resource Mobilization, among others.
Activities carried out under the Advocacy, Communication and Social Mobilization (ACSM) where the National Communication Strategy Review was initiated. Five strategies were developed for IPTp, Case Management including HBC, LLINs, SMC, and IRS. Bahaviour Change Communication (BCC)
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Activities were carried out during the year as well as a number of materials including data tools, manuals, policy guidelines and other IE&C materials developed, printed and distributed to all regions. Some documents that were worked upon included the finalization of Revised Reporting tools Second Edition of Standard Operating Procedures for Health Information, Data Quality Audit, National Malaria Monitoring and Evaluation Plan 2014-2020 developed, Research Demographic and Health Survey (DHS 2014) participated in and a study on Feasibility and Acceptability of Use of RDTs within the Private Sector in Ghana planned and carried out in collaboration with the Dodoma Health Research Centre.
Achievements In 2014, about 8.4 million cases of OPD malaria were recorded. This is a decline in comparison to the 11.4 million cases recorded in 2013, a reduction of approximately 23.6%.
Figure 6.9: OPD Malaria Cases from 2010 to 2014
There was an increase in the proportion of OPD malaria cases tested by microscopy or RDT from 48% in 2013 to 73.5% in 2014, representing a 53% increase. This is the best performance in four years.
Figure 6.10 Proportion of OPD Malaria Cases Tested, 2010- 2014
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There was a slight reduction in the number of OPD malaria cases put on ACT in 2014, representing a 5% decrease over the 2013 level. About thirty percent of all OPD cases were malaria, 73.5% of all OPD malaria cases were tested before being treated, 27.3% of all admission cases were attributable to malaria and about 7.2% of all deaths on admission were from malaria in the year under review.
Figure 6.11 Proportion of OPD Malaria Cases Put on ACTs, 2011-2014
Figure 6.13 Proportion of Inpatients Deaths Attributable to Malaria, 2010-2014
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Figure 6.14 Under-five case Fatality Rate, 2010-2014
There was 11% decline in under five case fatality between 2013 to 2014.
Survey Results: Figure 6.14b Prevalence of Malaria in Children 6-59months
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Figure 6.15 Proportion of Pregnant Women Put on IPTp, 2006-2014
Figure 6.16: Ownership and Use of ITNs, 2006-2014
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6.3 GUINEA WORM ERADICATION PROGRAMME
6.3.1 Major Activities
Grand Finale of National Quiz for Basic Schools was held as part of the awareness creation campaign. Two hundred thousand Guinea Worm cash reward educational posters were produced and distributed. The Guinea Worm Week was launched by Director-General at the Civil Servant Hall, in collaboration with WHO, UNICEF and JICA.
A water inventory was conducted in 805 formerly endemic communities and a review meeting was held for regional Guinea worm coordinators.
6.3.2 Major Achievements a) No case of guinea worm reported in Ghana since May 2010. b) Final country report endorsed by NCC and submitted by the Minister of Health to WHO formally requesting to be evaluated as Guinea worm free c) There were Intensive preparations in the area of surveillance and all administrative issues for ICT evaluation. The ICT concluded that Ghana met criteria for Guinea Worm certification
6.3.3. Social Mobilization and Health Education
There was an advertisement of the cash reward on GTV and all GBC radio stations. Radio talk shows, school health educations and various community level educational activities were held in the districts. A national quiz was also organized for basic schools from 170 districts in 2013 and the grand finale held in 2014.
Fig 6.17 Quiz for basic schools in Western and Central Regions
6.3.3. Capacity Building (Training, Meetings)
There was a Review Meeting for all Regional Coordinator, Regional Surveillance officers and Health Information officers in Kumasi from 1-3 December to usher the country into Post-certification phase of the programme.
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6.3.4 Logistics Support
Twenty thousand (20,000) CBS registers were supported by JICA and distributed. Two hundred thousand (200,000) Cash Reward posters donated by JICA for nationwide display.
6.3.5. Water Inventory in Formerly Endemic Communities
The Guinea Eradication Programme in collaboration with UNICEF undertook an inventory activity to collect and document all vital information about available safe water facilities in some selected communities. This important information, when collected, will inform decision-making and planning of WASH activities in the targeted communities. The information will also serve as evidence that the Guinea Worm formerly endemic communities have access to portable drinking water, which helped in the transmission breaking process of the disease. The inventory started in the month of August through to December 2014.
Fig 6.18 A Solar powered Borehole at Nanso in Krachi East
Fig 6.19 A community mechanised Water Centre at Dambai Junction in Krachie East
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6.3.6 Guinea Worm Programme Review Meeting
An annual programme review meeting was held on the 1-3 December 2014, in Kumasi to bring the year’s activities to an end. The main objectives of the meeting were to: a) Debrief participants on the outcomes of the ICT (International Certification Team) Visit b) Usher the country into Post-Certification Phase of the programme
6.3.7 Guinea Worm Free Pre-Certification: ICT visit to Ghana
In July 2014, the MOH sent a request to the WHO for Ghana to be certified free from Guinea Worm Disease. In response, WHO constituted an International Certification Team (ICT) comprising seven International experts from (Burkina Faso, Ethiopia, India, Nigeria, USA and Yemen), five national experts (Independent of GGWEP) and six national facilitators from GGWEP. The team visited all ten regions.
There was a Technical mission from WHO IST/West Africa to support Ghana’s administrative and technical preparedness for ICT visit. Twenty thousand CBS registers were distributed to volunteers in all districts. The International Certification Team (ICT) visited Ghana to assess the county for certification.
National Certification Committee held meeting and advocacy sessions with key stakeholders in Accra. Supervisory visits were organized from the National Level to all 10 regions. The Country Report for Certification was finalized and submitted to WHO. Nationwide case search was done during the 2nd Round of NID. No suspected case of Guinea Worm recorded. There was the promotion of Guinea Cash Reward in collaboration with NTD during Mass Drug Administration campaign.
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6.4 NON COMMUNICABLE DISEASE CONTROL PROGRAMME
6.4.1 Policy Reviews
The National Non Communicable Diseases Policy and Strategy document was finalized. These documents together with the National Cancer Strategy have been contracted by MOH for printing. Plans have been put in place to facilitate effective dissemination.
6.4.2 Monitoring
Monitoring visits were made to the regions. There was support to sensitization training on WHO-PEN, capacity assessment and other NCD related activities and identification of areas of potential support from the national level to regions. Data on facilities that conduct NCD screening and run various NCD clinics were collected. The number and proportion of facilities running NCD Clinic and providing screening services have increased especially for hypertension and diabetes.
6.4.3 Establishment of additional WHO-PEN sites
With support from WHO, the Service facilitated the establishment of Diabetes and Hypertension clinics at primary health care facilities especially CHPs and health centres in Akuapim North District.
6.4.4 Cervical Cancer screening in Ashanti and Greater Accra Regions
Ridge Hospital and selected Health Facilities in Ashanti Region including Kumasi South, South Suntreso, Bantama Market Clinic and Global cervicare charity foundation provided screening services for cervical cancer with visual inspection after acetic acid application (VIA) and Pap smear.
Table 6.16 Cervical Cancer Screening at selected facilities in Ashanti Region, 2012 -2014
CERVICAL CANCER SCREENING (VIA) 2012 2013 2014 Total number screened 405 549 1183 Total VIA positive 23 33 31 Total VIA negative 382 516 1152 Total cryotherapy done 22 13 16 Referral 0 1 7
6.4.5. Partnership for Cervical Cancer
There was engagment with Medtronics (a private partner) for assistance to provide three cryotherapy equipment, glucometers, blood glucose test strips, adult weighing scales (SECA), and BP apparatus for some districts in the Eastern Region. This is intended to increase the number of WHO-PEN sites to promote the early detection 71
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and treatment of major NCDs in Ghana. The NCD programme is collaborating with Marie Stopes and FHI 360 to build capacity in cervical cancer screening using VIA especially in primary care settings.
6.4.6. Training on WHO-PEN Protocols and Tools
In March 2014, from the capacity assessment conducted, 20 health professionals were trained on a variety of WHO-PEN protocols and tools, i.e. clinical record tools and risk prediction charts. Cadres trained were medical assistants, pharmacists, nutrition officers and medical officers. The facilities trained are now implementing the WHO-PEN using the protocols: a) Prevention of heart attacks, strokes and kidney disease, integrated management of Diabetes and Hypertension, b) General health education and counselling c) Specific counselling on cessation of Tobacco use: d) The 5 Steps- 5AsEarly detection of cancers, e) Treatment of Cancer Pain.
6.4.7 Support Services B.P apparatus, glucometers, clinical record tools and risk prediction charts were provide to the Akuapem North District during WHO-PEN to enable the site function effectively in the control and prevention of NCDs.
6.4.8. Disease Burden In Ghana, major NCDs include cardiovascular diseases (CVD), endocrine disorders, chiefly diabetes, haemoglobinopathies including sickle cell disorders, cancers, chronic respiratory diseases particularly asthma, and injuries. Other special NCDs are either managed under separate programmes in the Ghana Health Service (e.g. tobacco control, oral health, mental health) or do not yet have any established programme (e.g. hearing impairment).
An estimated 86,200 NCD deaths occur each year in Ghana with 55.5% occurring in persons under age 70 years (World Health Organization, 2011). An estimated 50,000 NCD deaths occur in males and 36,000 deaths occur in females. The proportion of deaths occurring under 70 years is 69% among males and 59% among females. The age standardized NCD death rate is 817 per 100,000. In 2008, NCDs accounted for an estimated 34% deaths and 31% of disease burden in Ghana(World Health Organization, 2008). CVDs are the leading cause of NCD- deaths with an estimated 35,000 deaths or 15% of the total deaths. NCDs cause an estimated 2.32 million disability-adjusted life years (DALYs) representing 10,500 DALYs lost per 100,000 populations.
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Table 6.17 Comparison of report outpatient NCDs, 2011-2014 Disease 2011 2012 2013 2014 Asthma 87613 105343 117647 102101 Cardiac Diseases 30062 43037 51424 48472 Hypertension 799028 964724 936954 830620 Diabetes Mellitus 189672 232535 220098 214357 Sickle Cell Disease 29764 33785 37690 43801
Table 6.18 Newly reported outpatient hypertension by region 2011 to 2014 Region 2011 2012 2013 2014 Ashanti 176245 187698 142520 140947 Brong Ahafo 74886 87100 72421 61761 Central 65288 97106 122697 106774 Eastern 126054 139991 120176 94962 Greater Accra 157549 196271 183904 152545 Northern 41168 53283 73519 59963 Upper East 17460 24695 29603 37789 Upper West 7997 8849 12593 13169 Volta 92387 116936 128858 118250 Western 39994 52795 50663 44460
Table 6.19 Newly reported outpatient Diabetes by region 2011 to 2014 Region 2011 2012 2013 2014 Ashanti 39583 46907 40753 44879 Brong Ahafo 17758 21088 18489 18331 Central 19530 31978 35357 29541 Eastern 37381 39376 29772 31887 Greater Accra 41780 54539 54482 50822 Northern 2780 1766 3084 3047 Upper East 1177 1213 2679 3477 Upper West 397 552 681 761 Volta 16807 18288 16472 15667 Western 12479 16828 18329 15945
Table 6.20 Newly reported outpatient sickle cell disease by region 2011- 2014 Region 2011 2012 2013 2014 Ashanti 4185 5351 4588 4896 Brong Ahafo 2873 3109 3262 5547 Central 2061 2649 2905 4030 Eastern 8307 7406 6237 7573 Greater Accra 4773 5847 8095 7126 Northern 1323 1395 1266 1776 Upper East 1125 1538 2913 3268
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Upper West 512 566 888 903 Volta 2492 2933 4709 4934 Western 2113 2991 2827 3748
6.4.9. Health research
Few research were conducted during the year: • Risk factors for Breast Cancer in Ghana in collaboration Korle-Bu Teaching Hospital, Accra and Komfo Anokye Teaching Hospital, Kumasi • Capacity Assessment of Non Communicable Diseases • Prevalence of NCDs risk factors in 3 districts in Ghana, data is currently being analysed.
6.5 NATIONAL YAWS ELIMINATION PROGRAMME
6.5.1 Activities
− Training o Sixty Disease Control Officers from all regions were trained in collaboration with the National Leprosy Elimination and Buruli ulcer Programs. o 200 members of the Ghana Association of Public Health Technical Officers (GAPHTO) were trained at their annual congress in Tamale. o 700 students of the Kintampo College of Health and Wellbeing and students and Fellows of the Ghana College of Physicians and Surgeons were trained on yaws. Health talks by field staff and radio and TV discussions were carried out. − Monitoring o Monitoring visits to Ashanti, Brong-Ahafo, Eastern, Greater Accra, Northern, Upper East, Upper West regions by the program alone or jointly with PPME GHS − Case count o Case count was done in selected districts in Brong-Ahafo and Northern regions in collaboration with the National Guinea Worm Eradication Programme. − Pilot o The first phase of the new WHO policy on yaws pilot study in Eastern Region was completed in collaboration with West Akyem and Upper West Akyem districts, KNUST School of Biological Science Microbiology Department, Noguchi, CDC Atlanta and WHO.
6.5.2 Returns and indicators
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The three key indicators to monitor yaws elimination recorded variable achievements in the regions. The Contact: Case Ratio minimum target of 10 was achieved in Ashanti, Brong-Ahafo, Eastern, Upper East and Western regions contributing to the national figure. The other regions improved significantly except Northern and Upper West regions. All regions now report through the DHIMS using the new yaws forms except Northern and Upper West Regions who have not submitted returns. The performance indicators for 2013 are shown below Table 6.21.
Table 6.21 Status of Implementation of Yaws Activities
SO2 Strengthen governance and improve the efficiency and effectiveness of the health system Activities Implemented Outputs/Outcomes Develop unified BU/leprosy/yaws tools Unified picture card developed Training on WHO new policy on yaws 100 staff and 350 CBS in West Akyem trained on yaws new policy Training on new point of care serology 6 labmen and 100 field staff in West diagnostic test for yaws Akyem trained Training on PCR diagnosis of yaws at Noguchi 6 lab personnel trained Azithromycin MDA pilot in Abamkrom Coverage 95 %
PCR diagnosis and resistance survey Awaiting feedback from CDC Prevalence survey of school children Clinical: 1.3%; serology: 10% Validation of new DPP lab test Sensitivity: 95.1%; Specificity: 81.4% SO4. Intensify prevention and control of communicable and non-communicable diseases and promote healthy lifestyles Routine and yaws months treatment activities 18,110 cases & 195,844 contacts treated Contact: case ratio: 10.8 Support visits carried out Eastern, Upper West, Brong Ahafo, Ashanti, Northern, Upper East Support additional MDA activities One district each in Brong-Ahafo and Western Regions Support of reported yaws outbreaks Containment done in Upper East Region
6.5.3 Remarks on endemic community baseline situation
Eastern Region: 3 old districts (W. Akyem, Birim Central and South) had community profiles after 2008 pilot surveys; Suhum has identified some endemic communities. Greater Accra: only Accra Metro submitted report. Eastern Region: 3 old districts (W. Akyem, Birim Central and South) had community profiles after 2008 pilot surveys; Suhum has identified some endemic communities. Greater Accra: only Accra Metro submitted report. Volta Region: only regional summary reprt available at national but no list of endemic communities. Western Region: Not submitted are: Asafo sub district of old Sefwi Wiawso, Amoaya Sub district of old Juabeso; Asankrangwa, Manso-Amenfi and Sameraboi Sub districts of old Wassa Amenfi did not know yaws situation of majority of their communities; 75
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6.5.4 Innovations
• Introduction of new point of care test on pilot basis • Use of volunteers as agents of mass drug administration of Azithromycin • Integrated training with leprosy and Buruli ulcer
6.6 NEGLECTED TROPICAL DISEASES
Background The Neglected Tropical Disease Programme (NTDP) came into being in 2007 when five NTDs, which were being managed individually, were integrated under one programme due to the common strategy of intervention. The NTDP operates under the Disease Control Unit of the Public Health Division of the Ghana Health Service. The NTD Programme manages five (5) of the NTDs for which the main strategy of intervention is annual and/or bi-annual mass drug administration (MDA) complemented by morbidity control (clinical management of complications) and public education. These five NTDs are Lymphatic Filariasis (elephantiasis), Onchocerciasis (river blindness), Trachoma, Schistosomiasis (Bilharzia); Soil transmitted helminthiasis (worm). The overall goal of the NTD Programme is to eliminate these five diseases that are obstacles to socio-economic development.
6.6.1 Lymphatic Filariasis
Lymphatic Filariasis also known as Elephantiasis, is a parasitic disease caused by the filarial worm – Wucherera bancrofti that is transmitted by the Anopheles mosquito the same mosquito that transmits malaria. It causes enlargement of the entire leg or arm, the genitals, vulva or breasts. The psychological and social stigma associated with these aspects of the disease is immense. The disease also causes internal damage to the kidneys and lymphatic system.
Lymphatic Filariasis (LF) is endemic in 98 out of the 216 districts in 8 regions aside Ashanti and Volta regions. The NTDP has completed 7 to 13 rounds of MDA in all endemic districts. Transmission has been observed to be broken in 69 endemic districts. LF is targeted for elimination by 2020.
6.6.1.1 Night blood Survey The impact of MDA is assessed through sentinel and spot check sites so as to provide program managers accurate information on the trend of infection over the course of the program. Data is collected on the prevalence of microfilaria in sentinel and spot check sites. For 2014 NBS, out of a total of 16 districts that were selected 4 districts had prevalence of more than the threshold of 1% and these are Nabdam, Lawra, Wa East and Wa West distrcts. Jirapa district had microfilaria prevalence of 0.97%, which was just about the threshold. Samples taken for the site were between 300-600.
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6.6.1.2 Transmission Assessment Surveys To be able to assess whether MDA has succeeded in lowering the prevalence of infection to a level where recrudescence is unlikely to occur, transmission assessment surveys was conducted during the year under review.
Results and Implications: In all, a total of 912 basic schools with over 39,320 pupils in classes one and two were sampled and tested with immunochromatographic test (ICT) kits for filarial antigen. The Survey Sample Builder was used to automate the calculations for determining the appropriate survey strategy. Only 10 positives were observed from all the samples taken. The critical cut-off point, which formed the basis to either ‘pass’ or ‘fail’ any district, was fixed at 18 positives per district.
The results indicate that all 64 districts have passed and therefore qualify to stop MDA activities against Lymphatic Filariasis from 2015. This together with 5 other districts that qualified in 2010 brings the total number of districts passed to 69 out of 98 districts. The summary results are as follows;
6.6.1.3 Community MDA In the period of May/June 2014 MDA for LF and Oncho endemic communities and districts was undertaken nationwide. Below is the regional coverage.
Table 6.22 Combined MDA data for LF & ONCHO, 2014
Combined MDA data for LF & ONCHO, 2014 Registered Treated Region Population Population Coverage Ashanti 461520 387426 83.95 Brong-Ahafo 956722 809000 84.56 Central 1797556.184 1425028 79.28 Eastern 1048139 853462 81.43 Greater Accra 2264036 1620151 71.56 Northern 2627630.709 2175271.48 82.78 Upper East 1011021 829867 82.08 Upper West 664911 538956 81.06 Volta 532333 440397 82.73 Western 1909407 1526855 79.96 Total 13273275.89 10606413.5 79.91
6.6.2 Onchocerciasis
6.6.2.1 Entomological surveillance Entomological surveillance for the year under review was undertaken between Septembers to December 2014. The programme, in its quest to refine the strategy 77
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for Onchocerciasis elimination, upon the advice of APOC, limited activities to undertaking periodic black fly infectivity assessments as well as conduct spot dissections. This mode of operation will afford the programme the opportunity to detect migrant vector species to enhance analysis of the results and its effects on hotspots.
Specific objectives were; • To monitor activities of migrant vector species for detection of Onchocerciasis disease recrudescence through spot dissection of black flies at eight (8) selected river basins in Ghana • To assess the impact of Ivermectin distribution on the transmission of Onchocerciasis at hotspots designated areas • To make appropriate recommendations for improvement of the Oncho control programme in Ghana
Activities were planned to commence from July through to November to coincide with the highest breeding and transmission of black fly infections. However, due to late receipt of funding the period was revised from September to December.
6.6.2.2 Epidemiological surveillance A total of 56 sentinel villages along the Black Volta, Pru, Tano, Asukawkaw, Tain, Oti, Daka, Densu, Birim and Bia river basins were evaluated to assess their prevalence levels and impact of Mectizan distribution in the respective river basins of the country. It was also to facilitate progress made so far by the country towards elimination of Onchocerciasis so as to help chart a way forward for accelerating interventions to problem areas. Various strategies for reducing prevalence levels at meso and hyper-endemic villages, especially at hotspots, are required to be put in place in line with global strategies to eliminate human Onchocerciasis.
The elimination indicators and targets outlined by APOC/WHO required all countries undertaking phase 1(b) evaluations for confirming whether break points have been achieved, or that treatment can be stopped, should ensure microfilaria prevalence in 90% of villages evaluated should fall below 1% standard prevalence.
Out of a preliminary total of 5,013 persons examined 84 were positive for Onchocerca volvulus. Results of eight other villages are being validated and would be updated when completed. The standard prevalence ranged from 0% to 17.2% on the Tano River. One of the significant impacts that treatments over the years has made is the dramatic reduction to 2.7% at Majimaji (2) from an initial 2007 prevalence of 45.2% and a community microfilaria load of 2.88mf/skin snip. Majimaji (1) has also reduced from 20.1% in 2007 to currently 0%. The interventions put in place to treat biannually and targeted at migrant groups, fishing and difficult to
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reach villages including farm huts have indeed paid off, although a lot more remains to be done.
There were 14 villages whose prevalence was above the recommended threshold of 1% implying that only 71.4% of villages had prevalence below 1% instead of the recommended 90%. Of significance is the microfilaria loads recorded. The counts were very low giving indications of hope of elimination if supervision of treatment and monitoring of affected persons are improved.
Interestingly, the prevalence at Asubende stood at 3.2% from 5.9% recorded in 2007. Review of the register and interview of the only positive case indicated that the case in question missed two consecutive years of treatment. He confessed to travelling to the city (Kumasi) to visit his relatives but did not make any effort to take the Mectizan tablets.
The periodic random selection of villages within a river basin to assess its prevalence, as part of the programme’s strategy of monitoring the river basins, has led to Asibrem being discovered as one of the high points for the transmission of Onchocerciasis.
The survey concludes that MDA activities especially in the Tain and Daka river basins need strengthening in order to deal with the persistent high prevalence of Onchocerciasis. These two areas require increased community participation, consistent tracking of migrants, intensification of IE&C activities and monitoring to put the programme on the course of elimination. Please find below preliminary results of villages evaluated;
6.6.3 Trachoma For the period of 2011-2014, surveillance was undertaken in the two regions totaling 37 endemic districts. For each district 2 communities were randomly selected and households were surveyed. Alongside in each district five schools were randomly selected and also surveyed. During this period of surveillance 8 communities were noted to have had prevalence above 5% threshold so they were treated for additional three years.
6.6.4 Schistosomiasis School Based Deworming was undertaken in all schools in 107 selected districts in the Country largely because the Program had limited number of praziquantel tablets- 4,500,000. The teachers were the implementers at these schools. Each child was given tablets of praziquantel based on height.
6.6.5 Soil-transmitted Helminths 79
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School Based Deworming was undertaken in all schools in 107 selected districts in the Country. The teachers were the implementers at these schools. Each child was given one tablet of albendazole.
Advocacy and Social Mobilization: The Ghana NTD ambassador in the persons of Dr. Joyce Aryee was engaged to support advocacy and fundraising effect of the NTDP. Her initiative during the reporting caught the attention of VOTO mobile.
6.7 NATIONAL TUBERCULOSIS CONTROL PROGRAMME
6.7.1 Key activities The national TB prevalence survey was completed in 2014. Clinical Care support visits were conducted for TB patients. Mortality audits for TB patients at Regional Hospitals were conducted.
6.7.2 Performance Indicator Trends
6.7.2.1 Trend of Reported TB Cases (All Forms) 2007-2013 Trend of reported cases slowed down in spite of efforts to increase case finding. Bacteriologically positive cases however increased to 50% of all cases. This is contrary to expected trend with the introduction of new diagnostic tools. Active case finding interventions are planned for the future to help identify more cases.
6.7.2.2 Trend of Proportion of Notified Childhood TB Cases (All Forms) 2008-2014 The proportion of childhood TB cases is expected to be 10% of reported cases. Though the country hit almost 6% in 2010 there has been a gradual decline to 5%, which has been maintained over two years. Efforts have been put in place to improve the numbers of childhood TB cases reported with the design of a special childhood TB management course. In addition special reporting tools have been designed and child friendly diagnostic methods and medicines have been introduced to address the weakness of childhood TB.
6.7.2.3 Comparison of Regional Trends of Reported TB Cases (All Forms) 2007-2013 Specific differences are being observed in various regions with regards to case finding and these may be attributable to different challenges that exist in each region.
The highest and least numbers of cases are reported in Volta and Northern Regions respectively. There was a general decline in numbers of cases reported compared with the previous year except in Eastern, Northern and Brong-Ahafo Regions where there was a marginal increase in cases reported. More effort is needed to increase case finding in the light of the established TB prevalence rate.
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6.7.2.4 Trend of National TB Case Notification Rates per 100,000 Population 2007- 2014 The trend of national case notification per 100,000 population has been on a downward trend since 2009 when the highest notification rate was recorded. This presents a major challenge as this trend show the true picture of case finding nationally. Preliminary report of the National TB Prevalence Survey reveals a higher than anticipated national TB prevalence estimated at 264 per 100,000 population. Greater efforts are needed to begin to push case notification upwards towards achieving the targets of the Post 2015 Global TB Strategy – The End TB Strategy.
6.7.2.5 Trend of TB Treatment Outcomes (All Forms) 2007-2013 Trend of successful treatment outcomes has progressed upwards annually and currently at 86.5% is above the WHO recommended global target. This is useful for the country to maintain high treatment success rate as it contributes to disease elimination.
6.7.2.6 Regional Performance against Set Target for 2013 Regions have maintained high treatment success outcome in recent times. All regions except Eastern Region achieved and exceeded the 85% global treatment success target. All the Teaching Hospitals could not make this target largely due to the large numbers of critically ill patients referred for treatment. There is need to build more capacity for staff in various peripheral facilities on early diagnosis and clinical management of TB. The NTP would focus more attention on this aspect of the Programme in the coming year.
6.7.2.7 Adverse Treatment Outcomes The trend of adverse treatment outcomes has been on the decline. This positive trend is a reflection of the successful interventions in place. The case fatality rates greater than 5% is still a major challenge that is being addressed through clinical care audit in regional hospitals.
6.7.2.8 Trend of TB/HIV Co-Infected on CPT and ART 2006-2013 The trend of TB/HIV co-infected patients receiving Co-Trimoxazole and Anti Retroviral Therapy has increased gradually over the years. The expected rate of enrolment on ART is far below the 100% target. The fear of rebound immune reconstitution inflammatory syndrome (IRIS), which has affected enrolment unto ART, is being addressed. Improved collaboration is expected to address this challenge.
6.7.2.9 Trend of Lost to Follow Up Cases (Defaulter Rate) All regions worked hard to significantly reduce their Lost to Follow Up (Defaulter) rate to less that 4% compared with the national average of 3%. Western Region on the contrary more than doubled the Lost to Follow Up rate for the previous year. This sudden increase must be appropriately investigated to address the cause of
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this sudden jump. KATH continued to maintain the zero lost to follow up rate. TTH also did well to reduce the lost to follow up rate by 30% from that of the previous year. It is expected that they would do better in subsequent years to reduce this figure downwards further.
6.7.2.10 High Treatment Success Rate A high treatment success rate of 87% was achieved and a Lost to Follow Up rate of 3%. Challenges exist with high case fatality and Lost to Follow Up rates in the Teaching Hospitals.
6.7.3 Completion of Nationwide Tuberculosis Prevalence Survey The first nationwide TB Prevalence Survey in fifty-seven (57) years was completed. A review of the whole project revealed minimal errors and implementation challenges so data cleaning was done in a very short period and data analysis conducted. Preliminary results of the survey reveal a national prevalence rate of 264 per 100,000 population. Detailed analysis also revealed bacteriological prevalence of 356 per 100,000 population and smear positive rate of 105 per 100,000 population.
6.7.4 Development of new Strategic Plan Based on the findings of Comprehensive Programme Review of 2013, Epidemiologic Analysis, Programme reports and findings of the prevalence survey, a new strategic plan, “The National Tuberculosis Health Sector Strategic Plan for Ghana 2015-2020” was developed. This strategic plan aims at prioritizing active case finding interventions among vulnerable and high-risk groups using various screening tools.
6.7.5 On site coaching for laboratory staff and QA Assessors To address the challenge of declining bacteriologically confirmed TB cases, the Programme Laboratory Working Group prioritized and conducted capacity building exercises using the hands on mentoring and coaching approach.
6.7.6 Continuous On Site Data Validation and Data Quality Audits Programme staff conducted continuous on-site data validation and data quality audits as part of the supportive supervisory visits to the regions and districts. This ensured high quality Programme data. The DHIMS 2 platform is being updated to receive case based data.
6.8 THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI) 6.8.1 EPI-related Health Indicators With the recent addition of Rubella-containing measles vaccine, the program is currently vaccinating children against twelve (12) vaccine preventable diseases. These are tuberculosis, polio, diphtheria, pertussis, pneumonia, rotavirus diarrhea, tetanus, diseases due to Haemophilus influenza Type b, hepatitis B; measles, yellow fever 82
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and rubella diseases. The program also vaccinates pregnant women against tetanus. Vaccinating against these diseases has contributed to a decrease in infant and under-5 mortality rates.
6.8.2 Global Coverage Goals for National Immunization Programme The program works within the context of global interdependency and as such targets are based on global goals, which include: • The Global Alliance for Vaccines and Immunization (GAVI) 2000: 80% of Penta3 coverage in every district of 80% of developing countries by 2005 • United Nations General Assembly Special Session (UNGASS) 2002: Full immunization of children less than one year of age with Penta3 coverage at 90% nationally, with at least 80% coverage in every district by 2010. • Millennium Development Goal 4: To reduce U5MR by two thirds of the 1990 levels by 2015 These goals are based on levels, which make epidemiological impact. The program also works within the context of the Global Vaccine Action Plan (GVAP).
6.8.3 Program Objectives for 2014 The Policy goal of EPI is to protect all children and pregnant women living in Ghana against vaccine preventable diseases. The specific objectives for the program set with reference to the global goals were: • To attain an operational target of 90% nationally for all antigens • To ensure more than 80% of districts attain Penta3 coverage of 80% and above • To maintain zero mortality due to measles: Measles mortality has been maintained at zero (0) since 2003 and the programme aimed at maintaining this achievement • To maintain ‘polio free’ status in the country: No case of poliomyelitis has been reported in the country since 2008. • To maintain Maternal and Neonatal Tetanus (MNT) elimination status
6.8.4 Key Strategies for 2014 • Improve access through strengthening of Reaching Every District (RED)/Reaching Every Child (REC) approach in all districts • Improve quality of service through strengthening of supervision and monitoring • Strengthen integration with other child health related programmes–Child Health Promotion Week celebration (CHPW), Integrated Maternal and Child Health, National Immunization Days (NIDs) against Polio etc. • Strengthen lower level planning by training in micro-planning • Strengthen collaborations with stakeholders to improve surveillance performance • Provide feedback on performance to reporting institutions
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• Support activities on capacity building for cold chain and vaccine management in all the districts • Improve waste management and injection safety through provision of incinerators • Improve routine reporting of Adverse Events Following Immunization (AEFI) in order to assure vaccine safety • Improve technical support and supervision 6.8.5 Main Interventions carried out in 2014 • Conducted nationwide routine vaccination • Conducted two rounds of National Immunization Days (NIDs) against Polio • Commemorated the African Vaccination and supported the commemoration of Child Health Promotion Week (CHPW) in an integrated approach • Piloted vaccine wastage monitoring using sentinel sites • Completed GAVI HPV demonstration vaccination in four districts • Conducted national EPI coverage survey • Conduct effective vaccines management assessment (EVMA) • Conduct EPI cold chain inventory and assets tagging • Conduct adolescent health needs assessment in relation to HPV vaccination • Conduct HPV costing analysis • Develop comprehensive multi-year plan (cMYP 2015-2019) • Applied to GAVI for introduction of one dose of IPV into the routine immunization
6.8.6 Service Delivery Strategies In order to improve routine EPI coverage, a number of innovative strategies were used. Static immunization was the main service delivery strategy. Every health facility has a static clinic responsible for daily routine immunizations.
The availability of such clinics in the country has made access to routine immunization easier. Outreach immunization services are organized to reach children in communities where static clinics are not available. The outreach program has contributed immensely towards bridging the gap between communities with health facilities and those who do not have. Thus, increasing access to EPI services to all eligible children and women. Mop-ups were done in areas with low coverage and difficult to reach areas (such as riverine, islands and mountainous areas) with the aim of reaching every child.
Transit point vaccination including vaccinations done at Lorry parks, markets, churches, mosques etc. was also used. Campaigns were also conducted to reach out to all eligible groups.
Table 6.23 Summary of Immunization Performance at a glance, EPI-GHS, 2011-2014
EPI Performance at a Glance, 2011-2014 Antige 2011 2012 2013 2014
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n No % No % No % No % Vaccinate Coverag Vaccinate Coverag Vaccinate Coverag Vaccinate Coverag d e d e d e d e BCG 1,071,098 105 1,082,408 104 1,047,710 98 1,122,420 103 Penta1 917,125 90 953,052 92 948,723 89 1,012,838 93 Penta2 878,053 86 904,520 87 907,342 85 976,311 89 Penta3 888,190 87 908,821 88 912,420 86 981,952 90 OPV0 678,971 67 733,037 71 746,248 70 828,644 76 OPV1 910,359 89 948,774 91 935,507 88 1,016,394 93 OPV2 874,009 86 902,013 87 909,698 86 977,718 90 OPV3 884,615 87 906,363 87 915,233 86 983,977 90 PCV- 667,237 64 936,906 88 1,014,709 93 13-1 PCV- 524,458 51 893,076 84 977,288 90 13-2 PCV- 419,715 40 897,154 84 989,147 91 13-3 Rota-1 613,983 59 926,423 87 1,009,329 92 Rota - 483,105 47 882,815 83 971,357 89 2 Measle 894,795 88 919,825 89 898,695 84 960,406 88 s-1 Measle 523,891 51 539,284 51 695,076 64 s-2 YF 888,854 87 910,272 88 893,362 84 952,384 87 TT1 339,304 33 347,457 33 347,119 33 336,673 31 TT2+ 773,092 76 763,182 74 754,985 71 679,344 62
Table 6.23 and Figure 6.20 give a summary of 2014 EPI performance for routine antigens. With the exception of Td1 and Td2+ performance, there was an increase in both absolute figures and percentage coverage of all antigens in 2014 as compared to 2013. The low Td performance may be due to the shortage of the Td vaccine in the country during the beginning for 2014.
Figure 6.20 Immunization Performance at a Glance, EPI-GHS, 2011-2014
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120 Trends'in'EPI'Performance:'201152014' 110 2011$ 2012$ 2013$ 2014$ 100 90 BCG'Target' 80 Others' 70 60 50 40 30 20 10 0
YF BCG TT1 OPV0 OPV1 OPV3 TT2+ OPV2 Rota-1 Penta1 Penta2 Penta3 Rota -2 PCV-13-1PCV-13-2PCV-13-3 Measles1Measles2
6.8.7 Equity in Vaccination Coverage To assess equity in vaccination coverage, districts are classified based on Penta-3 coverage. Of 216 districts, only 153 (71%) achieved Penta-3 coverage of 80% and above. Although this fell short of the target of 80% of all districts, there has been continuous improvement in the number of Districts achieving this target. Again fever districts obtained less than 50% coverage as compared to 2013.
Figure 6.21 100% Component Bar Graph showing trends in the number of Districts achieving specified Penta-3 Coverage Category, EPI GHS 2011-2014
100% Component Bar Graph showing trends in the number of Districts achieving specified Penta-3 Coverage Category, EPI GHS 2011-2014 100% 0 0 1 4 2 37 36 43 61 80% 76 Below 50% 60% 62 57 37 46 42 50-80% 40% 80-90% Above 90% 89 107 20% 71 77 94
0% 2010 2011 2012 2013 2014
Figure 6.22 Number of Unimmunized Children Using Penta-3 as proxy by region: 2014
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Number!of!Unimmunized!Children!Using!Penta+3!as!proxy!by!region:!2014! Northern +14,485!! Brong-Ahafo +2,101!! Upper East !4,740!! Upper West !6,278!! Western !7,648!! Central !12,885!! Eastern !15,624!! Ashanti !17,110!! Volta !17,784!! Greater Accra !44,487!!
Figure 6.23 Top 20 Districts with highest numbers of un-immunized children, EPI-GHS, 2014
!20!top!!districts!!with!>1400!!unimmunized!!children!in!2014!:!Using!PentaC3!as! proxy!! Afram Plains South !1,465!! !1,500!! Sefwi-Wiawso !1,520!! !1,652!! Jirapa !1,665!! !1,669!! Bia East !1,719!! !1,729!! Kassena-Nankana !1,803!! !1,861!! Gomoa West !1,861!! !2,139!! Tema !2,705!! !2,891!! Gomoa East !2,946!! !3,045!! Ho !3,948!! !8,669!! Asokore-Mampong !10,206!! !11,011!! Accra !28,093!!
Figure 6.24 Top 21 districts with “over immunized” children, 2014: using penta-3 as proxy Ahafo-Ano South Kintampo South Kintampo La-Nkwantanang-Madina Tarkwa-Nsuaem Atwima-Nwabiagya Kumbungu East Mamprusi Tolon Dormaa Tamale Juabeso Mamprugu-Moagduri Ejura-Sekyedumasi Wassa-Amenfi East Wassa-Amenfi Nzema East Nzema Nkwanta North Ga Central Nsawam-Adoagyiri Twifu-Ati-Mokwa Bia West Bia Chereponi -925 -925 -940 -940 -970 -970 -967 -967 -976 -976 -1,052 -1,052 -1,105 -1,105 -1,181 -1,181 -1,191 -1,191 -1,346 -1,346 -1,401 -1,401 -1,480 -1,480 -1,444 -1,444 -2,110 -2,110 -2,085 -2,085 -2,112 -2,112 -2,391 -2,391 -2,624 -2,624 -4,546 -4,546 -7,503 -7,503 -5,979 -5,979
There are some districts with various levels of unimmunized children using Penta 3 as a proxy. Population denominators are critical in evaluating coverage levels. Some 87
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districts continue to achieve over 100% immunization coverage levels, suggesting that these districts vaccinated more children than expected. Figure 6.23 shows top 21 districts that covered more children, administratively, than expected. Data management and/or population (denominator) could account in part for this.
6.9 OCCUPATIONAL HEALTH
6.9.1 Activities Table 6.24 Summary of Regional Performance on Occupational Health & Safety (OHS) and Health Care Waste Management (HCWM) Activities Activities Implemented Outcomes
Improving health An interface for OHS data entry was designed and introduced information system on into the DHIMS-2 for focal persons to report OHS activities. occupational diseases Some regions have started reporting through the DHIMS. and injuries
Monitoring implementation Monthly League table indicators have been developed and of OHS & HCWM policy circulated to all regional focal persons. Some regions have in the regions. begun submitting their monthly returns. Monitoring / support visits to 5 regions were carried out namely: the Brong–Ahafo, Volta, Upper East, Upper West and the Northern Regions (11th January 2015-4th February, 2015).
Figure 6.25 Regional performance of OHS and HCWM activities
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Key findings from monitoring & support visit
1. All Regional Hospitals have health and Safety Committees. 2. The Volta Region has included OHS indicators as part of their Peer- Review Activity. This has helped strengthen the program even at the district levels. 3. The Upper East regional hospital has a non-functional incinerator. This has severely affected waste management activities in the facility. 4. Lack of human resource and funds remains a challenge for the proper implementation of the program in the regions. 5. Integration of OHS, IPC and QA team is being advocated to ensure efficient use of resources. 6. Some of the facilities have already instituted this approach (Volta, UER,) 7. Proper waste segregation remains a challenge in the facilities. (Access to pedal waste bins, colored liners and education are some of the reasons)
6.9.2 Poison Control
Health sector objective 4: Intensify prevention and control of communicable and non-communicable diseases and promote healthy lifestyles.
Key Activities
1. Respond to enquiries on poisoning from healthcare providers and members of the public to assist in the management of the poisoned patient 2. Development of IE&C Material: Guidelines for the prevention and clinical management of toxic exposures and poisoning in Ghana 3. Education of high-risk target groups on chemical safety. 4. The Health effects of consumption of food in plastic materials including take- away packs were also communicated to the public through education programs on radio and in meetings.
Outcome of activities
1. 138 Enquiries on poisoning handled via HOTLINE: 020-2222-174 / 0-800-100-46 (Toll-free, Vodafone lines only). 2. The Centre also provides direct patient management support to clinicians at the Ridge Hospital, where the Centre is located 3. Draft guideline / protocol document has been completed and ready for peer- review 4. A total of 156 pesticide applicators in four (4) locations / districts were trained in recognition of effects of pesticide poisoning and first aid for pesticide poisoning. 5. A TV3 discussion programme, Consumer Watch was held on 01 June 2014
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6. Conducted introductory course in medical toxicology (CPD) course for healthcare professionals, Ghana College of Physicians and Surgeons, Accra, 22 October, 2014 7. Four paediatric nursing students received three (3) days training in basic toxicology awareness, prevention of childhood poisoning, first aid concepts for poisoning, management of common poisoning cases in children and the role of the Ghana poison control centre and how to use the poison control centre in an event of poisoning, Accra, June and July 2014. 8. Student project work. Educating mothers on prevention of poisoning in children at home; July 2014. 9. Educational activities were carried out at Madina Polyclinic and PML children’s hospitals respectively.
6.10 NATIONAL LEPROSY ELIMINATION PROGRAMME
Registered cases as at end of 31-12-2014 are 345, Point Prevalence 0.13/10,000 pop. WHO target is < 1/10,000 pop. A total of 366 new cases were detected CDR 1.35/100,000 Useful Indicator, Estimating Leprosy Transmission In An Area. Twenty- one (21) cases presented with DG 2 among new cases (5.7% of new cases reported). This is an indication of how early patients are presenting. Much depends on the awareness of its early presentation among the community and h/workers.
There were seven {7} children among the new cases representing 1.91% of the total cases seen. A high child proportion among new cases is a sign of active and recent transmission. Four hundred and thirty {430} patients completed treatment in 2014. This brings the total cumulative number of patients who have completed MDT to forty three thousand four hundred and thirty five {43,435} since the introduction of MDT in the early 1980s.
6.10.1 Leprosy Endemic Districts in Ghana
There are some districts in Ghana, which continue to report cases of leprosy every year.
Table 6.25 Leprosy Endemic Districts in Ghana District Prevalence Rate Lawra 1.7/10,000 Tatale Sangule 1.2/10,000 Ho 1.01/10,000 Kpando 1.32/10,000 Akyemansa 1.5/10,000
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Table 6.26 Leprosy Prevalence Rate by Regions, New cases and those released from Treatment Ghana, 2014 Region Prevalence Rate New Cases Released from Treatment Ashanti 0.08/10,000 46 49 Brong Ahafo 0.16/10,000 37 52 Central 0.05/10,000 9 10 Eastern 0.14/10,000 50 58 Greater Accra 0.14/10,000 31 26 Northern 0.21/10,000 4 53 Upper East 0.32/10,000 24 25 Upper West 0.43/10,000 42 73 Volta 0.26/10,000 62 72 Western 0.11/10,000 20 12
6.10.2. Priority Interventions
Passive case finding is the usual approach. To ensure good case finding activities Health Centre staff must be well trained to identify the cases that report to them in their facilities. In endemic districts Leprosy days are organized to change image of leprosy and ensure that those who are diagnosed complete their treatment
Management of complications of leprosy as early as they arise was done in the districts where they had cases. Reactions to treatment were referred to health facilities for appropriate treatment.
6.11 NATIONAL YAWS ELIMINATION PROGRAMME
6.11.1 Activities
1. An Integrated-monitoring visit was conducted in Northern and Upper West Regions 2. An Assessment visits were conducted in the districts where the trial on the use of oral Azithromycin for yaws was being conducted. The districts where the trial is taking place are: Adansi South (Ashanti Region), Asikuma-Odoben-Brakwa (Eastern Region) and Ayensuanor District (Eastern Region). 91
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3. The results of the pilot study was disseminated at the Directors meeting of GHS in Conference Room of Ghana Health Service, the Public Health Division meeting in HPU Conference Room 4. Training on Yaws management was organized for the following groups: 5. Kintampo Health and Welfare College – August 2014 6. Medical student batches on rotation to Programs 7. Scheduled Program Lecture, School of Public Health 8. Scheduled Program lecture, GCPS 9. Training of 120 Technical Officers from all regions at Ankaful: Dec 2014 10. Private Medical and Dental Practitioners in Koforidua (August 2014)
Table 6.27 Trend of Yaws Performance Indicators Year 2008 2009 2010 2011 2012 2013 2014 Cases 28080 36,328 10,869 8,824 9,356 18,110 2037 Contacts 97550 87,966 39355 40,360 89,156 195,844 5010 Contact: case 3.5 2.4 3.6 4.6 9 11 2.5 ratio # Districts 128/170 98 103/170 105/203 78/216 N/A reporting (%) (76%) (58%) (61%) (52%) (36.1%)
6.11.2 Innovations
In 2014, there was the introduction of new point of care test on pilot basis. Volunteers were used as agents of mass drug administration of Azithromycin.
6.12 NATIONAL AIDS CONTROL PROGRAMME (NACP)
6.12.1 HIV Testing and Counseling Services (HTC)
At the end of the year, Seven Hundred and Ninety-Eight Thousand, Seven Hundred and Sixty-Three (798,763) people received HTC services. These are people who completed HIV testing and received post-test counseling, thus getting to know their HIV sero-status. They were made up of Eighty-One Thousand One Hundred and Twenty-Five males (81,125) and Seven Hundred and Seventeen Thousand Six Hundred and Thirty-Eight females (717,638).
Out of the number that tested to know their HIV status in the period under review, a total of Forty-Three thousand Six Hundred and Ninety-Four (43,694) were HIV positive, indicating a period prevalence of 5.5%.
6.12.2 PMTCT Services
In the period under review, Six Hundred and One Thousand Seven Hundred and Twenty-Six (601,726) pregnant women tested to know their sero-status. Of the number that tested, Twelve Thousand Five Hundred Eighty-Three (12,583) were HIV
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Positive, which is 2% of those who tested within the reporting period. Eight Thousand Two Hundred and Ninety-Nine (8,299) HIV positive pregnant women who were due to receive ARVs were given ARVs to prevent mother to child transmission of HIV.
6.12.3 EID Services
In 2014, 2,878 babies were screened for EID. Of the number screened, 8% tested positive for HIV. In line with the country’s guidelines, early infant diagnosis was implemented across the country.
6.12.4 Clients on Antiretroviral Therapy
During the year under review, a total of Fourteen Thousand Nine Hundred and Ninety-Four (14,994) people made up of 4,179 males and 10,815 females were put on ART.
A total of Eighty-Three Thousand Seven Hundred and Twelve (83,712) persons are currently alive and are on ARVs (treatment) at the end of 2014. It is important to note that out of the 83,712 persons on treatment, 4,581 are children and the remaining 79,131 are adults.
6.12.5 Condoms
Five Million Four Hundred and Twenty-Nine Thousand Six Hundred and Eighty (5,429,680) pieces of male and female condoms were distributed together with FHD and other stakeholders in the period under review.
6.12.6 HIV Test Kits and Accessories
During the period under review, 2,053,200 Tests of HIV First Response 1&2 Kits and 22,700 tests of HIV OraQuick Kits to enhance HIV testing and counseling was provided.
6.12.7 Information and Communication materials
The Programme took delivery of the following to enhance data collection, research and communication materials.
Table 6.28 List of publications and materials NO. ITEM QUANTITY 1. 2013 NACP Annual Report 1,000 Pieces 2. ART Client Appointment Cards 150,000 Pieces 3. PMTCT Supervisors Checklist 1,200 Pieces 4. National Guidelines for PMTCT 5,000 Pieces 5. PMTCT Handbook November 2014 Version 7,000 Pieces 6. Model of Hope Facilitators Manual 160 Pieces 7. Model of Hope Participants Manual 520 Pieces
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8. 2013 HIV Sentinel Surveillance Reports 5,000 Pieces 9. 2013-2020 National HIV Prevalence & AIDS Estimates 2,000 Pieces Report 10. CDs for 2013 HIV Sentinel Surveillance Reports and 2013- 1,000 Pieces 2020 National HIV Prevalence & AIDS Estimates Report
6.12.8 Capacity Building for Health Care Workers
In response to the country updating its treatment guidelines for the management of PLHIV, series of trainings were conducted for health care workers involved in the Prevention of Mother-To-Child Transmission and Early Infant Diagnosis. Participants were drawn from Five Hundred and Twenty-Seven (527) Service Delivery Areas from Six (6) Regions. They were drawn from the following Regions; Brong Ahafo, Ashanti, Western, Northern, Upper East, Upper West
6.12.9 CDC Collaboration
In the period under review various activities took place including building of local capacity in strategic planning implementation and monitoring. This training was organized by the Association of Public Health Laboratories (APHL) and BD Global Health in collaboration with the African Centre for Integrated Laboratory Training (ACILT) and the Centers for Diseases Control and Prevention (CDC). During the period under review basic Laboratory Information System (BLIS) was extended to the Eastern Regional Hospital Laboratory to improve data capture, quality of reported data and its management. Staffof the Centre for Health Information Management (CHIM) were supported to enhance their use of GIS in DHIMS2 to ensure technology transfer and to support other facilities.
During the period under review, a delegation from Malawi paid a study tour to the country to understudy BLIS implementation. This delegation was made up of officials from the Ministry of Health (Malawi), CDC -Malawi, Howard University Technical Assistant Project and Baobab Health Trust, an implementing partner for CDC- Malawi.
During this period, one officer from the Ghana Health Service (GHS) was invited to facilitate in a Training of Trainer’s (TOT) program in South Africa organized by African Centre for Integrated Laboratory Training (ACILT).
A biometric access door was installed at the Koforidua regional hospital during this period; this was to ensure the safety of staff and the confidentiality of client’s results at the facility.
The Acting Program Manager paid a week’s working visit to Atlanta at the invitation of CDC, Ghana; this was to enable him meet up with subject matter experts and share country experience. 94
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6.12.10 Monitoring & Supervision
In the period under review, the Acting Programme Manager and Key Programme Officers undertook a Monitoring and Supportive Visits to the Northern and Upper East Regions, which was geared towards improvement in service delivery.
6.12.11 Research
The Programme disseminated the 2013 HIV Sentinel Survey and Estimates Reports
The Programme also undertook the 2014 HIV Sentinel Survey and its associated Monitoring. The 2014 Survey included the assessment of the PMTCT data for HIV Sentinel Survey. Completed HIV Drug Resistance Plan Completed the review of National ART Guideline
6.12.12 Resource Mobilization
In line with the continuation of the delivery of HIV services, the Programme together with other stakeholders prepared and submitted the joint HIV/TB concept note for the New Funding Mechanism (NFM) for the period July 2015-December 2017. The priority areas in the concept note included the following; ART, PMTCT, HIV testing and Counseling.
6.13 PUBLIC HEALTH LABORATORIES
6.13.1 Bacteriology, Measles/Rubella/Yellow Fever Bench The bench mainly deals with suspected samples of epidemic-prone-diseases, which are received in the laboratory from all the regions. These diseases include the following:
Measles, Rubella, Yellow fever, Cholera, Meningitis .In addition to the above, the following investigations are carried out on the bench, Water analysis, Food analysis, Parasitological investigations, Bacteriology and Outbreak investigation
6.13.2 Activities undertaken 1) Routine analysis and testing of measles, rubella, yellow fever, cholera and toxoplasmosis Data: Entry, analysis and dissemination of data were done weekly to WHO/IST/WA & Regions and feedback to regions and facilities on time. Bacteriology data are also analyzed and dissemination every month to the various stakeholders 2) PT and EQA Programs: The Bench continues to participate in Bacteriology PT from NICD South Africa and 10% quarterly measles specimens sent to Abidjan for EQA 3) Quarterly 10% of measles specimen sent for External Quality Assessment was done for only the first quarter. The three remaining quarters could not be sent due to the refusal of the courier service refusal to lift the packages because
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of the outbreak of Ebola in the sub region. Isolated cholera isolates for two research institutions for clinical studies 4) Monitoring and supervisory visit to Ashanti, Brong Ahafo and Northern Regions 5) Participation of Training in susceptibility testing and subsequent participation in national surveillance of antimicrobial resistance at the University of Ghana Medical School 6) Evaluation of Cholera Rapid Diagnostic Test Kit 7) Involved in two research projects; a. Cholera surveillance by Infectious Disease Epidemiology Department. Bernhard Notch Institute for Tropical Medicine Hamburg Germany b. Integrated study approach to understand the dynamics of cholera epidemics in Ghana- Aix Marseille University / UNICEF 8) Survey The PHL successfully took part in the Antimicrobial Resistance Survey organized in collaboration between Ghana Health Service and University of Ghana Medical School (UGMS) department of microbiology. One hundred and fifty-two bacterial isolates were sent by PHL to the microbiology department of UGMS. PHL also participated in the national HIV sentinel survey.
9) Outbreak Investigation The PHL was called upon to participate in the outbreak of African Swine Fever Virus among Pigs in Anokye, Baku, Ngalekyie and Ngalekploe towns in the Ellembelle district of the Western Region, in which over five hundred pigs were destroyed. The PHL also took part in the investigation of suspected measles outbreak in the WassaAmenfi West district.
10) Monitoring and Supervision The PHL conducted three External TB LAB quality assurance monitoring visit to TB smear microscopy sites in the region. The TB LAB EQA Assessor at the PHL joined national to undertake Lab TB EQA monitoring and supervision in the Ashanti Region.
11) Training and Workshop As part of activities to equip staff at PHL to work in an area of expanding public health programmes, staff attended various trainings and workshops. They include National HIV and TB review meeting, HIV Sentinel survey training, Method Validation and Quality Control workshop, SLMTA workshop, Ebola Contact tracing workshop, Manuscript writing workshop, Regional performance review meeting, Antimicrobial Resistance Survey workshop and Ebola, Cholera and Meningitis surveillance training.
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CHAPTER SEVEN
7.0 REPRODUCTIVE HEALTH, MATERNAL, NEWBORN AND CHILD HEALTH (RMNCH)
7.1 Adolescent Health and Reproductive Health Services
7.1.1 Policy and Planning in ADHD Programming A Ghana National Strategic Plan for the Health and Development of Adolescents and Young People (2009-2015) has been developed. This was disseminated in 2013 – twice at the national level involving stakeholders from the public sector and non- governmental organizations in the Greater-Accra Region, and then as a one-time event in the Brong-Ahafo and Volta Regions. There was a training programme organised for 708 service providers on the ADHD programming, and a total of 264 ADH corners were established throughout the country –246 corners in public sector and 18 corners in the private sector. A total of 202 institutions have ADH corners.
A total of 1,247 peer educators have been trained in Adolescent Health Advocacy and Communication. An estimated 290 ADH clubs have also been formed with 239 clubs in the public sector and 51 clubs in the private sector. Eight (8) new posters were developed on Adolescent Development and Health. Four existing information leaflets have been revised.
To augment efforts in improving focus on adolescent health, the GHS initiated the development of a Parent-Adolescent Communication brochure in 2013, and conducted a field test of a WHO checklist for assessing the ADH component of pre- service curricula of health training institutions in four (4) selected countries including Ghana. A total of 53,700 young people were counseled on Reproductive health (23,554), Mental health (3884), substance abuse (5,926) and nutrition (20,335).
The GHS contributed drafting a three-year (2014-2016) Adolescent Reproductive Health programme under the GOG|DFID Programme and the Annual Work Plan and a Monitoring Plan for the GOG|UNFPA programme.
7.1.2 Adolescent Health Services Approximately 376,657 pregnancies registered in 2013 were registered to young women aged 10-24 years. This represents 39% of a total of 971,268 registered pregnancies countrywide.
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There were 23,130 reported cases of spontaneous and induced abortions among young women (10-24 years). All cases recorded had been offered comprehensive abortion services.
Table 7.1 Adolescent Reproductive Health, 2013 10-14yrs 15-19yrs 20-24yrs 10–24 yrs. Pregnancies to young 3289 116,134 257,234 376,657 women Deliveries to young 1672 67456 146,466 215,594 women Postnatal care registrants 181,821 2,432 (0.7) 79,287 (31.2) 263,540 (young women) (67.9) Referrals 623 (0.9%) 14,940 (30.0) 29,610 (68.9) 45,173 Abortions (spontaneous and induced) in young 574 (2%) 8667 (37) 13, 889 (60) 23,130 women Maternal deaths among 9 84 171 264 young women
7.2 Family Planning
In 2013 there were a number of forums held in with the aim to increase acceptance and uptake of family planning service nationwide. These included the inter-agency coordinating council on contraceptive services and the national quantification (forecasting and supply planning) to determine contraceptive need.
Under the WAHO 2013 Capacity Building Fund, Ghana received funds to support training of the national team in quantification and forecasting of family planning commodities. Others efforts to promote efficiency were a stakeholder meeting held in collaboration with the national regulatory bodies including the Foods and Drugs Authority (FDA) to discuss the challenges associated with the quality of reproductive health commodities in the country. The key outcomes of the meeting included the need to strengthen the cold chain system at the ports to ensure that commodities remain in the right temperature until they reach the consumer. At this meeting there was a recommendation for a pre-service course in handling health commodities.
There was another stakeholder meeting that focused on the need to change the policy for community health nurses to provide implant services. Key issues discussed were: The results of the 2011 Nationwide Assessment of CHNs discourse on the experiences from other African countries and the2012 WHO recommendation on the use of targeted monitoring to support CHNs services.
The Second Family Planning Week Celebration was held in Ho in the Volta Region under the theme: “Your Future, Your Choice, Your Contraception, Act Now!” The
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Government and all partners in reproductive health supported the celebration of the Family Planning Week.
Diverse efforts are being made to ensure increase in uptake which includes: public education, procurement of Samsung tablets for training in DHIMS 2 mobile application for offline data capture, monitoring and supervision etc. These efforts have contributed to the rise in the family planning acceptor rate from 24.7% in 2013 to 29.1% in 2014.
7.3 Safe Motherhood and Child Health
As part of the current strategies towards improving maternal health and maternal death audits, the Ghana Health Service developed the Maternal Health and Death Audit Guidelines. Copies of this manual were printed and distributed to all regional health management teams with dissemination workshops held. This manual has since been adopted as the National Death Review document for Ghana. A process was also initiated to review the Reproductive Health Policy and Standards to reflect the current national goals and priorities.
7.3.1 Accelerated Reduction of Maternal Mortality
In November 2013, His Excellency, the President, Mr. John Dramani Mahama, launched a follow-up campaign on the Accelerated Reduction of Maternal Mortality in Ghana. This was a follow-up campaign to the launch in 2009 on the Accelerated Reduction of Maternal Mortality in Africa (CARMMA) adopted by Her Excellency, former First Lady Mrs. Ernestina Naadu Mills.
The launch focused on the accountability on CARMMA commitments made by the District Chief Executives and Municipal Chief Executives in 2011. His Excellency the president at the launch declared that assessment of performance of DCEs and MCEs would be based on their contribution towards maternal mortality reduction.
There was a forum to foster media engagements to discuss maternal and child health issues and to empower the media to give out the right information on pregnancy, childbirth and other reproductive health issues of concern. Media personnel were updated on the current situation of maternal and child heath in Ghana. Some key messages were developed for the media to use in giving out information to the general public.
7.3.2 Newborn Care
Development of Newborn Care Strategy A situation analysis was carried out, and an initial dissemination of the main outline of the Strategy has been carried out. The Final draft will be presented at a consensus meeting in 2014. 99
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Celebration of World Breastfeeding Week and Child Health Promotion Week The 2013 World Breastfeeding Week in Ghana was celebrated in Accra under the theme “Breastfeeding Support: Close to Mothers.” The Child Health Promotion Week was also celebrated in Accra under the theme “Healthy Children; Great Future.”
7.4 Nutrition
7.4.1 Vitamin A Supplementation
In 2013, there were two rounds of nationwide Vitamin A supplementation campaigns held concurrently with the NIDs against polio. A multi-sectorial task team has reviewed the World Health Organization (WHO) recommendations on Vitamin A Supplementation and adapted these to incorporate effectiveness and relevance to Ghana. Some new findings on Neonatal Vitamin A Supplementation have been disseminated.
7.4.2 Development of Guidelines & Protocols
Manual on healthy eating for schools was developed in collaboration with Ghana School Feeding Programme
7.4.3 Infant and Young Child Nutrition Program (IYCN)
The Infant and Young Child Nutrition program encompasses all programs and projects aimed at ensuring adequate nutrition for infants and children from birth till the age of five years. The focus areas are infant and young child feeding, growth promotion, supplementary feeding and rehabilitation of malnourished children. Training was relevant health service providers on the new WHO Growth Chart and revised Child Health Record Books. The C-IYCF manuals have been revised and adapted for Ghana. The National Infant and Young Child Feeding Strategy document was also reviewed.
7.4.4 NMCCSP/Growth Promotion
The second phase of the Nutrition and Malaria Control for Child Survival Project (NMCCSP) came to an end in 2012. In 2013, an Implementation Completion Report (ICR) on NMCCSP was prepared and submitted to World Bank. A new proposal for a continuation programme was also submitted to the World Bank.
7.4.5 Community Management of Acute Malnutrition (CMAM)
Ghana Health Service is implementing the Community-based Management of Severe Acute Malnutrition (CMAM) with the support of partners. This is to ensure the continued integration of CMAM into the health sector with a focus on strengthening 100
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competencies, quality of services and programme sustainability. In 2013, the CMAM programme scale-up strategy was developed. There was consensus building on the Nutrition Policy, which is to be submitted for approval by Cabinet.
Figure 7.1 Community Management of Acute Malnutrition
7.4.6 Nutrition Assessment Counseling and Support (NACS) for PLHIV
The NACS programme was initiated in Ghana with the principle that adequate nutrition is co-therapy for HIV-AIDS. This is because reliable evidence shows that good nutrition is required to boost the compromised immune system of HIV/AIDS sero-positive persons. The objectives of the programme in Ghana are to integrate quality nutritional assessment and counseling as a routine service in the care and treatment of people living with HIV (PLHIV) and TB clients, and to strengthen selected service sites to provide specialized food products for PLHIV and TB clients based on agreed eligibility criteria.
7.5 Health Promotion
In 2013, there were a number of elaborate steps taken to finalize the Health Promotion Policy. These covered one-on-one Consultative meetings with key Partners and Stakeholders, and with the Parliamentary Select Committee on Health, where the GHS with support from WHO-Ghana discussed the urgent need for the concept of health promotion to be strategically positioned to be able to lead public health delivery in Ghana.
7.5.1 Health Promotion Support for Programmes
A two-year campaign communication and advocacy strategy on Universal Salt Iodization was developed and launched to improve household consumption of iodised salt. Theme for the launch was "Iodized salt for intelligence and development.”
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The 2013 World No Tobacco Day was launched on 31st May 2013. The theme for the launch was "Ban Tobacco advertising and promotion." Post launch activities such as Radio/TV discussions and sensitization meetings in selected institutions and agencies were carried out.
There was public sensitization on the introduction of the HPV vaccination programme in Ghana. There were inputs to the communication subcommittee meetings on measles- rubella, pre-campaign monitoring to assess the level of preparedness for the measles-rubella campaign in the districts. This was followed by the post Measles-Rubella Vaccination Campaign Review and National Planning Meetings were held for the first and second rounds of NIDs against Polio.
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CHAPTER EIGHT
8.0 CLINICAL CARE SERVICES
8.1 Ebola Case Management And Infection Prevention And Control Trainings
All ten regional response case management teams and trainer of trainers have been trained on case management of Ebola viral haemorrhagic fevers and infection prevention and control. Ghana Quasi-Governmental Health Institutions, the Psychiatric hospital, Airport Clinic, the Police, the Military and Christian Health Association of Ghana were part of the trainings.
A total of five hundred and forty (540) participants, made up of various categories of health workers and other security agencies such as staffs from the Immigration Service and Customs were trained. The trainings were carried out from September to December 2014.
A total of three hundred and eighty six (386) participants were trained on Ebola and infection prevention and control in all three Volta River Authority (VRA) hospitals. Aboadze, Akosombo and Accra between 14th August and 13th September 2014.
8.1.1 Ebola Case Management Simulation Exercise
A day’s simulation exercise was planned and carried out at the treatment Centre in Tema in October. The trained rapid response team members were involved in the exercise. Since it was the first simulation activity, some gaps were identified and discussed. There is the need for more of such activity to build confidence and capacity of the team.
8.2 Development of Draft Policy on Antimicrobial Use and Resistance
Some key factors and issues identified are the absence of policy on Antimicrobial use and unregulated access to Antimicrobials. The absence of national antibiotic use policy that guides the use and control of resistance is also contributing immensely to the upsurge in abuse of antibiotics at the community and the institutional level across the country. Some evidence in Ghana suggests that, many infectious pathogens are failing to respond to common, potent and easily accessible antibiotics in the health system and thus resulting in increased morbidity and mortality from infections. (Nweneka, 2009). Furthermore, there is lack of information on the proper use of antimicrobials and irresponsible or inappropriate use of antimicrobials. Quite commonly, there are spurious, Substandard, Falsified, Fake and Counterfeit Antimicrobials.
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8.3 Cataract Surgeries
An average of 735 cataract surgeries were done depicting a low Cataract Surgical Rate. Cataract is the leading cause of avoidable blindness worldwide. Fortunately, it is curable by surgery and optical correction. In Ghana, it is estimated that 1% of the population is blind. Cataract blindness alone contributes about 50% to the burden of blindness. Thus, of the 25 million people in Ghana, 250,000 people are blind and cataract is estimated to cause 50% of the blindness. In other words for every 1,000,000 population, 10,000 people are blind from all causes and 5,000 of these are blind as a result of cataract. Every year an estimated 1,000 (that is 20% of the prevalence) more new cases are added to it.
With the total number of cataract blind patients and the additional yearly incidence of cataracts, Ghana needs to perform a minimum of 40,000 cataract surgeries per year in order to reduce blindness due to cataract (a Cataract Surgical Rate (CSR) of 2,000, i.e. number of operations per million population per year). Currently, with the resources available an average of 15,000 cataract surgeries is performed per year. A total of 18,140 cataract surgeries were performed at GHS, CHAG, quasi- government and private facilities giving a CSR of 736 for 2014.
The reasons for the low CSR recorded over the years are varied; among them are inadequate infrastructure and equipment, geographical access, inadequate awareness creation that cataract blindness is curable.
There are presently about 64 general ophthalmologists in the country but the distribution is skewed towards the big cities, mainly Accra and Kumasi. Cataract surgery is mostly done in the Regional and District Hospitals. Many of the surgeries performed at the District Hospitals are carried out by the Regional Ophthalmologists who undertake outreach surgical services to the Districts Hospitals. These outreach services are, however, hampered by lack of transport for the teams, obsolete equipment and inadequate funding.
8.4 Fight Against Epilepsy Initiative
The fight against epilepsy initiative completed its 3rd year of implementation. 10 districts, organized a stakeholders meeting on sustainability of the initiative. Sensitization of GHS staff on the Mental Health Act (Act 846). With the support of Basic Needs, Ghana, 130 health staff were sensitized on the Mental Health Act.
8.5 Customer Care Programme (Phase 2)
With support from Ecobank Ghana, the department conducted a mystery client study in February with the objective of assessing customer care practices in some 104
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selected facilities in Greater Accra that were trained in customer care in 2009. The findings would then be used to strengthen the customer care programme.
Among the findings that were also shared at the 2014 Health Summit at GIMPA, was that the environment was generally clean except for the toilets. OPD charges were generally uniform compared with the maiden study in 2009. However, there were situations of poor staff attitude such as during emergencies and registration. Some complaints desks were not manned and staff generally did not wear name tags. Some recommendations were that: 1) Health facilities should organise regular (not one-off) customer care training for staffs. 2) Give some focus to records staff during customer care training and improve records management 3) Explore the possibility of introducing appointment system to reduce client waiting time and 4) Facility management should monitor response time for emergencies 5) There should be regular public education on referral /gatekeeper system and guidance provided to staff on how to handle clients who bypass this system. 6) Supervision at the OPD should include customer care and discipline staffs that are rude and discourteous to patients. 7) Health facilities should also provide name tags for staff and ensure they are worn 8) MOH should start designating facilities as “patient/client friendly” using league tables
8.6 Guidelines on the Disposal of Dead Bodies
The department led a team to development of MOH SOPs on maternal and Child Health and cross cutting issues that is handling dead bodies including stillbirths. Interviews were conducted in selected health facilities in the Greater Accra Region to serve as a baseline for the development of guidelines on the disposal of dead bodies in health facilities. The assessment has been completed. Zero draft guidelines are available.
8.7 Distribution of several QA documents
A number of documents have been distributed to all regions. They are the Referral Policy, Referral Forms, Referral Feedback Forms, Guidelines for Complaints Management for all levels of health facilities, Informed Consent forms, Quality & Patient Safety Books, Customer Care Manual, Patients’ Charter and Code of Ethics posters, WHO Pocket Book for Managing Sick Children. The two new ones - Informed Consent Forms and Quality & Patient Safety Book are yet to be disseminated. 105
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8.8 Patient safety situational analysis
Patient safety situational assessment was undertaken in selected facilities with the aim of providing baseline information on the state of health facilities with regards to patient safety. The assessment covered sixteen facilities in four regions, Greater Accra, Volta, Brong-Ahafo and Northern regions respectively. The facilities, which were randomly selected, laid emphases on hospitals rather than Health Centers and Clinics. Hospitals because they serve as referral centers and quality care delivery could be envisaged as very crucial in their operations. An assessment to know the patient safety situations provides a broader view of what can be built on, discouraged and or developed to guide patient safety initiatives.
8.9 Training of Trainers in Paediatrics in Disasters
A training programme in Paediatrics in Disasters from 2 to 5 September 2014 was organized during the year under review. It was supported by the University of Colorado Denver and Anschutz Medical Center, Center of Global Health and the American Academy of Paediatrics to train paediatric staff. The objective was to equip a critical mass of paediatricians, paediatric nurses, paediatric staff and other health staff in paediatric disaster planning and response for their hospitals and communities. 30 health staff from CHAG and GHS facilities (all regions) was trained. The Denver team trained local paediatricians who would be facilitating the same program as a CPD with collaboration from the GHS and Paediatric Society of Ghana.
8.10 Quality Improvement work with Project Fives’ Alive
Since 2008, Project Fives Alive has been assisting the health delivery system in the country using proven quality improvement approaches and strategies. These initiatives were first tested in all 38 districts in the three northern regions including 36 hospitals. PFA! Introduced into these northern hospitals a package of high-impact interventions for improving care processes, developed in nine innovation Catholic Hospitals from southern regions. Within the National Catholic Health Service (NCHS) itself, the change package was spread to all 32 Catholic Hospitals during the pre- national scale-up phase. Using QI methods, we scaled up the Quality Improvement processes and two packages of effective interventions for improving the quality and reliability of under-five care. These packages were a consolidated sub-district change package for improving antenatal attendance, skilled delivery, post-natal care and referral processes, and the hospital change package for improving early care seeking, reducing delays in commencing treatment, and ensuring high adherence to standards and guidelines prescribed by the health system.
In May 2013, PFA! began a National Scale-Up began in the southern part of Ghana to improve the quality and reliability of care for children less than five years old. In the national scale-up regions, the project is currently running 14 improvement 106
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learning Collaborative in seven regions – Brong Ahafo, Ashanti, Western, Eastern, Central, Greater Accra, and Volta – including 134 district and regional hospitals. PFA! is therefore covering approximately 80% of public sector hospitals at this point. In October 2014, PFA! commenced the last phase of national scale-up by spreading best practices to an additional 70 districts and their sub-districts.
8.10.1 Design and implementation
The essential design of the Project, leveraging a peer-to-peer learning network of hospitals and health centers with supportive follow-up coaching and mentoring site visits from trained Improvement Advisors and Coaches, remains unchanged during this national scale-up phase. Following multiple engagements with Regional and District Directors of Health Services, including sessions held at the Project’s 2011 – 2013 Annual External Advisory Board meetings, various adaptations were made resulting in the following design modifications to the national scale-up phase. These included some separation of activities: the Hospital Learning Network (Wave 4A), the Sub-district Learning Network (Wave 4B), and the Data Quality Improvement (DQI) intervention (Wave 4C).
The hospitals continue to develop, test, adapt, and implement contextually relevant changes to address three root causes of mortality of children in their hospitals, namely, delayed care seeking, delayed provision of care, and inadequate adherence to protocols for treating high-burden diseases.
8.10.2 Some results on the interventions made by health staff a) Overall, under-five deaths in the 134 hospitals has recorded a downward shift, leading to an overall reduction of 27.8% since the first Collaborative was held in May 2013, from 15.8 deaths per 1000 admissions to 11.4 per 1000 admissions. b) Of the seven regions involved at national scale, three – Brong Ahafo, Western, and Greater Accra – have shown a downward shift in under-five mortality (U5M) rates, with mortality reducing by 24.4%, 41.0%, and 41.6% respectively. c) Clearly, the improvement recorded in the under-five mortality is attributable to improvements seen in the post-neonatal infant age group. Here, too, we have seen a downward shift in mortality, with 29.7% reduction in mortality across 134 hospitals in seven regions. Two regions – Brong Ahafo and Greater Accra – have seen significant improvements, with 33.5% and 40.2% reductions respectively. Western region has showed a consistent pattern of low mortality below its mean performance over a period of seven months. Post-Neonatal Infant Mortality Rates (1-11 months) d) Improvements in the post-neonatal infant and older child mortality rates are attributable to the improvements in the consistent and reliable application of 107
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approved malaria protocols and the attendant reduction in deaths from malaria (malaria case fatality rates). Across the Collaborative, we have recorded a 36% reduction in deaths from malaria. Brong Ahafo and Eastern regions have recorded the greatest gains in this area. While Brong Ahafo, with a malaria protocol adherence of 95%, has reduced Malaria CFR by 57%, Eastern region, with a protocol adherence of 100%, has reduced Malaria CFR by 56.9%. Two other regions – Volta and Western – have shown consistent reductions in malaria-related deaths over the last three to four months, while the rest show no change. Across 42 hospitals in the Collaborative, adherence to approved malaria protocols is at 85%.
8.11 Neonatal Mortality Rates
Neonatal mortality rates have remained stable across the Collaborative at 8.3 deaths per 1000 live births. Two regions, however – Volta and Eastern – have shown a consistent pattern of reduced neonatal mortalities below their mean performance over a period of six months.
Among other interventions, Volta region has the Regional Pediatrician, along with a trained Improvement Coach, conducting independent visits to all 21 hospitals to give clinical support on the correct application of protocols including newborn care. Additionally, there have been joint visits with the Regional Obstetrician to conduct maternal mortality audits in various district hospitals.
Figure 8.1 Out-patient Attendance, 2012 - 2014
Table 8.1 OPD per Capita per Region, 2012 – 2014 Region 2012 2013 2014 Ashanti 0.96 0.92 0.92 Brong Ahafo 1.6 1.7 1.8 OPD Central 0.97 1 1 per Eastern 1.4 1.3 1.2 Capita Greater Accra 0.94 0.85 0.82 Northern 0.65 0.74 0.79 Upper East 2 2.1 1.8
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Upper West 1.1 1.2 1.3 Volta 1 1.1 1.2 Western 1.3 1.4 1.4 Ghana 1.1 1.1 1.1
Figure 8.2 Percentage of OPD Attendants Insured by Region, 2012-2014 120%
100% 94.3% 93.6% 95.2% 96.5% 89.1% 88.8% 83.4% 83.5% 80.6% 79.6% 80%
60% 52% 2012% 2013% 40% 2014%
20%
0%
AR% CR% ER% NR% VR% WR% BAR% GAR% UER% UWR% GHANA%
Table 8.2 Bed Occupancy Rate by Region, 2012 - 2014 Data Region 2012 2013 2014 Ashanti 61.4 68.5 55.1 Brong Ahafo 70.8 71 69.1 Central 67.4 45.3 46.9 Eastern 59.3 53.9 60.3 Greater Accra 89.1 65.1 77.5 Bed occupancy rate - All Northern 84.5 72.2 76.4 Wards Upper East 68.1 62.8 60.2 Upper West 70 69.4 71.7 Volta 65.8 55.4 61.2 Western 53.6 55.4 49.3 Ghana 67.6 60.8 61.3
Figure 8.3 Average Length of Stay in Hospitals by Region, 2012-2014
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Table 8.3 Cataract Surgeries by Region, 2014 Region Cataract Surgical Rate 2014 Ashanti 903 Brong Ahafo 485 Central 497 Eastern 306 Greater Accra 1704 Northern 648 Upper East 1213 Upper West 459 Volta 234 Western 116 National 735 Target 2000
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CHAPTER NINE
9.0 COMMUNITY ENGAGEMENT AND PARTNERSHIPS
9.1 Community-based Health Planning Services (CHPS)
The GHS continues to expand and promote access to primary health care through CHPS. In 2014 the Ministry of Health and its Agencies began the process of reviewing the CHPS policy. The Ghana Health Service reviewed and finalized the operational guidelines for CHPS during the year under review. His Excellency the President has pledged his support for CHPS and came up with an innovative funding mechanism, which involves mobilizing resources from the salary of himself and his ministers to support CHPS implementation.
Figure 9.1 Trend in implementation of Functional CHPS across Ghana 2002-2014
Table 9.1 Total Number of Functional CHPS by Region, 2014
Region Number of Functional CHPS Ashanti 736 Brong-Ahafo 380 Central 207 Eastern 465 Greater Accra 142 Northern 172 Upper East 213 Upper West 145 Volta 263 Western 225 Ghana 2948
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9.1.1 Contribution of CHPS to Service Delivery
CHPS continue to contribute significantly to service delivery in the country as shown in the table below
Table 9.2 Contribution of CHPS to some service performance in 2014
OPV/Polio 3 Family OPD Skilled % doses % % % planning Attendance deliveries administered CHPS 143,727 30.4 213679 36.1 2,407,966 10.2 18,680 3.8% Health 203,287 43.0 314555 53.2 6,384,225 27.1 119,616 24.0 Centre Hospital 105,648 22.3 54354 9.2 13,856,154 58.7 326,732 65.6 Midwife / 20,136 4.3 9211 1.5 942,174 4.0 32,778 6.6 Maternity TOTAL 472,798 100 591799 100 23,590,519 100 100 100
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CHAPTER TEN
10.0 HEALTH INFORMATION, ICT AND HEALTH RESEARCH
10.1 Data Management and Information Technology to Improve Health Information Management and Service Delivery
A second edition of the Standard Operating Procedures (SOP) for data management was developed, printed and distributed with support of Population Council with funding from USAID.
The process of replacing the paper registers was continued with the deployment of the e-tracker in Awutu-Senya District. A proposal for support for data quality improvement was sent to Global Fund upon request and it was approved. Activities in this support will be implemented in 2015.
10.1.1 Data Quality Improvement
Quarterly data verification was organized and national support was provided for regions to do this. Monthly feedback on regional performance with regards to data completeness and timeliness were published and shared with regions.
Ghana Health Service in collaboration with CHAG started work on developing a guideline for conducting data verification.
Ghana Health Service coordinated the efforts of partners involved in data quality improvement activities to ensure standardization of procedures and outputs.
10.1.2 GHS Periodic Performance Reports
The 2013 GHS Annual Performance Report was produced and circulated to all senior managers and divisions and is available on the GHS website for download and printing. One Quarterly GHS Bulletins were produced, during the First Quarter. The GHS Senior Managers Meeting (SMM) came off and was attended by Senior Managers and Health Partners. The Ghana Health Service took part in the Ministry of Health Inter-agency review meeting in April 2014 and in August 2014. Where the annual and half year performances respectively were reviewed. The GHS 2013 Half- year report that highlight the priorities and progress on expected outputs of all GHS HQ Divisions was collated and disseminated.
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10.2 Health Research
10.2.1 Activities
The main activities implemented in the area of research was to build Capacity Building for Research and Set the national Research Agenda
Priority areas for research was collated from the various Programmes, Divisions and Regions of the Ghana Health Service and grouped according to the Health Sector Medium Term Development Plan (MTDP) 2014-2017
Technical Support for research was provided for other Divisions and Regions and scientific review meetings were held during the year under review.
10.2.2 Data Management Support for Research Studies
During the year under review, a total of studies were processed and analyzed. The table below shows the number of studies, data sets processed:
Table 10.1 Studies Processed during the period Jan-Dec 2014 Title Of Studies Principal Investigator (PI) Ghana TB Prevalence Survey National Tuberculosis Programme (NTP) Maternal and Neonatal Child Health Dr. Ivy Osei Non-Communicable Disease (NCDs) Module Form Dr. Margaret Gyapong Working with Community Health Officers and Volunteers Drs. Maria Hagan and Ivy Osei to Improve Primary Eye Care Service Delivery in Ghana
The Data Management Unit also developed a Continuous Professional Development Training Module for Capacity Building in data management using EPIDATA. Two (2) sessions of this CPD were organized during the year under review. A database of all the nine (9) Casual Data Entry Clerks; (6 females and 3 males) officially affiliated to the Unit was also compiled
10.2.3 Research Centres
There are currently three (3) operational research centres namely Dodowa Health Research Centre (DHRC) in the Shai-Osoduku District in the Greater Accra Region, Kintampo Health Research Centre (KHRC) in the Kintampo North District in the Brong-Ahafo Region and Navrongo Health Research Centre (NHRC) in the Kassena District in the Upper East Region.
These three research centres take part in identifying and carrying out priority operational/health systems/applied research to help address policy, planning and implementation, technical and management needs of the Ghana Health Service.
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ANNEX
A1 Participation in HAM by Staff Category Category of staff 2012 2013 2014 TOTAL Medical Officers 39 20 18 77 Pharmacists 9 4 3 16 Nurses 107 75 78 260 Physician Assistants 4 6 4 14 Biomedical Scientists 3 3 0 6 T.O Disease Control 2 0 2 4 Med. Herbalists 0 0 1 1 DDHS 11 11 8 30 Medical Superintendents. 2 0 4 6 Finance 6 1 2 9 Administrators 1 3 2 6 Physiotherapists 1 0 1 2 Audit Officers 1 0 1 2 Total 182 123 124 429
The table above clearly shows that medical officers and nurses are the majority of staff who accessed HAM program compared to any other professional groups. There is the need to motivate other professionals who aspire to be in management position to access the program.
A2 HAM – Regional Distribution of Participants (2012-2014) Region/Organization 2012 2013 2014 Total Greater Accra 23 25 24 72 Ashanti 16 14 10 40 Brong–Ahafo 7 5 4 16 Central 2 3 11 16 Eastern 20 15 16 51 Northern 0 4 3 7 Upper East 3 0 2 5 Upper West 2 0 1 3 Western 14 0 3 17 Volta 3 7 5 15 KBTH 30 22 20 72 KATH 4 3 2 9 TTH 0 0 0 0 CHAG 25 10 15 50 QUASI 32 14 6 52 GHS HQ 1 1 2 4 Total 182 123 124 429
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A3 Net Fleet Growth 1997-2014
A4 National Average Fleet Age Trend, 1997-14 (Vehicle Health State)
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A5. Vehicle Types in GHS and their Proportion
A6. National Vehicle Distribution-2014 Fleet Size Administrative unit Fleet number % of total Headquarters 250 15.63 Volta Region 173 10.81 Northern Region 157 9.81 Eastern Region 152 9.50 Greater Accra Region 137 8.56 Brong-Ahafo Region 136 8.50 Ashanti Region 129 8.06 Upper West Region 124 7.75 Western Region 118 7.38 Upper East Region 116 7.25 Central 108 7.65 Total 1600 100
A7. Vehicle Make as Percentage of Total Fleet-2014
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A8. National TB Control Programme Baseline Intended Actual Result % Indicator Description Target Value Year to date Achievement to date Number of new smear-positive cases notified to national 8255 2009 9,047 7,237 80% authorities Number of all forms of TB cases 14892 2007 19,386 15,473 80% notified to national authorities Treatment success rate: new 88% 86% 86.9% 2009 86.3% smear positive TB cases (7590/8625) (6124/7097) Number of health workers trained 3447 2008 2,539 6,881 271% according to national guidelines
A9. Regional Performance of Treatment Success Against Set Targets, 2012 cohort
A10. Adverse Treatment Outcomes for Regions, 2012
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A11. Annual Trend of Cholera Cases 1980-2014
A12. Cholera Cases by Districts, Ghana, 2014
A13. Influenza Sentinel Sites per Region Region Health Facility
Greater Manhean Health Centre, Tema Polyclinic, Legon Hospital, Achimota Accra Hospital, Ridge Hospital, 37 Military Hospital, Dua Clinic, Akai House Clinic, Airport Clinic Eastern Regional Hospital- Koforidua Upper West Regional Hosp- Wa,
Ashanti Kumasi South Hospital, Military Clinic – Kumasi
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Region Health Facility
Volta Government Hospital – Aflao, 7 MRS Brong Ahafo Sunyani Municipal Hospital, 3 MRS
Western Effia Nkwanta Hospital, Airforce Medical Centre
Northern Military Clinic –Tamale
Upper East War Memorial Hospital –Navrongo
Central Regional Hospital -Cape Coast
A14 Summary of EPI-related Health Indicators, 2004-2014
Indicator 9 2004 2005 2006 2007 2008 200 2010 2011 2012 2013
Infant mortality rate/1000 live births 64 64 64 64 50 50 50 50 53 53 Under five mortality rate/1000 live 111 111 111 111 80 80 80 80 82 82 births Maternal mortality ratio/100,000 live 214 214 214 214 451 451 451 451 350 350 births Penta-3 vaccination coverage (%) 76 85 84 88 87 89 87 87 88 86 Measles @ 9 mo vaccination 78 83 85 89 86 89 88 88 89 84 coverage (%) BCG vaccination coverage (%) 92 100 100 102 103 104 102 105 104 98 OPV-3 vaccination coverage (%) 76 85 84 88 86 89 87 87 87 86 Yellow Fever vaccination coverage (%) 76 82 84 88 86 89 88 87 88 84 TT2+ vaccination coverage (%) 62 71 68 71 76 79 76 76 74 71 Non polio AFP rate (%) 1.5 1.8 1.7 1.7 2.4 2.5 1.8 2.2 1.6 2.7
A15 Rota2 Performance by Regions 2012-2014
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A16. Summary of Activities Implemented maintain Guinea worm eradication status of Ghana
SO1: Bridge equity gaps in access to health care, nutrition and ensure sustainable financing arrangement that protect the poor Activities Implemented Outputs/Outcomes Distribute CBS registers 22,000 CBS registers distributed to regions and districts Community centre announcements Community announcement and gong-gong beating and gong-gong beating conducted daily in 5000 remote communities
SO2. Strengthen governance and improve the efficiency and effectiveness of the health system Activities Implemented Outputs/Outcomes Preparation of key communities The 19 priority communities prepared for certification for certification The 3 districts which reported the last cases prepared adequately for certification All districts which reported worm-like substances in 2013 and 2014 visited and prepared for certification Final Advocacy/Monitoring visits Final preparations monitored and evaluated by both NCC (NCC, National Secretariat, DCPD and National Secretariat and DSD The NCC Chair paid advocacy visits to NOR, UPE and UPW Regions Hold review meetings One Review Meeting for Regional Guinea Worm Coordinators and Surveillance Officers held ICT invited by MOH for Final ICT visited Ghana from 7th-26th July for assessment for Evaluated certification Submit Country Report for Ghana’s Country Report submitted on 1st June 2014 to Certification WHO
SO4. Intensify prevention and control of communicable and non-communicable diseases and promote healthy lifestyles Activities Implemented Outputs/Outcomes National Finals of Quiz organized National Finals of Quiz organized for basic schools for basic schools Produce and distribute Posters 200,000 posters produced kind courtesy JICA Produce Educational fliers 10,000 fliers produced Guinea Worm Week Celebration Press briefing conducted in all regions GTV Adult education for the week conducted on Guinea Worm National Guinea Worm Week launched and celebrated Two articles published in key national newspapers Final support for Regional and Regions and districts supported to implement their final District level activities preparatory activities
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A17 Annual Trends of Leprosy, 2000-2014 Year Prevalence New Cases RFT 2000 1427 1569 1501 2001 1263 1389 1450 2002 886 1090 1348 2003 692 820 969 2004 737 815 771 2005 762 803 729 2006 645 669 714 2007 620 594 619 2008 591 560 536 2009 646 623 510 2010 516 520 620 2011 568 547 516 2012 469 471 569 2013 424 413 489 2014 345 366 430
A18 Annual Trends of Leprosy, 2000-2014
A19 Trend of ANC4+ visits from 2010-2014
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A20 IPT 1,2 and 3 coverage by regions for 2014
A21 Trend of ANC 4+ Visits by Regions 2012- 2014
A22 Trend of skilled delivery 2010 - 2014
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A23 Trend of Postnational coverage 2010 - 2014
A24 Trend in Postnatal care coverage by regions 2012 - 2014
A25 Trend in Institutional Maternal Mortality Ratio 2010 -2014
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A26 Trend in Institutional Maternal Mortality Ratio by Region 2010-2014
A27 Male Genital Female Genital Urethral Vaginal Types Region Ulcer Ulcer Discharge Discharge and Number Brong-Ahafo 648 612 2,892 26,378 s of Central 1,314 200 1,181 9,650 STI Volta 128 430 2,373 14,656 Cases Upper East 435 431 1,165 14,602 by Upper West 76 76 534 6,075 Region, 2013 Western 445 150 771 15,616
Ashanti 497 769 3,620 14,966 Greater 116 48 501 3,024 Accra Eastern 26 4 108 506 Northern 261 344 1,225 13,865 KATH - - - - KBTH - - - -
Total 3,946 3,064 14,370 119,338
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A28 Trend of family planning acceptor rate
A29 Trend in Family planning Acceptor Rate by Region 2012 - 2014
A30 Drugs (ACTs) Received and Numbers of Patients Treated for 2012 and 2013
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A31 GHS Facilities Running NCD Clinic and Screening Services per Region Region Number of NCD CLINICS - Number (%) Facilities Hypertensi Sickle Breast Cervical on Diabetes Asthma Cell Cancer Cancer Ashanti 23 17 (74%) 17 (74%) 2 (9%) 1(4%) 0 (0%) 0 (0%)
Greater Accra 20 14 (70%) 14 (70%) 2 (10%) 4 (20%) 2 (10%) 4 (20%) Western 15 5 (33%) 6 (40%) 0 (0%) 0 (0%) 1 (7%) 1 (7%) Central 12 1 (8%) 4 (33%) 0 (0%) 0 (0%) 1 (8%) 0 (0%)
Northern 19 1 (5%) 1 (5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Upper West 7 2 (29%) 4 (57%) 0 (0%) 0 (0%) 1 (14%) 0 (0%)
Upper East 6 1 (17%) 2 (33%) 0 (0%) 1 (17%) 1 (17%) 0 (0%) Eastern 25 4 (16%) 17 (68%) 3 (12%) 1 (4%) 0 (0%) 2(8%) Brong-Ahafo 16 4 (25%) 4 (25%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Volta 22 16 (73%) 14 (64%) 6 (27%) 6 (27%) 4 (18%) 5 (23%)
Total 165 65 (39%) 83 (50%) 13 (8%) 13 (8%) 10 (6%) 12 (7%)
A32 Newly Reported Cases of Hypertension by Regions, 2010-2013 Region 2010 2011 2012 2013 Ashanti 138305 176245 187725 140200 Brong-Ahafo 53984 74886 87100 72297 Central 52709 65288 97106 98252 Eastern 123028 126054 139991 116482 Greater Accra 122066 157549 196271 181686 Northern 28921 41168 53284 72301 Upper East 11405 17460 24695 29477 Upper West 5835 7997 8849 12468 Volta 72182 92387 116936 128820 Western 43912 39994 52795 49713
A33 Newly Reported Cases of Diabetes by Region, 2010-2013 Region 2010 2011 2012 2013
Ashanti 35073 39583 46912 39953
Brong Ahafo 13609 17758 21088 18527
Central 12091 19530 31978 30792
Eastern 33423 37381 39376 29077
Greater Accra 31810 41780 54539 53870
Northern 2082 2780 1771 3032
Upper East 1254 1177 1213 2679
Upper West 277 397 552 673
Volta 9603 16807 18288 16699
Western 11872 12479 16828 18049 128
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A34 Newly Reported Cases of Sickle Cell Disease by Regions, 2010-2014
Region 2010 2011 2012 2013
Ashanti 3560 4185 5353 4502
Brong-Ahafo 3181 2873 3109 3217
Central 1654 2061 2649 2792
Eastern 5750 8307 7406 6138
Greater Accra 5464 4773 5847 8003
Northern 1016 1323 1395 1259
Upper East 838 1125 1538 2699
Upper West 388 512 566 864
Volta 1769 2492 2933 4707
Western 1800 2113 2991 2781
A35 Survey Results DHS 2014: Prevalence of Malaria in Children 6-59months
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A 36 Summary of objectives and key results for 2014 Goal/Objectives Indicator Description Baseline Year Intended Target (%) Actual Result (%) % (if applicable) of Achievement Target Value Year
Goal: To reduce Parasitemia prevalence: children aged 6–59 27.5% 2011 2014 24.5 26.7 91.0 the malaria months with malaria infection (by morbidity and microscopy) (percentage) mortality burden by 75% (using 2012 as baseline) Under five Case fatality rate 0.6% 2012 2014 0.55 0.51 107.3 by the year 2020 All-cause under 5 mortality rate 82/1000 LB 2011 2014 70/1000 LB 60/1000 LB 114.3
Confirmed malaria cases (microscopy and 186 2013 2014 166 138 116.9 RDT) per 1000 population per year
Objective 1: To Percentage of pregnant women on 64.4% 2011 2014 65.5% 67.50% 103.1 protect at least Intermittent preventive treatment (at least 80% of the two doses of SP) according to national population with policy effective malaria prevention Percentage of Households with at least one 33.7% 2011 2014 66.0% 68.30% 103.5 interventions by insecticide treated nets (LLINs). 2020
Percentage of children under 5 years old 39.0% 2011 2014 53.0% 58.8% 110.9 who slept under an insecticide-treated net the previous night
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Percentage of pregnant women who slept 32.6% 2011 2014 48.0% 54.6% 113.8 under an insecticide-treated net the previous night
Number and percentage of structures in 98.5% 2012 2014 85% 90.5% 106.5 targeted districts sprayed by indoor (43993 (2168183/2550804) (2886513/3188838) residual spraying in the last 12 months 7/446752)
Objective 2: To Percentage of reported suspected malaria 37.9% 2012 2014 70.0 74.3% 106.1 provide cases that received a parasitological test parasitological (RDTs or microscopy) diagnosis to all suspected malaria Percentage of reported uncomplicated 83% 2012 2014 90.0 82.6 91.8 cases and provide malaria cases (both suspected and prompt and confirmed) treated effective treatment with ACT at health facilities. to 100% of confirmed malaria Number and percentage of uncomplicated 100% 2012 2014 100% 100% 100.0 cases by 2020 malaria cases (tested positive) treated with (3086102) (3515912) ACT at health facilities.
Number of uncomplicated malaria cases 747615 2012 2014 129179 105631 81.8 among fewer than 5 year children treated with ACT by community based health workers (CBA).
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Objective 3: To Number of service providers from targeted 23250 2011 2014 24000 17733 73.9 strengthen and public and private health facilities given maintain the refresher training on malaria control (case capacity for management etc.) programmer management,
partnership and Number of meetings held by MICC and its 21 2012 2014 21 19 90.5 coordination to subcommittee/working groups achieve malaria programmatic objectives at all levels of the health care system by 2020
Objective 4: To Number of Districts with functional M&E 10 2012 2014 100 150 150.0 strengthen the unit with data quality improvement teams. systems for surveillance and M&E in order to Percentage (%) of health facilities 13.2% 2012 2014 65.0% 78.0% 120.0 ensure timely submitting timely and complete reports (on availability of malaria) to regional level quality, consistent and relevant Promotion of research that informs the 2 2012 2014 6 2 33.3 malaria data at all programmer in terms of policy and levels by 2020 operational issues
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Number of sentinel sites established and 21 2011 2014 26 30 115.4 functioning for epidemiological and insecticide monitoring
Objective 5: To Quantities of ACSM materials (Manuals, 12000 2012 2014 30000 50500 168.3 increase awareness posters, radio/TV spots, etc.) produced and knowledge of the entire population on malaria prevention Percentage of people who know the cause 96% 2011 2014 96.70% N/A N/A and control so as of, symptoms of, treatment for or to improve uptake preventive measures and correct use of all interventions by 2020 Number of mass media spots promoting 6533 2011 2014 21052 24369 115.8 key messages on malaria case management
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A37 Regional Stillbirth rates for 2014
REGIONAL STILL BIRTH RATES, 2014
2.5" 2.1$ 1.9$ 1.9$ 1.9$ 2$ 2" 1.7$ 1.8$ 1.8$ 1.5$ 1.6$ 1.5"
% SBR % SBR 1" 0.6$ 0.5"
0" AR BAR CR ER GAR NR UER UWR VR WR GHANA
A38 Trend of still birth rate Ghana 2010 - 2014
A39 Trend in Institutional Neonatal Mortality Rate FHD-GHS 2010-2014
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This report was collated and edited by PPMED. Contact specific programmes and divisions for details where needed. July 2015
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