Upper West Regional Health Service
2015 Annual Health Report
Dr. Winfred Ofosu
Ag. Regional Director of Health Services
April 2016
I Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
FOREWORD This Upper West Regional Annual Health Sector Performance report captures information on key health strategies and specific target interventions implemented during the year 2015.
In the midst of the numerous challenges confronted during the year under review, significantly the hard working souls that departed, shortage of doctors and critical staff, inadequate financial resource inflows, high maternal mortality, sporadic outbreak of communicable and other priority disease including other strives towards achieving set targets outlined by the Ghana Health Sector objectives, policies and priorities.
Notwithstanding these challenges; some significant achievements were made in our routine service coverage. Consistent with the trends showed by other data sources such as National/ international Survey reports and other stakeholder inputs.
These achievements are accredited to the committed frontline health facility staff, Community volunteers, traditional authorities, Districts Assemblies, fatherly support of the Regional Co- coordinating Council and development partners such as JICA, UNICEF, Jhpiego, UNFPA, Plan Ghana, World Vision etc.
This report is as a repository of health events evidenced by credible data, providing information for decision making in health as well as a reference guide for researchers and Partners who are advised to contact the various units and BMCs for more details.
It is hoped that these trends will continue through 2016 and beyond towards achieving MDG‟s in Health sustaining the gains made.
Thank you.
DR. Winfred Ofosu (Ag. RDHS –UWR)
II Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Executive Summary The 2015 Annual report covers all the key service delivery areas in accordance with the Six (6) strategic policy objectives of the Ghana Health Service. The performance indicators and the outcomes have been analyzed in line with the sector-wide indicators, representing performance of the entire health sector in the Upper West Region.
During the review period the region continued to operate under very challenging human resource base (doctors, midwives, Nurses and other staff categories/population ratios), erratic fund inflow, compounded by NHIA delay in reimbursing facilities and many others. Despite these challenges, the Upper West Regional Health Services continued to expand our mandate to reach the people through utilizing and implementing Primary Health Care and CHPS strategy.
The second phase of the JICA project of reducing MNH utilizing CHPS, constructed and equipped more compounds to increase the number of CHPS compounds and improve access during the review period from a total of 126 in 2013, to 163 in 2014 to 196 in 2015.
The population covered by CHPSs from increased 40% in 2013 to 42% in 2014, to 51% in 2015.
The proportion of OPD clients accessing health care with NHIS improved from 95.9% in 2013 to 96.5% in 2014, to 95% in 2015.
Management of the Health Services focused on strengthening financial management to enhance efficiency in the utilization of the limited resources. Special attention was paid to internal audit processes and financial monitoring.
The region consolidated the gains made in the implementation of the DHIMS2 Health Service reporting platform through its routine assessment of performance in Data quality, accuracy and reliability.
Monthly feedback on performance of districts and facilities are sent to enable them keep close watch of the data and further support in their data validation processes.
Poor internet connectivity and inadequate logistic support in terms of funds for data related activities, laptops and modems are some of the main challenges of the Health information Management System.
Efforts towards improving access to quality Maternal, Neonatal, child and Adolescent Health
Services, saw some achievements in Antenatal registrants attaining 88% (26,054) in 2013, to
III Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
84% (25,577) in 2014, further down to 83% (25,659) in 2015 though declining in coverage there is quality in services provided.
Mothers registered in the first trimester covered 54% (14,130) in 2013, 56% (14,417) in 2014 to
57% (14,592) indicating an improved trend in performance over the three year period. While
Third Trimester registration records covered 7% (1,925) in 2013, to 6% (1,614) in 2014 and then
6% (1,590) in 2015 of the total antenatal registrants over the three year trend.
Pregnant women making four or more ANC visits achieved 70% (18,232) in 2013, to 72%
(18,501) in 2014 then to 70% (17,874) in 2015.
Skilled delivery coverage performance was 58% (17,285) in 2013, to 63% (19,204) in 2014 then to 62% (19,123) of the expected deliveries in 2015.
Post Natal coverage attained 69% (20,592) in 2013, to 76% (22,877) in 2014 then to 68%
(21,113) in 2015.
Adolescent Teen Pregnancy (10-19) years covered 12% thus (3,167, 3,077 and 3,085) of the total Antenatal registrants throughout the three year trend.
Still birth rate showed significant reduction from 20.7 (359), to 19 (366) then 15.8 (308) in 2015.
Family Planning uptake covered 44.5% (78,425), to 50.5% (91,779) then to 52.9% (98,352) of the total women in their Fertility Age.
Institutional Maternal Mortality ratio made some successes from 196 (34/17,331 LBS) in 2013, to 161 (31/19,243 LBS) in 2014, then to 156 (30/19258 LBS) in the 2015 review period.
Neonatal Mortality rate stands at 7.4 (143/19,258LBS) in 2015, from 5.1 (98/19,243 LBS) in 2014 and 7.8 (98/17,331 LBS) in 2013, thus not revealing a reduction in neonatal mortality. In the area of Expanded Program on Immunization (EPI) most of the antigens recorded a decline. The target population covered with BCG in 2013 was 73.2% (21,744) then in 2014 covered 84.2% (25,482) in 2014 and then 84.4% (26,030) in 2015.
Number of children immunized with Penta3 covered 79.5% (23,615) in 2013, to 81% (24,539) in
2014 and then 83.6% (24,521) in 2015.
Measles 1 coverage in 2013 coverage in 2013 recorded 75% (22,514) to 76% (23,024) with measles Rubella covering 79.2% (24,430) in 2015. Yellow fever immunization covered 83.4%
(22,525) in 2013, to 80.4% (22,924) in 2014 and then 83.2% (24,401).
IV Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Children covered with measles 2 at 18 months 45.4% (12,914) in 2013, to 69.6% (20,890) in 2014 and then in 71.1% (21,943) in 2015 Intensify prevention and control of communicable and non-communicable diseases and promoting healthy lifestyles yielded some positive results.
Surveillance approaches impacted on AFP active case search during routine outreach services and Mass Immunization campaigns with a non-polio AFP rate of 6 (21) in 2013, 6 (21) in 2014 and (3.33) (12) in 2015.
Surveillance on Measles saw significant improvement with 70 cases reported, 1 confirmed in
2013, then 64 cases with 15 confirmed in 2014 and then 14 cases with 0 confirmed in 2015.
Monitoring CSM/meningitis thresholds throughout the year is one of the key surveillance strategies. In 2013, 69 cases were recorded with 13 deaths giving a case fatality rate of 18.8, then in 2014, 192 cases were recorded with 19 deaths giving a cases fatality rate of 9.9 and in 2015 203 cases were recorded with 17 deaths giving a fatality rate of 8.4.
Blood sample were collected from 55 people in 2013, 36 sample in 2014 and the 18 sample in 2015 for suspected Yellow Fever.
The Regional Health Directorate carried out surveillance for cases of Ebola, flu, sporadic and other diseases of Public Health importance.
Tuberculosis (TB) case notifications continue to improve from 328 in 2013 to 307 in 2014 and then 343 in 2015.
The proportion of suspected malaria tested was 86% (399,940) confirmed cases were 55.9%
(273,832) giving a test positivity rate of 68.5% in 2014. While 81.7% (372464) of suspected malaria were tested, confirmed 49.2% (213134) with a test positivity rate of 57.2% in 2015. Utilization of Out Patient services recorded per capita ratios of 1.1 from (851238 attendance) in 2013, to 1.3 (957466 attendance) in 2014 and then 1.1 from (855,888 attendance) in 2015. The proportion of OPD attendance covered by health insurance covered 95.9% (816,460), 96.5% (923465) in 2014 and then 95% (808,308) clients accessing health care with Health Insurance cards in 2015.
V Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Hospital admission rate per 1000 admissions recorded 85 (63446) in 2013, to 97 (73633) in 2014 and then 78 (59852) in 2015. Deaths and death rate per 100 admissions is seeing significant decline over the years with a death rate 2.0 (1,252 deaths) in 2013, in 2014 1.5 (1,116 deaths) in 2014 and then 1.8 (1,086 deaths) in the review period. Bed occupancy rate was 73.9 in 2013, to 71.7 in 2014 and 70.2 in the current 2015 year period. The average length of stay recorded 3.4 in 2013, to 3.1 in 2014 and 3.5 in 2015 Nutritional Health is making successes with the proportion of children 0-23 months severely underweight reducing from 13.8 in 2013, to 8.9 in 2014 and further down to 8 in 2015. Nutritional surveillance could not be conducted in the period under review.
Proportion of mothers dosed with postpartum vitamin A increased from 74.3% (22,076) in 2013, to 74.3 (22,507) in 2014 to 83% (25,600) in the year 2015.
VI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table of Contents FOREWORD ...... I Executive Summary ...... III List of Tables ...... XIII
List of Figures ...... XV
ACRONYMS and ABBREVIATIONS ...... XVIII
Chapter One: Introduction ...... 1 Regional Profile ...... 1
Regional Health Service Mandate ...... 1
Core values ...... 1
Shared Vision ...... 2
Goal ...... 2
Health Service Objectives ...... 2
Current Policy Objectives of the health Sector ...... 2
Demographic characteristics ...... 2
Location and Population Density ...... 3
Climate ...... 4
Economic Activities and Migration ...... 4
Transport and communication ...... 4
Health infrastructure ...... 5
Chapter 2: Bridging the equity Gaps in geographical access to health Services...... 7 Community-Based Health Planning Services (CHPS) ...... 7
CHPS Functionality & Population Coverage ...... 7 Staffing and Community Systems ...... 8 CHPS Contribution to Selected Service Indicators ...... 10 Key activities carried out in CHPS Implementation ...... 10 Transport Management ...... 14
VII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
No. of drivers...... 15 Procurement ...... 16
Equipment ...... 18
Eye Care Services ...... 19
Trachoma Control Programme ...... 19
Chapter2: Ensuring sustainable financing for health care delivery and financial protection for the poor ...... 21 Health Financing ...... 21
Revenue mobilization and fund inflows ...... 21 Programme funds Inflows ...... 22 NHIS ...... 24 Chapter3: Improving efficiency in governance and management of the health system ..... 24 Human Resource ...... 24
General Administration ...... 29
Mechanical Training Centre...... 30
Estates ...... 33
Status of activities ...... 33 Health Information system and M &E ...... 35
Information Communication Technology (ICT) ...... 37
Pharmaceutical Services ...... 40
Chapter4: Improving quality of Health Services delivery including Mental Health Services ...... 41 Clinical/Institutional care ...... 41
OPD Attendance and per capita...... 41 Financial accessibility of OPD services by use of NHIS ...... 43 Admission and Death Rates ...... 44 Bed Utilization ...... 46 Outpatient Morbidity Statistics ...... 48 Inpatient Morbidity Statistics ...... 49
VIII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Mental Health ...... 50
Chapter5: Enhancing Regional capacity for the attainment of the health related MDGs and sustain them ...... 54 Reproductive and Child Health Services ...... 54
Components of Safe Motherhood ...... 54 Activities carried out in 2015 ...... 54 RCH unit Priorities ...... 56 Antenatal Care ...... 56
Antenatal 4+ Visits ...... 61
Haemoglobin Checked At Registration ...... 62
Intermittent Preventive Treatment (IPTp) ...... 65
Skilled Delivery ...... 67
TBA Delivery ...... 68
Still Births ...... 68
Institutional Maternal Deaths ...... 69
Neonatal Mortality ...... 71
Postnatal Care ...... 73
PNC within 48 Hours ...... 73 Family Planning ...... 75
Couple Year Protection ...... 76
Adolescent Health...... 77
School Health Services ...... 79 R CH Plans for 2016 ...... 80
Integrated Community Case Management ...... 81 Concerns at the Beginning of the year ...... 81 Key Activities Carried out ...... 81 Integrated Community Case Management (iCCM) ...... 81
Logistics ...... 83
IX Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Constraints ...... 83 Recommendation ...... 83 Expanded Programme on Immunization ...... 83 Concerns at the beginning of the year ...... 83
EPI Activities Carried Out ...... 84
Achievements ...... 84
BCG ...... 85 Penta3 ...... 85 OPV3...... 86 Rota2 ...... 87 PCV-13 3 ...... 87 Measles ...... 88 TT2+ ...... 90 National Immunization Days ...... 90 Vitamin A Coverage during NIDs ...... 91 EPI Challenges ...... 91 Malaria Control Programme ...... 93
Malaria Control Program Goals and Objectives ...... 94 Malaria control activities carried out ...... 94 Logistics Supply and Distribution ...... 94 LLIN Continuous Distribution Strategies ...... 94 Malaria Case Management...... 95 Sulfadoxine Pyrimethamine to Pregnant Women ...... 98 Malaria out Reach Training and Supportive Supervision (OTSS) ...... 98 Seasonal Malaria Chemoprevention ...... 98 SMC Implementation ...... 99 BCC initiative for the promotion of RDTs/Microscopy – Institute for Social Research and Development (ISRAD ...... 101 Malaria Program Challenges ...... 101 Ways of addressing malaria control challenges ...... 102 Nutritional Health ...... 102
X Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Prevalence of underweight among children (GMP) ...... 104 Vitamin A supplementation (6-59 Months) ...... 106 Postpartum Vitamin A Supplementation ...... 107 Iodine Deficiency ...... 108 CMAM Performance Indicators ...... 113 Nutrition Assessment, Counseling and Support (NACS ...... 117 Supplementary Feeding Programme (SFP) ...... 117 Infant and Young Child Nutrition (IYCN) ...... 117 Tuberculosis Control ...... 120
Multi-Drug Resistance ...... 124 HIV, AIDS and STI Control ...... 127
HIV Sentinel Survey (HSS) ...... 129 Sexually Transmitted Infection (STIs) ...... 130 Chapter6: Intensifying the prevention of and control of communicable and non- communicable disease ...... 132 Disease Surveillance and Response ...... 132 Disease surveillance activities carried ...... 132 Meningitis ...... 135 Yellow fever ...... 137 AFP ...... 138 Disease Surveillance challenges ...... 139 Strategies to address Disease Surveillance Challenges ...... 139 NEGLECTED TROPICAL DISEASES (NTDs) ...... 140
Lymphatic filariasis ...... 140 Findings during Mass Drug Administration ...... 143 Summary of treatment outcomes ...... 144 Adverse drug reactions/events ...... 145 Challenges of the L F Programme ...... 146 LF Programme Recommendations ...... 146 Guinea worm Eradication ...... 146
Guinea Worm Activities ...... 147
XI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Onchocerciasis ...... 148
Main findings during MDA Implementation ...... 149 School deworming impact assessment survey ...... 153
School based mass drug distribution campaign ...... 155
Campaign activities ...... 155 NTDs Recommendations ...... 157 Leprosy Control...... 157
Leprosy Prevalence ...... 158 Non communicable diseases ...... 162
Health Promotion ...... 165
Performance of Health promotion activities ...... 171 Standard Indicators Definitions ...... CLXXVI
XII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
List of Tables Table 1: Upper West Regional Population and Target Populations 2014 -2015 ...... 3 Table 2: Distribution of Health Facilities by Type as at December 2015 ...... 6 Table3: Functioning zones and Population coverage ...... 8 Table 4: Human Resource Situation at CHPS zones ...... 9 Table5: Distribution of Home Visits by Community Health Officers ...... 10 Table6: Summary of Trainings ...... 11 Table7: Status of Compounds constructed/under construction ...... 12 Table8: Summary of Fleet situation ...... 14 Table9: Summary of key performance indicators Vehicles Motorcycles ...... 15 Table10: Fleet Inventory-by Age Block ...... 15 Table 11: Trend of Total Procurement ...... 16 Table 12: Trend of Total Medicine and Non-medicine Procured ...... 17 Table 13: Performance of Eye Care Services ...... 19 Table14: Internally Generated Funds - NHIS verses Cash & Carry by Hospitals in UWR ...... 21 Table 15: Internally Generated Funds - NHIS verses Cash & Carry by District Health Administrations 21 Table 16: Revenue Income 2013 to 2015 in UWR ...... 22 Table 17: Revenue Expenditure 2013 to 2015 in UWR ...... 22 Table 18: Summary of Programme Funding in UWR 2015 ...... 22 Table 19: Distribution of New Appointments ...... 25 Table 20: Table Showing Wastage ...... 25 Table 21: Distribution of Staff Strength ...... 26 Table 22: Distribution of 2015 Human Resource Status ...... 27 Table 23: Distribution of Mop up exercise showing anomalies ...... 28 Table 24: Summary of Mails ...... 30 Table 25: Details of Workshop Load Trends for 2015 ...... 31 Table 26: Data Verification Template ...... 36 Table27: ICT Equipment Inventory UWR ...... 38 Table 29: Bed statistics by facilities – 2015 ...... 48 Table 30: Trend of bed statistics 2006 – 2015...... 48 Table 31: Top Ten OPD Morbidity in UWR 2015 ...... 49 Table 32: Top Ten Causes of Inpatient Admision-2015 ...... 49 Table33: Mental Health Staff Strength 2015 ...... 51 Table 34: Summary of Mental Health Conditions by Registrants 2015 ...... 51 Table 35: Summary of Mental Health Cases by Re-attendance 2015 ...... 51 Table 36: Summary of Mental Health Community based activities 2015 ...... 53 Table 37: IPT1...... 65 Table 38: IPT3...... 66 Table 39: TBA delivery by districts for 2013-2015 ...... 68 Table 40: CAUSES OF NEONATAL DEATHS...... 72 Table 41: FP Acceptors by Preferred Methods; for-2013-2015 ...... 75 Table 42: School Health Service; for-2013-2015 ...... 79 Table 43: Malaria cases managed by districts – 2013- 2015 ...... 81
XIII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 44: Diarrhoea cases managed by districts - 2013 – 2015...... 82 Table 45: ARI cases managed by districts - 2013 - 2015 ...... 82 Table 46: Rota2 Coverage by districts in UWR - 2012 - 2015 ...... 87 Table 47: PCV -13 3 Coverage by district in UWR -2012 to 2015...... 87 Table 48: YF Coverage by District 2012-2015 ...... 89 Table49: TT2+ Coverage in Upper West Region ...... 90 Table50: Total number of Beneficiaries of LLIN continuous distribution exercise per district ...... 94 Table 51: Children 3-59 months Dosed during SMC in 2015 using Registered population ...... 100 Table 52: Children registered and weighed at Growth Promotion sessions in UWR ...... 104 Table 53: Total children weighed at growth Promotion by attendants in UWR ...... 104 Table 54: Prevalence of Low Birth Weight (LBW) ...... 106 Table 55: Routine Vitamin A Supplementation (6-59months) – 2015 ...... 107 Table 56: Children who received At Least One Dose of Vitamin A (SNIDs Performance) ...... 107 Table 57: SAM Treatment Coverage ...... 110 Table 58: Met Need against Unmet Need in the CMAM programme ...... 111 Table 59: Treatment Outcomes in the CMAM Programme ...... 112 Table 60: Infant and Young Child Feeding Activities Carried Out ...... 118 Table 61: Funds and Logistics received for Tuberculosis Activities ...... 121 Table 62: Trend Analysis of TB Indicators ...... 122 Table 63: Categories of TB Cases reported by Districts: 2015 ...... 122 Table 64: Trend of TB Notification all cases ...... 123 Table 65: Tuberculosis all cases by Districts ...... 123 Table 66: Treatment Outcome of All Cases Recorded in 2014 ...... 124 Table 67: Regional Multi-Drug Resistance Management Team ...... 125 Table 68: The overall performance of diagnostic centers...... 126 Table 69: HTC Service Data by Sex- Annual 2013 - 2015, UWR ...... 128 Table 70: PMTCT Service Data, Annual 2013-2015 UWR ...... 128 Table71: Clients on HAART, Annual 2014– 2015, UWR ...... 129 Table72: HIV Sentinel Surveillance, 2005 - 2014, UWR ...... 130 Table 73: STI cases reported – Annual 2012 to 2014 ...... 131 Table74: Monthly IDSR Reporting Rates ...... 133 Table75: Weekly IDSR Reporting rate ...... 134 Table76: Percentage of Districts reporting at least one priority diseases in UWR ...... 134 Table77: Meningitis surveillance (Both suspected and Confirmed cases ...... 135 Table 78: Trend of Reported Cases of Suspected Meningitis in Upper West Region - 1999 to 2015 ... 135 Table79: Measles Samples collected from Districts to NPHRL for 2010-2015, UWR ...... 136 Table 80: Yellow Fever Samples collected from Districts to NPHRL in UWR ...... 137 Table81: AFP Samples collected from Districts to NPHRL for 2010-2015, UWR ...... 138 Table 82: Number of some structures by districts during MDA -2015 ...... 141 Table83: Distribution drugs and posters ...... 142 Table 84: Therapeutic Percentage Coverage by Districts ...... 144 Table 85: Table 6: Geographical Percentage Coverage by Districts ...... 145 Table 86: Trend of Guinea Worm cases UWR ...... 148 Table 87: Oncho round one therapeutic coverage ...... 150 Table88: Oncho round one (Non-Eligible and Clinical state) ...... 151 Table89: Table 33: Oncho round two therapeutic coverage ...... 151 Table90: Oncho round two (Non-Eligible and Clinical state)...... 152 Table 91: Drug Records ...... 153
XIV Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 92: Schools visited for deworming impact assessment survey ...... 153 Table93: Positive cases from the survey by schools ...... 154 Table 94: School Deworming Exercise ...... 156 Table 95: School Deworming Exercise drug records ...... 156 Table 96: Cases of Leprosy 2010-2015 ...... 158 Table 97: Trend of new Leprosy cases and Leprosy prevalence in UWR ...... 159 Table 98: Summary of Leprosy Indicators ...... 160 Table 99: Target Audience Reached in the six C4D districts 2015 ...... 166 Table 100: Outcome of Video Shows in selected communities 2015 ...... 167 Table 101: Distribution of participants at the startup meeting ...... 168 Table 102: of I E & C Materials received and distributed...... 173
List of Figures Figure 1: Trend of Population Covered by CHPS ...... 8 Figure 2: NHIA Level of Indebtedness to BMCs ...... 23 Figure 3: NHIA Indebtedness (Corporate Debtors) by hospitals 2015 performance ...... 23 Figure 4: NHIA Indebtedness by DHMTS in UWR ...... 24 Figure 5: Workshop load Trend analysis...... 31 Figure 6: Results of data quality league table ...... 35 Figure 7: Trend of OPD Attendance in UWR ...... 41 Figure 8: OPD Per Capita by districts in UWR ...... 42 Figure 9: OPD attendance by districts in UWR ...... 42 Figure 10: Doctor to Population ratios in UWR ...... 43 Figure 11: Service Utilization by Health Insurance status ...... 43 Figure 12: OPD attendance Insured by districts in UWR ...... 44 Figure 13: Hospital admissions and admission Rates ...... 44 Figure 14: Hospital Admission rates by districts 2015 performance ...... 45 Figure 15: Institutional Deaths and Death rates ...... 45 Figure 16: Deaths rates by Hospitals in UWR ...... 46 Figure 17: percentage bed Occupancy rates in UWR ...... 46 Figure 18: Percentage bed Occupancy by districts ...... 47 Figure 19: Average Length of stay by Facilities ...... 47 Figure 20: Mental Health Client status 2015 ...... 52 Figure 21: Trend of Antenatal Coverage in Upper West Region -2003 to 2015 ...... 56 Figure 22: Percentage Antenatal Coverage by Districts - 2015 Performance...... 57 Figure 23: Trend of Proportion of Antenatal mothers registered in 1st trimester ...... 57 Figure 24: Percentage of mothers registered in 1st trimester by districts ...... 58 Figure 25: Percentage of Antenatal Mothers Registered in 3rd Trimester in UWR ...... 58 Figure 26: Proportion of Antenatal mothers Registered in their 3rd Trimester by districts ...... 59 Figure 27: Trend of Early Teenage Pregnancy among Antenatal Registrants in UWR ...... 60 Figure 28: Early Teenage Pregnancy (10-14 years) among ANC mothers by districts ...... 60 Figure 29: Trend of Proportion of Antenatal Registrants age 35 + in UWR ...... 61 Figure 30: Mothers age 35+ Registered at Antenatal by districts in UWR ...... 61 Figure 31: Proportion of Mothers making more than 4 Visit sat Antenatal Clinics ...... 62 Figure 32: Proportion of mothers making 4+ Antenatal visits by districts in UWR ...... 62 Figure 33: Haemoglobin Check among Antenatal Registrants in UWR ...... 63 Figure 34: Percentage HB tested among Antenatal Registrants by districts ...... 63
XV Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 35: Anaemia among Antennal Registrants and at 36 weeks in UWR ...... 64 Figure 36: Percentage clients anaemic at Antenatal Registration by Districts ...... 64 Figure 37: Percentage of clients Anaemic at 36 weeks of pregnancy by Districts ...... 65 Figure 38: IPT1-IPT3 Dropout Rates by districts - 2013 to 2015 ...... 66 Figure 39: Trend of Percentage Skilled Delivery Coverage in UWR ...... 67 Figure 40: Percentage Skilled Delivery Coverage by Districts ...... 67 Figure 41: Trend of Still Births and still birth rates in UWR ...... 68 Figure 42: Still Birth Rate by Districts in Upper West Region - 2015 Performance ...... 69 Figure 43: Trend of Maternal Deaths and Maternal Mortality Ratios in UWR...... 69 Figure 44: Maternal Mortality Ratios by Districts ...... 70 Figure 45: Duration of stay of maternal deaths; 2013-2015 ...... 70 Figure 46: Age Distribution of Maternal Death; 2013-2015 ...... 71 Figure 47: Trend of Neonatal Deaths per 1,000 Live births in UWR ...... 71 Figure 48: Neonatal Deaths/1,000 live births in UWR by districts ...... 72 Figure 49: Percentage Postnatal Coverage in Upper West Region from 2003 - 2015 ...... 73 Figure 50: Percentage Postnatal coverage by districts in UWR ...... 73 Figure 51: Percentage Postnatal coverage within 48 hours after delivery by districts ...... 73 Figure 52: Proportion of Post-partum Mothers dosed with Vitamin A in UWR ...... 74 Figure 53: Percentage Postpartum mothers dosed with Vit A by districts ...... 74 Figure 54 Trend of Family Planning Coverage in Upper West Region 2003 -2015 ...... 75 Figure 55: Percentage Family Planning Coverage by Districts ...... 75 Figure 56: Trend of Total couples Year of Protection in UWR ...... 76 Figure 57: Total Couples Year of Protection by districts in UWR ...... 76 Figure 58: Proportion of Adolescents (10-19) Years registered at ANC in UWR ...... 77 Figure 59: Percentage Adolescent Pregnancy (10-19) by districts ...... 78 Figure 60: Proportion of Adolescents (10-19) accepting family planning in UWR ...... 78 Figure 61: Proportion of Adolescents (10-19 years) accepting Family Planning by districts ...... 79 Figure 62: Percentage BCG Coverage in Upper West Region - 2003 to 2015 ...... 85 Figure 63: Percentage BCG coverage by districts in UWR ...... 85 Figure 64: Coverage of Penta3 in Upper West Region 2003 - 2014 ...... 86 Figure 65: Penta3 coverage by districts in Upper West Region - 2015 performance ...... 86 Figure 66: Measles (0-11 months) Coverage in Upper west Region - 2010 to 2015 ...... 88 Figure 67: Performance of Measles (0-11 months) coverage by districts ...... 88 Figure 68: Coverage of OPV during mass Immunization days in Upper West Region ...... 90 Figure 69: Vitamin A Coverage by Districts Compared - October, 2013 & Oct-Nov, 2014 ...... 91 Figure 70: LLIN distribution to target groups by Districts in UWR - 2014 to 2015 ...... 95 Figure 71: Trend of Malaria Cases against OPD attendance in Upper West Region ...... 95 Figure 72: Distribution of OPD attendance against OPD Malaria cases by Districts in UWR ...... 96 Figure 73: Trend of Malaria Diagnosis in Upper West Region ...... 96 Figure 74: Malaria Diagnosis by districts - 2015 Performance ...... 96 Figure 75: rend of Children Malaria < 5 Case Fatality Rates in Upper West Region - 2002-2015 ...... 97 Figure 76: Distribution of Malaria <5 Case Fatality Rate by districts - 2015 performance ...... 97 Figure 77: Trend of IPTp Coverage in Upper West Region - 2011 - 2015 ...... 98 Figure 78: Regional percentage representation of Children dosed during rounds of SMC ...... 100 Figure 79: Adverse Drug Reaction during implementation Round 1- 4 ...... 101 Figure 80: Distribution of Children 0-23 Months underweight in UWR ...... 104 Figure 81: Percentage of children 0-23 months underweight by districts ...... 105 Figure 82: trend of Post-partum mothers dosed with Vitamin A in UWR ...... 108
XVI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 83: Postpartum Vitamin Coverage by districts in UWR ...... 108 Figure 84: Three year household Salt survey report...... 109 Figure 85: Distribution of CMAM Admissions ...... 110 Figure 86: CMAM Cure rates in UWR ...... 113 Figure 87: CMAM cure rate by districts ...... 114 Figure 88: CMAM Defaulter rates in UWR ...... 115 Figure 89: CMAM Defaulter rate by districts in UWR ...... 115 Figure 90: Trend of CMAM death rate in UWR ...... 116 Figure 91: CMAM Death rate by districts in UWR ...... 116 Figure 92: Trend of HIV Prevalence rates in UWR ...... 130 Figure 93: Trend of Measles Cases notified and results of sample collection - 2003 to 2015 ...... 136 Figure 94: Trend of Jaundice Syndrome sample collected for Suspected Yellow fever ...... 137 Figure 95: AFP Cases notified and Non - Polio AFP Rates in UWR 2005 - 2015 ...... 138 Figure 96: MDA Therapeutic Percentage Coverage by Districts ...... 144 Figure 97: Oncho Round one Therapeutic coverage ...... 150 Figure 98: Oncho round two therapeutic coverage ...... 152 Figure 99: Trend of Leprosy Prevalence and rates ...... 159 Figure 100: Trend of Leprosy Case Detection Rates in UWR ...... 160 Figure 101: Leprosy Case Detection Rate by Districts ...... 160 Figure 102: Trend of recorded Hypertension cases ...... 163 Figure 103: Distribution of Hypertension cases by districts ...... 163 Figure 104: Trend of Diabetic cases reported in UWR ...... 164 Figure 105: Diabetic cases by districts in UWR ...... 164 Figure 106: Pregnant women reached through Health promotion by districts...... 171 Figure 107: Adolescents reached through Health promotion by districts ...... 172 Figure 108: School Pupils reached with Health Promotion by district ...... 172 Figure 109: People reached in households through Health promotion by districts ...... 173
XVII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
ACRONYMS and ABBREVIATIONS
A/A - Artesunate Amodiaquine
ACT - Antersunate Combination Therapy
AFP - Acute Flaccid Paralysis
AGM - Annual General Meeting
AHSAG - - Association of Health Service Administrators of Ghana
ALOS - Average Length Of Stay
ANC - Antenatal care
ARI - Acute Respiratory Infection
ART - Anti Retroviral Therapy
ARVs - Anti-Retroviral Drugs
BCG - Bacille Calmette Guérin (Tuberculosis Vaccine)
BMCs - Budget Management Centres
BMI - Body Mass Index
C/S - Caesarean Section
C4D - Communication for Development
CBA - Community Based Agents
CBGP - Community-based Growth Promoters
Cd1 - Communicable Diseases Form 1
Cd2 - Communicable Diseases Form 2
CHAG - Christian Health Association of Ghana
CHN - Community Health Nurse
CHO - Community Health Officer
XVII I Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
CHPS - Community Based Health Planning and Services
CHPW - Child Health Promotion Week
CHV - Community Health Volunteers
CMAM - Community-based Management of Severe Acute Malnutrition
CMS - Central Medical Stores
CPT - Co-trimoxazole
CSM - Cerebrospinal Meningitis
CWC - Child Welfare Clinic
DA - District Assembly
DDCC - Deputy Director for Clinical Care
DDG - District Directors Group
DDHS - District Director of Health Services
DHA - District Health Administration
DHMT - District Health Management Team
DPF - Donor Pooled Fund
DTC - Drug and Therapeutic committee
ENT - Ear Nose and Throat
EPI - Expanded Programme on Immunization
EQA - External Quality Assurance
FIDS - Faculty of Integrated Development Studies
FM - Frequency Modulation
FSV - Facilitative Supervision
FT - Field Technician
GAM - Global Acute Malnutrition
GES - Ghana Education Service
GHS - Ghana Health Service
XIX Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
GMP - Growth Monitoring and Promotion
GOG - Government of Ghana
GWP - Guinea Worm Programme
HATS - Health Assistants Training School
HBC - Home Base Care
HIRD - High Impact Rapid Delivery
HP - Health Promotion
HTC - HIV Testing and Counselling
ICD - Institutional Care Division
IDSR - Intergraded Disease Surveillance and Response
IGF - Internally Generated Funds
IMCI - Integrated Management of Childhood Illness
IPC - Interpersonnel Communication
IUA - Infernal Audit Unit
IYCF - Infant and Young Child Feeding
JCC - Joint Co-ordinating Committee
JICA - Japanese International Cooperation Agency
KRHTS - Kintampo Rural Health Training School
LDP - Leadership Development Programme
LGS - Local Government Service
LP - Lumber Puncture
M/DAs - Municipal/District Assemblies
MAF - Millennium Acceleration Framework
MBs - Multibacillary
MDGs - Millennium Development Goals
MHD - Municipal Health Directorate
XX Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
MOH - Ministry of Health
MOU - Memoradum of Understanding
NACP - National Aids Control Programme
NACS - National Assessment Counselling and Support
NGOs - Non-Governmental Organisations
NHI - National Health Insurance
NHIS - National Health Insurance Scheme
NIDs - National Immunization Days
NMCCSP - Nutrition and Malaria Control for Child Survival Project
NTD - Neglected Tropical Disease
OI - Opportunistic Infections
OPD - Out Patients Department
OPV - Oral Polio Vaccine
PBs - Paucibacillary
PLHIV - People Living with Human Immune Virus
PMTCT - Prevention of Mother to Child Transmission
PNC - Post Natal Care
PPM - Parts Per Million
PPM - Planned Preventive Maintenance
ProMPT - Promoting Malaria Prevention and Treatment
QA - Quality Assurance
QI - Quality Improvement
RCC Regional Coordinating Council
RGN - Registered General Nurse
RHD - Regional Health Directorate
RHMT - Regional Health Management Team
XXI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
RMS - Regional Medical Stores
SAM - Severe Acute Malnutrition
SBS - Sector Budget Support
SDA - Seventh Day Adventist
SFP - Supplementary Feeding Programme
SIAs - Supplementary Immunization Activities
SOPs - Standard Operating Procedures
STIs - Sexually Transmitted Infections
TB - Tuberculosis
TBAs - Traditional Birth Attendants
TOT - Trainers of Trainees
UDS - University for Development Studies
UNICEF - United Nations Children Fund
UWR - Upper West Region
VPD - Vaccine Preventable Disease
WAP - Wa Polytechnic
WFP - World Food Programme
WHO - World Health Organisation
WIFA - Women in Fertile Age
YF - Yellow Feve
XXII
Chapter One: Introduction
Regional Profile The Upper West Region has a total of eleven (11) administrative districts, comprising Daffiama Bussie Issa (DBI), Jirapa, Lambussie- Karni, Lawra, Nadowli –Kaleo, Nandom, Sissala East, Sissala West, Wa East, Wa Municipal and Wa West. The latest districts added in 2012 are (DBI) and Nandom districts. The district health systems in the region are managed by the eleven Budget Management committees known as District Health Management Teams (DHMT’s), supervised by the Regional Health Management Team (RHMT). There are sixty six (66) sub-districts administratively managed by Sub-district Health Teams (SDHT’s) and a total of () communities. Below is the regional map showing how the facilities are distributed in the region.
The distribution above shows clearly a greater proportion of the facilities are concentrated in the western part of the region
Regional Health Service Mandate To provide and prudently manage comprehensive and accessible quality health services to all people living in the Upper West Region and beyond with emphasis on Primary Health Care in accordance with approved national policies Core values Professionalism, Teamwork, Integrity, Discipline, Excellence, People Centred
1 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Shared Vision A Healthy Population with Universal Access to Quality Health Service
Goal The goal of the Regional Health Service (GHS) is to ensure that all children survive beyond five years; all pregnant women have safe delivery and healthy babies; all people sensitized to live healthy life styles and avoid unwanted pregnancies, Communicable and Non-communicable diseases.
Health Service Objectives 1. Implement approved national policies for health delivery in the country.
2. Increase access to good quality health service; and
3. Manage prudently resources available for the provision of the Health Service
Current Policy Objectives of the health Sector 1. Bridge the equity gaps in geographical access to health services
2. Ensure sustainable financing for healthcare delivery and financial protection for the poor
3. Improve efficiency in governance and management of the health system
4. Improve quality of health services delivery including mental health services
5. Enhance national capacity for the attainment of the health related MDGs and sustain gains
6. Intensify prevention of Communicable and control of non-communicable diseases.
Demographic characteristics The projected population for 2015 based on the 2010 Population and Housing Census growth rate of 1.9% was 771,394. The regional population specific targets for children under one year/expected pregnancies and women in the fertile age (WIFA) have been given as 4% and 24% respectively. Table 1 shows the total and target populations of the various districts for
2 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
2013 -2015. Table 1: Upper West Regional Population and Target Populations 2014 -2015
2014 2015 District < 1 Year WIFA < 1 Year WIFA Pop Pop < 5Years (4%) (23.7%) (4%) (23.7%) Daffiama Bussie 33,425 1,337 7,922 35,799 1,432 7,160 8,484 Issa Jirapa 95,314 3,813 22,590 97,125 3,885 19,425 23,019 Lambussie Karni 55,693 2,228 13,199 56,751 2,270 11,350 13,450 Lawra 51,667 2,067 12,245 61,123 2,445 12,225 14,486 Nadowli - Kaleo 68,343 2,734 16,197 67,903 2,716 13,581 16,093 Nandom 57,155 2,286 13,546 49,766 1,991 9,953 11,794 Sissala East 60,948 2,438 14,445 62,106 2,484 12,421 14,719 Sissala West 53,449 2,138 12,667 54,465 2,179 10,893 12,908 Wa 115,597 4,624 27,397 79,186 3,167 15,837 18,767 Wa East 77,710 3,108 18,417 117,794 4,712 23,559 27,917 Wa West 87,709 3,508 20,787 89,375 3,575 17,875 21,182 REGION 757,011 30,280 179,412 771,394 30,856 154,279 182,820
Location and Population Density The Upper West Region, situated in the north-western part of Ghana lies between longitude 1o 25’’ W and 2o 45’’ and latitudes 9o 30’’ N and 11oN (Refer Figure 1). It is bordered to the south by the Northern region, to the north and West by Burkina Faso and to the east by the Upper East region. With an area of 18,476 km2, the region’s population density stands at 40 persons per square kilometre.
The Sissala East, Wa East and parts of the Nadowli-Kaleo districts (in the eastern parts of the region) have nucleated communities that are far apart, with a resultant population density of 13 persons per square kilometre. This implies that health staff have to travel over long distances in order to deliver health services including immunization to the people. There is an increasing phenomenon of nomadic Fulani herdsmen moving into the eastern part of the region from Burkina Faso and Niger. The health services have faced difficulties in determining the real population as well as tracking these nomads to provide both routine services and immunization during National Immunization Days (NIDs) against Polio and Supplementary Immunization Activities (SIAs) against Measles.
Topography and Water Bodies
The landscape is generally flat and below 300m above sea level with a central plateau ranging between 1,000 and 1,150 ft. The low lying nature of the region opens up several communities
3 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys to flooding during the rainy season. The Black Volta forms the western border of the region with Burkina Faso whilst the Kulpawn and Sissili which are tributaries of the White Volta also run through the eastern part of the region.
Climate The climate is tropical with an average minimum temperature of 22.6oC and maximum of 40.0oC. There is one rainy season from May- October with an intensity of 100-115 cm/annum with humidity ranging between 70% - 90% but falling to 20% in the dry season. During this time from November to March, the cold dry and dusty wind, the harmattan, blows from the Northeast across the region. It is this period from November to March that the region is most prone to outbreaks of cerebrospinal meningitis.
Economic Activities and Migration Since the predominant activity is farming the long dry season means that many people are idle for so many months each year resulting in a lot of seasonal migration to the southern parts of the country especially to the Brong-Ahafo, Ashanti and Eastern regions. This form of migration has implications for public health in the region. The emergence of Galamsey (illegal mining activities) activities currently in Nadowli, Wa East, and Sissala East districts poses an increasing risk of respiratory related health problems as well as sexually transmitted diseases.
Transport and communication The region has the least kilometers of tarred roads in Ghana. Only three of the district capitals are linked to each other and to the regional capital courtesy parts of the Bamboi-Hamile trunk road. The bad nature of most of the roads during the rainy season also makes movement to some of the communities in the eastern part of the region very difficult. Telephone and fax facilities exist in all the districts. Mobile phone coverage to the entire region is about 90% but the eastern parts of the region have poor phone coverage. There is a small airstrip in the regional capital but this is rarely used, as there are no commercial flights. The predominant means of transport is by road using Lorries, buses, motorcycles, tricycles or bicycles and rarely donkey carts. The region prides itself with about eight (8) FM radio stations currently in operation that
4 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys broadcast in English and in more than three local languages (Dagaare, Brifo, Sissala and Akan). Majority of the stations are situated in the regional capital namely, Progress, Radio Upper West, Fids,Sungmal, Wfm and Waps. The others are two – Nandom (FREED and Voice of Nandom) and RADFORD in Sissala East.
Health Resources
Primary Health care activities are supported by community based health system (CBS) implemented by volunteers and community health workers made up of one thousand two hundred and nine (1,209) Traditional Birth Attendants (TBA’s), one thousand eight hundred and fifty (1,850) community based surveillance volunteers CBDSV’s), three thousand five hundred and twenty (3,520) Community Based Agents (CBA’s), () growth promoters (GP’s) under the community based growth promotion programme and one hundred and eighty four (184) guinea worm volunteers who are providing various services in 3,557 demarcated areas with supervision from sub district health staff. There are 861 outreach points for the provision of immunization and other services. Since 2003, the region has, in line with the policy of the Ghana Health Service, been implementing the Community-based Health Planning and Services (CHPS) strategy. This strategy is aimed at the provision of close to client/ door to door high impact rapid delivery (HIRD) and other health interventions to communities. These services are provided by designated Community Health Officers (CHO) supported by CHPS volunteers operating out of a building constructed and located in the community called a CHPS compound.
Health infrastructure The Regional Health Management Team (RHMT) oversees the planning and implementation of health services in the region. Eleven district health management teams planned and supervised health service delivery in 65 sub-districts and 176 CHPS compounds in 2015. There are a total of two hundred and forty two (352) health facilities providing various types of services in the region. These are three (3) district government hospitals, one (1) Regional hospital, two (2) CHAG Agency hospitals and three (3) private hospitals. The rest are five (5) Polyclinics, sixty six (66) health centres, ten (10) clinics and one hundred and forty seven (176)
5 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
CHPS Compounds and four (4) maternity homes (Refer Table 2). Three out of the nine districts in the region (Wa East, Wa West, and Lambussie) have no district or private hospital.
Table 2: Distribution of Health Facilities by Type as at December 2015 Healt Midwife Region District Organisation CHP Clini Distric h Hospit / Polyclini al Sub- Tota Hospit unit S c t Centr al Maternit c Hospita district l al e y l DBI 12 0 1 0 5 0 0 0 0 5 23 Jirapa 14 0 1 0 7 1 0 1 0 7 31 Lambussie.Kar ni 12 1 1 0 5 0 1 1 0 6 27 Lawra 11 1 1 1 4 0 0 1 0 5 24 Nadowli-Kaleo 23 0 1 1 10 1 0 0 0 8 44 Nandom 9 1 1 0 3 1 1 1 0 5 22 Sissala East 24 1 1 1 7 0 1 0 0 7 42 Sissala West 9 0 1 0 4 1 0 0 0 4 19 Wa 22 9 1 0 6 2 1 0 1 6 48 Wa East 14 1 1 0 7 0 0 0 0 7 30 Wa West 26 1 1 0 6 0 1 1 0 6 42 Upper West 176 15 11 3 64 6 5 5 1 66 352
Health services such as clinical care, reproductive and child health, nutrition, immunization and other disease control services were delivered by the eleven district health management teams and 65 sub-district health management teams.
6 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Chapter 2: Bridging the equity Gaps in geographical access to health Services.
Community-Based Health Planning Services (CHPS) CHPS is a primary health care strategy aimed at improving access to healthcare. It seeks to drive a change of the health orientation from curative to preventive at the community level. This is achieved through six major implementation milestones; planning, community sensitization, compound construction, equipment supply, training and deployment of Community Health Officers and lastly volunteer selection. The implementation of CHPS varies from one region to the other especially the way in which communities are engaged in the implementation process. Community Health Action Plans (CHAPs), Community Emergency Transport Systems (CETS) among others are some of the strategies adopted by the region to ensure the effective implementation of the CHPS strategy. The region through a stakeholder engagement and consensus building on CHPS implementation set a target of making 197 demarcated CHPS zones functioning by 2015; however due to emerging developmental needs of districts, the total number of demarcated zones have increased to 246.
CHPS Functionality & Population Coverage The number of functioning zones increased from 148 in 2014 to 202 in 2015. The increment corresponded with an increase in the number of compounds from 163 in 2014 to 194 in 2015. The surge in the number of compounds was the result of the massive construction support of 64 compounds through the JICA grant aid support as well as the District/Municipal Assemblies in the region. The population coverage increased from 42% in 2014 to 51% in 2015. The GHS policy directive to improve geographic access by aligning CHPS zones to electoral areas also saw the region increase in the number of demarcated zones to 246- a short fall in matching the 298 electoral areas in the region.
7 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table3: Functioning zones and Population coverage
General Indicators Population Coverage # of zones Population Pop. District # of Current # of zones with (Functioning Coverage SDHTs demarcated Functioning compounds zones) (%) DBI 5 17 12 12 17809 50 Jirapa 7 23 14 17 28605 29 Lamb 6 19 19 18 28859 51 Lawra 5 18 14 13 24170 40 Nadowli 8 28 25 18 57706 85 Nandom 5 13 11 11 15630 31 Siss. East 6 25 25 21 38735 62 Siss. West 4 21 10 19 24147 44 Wa East 7 21 21 20 42139 53 Wa Muni 6 24 24 19 67749 58 Wa West 6 37 27 26 48815 55 Region 65 246 202 194 394,364 51
Figure 1: Trend of Population Covered by CHPS
Total CHPS and Proportion of Population Served by CHPS in Upper West Region - 2011-2015
300 51 60 40 42 200 29.4 30.6 40 194 covered 100 163 20 114 126 No. of CHPS of No. 95 0 0 2011 2012 2013 2014 2015 Period No. of CHPS Proportion of population served by CHPS Population of % Below is the trend of population covered by CHPS in the region
Staffing and Community Systems Staffing at the CHPS zones is one of the crucial milestones in the CHPS implementation process. The region was able to increase the number CHOs from 179 in 2014 to 326 in 2015. The tremendous increment in the number of technical staff who have the orientation on community work is associated with the output of the GHS-JICA support project that piloted the pre-service training of CHOs in the region. The number of staff, when compared to the number of functioning zones shows that some zones have about two CHOs working in them and this enhances the effective operations of such zones. Aside the Community Health Officers, the
8 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys region currently has 88 ENs, 28 CHNs and 28 Midwives working at the various CHPS zones providing services at the community level also play.
Every functioning CHPS zone requires an effective volunteer system that provides the needed community backing, ownership and support in pursuing the health needs of communities within the respective catchment areas. The total number of active community health committees increased from 139 in 2014 to 183 in 2015.
The region realized a resurgence in the number of active CHVs supporting CHOs in their activities at the community level. In 2015, the various functioning zones had a combined number of 1,316 active volunteers supporting CHPS activities.
Community Health Action Plan (CHAP) is one of the community-led systems of appraising and identifying community health needs, prioritizing the needs and establishing an action plan to address them. The region made some progress with the establishment of this community engagement system. In 2014, 115 out of 148 functioning zones had CHAPs established in the various zones; this increased marginally to 120 out of 202 functioning zones in 2015.
Table 4: Human Resource Situation at CHPS zones
Technical Staff Volunteer Systems # of No. of No. Of District No. of No of No of No of Avg. # of zones active active Active CHO CHN EN Midwives staff/Zone Fxning CHMC CHV
DBI 12 26 10 13 2 4 12 41 7 Jirapa 14 25 1 0 4 2 14 101 9 Lamb 19 25 0 2 1 1 13 147 0 Lawra 14 28 0 9 0 3 14 105 9 Nadowli 25 39 1 9 6 2 25 372 0 Nandom 11 26 6 5 0 3 8 60 7 S.E 25 31 1 11 1 2 25 92 23 S.W 10 30 0 15 0 5 10 47 1 Wa Muni 24 30 6 9 5 2 22 125 15 Wa East 21 27 3 4 4 2 14 139 12 Wa West 27 39 0 11 5 2 26 87 12 Total 148 326 28 88 28 2 183 1,316 95
9 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
CHPS Contribution to Selected Service Indicators Home Visits Table5: Distribution of Home Visits by Community Health Officers
# of Staff @ # of zones Total # of Average District CHPS HH visits Staff/Zone Functioning HH Visit/HH(2015) zones DBI 12 51 3102 1860 4 0.6 JIRAPA 14 30 3696 2766 2 0.7 LAMB. 19 28 2765 1605 1 0.6 LAWRA 14 37 5019 2732 3 0.5 NAD-K. 25 55 7704 2635 2 0.3 NANDOM 11 37 2760 2862 3 1 S. EAST 25 44 1071 2298 2 2.1 S. WEST 10 45 1906 2039 5 1.1 WA MUN. 21 38 17666 26646 2 1.5 WA EAST 24 50 6168 395 2 0.1 WA WEST 27 55 7447 5702 2 0.8 REG. 202 470 59,304 51,540 2 1
The main thrust of the community health officers duty is home visiting where they are expected to deliver a package of integrated basic health services to the households.
Selected Service Areas
Service areas such as ANC, PNC and Deliveries and EPI, the contribution of CHPS for ANC improved over the period from 24% in 2013 to 29% in 2015. The number of deliveries conducted by CHOs also increased from the previous year from 3% of total deliveries to 5%. This can be attributed to the increasing number of midwives deployed to the various CHPS zones. Post-natal services remained unchanged over the last two years at 10%. In terms of antigen coverage, CHPS contribution to BCG remained unchanged at 22% whiles Penta 3 increased from 37% in 2014 to 40% in 2015.
Key activities carried out in CHPS Implementation The review period coincided with the penultimate year of the GHS/JICA phase two project which aims to improve maternal and neonatal health services utilizing CHPS systems in the
Region. The project continued to support the CHPS unit with capacity building, health systems strengthening, community mobilization and Stakeholder engagement sessions.
10 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Training/capacity building
With respect to the CHO fresher training, a total of 74 CHNs/ENs were taken through the CHO technical skills training made up of one week theoretical presentation of modules and one week field practice.
As part of efforts to strengthen the strategy of introducing pre-service CHO training approach, a pilot was undertaken at the Jirapa Community Health Nursing Training School. A total of 99 health trainees were taken through the modules- one week theory and three weeks fieldwork-.
Refresher trainings on Community mobilization/Facilitative Supervision (FSV), Community- based Maternal and New born care and Enhanced skills on Ante-Natal Care, Emergency Delivery and Post-Natal Care for CHOs were also organized within the year.
A total of 196 CHO/CHN were refreshed on how to effectively engage communities through the use of a number of Participatory Learning and Action (PLA) tools.
Strengthening the health system was hinged on providing regular facilitative supervision from the higher levels to the lower levels. The region improved this system by developing and finalizing the monitoring tools for the various levels; developed a data base to ensure effective data entry and analysis and conducted series of trainings targeted at the RHMT, DHMTs and the various SDHTs.
As part of efforts to empower CHOs with skills to manage maternal and new-born complications, 100 CHOs were refreshed on Community-based Maternal and New born Care.
A total of 121 CHOs were taken through refresher training modules that sought to empower them to effectively conduct focused ANC, assist in managing emergency deliveries and follow up on postpartum mothers and new born.
Table6: Summary of Trainings
Total # Name of Training Duration Trained CHO Fresher Training 2 weeks 74 Refresher on Community Mobilization and FSV 5 196 Refresher on Community-based MNH 6 100 Refresher on Focused ANC, Assisted Delivery and PNC 3 121 Refresher on Pre-service Training at Jirapa CHNTS 4 weeks 99
11 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Strengthening CHPS System The Regional Health Directorate with the support of JICA printed the newly improved referral and feedback forms and made available to the various facilities through the Regional Medical Stores. A total of 216 CHOs including some staff from the Health Centre’s, Polyclinics and Hospitals had a refresher training on improving the referral system.
Facilitative Supervision was also conducted to the various BMCs. The Regional Health Directorate conducted two visits out of the total of four quarters for the year 2015.
Stakeholder Engagement sessions Following the roll out of community and stakeholder participation in the CHPS strategy through the District Assembly/Stakeholders engagement approach, action plans were developed and engagement sessions were monitored to assess the level of implementation. In addition to strengthening the engagement process, a joint monitoring approach from all stakeholders will be undertaken bi-annually to access the progress of implementing action plans.
CHPS Compound Construction Through the support of JICA Grant Aid scheme, the region benefitted from the construction of 37 CHPS compounds in four districts in 2014. The remaining seven districts benefitted from a total of 27 compounds constructed in 2015.
Before the close of the year, a total of 17 compounds were under construction through the support of the District Assemblies, MOH, and some philanthropist. These numbers augmented the existing compounds by increasing the CHPS compound status from 164 in 2014 to 194 in 2015.
Table7: Status of Compounds constructed/under construction
Under Constructed District construction 2012 2013 2014 2015 2015 DBI 0 0 1 3 1 Jirapa 0 0 0 5 3 Lambussie 0 2 7 0 1 Lawra 2 2 0 3 1 Nadowli 2 0 0 3 1 Nandom 0 2 3 0 1 Sissala East 1 4 9 0 4 Sissala West 2 1 9 0 0 Wa East 3 0 0 6 1 Wa Municipal 0 0 0 6 1
12 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Wa West 3 0 9 1 3 Total 13 11 38 27 17 Exit Strategy for GHS-JICA Project
CHO Fresher training is an integral component for CHPS enhancement process; however there are a number of challenges inhibiting the regular training of personnel for CHPS. High cost of the training and high rate of attrition among CHOs warranting regular training to re-fill the Human resource gap.
With the JICA project phasing off in 2016 and considering the high cost associated with the training, a proposed cost effective and sustainable way of churning out CHOs directly from the various health training schools in the region was developed.
The pilot for this strategy was conducted at the Jirapa Community Health Nursing Training School where tutors were orientated on the improved CHO training modules. Through which 99 students were taken through pre-service training. The pilot training has given basis for extending the pre-service training approach to other Health training institutions such as the Health Assistant Clinical.
Achievements
Some achievements were attained with respect to CHPS implementation in the region were the various trainings (Fresh and Refresher courses).
The establishment of a framework of training graduates of the various health training institutions as part of their course content was successfully modeled and implemented in the Jirapa Community Health Nursing Training School and efforts to scale up the approach to the other health training schools such as Health Assistants Training School, Midwifery and Nursing Training Collages.
Successfully organized 7th and 8th Joint Co-ordination Committee meeting Sessions for the Project of the improvement of maternal and neo-natal health services utilizing the CHPS system. Organized a one day Regional CHPS forum, which was used for the engagement of stakeholders to support CHPS implementation involving key stakeholders such as the Regional Minister, Municipal/District Chief Executives, Chiefs and Opinion Leaders, Health professionals, Development partners among others.
13 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Challenges
CHPS implementation in the region is still beset with a number of challenges significant among them is the frequent transfer/changes of CHO leading to the decline in some community level activities such as CHAPs, Inadequate equipment and weak transport for CHPS activities, Inadequate working space and poor provision of basic amenities such as toilet facilities for clients, water, electricity (any form) in CHPS compounds, Inadequate funding for CHPS activities.
There is continuous demand for increase in demarcated CHPS zones resulting in the distortions of districts CHPS scale up plans, Poor community participation due to community fatigue and Poor stakeholder consultation resulting in the construction of some compounds that fall outside the scale up plans of districts.
Transport Management Transport is a crucial component of service delivery in any developmental process. In Health delivery, it is used to convey logistics, run administrative errands and outreach service to the population and ensures timely positioning of health logistics for effectiveness and efficiency of health provision.
During the year under review there was training for Regional Transport Managers on transport Management operations in Accra.
Fleet Situation
The transport unit of the Regional Health Administration received 2 new vehicles, 87 motorbikes and 80 bicycles
Table8: Summary of Fleet situation
Status Type New Auction Accidents Injury Death Incidents Vehicles 2 0 1 1 0 0 Motorbikes 87 0 1 1 0 1 Bicycles 80 0 0 0 0 0
There are 42 drivers currently on pay roll and 14 casuals making a total of 56
14 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Vehicle/ driver ratio = No. of vehicles = 103/42 = 2.452
No. of drivers
Vehicle/ driver ratio = No. of vehicles = 103/56 =1.839
No. of drivers
Table9: Summary of key performance indicators Vehicles Motorcycles
Averag Total % % % e Total Maintenanc Indicator Total Repo Report Availabili Utilizatio KM/L Runnin (KM) e Cost/KM rted ed ty n g Cost KM Vehicles 103 100 97 55 70 0.51 47926.1 C+ 554 554 100 85 90 A+ Motorbikes
Table10: Fleet Inventory-by Age Block
Total Fleet Type Age Group Zone % Number Vehicles 1 – 5 years 35 34.0% GREEN Motorbikes 1-3 Years 315 56.9% Vehicles 6 – 9 years 45 43.7% YELLOW Motorbikes 4-5 Years 205 37.0% Vehicles 10 years & above 23 22.3% RED Motorbikes 6 Years & Above 34 100.0%
Transport Targets for 2016
The unit Forecasts 100% availability, reliability and utilization of vehicles, Acquire one new mini bus for social activities, acquire one new pick-up to support old ones for complete health delivery as old ones are getting weak, engage half of the number of the casual drivers in other to slow down pressure on orders such as emergency cases, organize Workshop for drivers on defensive driving service and road traffic regulations and strengthen strategies to improve transport system in the region the year 2015
Transport Challenges
There is poor utilization, adherence to maintenance schedules of vehicles due to inadequate funds and fueling issues, Unwillingness of some staffs to make a joint trip for official work want to use different vehicles instead of one and the unauthorized use of personal vehicles for official duties.
Suggestions to Address Challenges
15 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
There is the need to strictly adhere to maintenance schedules so as to improve vehicle availability, reliability and utilization and as well extend the life span of the vehicles.
Need to procure about 33seater mini bus to cater for group travelling, approval should be sort for the use of personal vehicle for official use before fuel is given out and Vehicle request for local running should be approved by heads of units and administrator and should be submitted to the transport office a day earlier.
Procurement The unit’s main objective is to ensure the efficient procurement of goods, works, and services in accordance with procedures laid down in the public procurement Act, Act 663 of 2003 and the Ghana Health Service procurement procedure manual. The Procurement Manager facilitates the execution of procurement of all goods, services and works within the entity.
Prioritized Activities
Main priorities of the procurement unit is to ensure the preparation and availability of an approved annual procurement plan, administer procurement activities to ensure preservation of an audit trail, and conservation of procedures in accordance with public procurement Act, Apply procurement thresholds and determine appropriate procurement method to use. Ensures correct recording of minutes of the Entity Tender Committee, Procure according to decisions at Entity Tender Committee meetings, ensure that there is a procurement register and participate in activities within MOH/ GHS/ SSDM/ PU that results in improvement of procurement mechanisms within the health care system. Compilation of procurement plan into consideration the requirements of all the four BMCs under the RHA, Supplier register has been updated as a requirement of the public procurement act and a suppliers’ register and data base maintained.
Compilation of suppliers register for the period under review, update of procurement register and Six
Trend of Total Procurement made in Upper west Region from 2010 to 2015
Table 11: Trend of Total Procurement
14,000,000.00
12,000,000.00 12,463,976.33 9,347,427.51
10,000,000.00 8,279,343.47
8,000,000.00 6,143,696.81
6,000,000.00 4,043,229.71 Total 4,000,000.00 2,000,000.00 1,621,476.49 0.00 2010 2011 2012 2013 2014 2015 Period Tender Committee Meetings were held during the period under review.
16 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
During the review period there was Procurement of quality medicines and non-medicines at a competitive cost through National Competitive Tendering. Significant achievement was the relocation of the unit to a new office and throughout the period there were no audit queries. The increase in trends over the years, indicate the Health facilities were patronizing the Regional Medical Stores, or quick reimbursement of Health facilities by NHIS thus, the
Table 12: Trend Trendof Total of Medicine Total Medicine and Non & -Nonmedicine Medicine Procured Procurement in UWR - 2011 to 2015 15,000,000.00 12430533.72
9,127,140.44 8,209,544.27 10,000,000.00 6,143,696.81 3,872,174.44
Amount 5,000,000.00
- 2011 2012 2013 2014 2015 Period Medicine & Non Medicine increment.
Challenges
The procurement process has generally been destructed resulting in the non-adherence to the annual procurement plan. There is Delays in the execution of planned procurements due to administrative bureaucracies and some suppliers have not been paid for about Four (4) years now; therefore going back to them for more supplies is a mirage.
Strategies to address challenges
The unit would organize more Competitive Tenders, training on Strategic Negotiation and Microsoft Package, advocacy for adequate and regular flow of funds, need to widen the supplier base and orientation on their responsibilities and obligations under the public procurement Act. Team work and Intensified Monitoring and supervisory visits of Procurement in the Region
17 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Equipment The equipment unit of the Regional Health Directorate has the mandate to assess and update the existing medical equipment at the Hospitals and facilities, conduct planned preventive maintenance (PPM), and promptly responds to service calls, dispose unserviceable equipment with the help the procurement unit and arrange user training for cold chain fridge attendants.
Achievements
During the period under review the unit repaired and maintained all the reported faulty vaccine fridges, Serviced all power generator sets at some hospitals, medical stores, and functioning test was successfully carried out. By the help of planned preventive maintenance (PPM) most of the faulty equipment at the hospitals has been repaired and fixed. These include: Air compressor 1pc, Theatre operating table 1pc, Oxygenator 1pc, Nebulizer 9pcs, Autoclave 6pcs, ECG Machine 2pcs, Suction 8pcs, Vacuum extractor 2pcs, Voltage stabilizer 6pcs, Vaccines fridge 23pcs, Programmed blood bank fridge 1pc, Hydrolic mayo table 1pc, X-Ray machine and X-Ray film dryer. All the districts benefited some medical equipment from JICA/IC NET phase 2 projects. The delivery of good, installation, inspection and training was successful, six hospitals within the region received laboratory microscope and Unit two (2) of the cold-room at the medical stores was replaced through the effort of the equipment unit.
Challenges
The unit is challenged with lack of funds to respond to service calls, assessment of the state of equipment, update our inventory, carry out repair work and adhere to our maintenance schedule and lack of spare parts for maintenance works.
Strategies to address Challenges
Conduct familiarization visits to all districts and sub-districts to assess the state of equipment, all TP Radio setups should be converted to solar lighting systems for the facilities as alternative source of power, there should be availability of funds to facilitate the movement of the equipment unit, replacement of solar accessories and the implementation of revolving fund for maintenance of equipment.
Projections for 2016
Prompt response to all service calls, quarterly scheduled planned preventive maintenance will be adhered and all faulty reported medical equipment will be attended to promptly and repaired by the equipment team.
18 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Eye Care Services In the wake of the phasing out of the partnership of the Ghana Health Service with the Swiss Red Cross and the Ghana Red Cross Society for the provision of eye care services, the Region came up with a local initiative of inviting an external Ophthalmologist enhance the Surgical Services.
Within the year under review eye clinic attendants seen at the OPD were 12,953, total recorded through Community Outreach were 2,143, School health outreaches were 2,054 and Surgical Operations were 402.
Comparatively the performance for the year under review dropped as a result of most of the ophthalmic nurses being out of post to conduct the National Trachoma surveillance of Trachoma, hence the clinics were virtually closed down.
Table 13: Performance of Eye Care Services
School Total Static Outreach Total Major Minor Specialist Period Health Operation Attendance Attendance Attendance Operations Operations Visits Attendance s 2013 27,886 16,101 11,952 55,939 316 147 463 2
2014 23,147 7,215 3,830 34,192 292 63 355 2
2015 12,953 2,143 2,054 17,150 354 48 402 2
Trachoma Control Programme The National Trachoma Programme in its quest to certify Ghana of Trachoma Free with the WHO undertook an intensive surveillance within the Upper West and Northern Regions which are the Trachoma Endemic Regions. Prior to this national exercise which elapse over half a year, virtually all the ophthalmic nurses in the two regions were given the opportunity to travel to Nigeria for a Case identification Training Programme. Those who passed formed the core team of the exercise whilst the others played the supporting roles with the data aspect had been herald by the health information officer.
The report of this survey is yet to be made available since the programme activities went into the ensuing year.
Successes
Ensuring partnership with Sight Savers and the good rapport between GHS and partners has impacted positively in efforts aimed at effective eye care delivery in the region as well as
19 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys preparations towards the elimination of blinding trachoma and achievements towards certification status.
The excellent collaboration of ophthalmic nurses, health workers and community volunteers is worth commendable and posting of a resident Ophthalmologist to the region serves as relief to the eye care delivery as most complicated cases will not referred out of the region.
Challenges
There is gradual decline in the staff strength of Ophthalmic nurses with the current total of 13 ophthalmic nurses of which some are pursuing other academic advancements, re-appointment to administrative post and likelihood of majority retiring within the next 5years. This situation is compounded by the lack of interest in eligible enrolled nurses specializing in Ophthalmic Nursing in the region
Eye Care Outlook for 2016
Plans to liaise with the Human resource unit to look into the attrition of the Ophthalmic Nurse in the region so as to curb the collapse of the service in the region.
Efforts to build the capacity of primary health workers most especially in districts without eye units / ophthalmic nurses on basic eye care to enhance their skills in screening, referral and for management of eye conditions.
Plans to increase public awareness about eye care services through community sensitization and education.
20 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Chapter2: Ensuring sustainable financing for health care delivery and financial protection for the poor
Health Financing
Revenue mobilization and fund inflows
Table14: Internally Generated Funds - NHIS verses Cash & Carry by Hospitals in UWR
BMC NHIS Cash & Carry Total %NHIS % Cash Regional Hospitals, Wa 4,907,723.69 586,753.77 5,494,477.46 89.32 10.68 Lawra District Hospital 1,271,754.75 154,322.85 1,426,077.60 89.18 10.82 Nandom Hospital 3,341,761.13 573,699.48 3,915,460.61 85.35 14.65 Jirapa Hospital 1,818,574.55 333,452.98 2,152,027.53 84.51 15.49 Tumu Hospital 1,405,230.05 53,740.34 1,458,970.39 96.32 3.68 Nadowli Dist. Hospital 1,603,290.33 197,359.66 1,800,649.99 89.04 10.96 Gwollu Hospital 611,466.04 13,195.09 624,661.13 97.89 2.11 Sub-totals Hospitals 14,959,800.54 1,912,524.17 16,872,324.71 88.66 11.34
Table 15: Internally Generated Funds - NHIS verses Cash & Carry by District Health Administrations
BMC NHIS Cash & Carry Total %NHIS % Cash Nadowli DHA 369,150.55 8,222.77 377,373.32 97.82 2.18 Jirapa DHA 373,296.32 18,203.53 391,499.85 95.35 4.65 Lawra DHA 502,340.69 14,434.72 516,775.41 97.21 2.79 Sissala East DHA 372,278.73 26,566.54 398,845.27 93.34 6.66 Sissala West DHA 233,962.86 2,518.19 236,481.36 98.94 1.06 Wa East DHA 355,024.83 49,588.53 404,613.36 87.74 12.26 Wa West DHA 841,044.07 77,997.60 919,041.67 91.51 8.49 Wa Municipal 1,336,361.04 32,769.15 1,369,130.19 97.61 2.39 Lambussie Karni 882,184.65 25,029.83 907,214.48 97.24 2.76 Nandom DHA 129,155.73 5,194.79 134,350.52 96.13 3.87 DBI 316,893.41 19,936.64 336,830.05 94.08 5.92 Sub Totals 5,711,692.88 280,462.29 5,992,155.48 95.32 4.68
21 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 16: Revenue Income 2013 to 2015 in UWR
Item 2013 2014 2015 GOG Item 2 36,672.02 12,138.49 8,043.41 GOG Item 3 Donor Pool Fund 541,815.000 152,283.70 5,990.00 Internal Generated Funds 19,749,948.520 22,132,331.790 22,864,479.88 Programmes 2,730,075.92 5,877,004.35 4,494,797.95 Grand Total 23,058,511.46 28,173,758.33 27,373,311.24
Table 17: Revenue Expenditure 2013 to 2015 in UWR
Item 2013 2014 2015 76,035.34 GOG Item 2 2,784.58 8,672.59 GOG Item 3 Donor Pool Fund 412,788.91 157,760.86 40,631.59 Internal Generated Funds 16,187,719.59 16,666,883.51 23,135,260.57 Programmes 2,706,307.57 4,743,027.23 4,645,982.70 Grand Total 19,382,851.41 21,570,456.18 27,830,547.45
Programme funds Inflows
Table 18: Summary of Programme Funding in UWR 2015
Programme Opening Balances Amount Receipt Amount Spent JICA Project - 2,785,000.00 139,613.53 Project 5s Alive 13,278.00 - 13,278.00 MEDA - 8,197.86 8,197.85 UNFPA - 142,540.00 142,540.00 Mental Health - 83,710.00 29,526.69 IPAS 29,684.00 150,142.98 179,826.98 UNICEF 124,650.54 924,921.00 1,014,236.50 Totals 167,612.54 4,094,511.84 1,527,219.55
22 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 2: NHIA Level of Indebtedness to BMCs
Trend of NHIA Indebtedness (corporate Debtors) in Upper West Region - 2013 to
2015
16,738,703.69
20,000,000.00
14,537,850.20
15,000,000.00
10,299,319.70
9,597,189.52
8,626,262.38
10,000,000.00 5,754,249.27
4,415,885.02
4,352,540.97
2,879,093.39
2,725,629.15
1,665,977.04
amount 1,559,046.85
5,000,000.00 - Reg.Hospital Hopsitals DHMTs Grand Totals uwr 2013 2014 2015
Figure 3: NHIA Indebtedness (Corporate Debtors) by hospitals 2015 performance
NHIA Indebtedness (Corporate Debtors) by Hospitals in Upper West Region - 2015 Performance 5000000 4041482.85 4000000 3000000 2283707.22 2000000 1247807.71 947929.9 903209.78 Amount 1000000 173052.06 0 Lawra Hospital Nandom Jirapa Hospital Tumu Hospital Nadowli Gwollu Hospital Hospital Hospital Hospital
23 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Financial Audit
NHIS
Chapter3: Improving efficiency in governance and management of the health system
Figure 4: NHIA Indebtedness by DHMTS in UWR
NHIA Indebtedness (corporate Debtors) by DHMTs in UWR - 2015
900,080.11
1,000,000.00
687,600.54 687,600.54
628,507.95 628,507.95
800,000.00 541,679.96
600,000.00
311,598.40 311,598.40
280,056.48 280,056.48
270,210.91
265,807.88
228,143.32 228,143.32
400,000.00 184,971.92
117,227.55 117,227.55
Amount 200,000.00 - Nadowli Jirapa DHA Lawra DHA Sissala East Sissala West Wa East DHA Wa West Wa Lambussie Nandom DBI DHA DHA DHA DHA DHA Municipal DHA DHA District
Human Resource The Human Resource unit has the mandate as part of the Regional Health Administration and Support Services to provide adequate support in the area of Human Resource Management towards the attainment of efficient and effective Healthcare delivery in the region.
The Unit ensure that the right numbers and categories of staff in terms of pedigree and caliber are available at all times to ensure quality and effective healthcare delivery at all levels is achieved.
The objectives of the Unit are to effectively and efficiently manage the Human Resource in the Region in the areas of equitable distribution of staff, Provision of congenial environment to enhance performance and output, Staff Motivation, Staff Development, attracting and retaining the right caliber of personnel
The major functional areas of the Unit are recruitment and Selection, Wages and Salaries administration and Human Resource Information Management and Systems.
Achievements
24 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The period has seen the appointment and posting to the region as well as some transfers-in of some key personnel to strengthen key functional areas of our set up. These modest gains have added to the numbers of personnel.
The period was however not without some losses as the region lost a few members through various means.
Below is a table showing gains and wastage and their categories for the period under review.
Table 19: Distribution of New Appointments
No. Grade Category Total 1 Technical Officers Disease Control 175 2 Field Technicians Disease Control 94 3 Laboratory Technicians laboratory Services 57 4 Pharmacist Pharmacy 36 DDPS Pharmacy 3 5 Dispensing Technicians Pharmacy 35 6 Human Resource Manager Administration 1 7 Community Health Nurses Nursing 772 8 Staff Nurses Nursing 435 9 Midwives Nursing 219 10 Staff Cook Catering 37 11 Watchman Security 52 12 Accountant Accounting Class 91 13 Administration Health Service Adm. 13
Staff categories transferred in were 4 medical superintendent and 3 Deputy Directors of Pharmaceutical services.
Table 20: Table Showing Wastage
Type No. Remarks Deaths 17 Yet to be Replaced Retirements 34 Yet to be Replaced
25 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Transfers Out 21 Yet to be Replaced Vacation of Post 11 Yet to be Replaced Dismissals 2 Yet to be Replaced
For the same period a total of nine (9) personnel of different categories have been re-assigned to different districts and facilities to augment the staff strength in such districts and facilities. Staff wastage due to deaths and retirements are being collated for replacement.
Total staff strength stands 4369. Below is the staff distribution for the various BMC’s for the review period
Table 21: Distribution of Staff Strength
NO BMC 2015 1 Regional Health Directorate 2 Regional Hospital 227 3 Wa West Heath Directorate 186 4 Wa East Heath Directorate 118 5 Wa Municipal Health Directorate 348 6 Nadowli Health Directorate 160 7 Nadowli Hospital 160 8 Jirapa/Lambussie Health Directorate 197 9 St. Joseph’s Hospital, Jirapa 197 10 Lawra District Health Directorate 149 11 Lawra Hospital 171 12 Nandom Hospital 196 13 Tumu Hospital 14 Sissala West Health Directorate 173 15 Sissala East Health Directorate 142 16 Jirapa NTC 17 Gwollu Hospital 123
A table showing staff distribution by professional categories against set targets
26 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 22: Distribution of 2015 Human Resource Status
CATEGORY Norm ACTUAL DIFFERENCE Specialists 15 6 9 Medical Officers 25 14 11 Housemen 15 3 12 Dental Surgeons 9 0 9 Dental Technicians 9 9 Medical Assistants 79 61 18 Nurses 1379 544 853 Nurse Anesthetist 19 7 12 Pharmacists 13 13 0 Dispensing Technicians 95 24 17 Laboratory Technologists 9 4 5 Laboratory Technicians 91 34 63 Radiographer 1 1 0 X-Ray Technicians 18 11 7 Human Resource Managers 2 1 1 Health Service Administrators 13 11 1 Regional Director 1 1 0 The Region can boast of only five Specialists made up of 2 Public Health (PH) Specialists and 3 Clinical Specialists. It is important to note that, of the two Clinical Specialists, one is a retired staff on contract and at the same time the only surgical Specialist in the Region.
The percentage of Nurses available as against the norm is 35% with a difference of a whopping 75%. That of Laboratory Technicians is 11%, Dispensing Technicians is 25% and that of Nurse Anesthetists is 36%
Category No. Ratio Medical Officers 12 1:53,163 Laboratory Technician 10 1:63796 Pharmacist 13 1:49073 Nurses 544 1:1,173
Key Human Resource Activities Implemented
During the period under review the unit participated in the annual performance review session, conducted regular processing and follow –ups on newly appointed staff’s salaries as well as those of promoted staff, Collation and processing of data for the newly recruited staff and Collation of list of Staff due for promotion under the Ghana Health Service 2015 promotion plan.
Processing of salaries
27 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The unit processed the salary inputs of newly appointed staff as well as that of promoted and upgraded staff. The period saw a total of over 522 personnel.
Collation of data for new salary Implementation
GHS personnel are no more on the Ghana Universal Salary Structure (GUSS) calling for a special exercise to ensure the effective implementation of this new scheme.
The Unit thus undertook this exercise of collating data for the implementation of the scheme. This was carried out in all districts and facilities.
The mop up exercise came out with the following anomalies.
Table 23: Distribution of Mop up exercise showing anomalies
No of persons Anomaly 2013 2014 2015 Omission 15 12 17 Wrong grade 17 11 34 New entrants 256 304 522 Others 153 156 112 Total 482 584 685
After re-submission, it was detected that 19 personnel were actually assigned wrong staff numbers, 34 personnel had been paid but did not receive their pay slips at the time the mop up exercise was carried out and 46 personnel were presumed to have been omitted
Promotions
The Service’s promotion plan for the year 2015 has been duly circulated and all BMC’s entreated to submit names of staff who qualify under the criteria set for consideration.
The period also saw the confirmation of some Medical Superintendent, appointment of Health Service Administrators and a District Directors of Health Service.
28 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Achievements
The review period saw remarkable improvement in the staff situation, especially in the Pharmacy and Support Service Units.
Challenges
There is Inadequate staff especially in the nursing category to carryout effective and quality healthcare delivery. Lack of funds to support newly appointed staff whose salaries sometimes takes a while to be mechanized and Poor Human Resource Information Systems leading to poor data management and inadequate tools and equipment to facilitate the work of the HR unit.
Strategies to address Human Resource Challenges
Focus on improving the staffing situation especially for the nursing category to enhance our service delivery efforts. BMC’s are entreated to support newly appointed personnel by way of salary advances to alleviate their financial burden as efforts are made to get their salaries mechanized. Strengthening the Personnel Units in the Districts and facilities to improve on the HRIS management for effective decision making and District Directors and Medical Directors to take keen interest in Human Resource Issues especially in the area of Payroll Audit to ensure only the right names are maintained on our PV’s at all times.
General Administration The main mandate of this unit is to see to the Day-to-day Administration, Registry Office Procedure, Records /Filing, Sanitation and Security
The objective is to ensure safe sound office procedures, safe documentation, records of all Correspondences and ensure sanity and security of RHA and HASS units
Key Activities
Day –to- Administration
Involves Signing requisitions, signing loans forms, endorsing student’s forms, endorsing leave forms, directing visitors to appropriate place, general advice and counseling service to junior staff, Organizing weekly meetings for registry/secretarial and cleaners and security men, Preparation of monthly allowance budget for payment, report writing, attending meetings on behalf of RDHS/RHSH, Registry/office procedures, Supervising incoming and outgoing mails, Drafting letters and adhering to approved office procedures with respect to correspondence
29 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 24: Summary of Mails
Classification 2013 2014 2015 Incoming 2440 2096 2,945 Outgoing 2230 2018 1008
Filing
The office ensures safe keeping of both personal and general files, adhering to standard filing practices and Opening and closing of new and old files respectively.
Sanitation
The unit conduct supervising cleaners/laborers, Provision of cleaning materials and ensure periodic fumigation of RHA/HASS premises and offices
Security
The office do rotation of security men, Provision of security items e.g. battery, Touch light and rain coats
Achievements
The unit realized a strengthened filing system and organized five meetings with general administration staff on their jobs.
Challenges
There is Lack of funds to purchase working material for sanitation, obsolete computers in General Administration office thus slowing down work, Irregular impress for postage of outgoing letters and Office needs renovation and refurbishment.
Strategies to address Challenges
Capacity building of RHA staff on the need to know and respect office practices and procedures. Logistics needs of the General Administration should be adequately provided
Mechanical Training Centre The workshop continued to play its vital role in supporting health delivery by ensuring effective and efficient PPMI, servicing and maintenance of vehicles and motorbikes, enhancing the availability and reliability of vehicles and motorcycles for health service delivery in the region.
30 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Staff Analysis
The unit has 4 vehicle mechanics, 2 electricians, 2 motorbike mechanics, 1 welder, 1 store keeper, 1 receptionist and 1 accountant
Staff Age block
Staff at the MTC age groups between 18-40 years of age are 3, between 41-50 Years are 5 and those almost retiring between 51-60 years are 4 making a total of 12 staff at the unit.
Workshop Load
Figure 5: Workshop load Trend analysis
UWR MTC Workshop Load Monthly Trend analysis - 2013 to 2015 73 80 64 59 60 55 56 60 51 51 53 52 51 60 46 49 47 45 50 39 44 39 40 40 4341 3535 36 33 38 37 40 31 2927 20 24 20 Number 20
0 JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Period 2013 2014 2015
A total of 557 was recorded for 2013 against 543 in 2014 and 478 in 2015
Table 25: Details of Workshop Load Trends for 2015
Gran Ma Apri Ma Jul Au No Tota Category Type Jan Feb Jun Sep Oct Dec d r l y y g v l Total
Motor 2 4 5 7 2 2 2 6 3 4 2 2 41 159 Private Vehicle 9 10 14 7 11 3 13 18 11 12 4 6 118 Governm 10 10 11 4 5 10 8 4 9 6 3 6 86 319 ent Motor Vehicle 18 20 29 21 17 18 15 24 17 19 22 13 233
Total per month 39 44 59 39 35 33 38 52 40 41 31 27 478 478
Workshop Revenue Generation Patterns
31 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Revenue generated per month from government private vehicles and motorbikes was 7,070.21 giving an annual total of 84,842.51 generated. Total monthly generation from private vehicles and motorbikes was 795.50, making an annual total of 9,546.00 for the 2015 year period.
Achievements of the MTC
Total of 478 vehicles and motorbikes were serviced/maintained which generating a total amount of Ghs 84,842.51. Over Ghs 60,000.00 worth of spare parts were procured from Central Mechanical Workshop in Tema during the year under review. One mechanic was sent for training at Toyota Ghana Limited. The technical working committee and operational plan put in place improved services of the workshop and the Patronage of services by other organization continues to increase.
Workshop Challenges The huge indebtedness to the workshop by Regional Health Directorate, poor staff strength, lack of fast moving spare parts, Defective Arc welding and vehicle lifter machines. There is high Monthly expenditure as against monthly payments of service bills resulting in depletion of accounts (security, spare parts etc.), Computerization yet to be done and G.H.S/H.T.Is prefers to ignore bills from the workshop but rather readily pay to other private garages.
Strategies to address Challenges in 2016
Some key approaches is to ensure adherence to operational plan to improve services, Intensify debt collection, Improve staff situation by engaging more mechanics and auto electricians on casual, Keep to procurement arrangement with CMW-Tema to pay and receive more spare parts on credits, Procure diagnostic machine and additional basic tools including protective clothing.
There is the need to computerize procedures to improve services, obtain accreditation to service and maintain Toyota and Nissan vehicles in the region, organize training for the workshop staff on: Plan preventive maintenance inspection, Workshop procedure, Workshop safety procedure and Firefighting techniques
32 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The unit would conduct stock taking of spare parts in the store and the need to repair the vehicle lifter machine.
Estates The mission of the estates unit of the RHA is to preserve MOH/GHS properties and to ensure that staff are adequately accommodated in a safe and clean environment.
Our set objectives to promptly attend to maintenance request on physical infrastructure, manage land and buildings for GHS in a prudent manner and strengthen relations with Regional Coordinating Council, District Assemblies, Donor Organization and Traditional Rulers in the areas of providing accommodation, health infrastructure and maintenance.
Status of activities During the review period, assets Register has been updated, building register is yet to be updated, accommodation Register has been updated.
The newly constructed incinerators by Ghana Health Service and Estate Management Department at Tumu, Nandom, Gwollu Hospitals, Daffiama and Bulenga Health Centers, have been completed and handed over in April 2015.
Tools procured during Danida Support system are either missing, worn out or not functioning anymore or cannot be traced in the system and would need reassessment or replacement.
Human Resources and Logistics
The unit has 1 Regional Estate Manager, 4 Estate Managers/Officers (1@ Regional Hospital, 1 @ Jirapa DHA, 1@ Jirapa Hospital (CHAG) and 1 @Tumu District Hospital as a Casual), 2 Plumbers, 1 General Artisans, 1 Carpenter, 10 Orderlies and 10 security men (one injured.
Assets available for the unit are 2 Residential Accommodation for the Regional Estate Manager and the Regional Hospital manger, 1 motor bike at the Regional Hospital, All artisans are renting their own residential accommodation.
Achievements
33 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
During the period under review, the unit was able to carry out Monitoring and attending technical meetings of JICA/JICS construction of CHPS Compounds with the assistance of the project constultants, taking over 2 culverts constructed by JICA/JICS as part of contract for Wa West CHPS Compound, forwarded payment certificates for the completion of Remodeling and Expansion of Health Centre projects.
The unit facilitate the renovation of Bungalows 23 Jahan Residential Area, physical inspection of assets at RHD, Successfully procured works on the construction of Infection Disease Holding Center (Ebola Project) for Regional Hospital and Site visit to a 2 storey classrooms and office accommodation for Nursing Training College, Wa
Challenges
The estates unit is not assigned a vehicle for monitoring/supervision and other official errands which makes work extremely difficult, there is difficulty in getting materials for maintenance works on buildings.
Efforts in getting contractors back to site to complete the Construction of 3-Bedroom Bungalow for Wa Hospital, 1 No. 4 Unit (2-Bedroom) Staff Quarters at Funsi, Lawra and Tumu, DHMT Office Block for Wa Municipality, Administration Block at Nandom Hospital and completion of 150 capacity Lecture Theater for the Jirapa Midwifery Training School is proven quit challenging as there appear to be no funds.
Work at the newly constructed Regional Hospital is behind schedule and difficult to get information on the project and is at a slow pase, inadequate fuel for sites monitoring and inspection of the ongoing construction projects, updating of building register and other activities.
There is uncoordinated movement of assets making it difficult to update assets register, inadequate office and residential accommodation for staff, Poor maintenance culture among staff and attention is not given to systematic procedure of procurement of civil works.
Strategies to address challenges
There is the need to assign a vehicle to the Estate Unit to enhance the effectiveness and efficiency of activities of the Directorate, proper attention should be given to procurement of civil works to avoid future embarrassment of audit queries and ensuring materials for maintenance activities are available.
Management to form a board of survey to dispose of the obsolete furniture, equipment old documents, computers and printers in the offices.
Management to enforce forceful eviction of staff illegally occupying MOH/GHS allocated bungalows, Occupants on transfer must be released finally when keys to their residence is
34 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys submitted to the Estate Management Unit, Occupants in MOH/GHS allocated accommodation must especially keep the internal portion of the building neat and habitable before handing over keys when being transferred.
Activation of Housing Committee must be done within the first quarter of the year and members informed of scheduled meetings for the twelve calendar months of the year.
Health Information system and M &E The Regional Health Information unit is responsible for managing health data and providing Information for health service Management decision making and planning health interventions. The objective is to ensure Quality, Reliable, and Consistent, Timely, accurate and credible data that impacts on Health care services hence providing evidence for action.
Our Core mandate is to ensure data sufficiency and reliability of the DHIMS2 Software and other alternate data sources for health Information in Health Service delivery in Ghana.
The unit performs functions of Data analysis and interpretation, routine data quality checks, monitoring health service performance trends, Data quality improvement (accuracy, consistency, and completeness checks), data reviews, performance reviews, health newsletters/bulletins, feedback to all levels, provision of information for planning purposes and health service decision making, report writing, planning and budgeting functions and many others.
Activities Implemented
Monthly Data Quality checks and League tables
The H.I unit as part of the data quality improvement initiatives, implemented monthly routine data quality checks in the DHIMS2 software using outlined decision rules per selected data sets. A true or false output is generated to evaluate whether the data elements assessed conforms to the decision rules.
At the end of each procedure, a league table is generated from the performance and sent to the districts for follow up actions. Below is the summary of the league table of selected data
Figure 6: Results of data quality league table
35 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys elements for RCH, HIV and Malaria data quality checks for the review period
From the performance table above, region attained average of 57% with Sissala west coming 1st with an average score of 98.7% and Wa East came last with 70.5%.
Quarterly Service Performance feedback to RDHS and lower levels
The unit compiles analysis report on key performance indicators highlighting best and least performing districts with emphasis on key service outcome indicators for every quarter, half year and annually to the Regional Director of health services and other BMC’s on the progress of performance against targets set for the period
Data Accuracy checks in facilities (data reviews)
Significant to the data quality improvement initiatives is efforts at improving data accuracy, aimed at exploring the variation between what is captured in the source registers and what is reported in DHIMS2. It assesses data consistency along the channels of transmission thus the registers, summary data, at facility, DHA and reported figures in DHIMS2 software.
Table 26: Data Verification Template
Facility Recounted data at Facility Dhims Level of Data Date Indicator Summary data Facility (Register) Summary data data Discrepancy at DHA
During the 2015 year period the unit together with PPME/CHIM (National) conducted one visit to six selected districts and 12 facilities in the region. However sustainability of this exercise is low due to funding implications.
Monthly data validation with RHMT
The unit with the support of the DDPH instituted monthly data validation sessions of the RHMT. A peer review interactive section with the RHMT unit heads and Programme managers where unit heads are assigned data validations responsibilities, during meetings presentations are made by individuals on data validation activities carried out for the month after which there are discussions on ways of improvement.
Monitoring Health Service Performance Trends
The unit facilitated data analysis and performance trends of key health service indicators, through which performance curves are generated and shared with all stakeholders for planning and decision making at all levels
Strategies to address challenges
36 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
There is the need to initiate Quarterly DHIMS2, Standard Operating procedures for Health Management Information Systems in the Ghana Health Service Refresher trainings and data management protocols.
Intensify quarterly data reviews and accuracy checks (RDQA) in facilities and technical support visits on data management issues
Routine monthly data validation sessions with RHMT units and effective implementation of data management responsibilities
Develop bulletins, news feeds and performance feedback on progress of districts and reporting facilities towards set goals and targets.
Information Communication Technology (ICT)
Information and Communication Technology presents several opportunities for improving the performance of health systems in developing countries like Ghana. This has been demonstrated in several pilot projects across the developing world.
The availability of affordable and easy to use systems and equipment’s has to the several initiatives aimed at improving the effectiveness of health care services, outputs of system managers and new opportunities for health care consumers.
Within the last three decades, the demand to intensify the use of Information and Communication Technology has increased. This demand has arisen partly as a result of new insights into the extent to which such applications can influence the health of the population and also as a response to the need to accelerate progress towards the attainment of the Millennium Development goals (MDG’s) four (4) and five (5). The increasing need to bring technology to bear on health sector performance is shown in global health strategies.
The key Objective are to ensure a paperless health delivery and reporting systems in the region and the nation at large, improving upon the quality of health care Information Communication Technology. Ensure effective communication between all the institutions that matter in health delivery, providing information for effective decision making and planning at all levels of the health service and improve on the database management system in the health sector.
Activities Carried out
37 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Some of the key activities implemented during the year under review were the installation and maintenance of hardware components such as computer systems, printers, scanners in some selected BMCs and RHD.
Software installation and maintenance, such as antivirus, MS office, and other utilities in the directorate and other sub BMCs. The unit Participated as one of the facilitators in the training and distribution of computer systems (laptops) to the various BMCs (Health Centers).
Routine inventory check was conducted on all systems available to the GHS and registration of staff of the GHS onto the new GOG E-pay slip.
Management advisory on basic ethics in the use and management of IT systems, successfully Completed the LAN (Local Area Network) installation, a server and rack at Nandom hospital.
Network extension at the Wa Regional Hospital, the unit carried out activities on the E-claims both in the region and the two other northern regions, Installed a backup utility for the HAMS Database at the Wa Regional Hospital.
Table27: ICT Equipment Inventory UWR
BMC Desktops Laptops Printers Photocopiers Scanners RHD 35 19 29 3 4 Reg. Hosp. 73 4 10 2 12 Nadowli.Kaleo DHMT 12 0 11 0 0 Nadowli. Hosp. 6 3 7 0 0 Jirapa DHMT 9 6 5 0 0 Lawra DHMT 9 0 5 0 0 Babile Polyclinic 2 1 1 1 Lawra Hosp. 18 1 9 0 0 Nandom DHMT 4 0 3 0 0 Ko Polyclinic 3 1 2 1 0 Nandom Hospital 17 0 5 0 0 Gwollu DHMT 3 1 1 0 0 Gwollu Hospital 1 1 2 0 0 Tumu DHMT 9 3 5 1 0 Tumu Hospital 8 5 8 2 0 Lambussie DHMT 4 4 3 1 0 Lambussie Polyclinic 1 0 0 0 0 Wechau DHMT 2 3 5 1 0 Wechau Polyclinic 2 0 1 0 1 FAULTY Totals 218 52 112 12 16
38 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Challenges
The problem of inadequate staffing, there are 11 districts and 6 hospitals with only 3 IT managers, 2 IT officers and 5 casuals. Therefore more hands to execute the IT responsibilities within the region.
There is Lack of transport for effective monitoring of activities within the region, the unit lacks a dedicated vehicle to undertake effective and efficient monitoring of programs and projects especially in the districts.
The unit is not financially resourced to pay visits to the various BMCs to take inventory of the IT equipment in the region.
General Issues and Recommendations
During the last support visit to some of the BMCs, the issues identified were on implementation of DHIMS2 and Viruses due to lack of training for health information officers and lack of internet access to constantly update their anti-viruses coupled with the inability to purchase the original version of anti-viruses.
In the RHD and some of BMCs, power fluctuation is another problem affecting the computers and the inability to purchase the specified or correct UPSs, most of the systems are broken down
There should be internet connectivity (LAN; Local area network, WAN; Wide area network, or GPRS Modems) in all BMCs to ensure easy access to information, share of resources like files, folders, printers and even forwarding of reports to the region and national level. Official E-mail addresses should be created for district offices and hospitals to enhance easy identification where information is coming from and easy access. Issues relating to information technology (ICT) should be managed by IT Officers in the BMCs since that is their job description and hence have better understanding of the situation. Active involvement of the Regional IT manager in Software procurement, deployment and training in the region.
39 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Quarterly training on current or new software’s that come into the system e.g. DHIMS, Magnum, Hams etc. Quarterly monitoring in the RHA, DHAs and Hospitals to rate the performance of ICT equipment.
Next Steps
Advocacy for more IT staff to do away with the shortfall of inadequate staff, need for management to allocate the IT unit with vehicle to facilitate effective and efficient monitoring of the various BMCs on their IT issues.
Provision of adequate financial resources to enable the unit to undertake all its required monitoring, IT staff should be supported to partake in continuing professional development (CPD) programs organized for IT personnel to build their capabilities, which will enable them to cope with the changing trend in technology.
Heads of BMCs and the general staff of the GHS need to be sensitized on the role of the IT worker; this is to deepen their understanding on the relevance of IT.
Pharmaceutical Services The pharmacy unit is responsible for the delivery of pharmaceutical care in the region. There are forty five personnel under the unit implementing various forms of pharmaceutical services provision in the region
Major concerns at the beginning of the year were the inadequate personnel, erratic funds inflow for planned activities, high indebtedness of BMCs to the regional Medical Stores and low patronage.
Priorities are targeted improving the number and mix of pharmacy personnel to ensure most BMCs to the Regional Medical Stores and reduction of indebtedness.
Planned activities implemented during the year were the prudent staff development, health commodity management, rational use of medicines and supportive supervision.
The region received quarters for pharmacists and 40 pharmacy technicians, however as at the end of the year only 3 pharmacists and 6 pharmacy technicians/technologists were added to the unit. There was a launching of one national completive tendering to procure pharmaceutical products in the region.
40 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
There was regular inspection of items to assess quality and effective flow of the supply chain.
Strategies to address challenges are to approach measures to improving the number and mix of pharmacy personnel, explore and expand funding sources, aggressively pursue BMCs to reduce their indebtedness to the RMS and ensure reports of activities are submitted.
Chapter4: Improving quality of Health Services delivery including Mental Health Services
Clinical/Institutional care
Utilization of Outpatient Services: OPD Attendance and Per Capita Ratios in UWR 2005- 2014 1,200,000 1.3 1.5
1.1 1.1 1.1 1.1
1,000,000
0.9
800,000 0.6 1
0.7 0.7 0.7
600,000 0.5
400,000 957,466 0.5
Attendance
851,238
855,888 855,888
814,406
Per Capita ratio Capita Per
200,000 758,084
484,513
349,539
479,360 598,533 364,996 Figure 7: Trend of OPD Attendance in UWR456,598 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
OPD Attendance per capita
OPD Attendance and per capita The region in the period under review recorded a total OPD attendance of 855,888 compared to 957,466 in 2014, and 851,238 in 2013, 814,406 in 2012 and 758,084 in 2011. The OPD attendance shows a decrease of 101,578 (11.9 %) over the previous year. The figure below gives the trend of utilization of OPD services
Distributing the above per capita ratios by districts Wa Municipal recorded the highest ratio of 1.6, followed by Lawra District with 1.5. Wa East, Wa West, Jirapa, Sissala West and D.B.I recorded lowest.
41 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 8: OPD Per Capita by districts in UWR
Distribution of OPD Per Capital Ratios by Districts in UWR - 2015 Performance 2 1.6 1.5 1.4 1.4 1.5 1.2 1.2 1.1 0.85 0.83 0.84 1 0.55 0.7
0.5 per capita 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District
Distributing OPD attendance by districts saw Wa Municipal recording the highest of 193,751 followed by Lawra with 91,345. Jirapa district though high with 80,894 has low per capita ratio indicating majority of the population did not access health care during the review period.
Figure 9: OPD attendance by districts in UWR
Total OPD Attendance by Distrits in UWR - 2015 Performance 300,000 193,751 200,000 91,345 80,894 68,072 84,880 68,573 85,421 62,637
100,000 30,371 46,072 43,872 Attendance - DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West District Total OPD Attendance
The Doctor to population ratio targeted at 1:9,900 population, stood at 1: 20,300 at the end of 2015 against 1:22,940 in 2014 with an increase in number of doctors from 33 to 38 during the review period.
42 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 10: Doctor to Population ratios in UWR
Trend of Doctor to Population Ratios against Set Target in Upper West Region - 2008-2015 74,290 38
40 80,000 60,754 33 51,619 30 50,756 45,497 49,201 60,000
20 13 13 15 14 22,940 40,000 12 10 20,300
10 20,000 No. of Doctors of No.
0 - ratios Population 2008 2009 2010 2011 2012 2013 2014 2015 No. of Doctors Ratio/per total population Target= 1:9,900 population
Financial accessibility of OPD services by use of NHIS Out of the total of 855,888 clients that utilized OPD services 808,308 representing 95% insured
Figure 11: Service Utilization by Health Insurance status
Trend of Percentage Health Insurance Status of OPD Attendants in Upper West Region- 2005 to 2015 150.0
86.7 90.7 94.3 95.6 95.9 96.5 95 100.0 72.0 72.5 52.6 50.0 27.5
Percapita 47.4 28.0 13.3 0.0 9.3 5.7 4.4 4.1 3.5 5 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
% OPD Attendance Insured. Target % OPD Attendance non - Insured clients. The 2014 regional coverage was 96.5%.
43 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Distributing the above current year performance by districts gives sissala west with the highest coverage of 98.8%. Wa East recorded the lowest 79.7% followed by Wa West with 88.8% and then Daffiamah Bussie Issa with 89% for the 2015 year period
Figure 12: OPD attendance Insured by districts in UWR
% OPD attendants covered by Health Insurance in UWR -2015 Performance 120 98.1 96.9 98.7 96.5 98.8 96.5 89 94.8 94.8 88.8 95 100 79.7
80
% 60 40 20 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
During the period under review, districts were confronted with Delay in the issuance of cards to prospective clients, Delays in claims reimbursement to health facilities and Reduction in claims submitted by facilities.
Admission and Death Rates The total admission recorded in the period under review was 59,852 compared to 73,633
Figure 13: Hospital admissions and admission Rates
Trend of Admissions and Hospital Admission Rate per 1,000 population in Upper West Region - 2005 to 2015
80,000 150 85 97 89 87 78
60,000 rate
76
100
68 65
57
40,000 47 47
50
73,633
63,655
61,546 59,852 59,852
20,000 63,446
dmission dmission
51,686
A
29,723 43,785
44,632
36,956 29,819
0 0 Hospital Admission Hospital 2005 2,006 2,007 2008 2009 2010 2011 2012 2013 2014 2015 Period Admission Admission Rate
recorded in 2014, 63,446 in 2013, and 63,655 in 2012.
44 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The region recorded a hospital admission rate of 78 for the review period, an improvement over the previous year. Distributing the current year performance by districts gives Nandom recording the highest 204/1000 admissions shown the below
Figure 14: Hospital Admission rates by districts 2015 performance
Institutional Death Rate by Districts in Upper West Region - 2015 Performance Hospital Admission Rate by Districts in Upper West Region – 2015 3 2.5 2.4 Performance 2.0 1.6 1.7 1.8 3002 204 1.0 0.5 153 2001 115 0 0.0 78 106 106 0.0 0.0 78 admissions 1000 37 Death rate/100 rate/100 Death DBI0 Jirapa Lambussie0 Lawra Nadowli Nandom Sissala East Sissala Wa Wa East0 Wa West0 Upper 0 West West DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper
Rate/1000 Pop. Rate/1000 District West West District
The total number of deaths recorded in the period was 1,086 compared with 1,116 in 2014 and
1,252 in 2013, 1,264 in 2012 and 1,262 in 2011.
The institutional death rate for the period stood at 1.8% compared with 1.5% in 2014. The death rate for 2012 and 2013 was 2.0. The trend of deaths and deaths rates is illustrated in the chart below.
Figure 15: Institutional Deaths and Death rates
45 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Distributing the above coverage by districts gives Jirapa 2.5% (276 deaths) followed by Lawra 2.4% (115 deaths), Nandom recorded 2% (198 deaths), Wa recorded 1.7% (303 deaths), Nadowli Kaleo recorded 1.6% (116 deaths). Sissala West recorded 0.5% (11 deaths) though the least, Sissala East recorded 1% (67 deaths) for the period illustrated in the figure below.
Figure 16: Deaths rates by Hospitals in UWR
Bed Utilization The region recorded 70.2% Bed Occupancy Rate compared to 71.7% for 2014 and 73.9% in 2013 and 72.6% in 2012. The average length of stay recorded for the period also stood at 3.5 co Figure 17: percentage bed Occupancy rates in UWR mp are
Percentage Bed Occuacy Rate in UWR Hospitals - 2005 to 2015 67.2 67.2 72.6 69.7 73.9 71.7 70.2 80.0 60.0 62.1 60.0 43.0 48.0 40.0 20.0 0.0
% bed % occupancy 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Bed Occupancy Rate Institutional Deaths and Death Rate per 100 Hospital Admissions in Upper West Region -2005 3.7 to 2015 1,500 931 4.0 3.1 1,095 1,262 1,264 1,252
1,175 1,095 1,057 1116 1086 2.5 2.5 921 2.4 2.3 3.0 1,000 2.1 2.0 2.0 1.8 1.5 2.0 500
1.0 Rate Death Hospital deaths
0 0.0 2005 2,006 2,007 2008 2009 2010 2011 2012 2013 2014 2015
Deaths % Death Rate d with 3.2 in 2014 and 3.4 in 2013.
46 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Distributing the above by districts the Upper West Regional hospital recorded the highest occupancy rate of 76.1% followed by Jirapa hospital with 67.1%. Gwollu hospital 34.8% and Tumu hospital 45.2% recorded the least percentage bed occupancy.
Figure 18: Percentage bed Occupancy by districts
Bed Occupancy rate by districts in UWR- 2015 Performance 74.3 76.1 80 67.1 70.2 60 47.4 53.1
45.2 34.8
40 rate 20 0 0 0 0 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
The average length of stay for the year 2015 stood at 3.5 against 3.4 in 2013 and 3.2 in 2014 respectively. Distributing the current performance by district hospital shows Nandom hospital has the highest 5.9 followed by Jirapa 3.4 and lawra of 3.1 shown in the figure below
Figure 19: Average Length of stay by Facilities
Average length of stay by Hospitals in UWR - 2015 performance 8
5.9 6 3.4 3.1 2.9 2.9 2.9 3.5 4 1.9
coverage 2 0 0 0 0 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
The high average length of stay for the Nandom hospital was due to the availability of resident orthopaedic surgeon at the hospital.
47 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 28: Bed statistics by facilities – 2015 Avail. Av. Turn Patient Death % Bed Hospital Bed ALOS TOI Daily Over Per Days Rate Occupancy Days Occup. Bed Jirapa Hosp 44,544 68,985 2.5 3.5 1.9 121.7 64.6 67.7 Lawra Hosp 15,600 32,923 2.2 3.1 3.4 42.6 47.4 56.7 Nadowli Hosp 21,451 40,333 1.6 2.9 2.5 58.6 53.2 67.6 Nandom 58,917 79,278 1.9 5.9 2 161 74.3 45.8 Tumu Hosp 17,974 39,785 1 2.9 3.5 49.1 45.2 57.3 Gwollu Hosp 3,799 11,315 0.7 1.9 3.9 10.4 33.6 62.9 UWR Hosp 55,547 73,037 1.6 2.9 0.9 151.8 76.1 95.7 Total 217,832 345,655 1.8 3.5 2 595.2 63 66.2
The regional trend in the bed statistics revealed an improvement in percentage bed occupancy from a little over 62.5% in 2008 and 2009 to over 67% in 2010. This improved further to 72.6% in 2011 with decline to 69.7% in 2012 and up again to 73.9% in 2013 and 74.2% in 2014. However there is a decline to 70.2 in 2015. The distribution is shown in the table below
Table 29: Trend of bed statistics 2006 – 2015 Patient Av. Daily Av. Length Turn Over Turn Over Year % Occupancy Days Occupancy of Stay Per Bed Interval 2008 157,794 432 62.5% 3.3 69.0 2.0 2009 156,862 430 62.1% 3.5 64.0 2.2 2010 177,124 485 67.2% 3.5 70.6 1.7 2011 192,489 527 72.6% 3.2 83.1 1.2 2012 282,918 539 69.7% 3.1 82.0 1.4 2013 208,365 569 73.9% 3.4 80.3 1.2 2014 227,974 623 74.2% 3.2 85.0 1.1 2015 217,832 595.2 63.0% 3.5 66.2 2.0
Outpatient Morbidity Statistics Malaria though on the ascendancy still remains the leading cause of OPD morbidity contributing
37.5% of the total OPD attendance in 2014 followed by upper respiratory tract infections 14.2%
compared to 31.2 % and 17.4% as indicated in the top ten chart. The total of the top ten
48 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys diseases accounts for 73% of all attendant conditions in the period under review illustrated in the table below
Table 30: Top Ten OPD Morbidity in UWR 2015
Disease Condition Total % 1 Malaria OPD cases - clinical and confirmed 267,050 31.2 2 Upper Respiratory Tract Infections 149,335 17.4 3 Diarrhoea Diseases 54,123 6.3 4 Skin Diseases 36,946 4.3 5 Rheumatism & Other Joint Pains 35,896 4.2 6 Acute Eye Infection 23,843 2.8 7 Acute Urinary Tract Infection 18,279 2.1 8 Anaemia 14,604 1.7 9 Hypertension 12,801 1.5 10 Other Acute Ear infection 11,898 1.4 Total OPD attendance 855,888 73.0
Inpatient Morbidity Statistics The Top Ten causes of admissions for the year under review is shown in the table below
Table 31: Top Ten Causes of Inpatient Admision-2015 Diagnosis Count % of Total Malaria 9,793 25.3 Spontaneous delivery 2,312 6.0 Gastroenteritis 1,808 4.7 Anaemia 1,571 4.1 Sepsis 1,112 2.9 Infection of Urinary Tract (UTI) 1,087 2.8 Hypertension 947 2.5 Enteric Fever 849 2.2 Infection of Respiratory Tract (RTI) 822 2.1 Road Traffic Accident 815 2.1 All Others 17,519 45.3
Challenges
49 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The challenges identified with institutional care include (1) inadequate staff (2) Inadequate equipment (3) Inadequate facilities (4) Delays in referrals (5) Accommodation for staff (6) Carrier progression pathway not well defined (7) Inability to fully implement peer review.
The region has planned to tackle these challenges by doing the following: (1) promote specialist outreaches and extend it to more facilities (2) make deliberate attempts to attract doctors to the region (3) Conclude discussions and put in place incentive packages for the purpose of attracting doctors to the region. (4) Make conscious efforts to support poor performing districts due to lack of facilities and
Referral System
Mental Health The Vision is to build an efficient and robust mental health service capable of addressing the total health needs of the population of the Upper West Region. The Mission therefore is to deliver a culturally appropriate, affordable, accessible, integrated and decentralized mental health care in the Upper West Region.
Planned activities Implemented
During the 2015 year period, the co-ordination of the mental health authority facilitated the formation and inauguration of Regional mental health subcommittee, Identified and set up office for the Regional mental health coordinator, Launching and commencement of mental health literacy/ patient safety project.
There were Visits to faith based healers in the Region, Sensitization, awareness creation and celebration of world mental health day.
Capacity of mental health staff was built on the ICD 10 diagnostic tool and new reporting format.
Achievements
50 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Successfully formed and inaugurated the Regional Mental Health subcommittee, extension of mental health services to Funsi, Gwollu, Fielmuo, Lassie, Eggu and Issa.
There is improved availability of anticonvulsant and antipsychotic medication, Universal reporting format for capturing of data in the region, carried out Specialist psychiatrist outreach clinic and Successfully completed the mental health literacy phase of the mental health literacy project,
Sensitization of the Media, mental health staff, Police and Prison officers on the Mental Health Act 846, 2012 and World mental health day commemorated in the region.
Table32: Mental Health Staff Strength 2015
Wa Wa District DBI Jirapa Lamb. Lawra Nadowli Nandom S.E S.W Wa Total East West Psychiatrist 0 0 0 0 0 0 0 0 0 0 0 0 Psychologis t (clinical) 0 0 0 0 0 0 0 0 0 0 0 0 CPO 0 0 0 0 0 0 0 0 0 0 0
RMN 1 2 1 1 1 2 2 1 4 2 1 18 CMHO 1 2 3 3 6 3 1 2 4 1 3 29 Study Leave 0 0 0 0 2 0 1 0 1 1 0 5
Table 33: Summary of Mental Health Conditions by Registrants 2015
Conditions M F T Schizophrenia, schizotypal and delusional disorders 210 135 345 Depression 63 75 138 Bipolar Disorder 9 5 14 Organic Mental Disorder 42 38 80 Epilepsy/Seizures 322 282 604 Neurotic, stress-related and somatoform Disorders 59 79 138 Mental Disorder due to Alcohol use 44 20 64 Mental retardation and other childhood mental disorders 9 12 21 Mental Disorders due to Psychoactive Substance use 42 2 44 Adult Personality and behavioral disorders 14 15 29 Mental Disorders not specified above, others 31 24 55 Pregnancy Related Mental Disorders 0 5 5 Special Clients( Domestic Violence, rape, defilement, Suicides) 0 0 0
Table 34: Summary of Mental Health Cases by Re-attendance 2015
Conditions M F T
51 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Schizophrenia, schizotypal and delusional disorders 1204 1007 2211 Depression 568 712 1280 Bipolar Disorder 34 18 52 Organic Mental Disorder 290 245 535 Epilepsy/Seizures 2623 2230 4853 Neurotic, stress-related and somatoform Disorders 152 125 277 Mental Disorder due to Alcohol use 136 96 232 Mental retardation and other childhood mental disorders 24 42 66 Mental Disorders due to Psychoactive Substance use 208 11 219 Adult Personality and behavioral disorders 59 8 67 Mental Disorders not specified above, others 69 94 163 Pregnancy Related Mental Disorders 0 5 5 Special Clients( Domestic Violence, rape, defilement, Suicides) 0 0 0
Figure 20: Mental Health Client status 2015
Distribution of Mental Health Clients status in Upper West reion 2015
6000 5376
4593
4000
2000
845
692
Number
180
94
58
15
0 0 0 0 0 0 0 0 0 0 0 0 0
7 5 5 5 1 0 New Revisit Referred (in) Rreferred Deaths Defaulted From TFBH From special Admissions Discharges Vagrants Vagrants HTC Clients (out) centres Institutions
M F Client Status
The period saw a total of 845 males against 692 females without any records of deaths and hospital admissions.
52 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 35: Summary of Mental Health Community based activities 2015
Audience Activities Number Reached Community durbars 117 8,316 School health conducted 181 124,686 Home visits 1518 8,808 Health talks 409 18,755 Outreach Clinics 190 13,837 Static Clinics
Service users’ for a 0 0 Clinical meetings 0 0 Traditional and faith based Centre’s visited 0 0
Mental Health Challenges
The rising numbers of vagrants on the streets, Mental health services not well integrated into general/ primary health care, Inconsistent availability of anticonvulsant and antipsychotic medication, Inadequate transportation to carry out home visits , case finding and defaulter tracing.
There is Poor quality of data submitted by lower levels, Absence of a mental health department at the “NEW” regional hospital, the Poor blend of human resource and Human rights abuse and stigma still prominent
Suggestions to address challenges
Solicit support to clear the streets of vagrant mentally ill clients, District targets should be geared towards achieving regional and national targets, Strengthen supportive supervision to district, sub district and CHPS.
There should be advocacy for collaboration with traditional healers, aggressive formation of self-help groups, Operationalize mental health research, and liaison for the constant availability of psychotropic medication
Collaboration with NHIA to register all clients with mental disorders onto the NHIS and effective monitoring and supervision at least once every half year at all levels of care.
Mental Health Outlook for 2016
53 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Plan to fully integrate mental health services into general/primary health care, liaison with appropriate authorities to ensure the new regional hospital has a mental health department.
Plans to educate 20% of the population of the upper west region on mental health related issues, facilitate the formation and inauguration of District mental health subcommittees and visiting committees.
Establishment of mobile crisis and criminal justice teams, Deepen collaboration with stakeholders such as traditional rulers, traditional healers, corporate bodies, department of social welfare, MMDA’s, lobby DDHS/ Med. Supt to plan and budget for mental health activities and then registration of mentally ill clients onto the NHIS
Chapter5: Enhancing Regional capacity for the attainment of the health related MDGs and sustain them
Reproductive and Child Health Services The reproductive and child health unit focuses on mother and child including male involvement in maternal and Child Health Services. The safe motherhood goal is to improve women’s health, reduce morbidity and mortality and contribute to reduction of infant morbidity and mortality.
Components of Safe Motherhood The key components of the Safe motherhood protocol include Antenatal Care, Labor and Delivery, Postnatal care, Family Planning, Prevention and Management of Unsafe Abortion, School Health/Adolescent Health and Public Health Education
Activities carried out in 2015 Trainings
The unit held series of training towards strengthening service provision some of which were; LSS training for midwives and follow-up/onsite coaching on in 3 districts (Sissala East, Nadowli &Wa-West).
Training and follow up/onsite coaching on Implanon/Jadelle insertion and removal in (3) selected districts (Nadowli, Sissala East & Sissala West).
54 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Organized a 5 day training for (30) midwives on family planning for 5 districts, there was also a 5 day training on Implanon insertion and removal for (15) health care providers (midwives, CHNS) drawn from 5 districts different from UNFPA Focused districts.
Training of (10) midwives 0n Safe Motherhood at Nadowli hospital
Comprehensive abortion care and counseling Training for CHNS, master trainers on the new implant (NXT Implanon) 10participants, Clinical staff Training on the new implant-20 participants.
There was LSS training for 12 midwives, 100 staff (CHNs, ENs, and Midwives) on NXT Implanon insertion
Durbars
Organized a durbar to commemorate family planning week celebration and Four (4) Districts
(Wa West, Wa East, Sissala West and Nandom) also organized durbars to commemorate family planning week activities.
Monitoring
Public health safe motherhood facilitative supervision review meeting was held on monitoring visits conducted and districts were monitored to assess selected midwives for award
Radio Discussions
Organized quarterly Radio discussion on obstetric fistula/prematurity
Stock Taking
There was Monthly family planning stock taking throughout the year
Data Validation
Conducted monthly RCH data validation using DHIMS2 data quarterly maternal death audit reviews.
55 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
RCH unit Priorities Build capacity of staff in maternal and neonatal care, monitoring and supervision of maternal and child health activities
Maternal and neonatal death audits and strengthening capacity of institutions to implement audit recommendations by audit committees
Improve communication between facilities and communities with focus on emergency obstetric and neonatal care (EmONC)
Antenatal Care The package of ANC services provided include prevention of Malaria in Pregnancy through chemo prophylaxis, promoting the use of insecticide treated bed nets, iron/foliate supplementation, Tetanus Toxoid Immunization, Haemoglobin laboratory investigation, CT/PMTCT, Education on nutrition, exclusive breast feeding, care of the new born and family planning. It creates an avenue for women and care providers to establish a delivery plan based on needs, resources and circumstances. Figure 21: Trend of Antenatal Coverage in Upper West Region -2003 to 2015
Trend of Antenatal Coverage in Upper West Region -2003 to 2015
100 95 96
94 90 91 92 86 88 86 88 90 85 84 83.1
80 % coverage % 70 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Period cov. Target = 90 Median= 89 56 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Antenatal coverage dropped slightly in 2015 83% (25,659) as compared to previous years as shown in the chart above. From the district performance, it is clear from the distribution that Wa-municipal recorded the
Trend of Proportion of Antenatal mothers registered in 1st trimester in Upper west Region - 2010 to 2015 52.5 54.2 56.4 56.9
60 47.1 51.2 20,000
40
10,000
Cov.
14,417 14,417 14,592 14,592
20 14,130
Number
13,042 13,042
Figure 23: Trend of Proportion of Antenatal mothers registered in 1st trimester
12,050 12,050
11,080 11,080
0 - 2010 2011 2012 2013 2014 2015 No. Cov. Period
Figure 22: Percentage Antenatal Coverage by Districts - 2015 Performance
Percentage Antenatal Coverage by Districts in Upper West Region - 2015 Performance
150 128.7 98.5 75.5 80.3 89 82.5 83.2 100 75.1 59.3 65.5 58.9 63.8 50
% anc anc cov. % 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District highest 128.7% followed by Sissala East with 98.5% and the least Lawra with 63.8%. All others districts recorded values between 64%-82%. There is the need for support from stakeholders especially male’s involvement at all levels to improve upon accessibility of antenatal care.
57 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Registration at first Trimester recoded some improvement over the period. There is ongoing effective home visiting by Community Health Workers, tracing of defaulters and other mechanisms towards improving early Antenatal registration.
Percentage of Antenatal Mothers Registered in 3rd Trimester in Upper West Region - 2010 to 2015 15 3,000
10.2
8.4 8.5
10 7.4 6.4 2,000
6.2
2,387 2,387
5
2,134 2,134 1,000
Number
1,983 1,983
1,925 1,925
coverage
1,614 1,614
1,590 1,590
0 - 2010 2011 2012 2013 2014 2015 No. cov. Period
Figure 24: Percentage of mothers registered in 1st trimester by districts Figure 25: Percentage of Antenatal Mothers Registered in 3rd Trimester in UWR
percentage of mothers registered in 1st trimester in Upper west region - 2015 Performance 80 66.6
63.1 57.4 58.9 52.2 59.5 55.1 58.3 56.9 60 44.4 46.6 50.4 40
20 coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
Early pregnancy registration is very essential in determining birth outcomes in Safe motherhood. From the figure above Wa Municipal recorded the highest of 66.6% (4,038), followed by Daffiama Bussie Issa with 63.1% (679) pregnancies recorded in the 1st trimester. Sissala West and wa East registered below 50% thus 44.4% and 46.6% respectively.
There is the need for intensified health education on early registration to help reduce pregnancy and birth related risks.
However late registration is still significant in the region as it is expected that all pregnant women register their pregnancies early for possible identification of pregnancy related problem and management of complication.
58 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Out of the total ANC 25659 Antenatal registrants 1590 (6.2%) of the women came in the third trimester in 2015.
Distributing this by districts in the figure below Sissala West recorded the highest of 12.1 %
Figure 26: Proportion of Antenatal mothers Registered in their 3rd Trimester by districts (211) though small in absolute numbers.
Wa Municipal recorded the lowest of 3% (181) as reported in the DHIMS2 platform.
Proportion of Antenatal mothers Registered in their 3rd Trimester in Upper West Region - 2015 Performance
20 12.1 9.2 10.9 10 6.1 6.2 4.2 5 5.3 5.2 4.9 5.2 3 coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West 3rd trim 2015 District
59 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
However early adolescent teenage (10-14 year) pregnancy is an area where much focus is placed, though decreasing in trend there is the need to explore more avenues geared towards
Figure 27: Trend of Early Teenage Pregnancy among Antenatal Registrants in UWR
Proportion of early Teenage Pregnancy (10-14 years) among Antenatal mothers in Upper West Region - 2015 Performance
0.6 0.47 0.49 0.47
0.43 0.35 0.34 0.4 0.28 0.22 0.21 0.2 Coverage 0 0 0.04 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District
address these critical risk factors
The distribution above indicates high early teenage pregnancy in Nadowli Kaleo 0.49 (10), Wa West 0.47 (14), Lambussie – Karni 0.49 (7), Wa East 0.43 (12) and Sissala West 0.34 (6) districts.
Trend of Early Teeange Pregnancy Among Antnenatal regitrants in Upper West Region - 2010 to 2015
0.6 0.46 150
0.34
0.4 0.31 0.28 100
115
0.13
0.1 88 80 50
0.2
73
Number
coverage
30 23 0 0 2010 2011 2012 2013 2014 2015 Period No. cov.
Figure 28: Early Teenage Pregnancy (10-14 years) among ANC mothers by districts
Mother’s age above 35+ is a risk factor in assessing quality and risk associated factors. It is worth noting that this is recording and increase in trend from the DHIMS2 data as shown in the figure below with 2015 recording the highest 14% (3,604) women
Further analysis into the district performance to outline factors accounting for the current year performance is shown by districts in the figure below
60 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 29: Trend of Proportion of Antenatal Registrants age 35 + in UWR Trend of Proportion of Antenatal Registrants 35 years and above in Upper West Region - 2010 to 2015
14.5 14 4000
14 13.7 13.3 13.7
3500 13.2 13.1
13.5
3604
3514 3000
3475 Number
coverage 13
3211
3277 3105 12.5 2500 2010 2011 2012 2013 2014 2015
No.Period cov.
All the districts registered at least some significant number of mothers above 35 years getting
Mothers age 35+ Registered at Antenatal in Upper West Region - 2015 Performance
30
16.9 19.2 17.5 20 15.8 14.8 15.2 14 12.9 12.8 13.6 12 11.3
10 Coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District Age 35+ at ANC 2015 Figure 30: Mothers age 35+ Registered at Antenatal by districts in UWR
pregnant with Lawra district recording the highest 19.2% (276) and wa west the least with 11.3% (318).
Antenatal 4+ Visits
61 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The national reproductive health policy recommends that every pregnant woman should make at least a minimum of four visits to the facility before delivery.
Figure 31: Proportion of Mothers making more than 4 Visit sat Antenatal Clinics
The proportion of women who made four plus visits increased slightly from 70.3% (18,232) in 2013 to 72.3% (18,201) in 2014 and down to approximately 70% (17,874) in 2015.
The performance by districts for the period under review reveal that Sissala East reported the highest coverage of 4+ visits by antenatal attendants with a coverage of 96.6% (2,365).
Figure 32: Proportion of mothers making 4+ Antenatal visits by districts in UWR
The least coverage was recorded by Lawra district 45.7% (6, 59) in 2015. Community health officer’s need to intensify education at community level make follow up visits to ensure that the women come for services to make the minimum visits.
Haemoglobin Checked At Registration
62 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Checking of hemoglobin level of pregnant women at registration is necessary to help service providers put in interventions in case of any problems. This package is challenged due to lack of laboratory services at some service points, therefore clients are referred to other facilities. However some women fail to go due to distance and lack of transport or funds and many other
Figure 33: Haemoglobin Check among Antenatal Registrants in UWR
internal and external barriers.
A total of 15039(58.6%) women who had their Hb checked at Registration while 4632 (18.1%) had their Hb checked at 36 weeks during the year under review, a comparative lower performance compared to previous years.
Performance by districts is shown in the figure below with Wa Municipal recording the highest coverage of 97.7% while Wa West covered 8.4% significantly low.
Figure 34: Percentage HB tested among Antenatal Registrants by districts
Anaemia in pregnancy is another risk factor in maternal health the distribution in the figure below outlines the trend of performance over the years
63 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 35: Anaemia among Antennal Registrants and at 36 weeks in UWR
Anaemia situation is not reflecting a very good trend with the current year recording 5,746 (38.2%) at Registration and 1,334 (28.8%) at 36 Weeks compared to 6,092 (36.7%) among registrants and 1469 (22.2%) at 36 weeks in 2014.
Distribution of performance by districts in the figure below reveal high rate of Anaemia among
Figure 36: Percentage clients anaemic at Antenatal Registration by Districts
pregnant women in Nandom 48.9% (622), the lowest being Wa West 4.4% (130).
Anaemia status at 36 weeks distributed by districts in the figure below show high amaemia situation in Wa West 52.9% (45) and the least 5.8% (20) in Sissala East District. The rest of the other districts though higher in numbers, in terms of coverage it is high.
Therefore Wa West, Sissala West, Nandom, Lawra and Jirapa districts should take a critical look.
Anaemia in pregnancy is still high, health staffs need to intensify their education on nutrition and the importance of CETS in the communities. They should try and follow up all clients referred for laboratory investigation and document all results appropriate. To further increase access there is the need to establish laboratories diagnostic centers at all facilities in the region.
64 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 37: Percentage of clients Anaemic at 36 weeks of pregnancy by Districts
Intermittent Preventive Treatment (IPTp) Malaria in pregnancy poses an extensive risk on the mother and her fetus; it may result in abortions, stillbirths, as well as low birth weight babies. Sp administration decreased in coverage from 42%in 2013, to 14%in2014 to 35%in 2015. The low coverage is also as a result of the drug being out of stock for some time now, as a program me drug, districts are waiting for directives from national level. However others have taken the initiative to prescribe for pregnant women to buy. Health staff should do well to explain to clients about the importance of taking the three doses, and also follow up for those who have miss their doses and ensure they finish all the doses. We also need to intensify education on early registration to enable them finish the five doses before they deliver.
Table 36: IPT1
2013 2014 2015 District % % % Absolute Absolute Absolute DBI 689 61 605 43 605 42 JIRAPA 1651 44 977 26 1670 43 LAMBUSSIE 1061 49 1110 50 1157 51 LAWRA 940 46 871 41 975 40 NAD./KALEO 1400 52 1268 48 1288 47 NANDOM 884 39 575 29 1151 58 SISSALA EAST 1561 65 1487 61 1406 57 SISSALA WEST 1177 117 781 37 1242 57 WA EAST 3759 123 2577 83 1874 40 WA MUNICIPAL 1625 36 1105 24 4149 131 WA WEST 1636 48 555 16 1670 47 REG TOTAL 16,383 58 11,911 40 17,187 56
65 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 37: IPT3
2013 2014 2015 Absolute % Absolute % Absolute % DBI 513 46 225 16 454 32 JIRAPA 1466 39 236 6 1115 29 LAMBUSSIE 676 31 394 18 733 32 LAWRA 698 34 324 15 640 26 NAD./KALEO 1076 40 456 17 819 30 NANDOM 832 37 229 12 815 41 SISSALA EAST 1084 45 663 27 840 34 SISSALA WEST 900 89 137 6 679 31 WA EAST 2558 84 1257 40 870 18 WA MUNICIPAL 1148 25 249 5 2976 94 WA WEST 972 28 99 3 747 21 REG TOTAL 11923 42 4269 14 10688 35
Figure 38: IPT1-IPT3 Dropout Rates by districts - 2013 to 2015
Drop-out rate between IPT1-IPT3 ranges from 27% in2013, to64%in 2014 and then 38%in2015 more than the accepted drop-out rate which should be less than 10%. The drop –out could also be due to lack of follow-up of clients to ensure they finish the course.
66 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Skilled Delivery Skilled delivery is one of the key strategies towards achieving reduction and maternal and
Figure 39: Trend of Percentage Skilled Delivery Coverage in UWR
neonatal mortality, by ensuring all birth are managed by skilled health professionals.
Skilled delivery increased steadily from58.2% (17,285) in 2013 to 63.4% (19,204) in 2014 and dropped slightly to 61.9% (19,123) in 2015. The region achieved an approximate 62% coverage, exceeding the annual target of 60%.
Performance by district of the year under review saw Wa Municipal recording 120.7% (5,687) coverage due to referrals from other districts.
The lowest skilled delivery coverage was in Wa East 27.4% (867).
Figure 40: Percentage Skilled Delivery Coverage by Districts
67 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
TBA Delivery Reduction in deliveries by Traditional Births Attendants is receiving some improvement over the years. Dropping from 85 in 2013 to 5% in 2014 and 4% in 2015.
Table 38: TBA delivery by districts for 2013-2015
District 2013 2014 2015 DBI 135 52 31 JIRAPA 212 249 168 LAMBUSSIE 72 90 57 LAWRA 66 52 58 NAD./KALEO 96 47 33 NANDOM 87 57 40 SISSALA EAST 587 389 219 SISSALA WEST 351 334 235 WA EAST 75 61 35 WA MUNICIPAL 807 720 742 WA WEST 493 511 448 REG TOTAL 2981 2562 2066
Still Births Still birth is an indirect measure of quality of management during Pregnancy, Labour and
Figure 41: Trend of Still Births and still birth rates in UWR
Delivery. The region recorded 359 stillbirths‟ in 2013, 366 in 2014 and 308 in 2015.
68 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Though there is a decrease in the Regional still birth rate of approximately 16. Health service providers need to ensure early reporting and effective management during Labour, Delivery and
Figure 42: Still Birth Rate by Districts in Upper West Region - 2015 Performance
Post-partum procedures.
Regional hospital being the referral hospital received clients from neighboring districts recorded the highest rate 28 followed by Nandom with 17 and Jirapa hospitals.
Institutional Maternal Deaths The region recorded 30 institutional maternal deaths during the year under review. All deaths were audited and audit recommendations were implemented.
Figure 43: Trend of Maternal Deaths and Maternal Mortality Ratios in UWR
Though there is a decline, there is still the need for urgent intervention to reduce the ratio further.
69 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The audits revealed that the direct causes of maternal death remain as hemorrhage, severe anemia, sepsis, ectopic pregnancy abortions, eclampsia, haemorrhage and other causes include amniotic fluid embolism, respiratory in sufficient, snake bite and, cardiac arrest and so on.
Statistics show that direct causes accounts for 70% of the causes of maternal deaths
Next steps include; effective monitoring and implementation of Recommendation by maternal audit committees, more Community durbars to address maternal mortality issues targeting all
Figure 44: Maternal Mortality Ratios by Districts
communities.
Distributing by reporting facilities, Regional Hospital recorded the highest 335 (19/) followed by Lawra 281 (3/1,068), Jirapa 181 (4/2,215), Wa West 131 (2/1,524), Sissala West 111 (1/898) and Nandom 57 (1/1,749) details as explained in the chart below
Except for Lambussie, DBI, Nadowli, Sissala East and Wa East all other districts including SawlaTunaKulba contributed to the 30 maternal deaths in the period under review.
Figure 45: Duration of stay of maternal deaths; 2013-2015
25 20 15 10 5 0 <24Hrs 24-72hrs >72hrs-7days >7days Number of Number deaths 2013 17 11 5 3 2014 16 9 4 2 2015 21 5 2 2
70 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 46: Age Distribution of Maternal Death; 2013-2015
Age Distribution
30 25 20 15 10 5 0
10-14yrs 15-19yrs 20-34yrs 35yrs plus Number Number of deaths 2013 0 5 27 6 2014 0 7 18 6 2015 0 2 21 7
The number of death with 24hrs increase in 2015 (21) as against (16) in 2014, and17 in 2013, Women between the ages of 20- 34 years die more than the other age groups as well as women with parity 1,3,4,6 and7
Neonatal Mortality Most of the new born deaths occur within 0-7 days after birth due to inadequate Pediatricians in the region to take care of new born with problems.
Figure 47: Trend of Neonatal Deaths per 1,000 Live births in UWR
71 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
There is increase in neonatal mortality rate from 7.8 (98/17,624) in 2013 to 5.1 (98/19,243) in 2014 and then 7.4 (143/19258) in 2015.
Distributing the current year performance by districts shows Wa municipal recorded the highest 14.1 (80/5,667), followed by Sissala West With 8.9 (8/898), Lawra with 8.4 (9/1,068), Jirapa with 8.1 (18/2,215, Nandom with 6.9 (12/1,749), Nadowli with 6.5 (13/1,987), wa East with 2.3 (2/886) and Daffiama Bussie Issa with 1.3 (1/773). Lambussie, Sissala East and Wa West recorded no neonatal deaths during the period under review
Figure 48: Neonatal Deaths/1,000 live births in UWR by districts
The safe motherhood clinical skills programme trained midwives on the assessment of new born during immediate post-partum and gave out forms which they will use to closely monitor the condition of the mother and baby up to six hours after delivery and we hope if used religiously it will help reduce the new born deaths
Table 39: CAUSES OF NEONATAL DEATHS.
2014 2015 Asphyxia - 96 Asphyxia -100 jaundice - 16 Jaundice - 13 Sepsis of cord -6 Sepsis of cord - 10 Others - 15 Others - 9
72 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Postnatal Care Postpartum period is from delivery up to six weeks. The aim is to maintain the physical and psychological wellbeing of mother and baby, detect complications, treat or refer and counsel
Figure 49: Percentage Postnatal Coverage in Upper West Region from 2003 - 2015
mother on family planning.
Utilization of postnatal services decreased from approximate 76% (22,877) in 2014 to 68% (21,113) in 2015 shown in the distribution below.
Distribution the above current year performance by districts shows that Wa Municipal recorded very high 180.8% (5,728/3,167) beyond the expected Target due to referrals from other facilities. The rest of the other districts coverage was very not encouraging particularly Wa East 34.7% (1,633/4,712 expected deliveries)
PNC within 48 Hours Almost all districts recorded a coverage above 90% with Wa Municipal attaining 99.7% (5,713/5,728), followed by Nadowli with 99.5% (1987/1997), Daffaiama Bussie Issa attained Figure 50: Percentage Postnatal coverage by districts in UWR
Figure 51: Percentage Postnatal coverage within 48 hours after delivery by districts
73 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
99.1% (791/798), Jirapa with 97.5% (2,296/2354), then Lawra with 96.8% (1,084/1,120), then Lambussie with 95.9% (778/811), Sissala East recorded 93.6% (1,811/1,935), then Sissala West with 91.8% (1,025/1,116), wa west covered 84.8% (1,726/2,036). The least coverage was by Wa East 78.3 (1,279/1,633) and Nandom 78.2% (1,240/1,585).
However the proportion of post-partum mothers dosed with Vitamin A is making significant progress over the years increasing from 74.3% in 2013, to 74.3% in 2014 to 83% in 2015
Figure 52: Proportion of Post-partum Mothers dosed with Vitamin A in UWR
Figure 53: Percentage Postpartum mothers dosed with Vit A by districts
Performance by districts for the review period saw wa Municipal with an approximate coverage of 126% (5,932), followed by wa west with 133% (4756) and the least being Lambussie with a coverage of 38.5% (2,093). Shown in the distribution in the figure below
74 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Family Planning
Percentage Family Planning Coverage by Districts in Upper west Region - 2015 Performance
85.4 100 67.2 80 51 59.3 53.1 Figure 5460 Trend 44.2of Family Planning Coverage46.7 in Upper West43.3 Region 44.2 2003 38.8 -2015 41.2 40 26.4 20 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper % F.P F.P % Coverage West West District
This is the method and practices to space, limit family size and prevent unwanted pregnancy as well as STIs. Contraceptives use reduces maternal deaths and improves women’s health. Coverage improved from approximate 51% (91,779) in 2014 to 53% (98,352) in 2015, shown in the distribution below
Distributing the above coverage by districts reveal 85.4% () coverage by Wa Municipal with the lowest being Lambussie – Karni district with 26.4% () apart from Wa Municipal all other districts.
Figure 55: Percentage Family Planning Coverage by Districts
Apart from Wa Municipal and Wa East, none of the districts were able to attain the annual target of 60%.
Contraceptives such as Depo, Implanon, pills, Norigynon, Jadelle, and Condoms continue to be the preferred method over the years. CHOs, midwives and other health staff need to intensify education on the benefit of family planning and also make sure that all devices are available all the time and also counsel clients well to enable them make an inform choice.
Table 40: FP Acceptors by Preferred Methods; for-2013-2015
75 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Methods 2013 2014 2015 Depo 61012 66634 61535 Combined Pill 1388 112 8527 Male Condom 7076 7451 7567 Norigynon 4701 5982 7314 IUD 6 144 177 Jedelle 1815 2064 3201
Trend of Total couples Year of Protection in Uppwer West Region - 2011 to 2015
60000
39554.5 34111 40000 25463.4 19531.4 20893.3
20000 total total CYP 0 2011 2012 2013 2014 2015 Period cyp
Implanon 705 2699 4509 Female condom 17 217 48 Nutural (Cycle Beads) 25 48 45
Figure 56: Trend of Total couples Year of Protection in UWR
Couple Year Protection The couple year protection is a measure of couples that have been protected against unwanted/ unplanned pregnancy coverage increased from 25463.44 in 2013 to 34115 in 2014 and 38986.8 in 2015.
Distributing CYP by districts for the 2015 perfromance shows Wa municipal has the higest followed by Jirapa and Wa East shown below
Figure 57: Total Couples Year of Protection by districts in UWR
76 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Proportion of Adolescents (10-19) Years registered at Antenatal clinics in Upper West Region - 2010 2015 13 4000 12.2
11.5 12 12
11.1
12 10.8
2000
3167
3077 3085
11 2857
2599
2530
Number Coverage 10 0 2010 2011 2012 2013 2014 2015 Figure 58: Proportion of Adolescents (10-19) Years registered at ANC in UWR Period No. cov. Adolescent Health Health facilities are required to have adolescent health corners to peer review, discuss and
facilitate factors pertaining to the reproductive and sexual health of adolescents and young
Total Couples Year of Protection by districts in Upper West region - 2015 Performance
50000 39554.5
40000
30000
20000
8255.9
total CYP
5320.3
3971.3
3863.3
3629.7
3184.9
2727.6
2654
1932.1 2057 10000 1958.4 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District total cyp 2015 adults.
From the trend in the distribution below shows an increase in Adolescent pregnancy with a performance of 12% (3,085/25,659).
77 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Giving the above distribution by districts high adolescent pregnancy in Wa West 15.5%
Proportion of Adolescents (10-19) accepting family planning in Upper West Region - 2012 to 2015 16.3 Figure20 59: Percentage Adolescent Pregnancy (10-19) by districts 14.3 6,000 15 11.7 12.1
4,000
10
2,000 4,005
Coverage 5
3,267
1,315 2,621 0 0 2012 2013 2014 2015 No. cov. Period
(456/2, Figure 60: Proportion of Adolescents (10-19) accepting family planning in UWR 948), Daffiama Bussie Issa 15.3% (165/1,076, Wa East 14.8% (417/2,818) and Nadolwi 14.3% (293/2,050) districts with
Percentage Adolescent Pregnancy (10-19) in Upper west Region - 2015 Performance 20 15.3 14.8 15.5
14.3 13.5 12.7 15 10.9 11.9 11 12 8.8 10 8.3
coverage 5 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District
The above regional coverage Distributed by districts indicates high family planning uptake among adolescents in Sissala East 20.8% (110) and Sissala West 19.2% (208) and Jirapa 17.7% (611). Nandom recorded the least 5.5% (100) the above coverage by districts saw
78 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 61: Proportion of Adolescents (10-19 years) accepting Family Planning by districts
There is the need to intensify our education on family planning for the adolescent, revive the existing adolescent corners to take care of adolescent health issues be friendly so that they can come freely to access the services.
School Health Services The number of school children physically examined was 88492 (85%) in 2015 as against 104,398 in 2014 (102%) a decrease in coverage. Sometimes distance schools are left unattended as well as poor documentation, monitoring of the figures at district and regional levels needs to be strengthened and also to liaising with GES to get correct enrollment figures as well as the
Proportion of Adolescents (10-19 yrs) accepting Family Planning by districts in Upper West Region - 2015 Performance 25 20.8 19.2
17.7 20 15.3 14.2 14.1 14.7 13.4 14 14.3 15 12.9 10 5.5
Coverage 5 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District number of schools as this have been a problem and as such affects school health services.
Table 41: School Health Service; for-2013-2015
No. # No. # No. # District enrolled Examined % enrolled Examined % enrolled Examined % DBI 6184 6759 109 6125 6278 102 1626 2238 138 JIRAPA 4154 9291 224 17129 17105 99.8 22800 17105 75 LAMBUSSIE 6718 9999 149 5855 7929 135 6295 8462 134 LAWRA 7220 3236 45 6066 4006 66 9540 6370 67 NAD./KALEO 10090 11742 108 10733 6858 64 11309 6859 61 NANDOM 2980 12880 432 4437 7782 175 5445 3255 60
79 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
SISSALA EAST 6486 6131 95 7727 7965 103 4585 3914 85 SISSALA WEST 3819 1900 50 1816 1489 82 1531 1227 80 WA EAST 3012 8728 290 3707 7596 205 10044 10377 103 WA MUNICIPAL 32120 15683 49 37814 23841 63 41065 17854 43 WA WEST 7895 6846 87 82222 7697 93.6 11268 17038 151 REG TOTAL 91478 93195 102 104398 107965 103 104160 88492 85
R CH Plans for 2016 Supervision and monitoring
There would be quarterly facilitative supervision/onsite coaching for LSS and Implanon trainees, quarterly maternal and neonatal death audit and follow-up on implementation of audit recommendations, work towards improving upon referral situation, Carry out at least two technical support visits to all districts and if possible to the CBAs and Monitor and assess facilities for district base safe motherhood training
Training/capacity Building
Efforts will be geared towards improving family planning uptake by ensuring commodity availability, more radio discussions on obstetric fistula, Train CHNs/district co-coordinators on adolescent health report format, proposed refresher training for CBAs on case assessment, treatment, logistics management etc and conduct maternal/neonatal death/audit reviews conferences.
Data Management
There would be monthly data validation Carry out monthly/quarterly data validation in DHMS2 and Continue with monthly/quarterly data reconstruction/accuracy exercise in districts and facilities
Collaboration
The unit will hold planning meeting with GES/GHS on the formation of the adolescent clubs and Launch adolescent health clubs in four selected senior high schools
80 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Integrated Community Case Management The World Health Organization (WHO), African Region initiated IMCI implementation among its member countries in 1995. The strategy was adopted by Ghana in 1999 as a key strategy for reducing childhood deaths and improving health of children under five years.
The strategic components include; Case Management, Community IMCI and Improvement in the Health System.
The upper west regional services adopted the aforementioned strategies to promote a core set of household practices to improve child health and development at the household level.
The integrated approach for the sick child is from the fact that, most children present with signs and symptoms relating to more than one condition, a single diagnosis may therefore not be possible or appropriate. As a result, CBAs were trained to handle simple malaria, Diarrhoea and Acute Respiratory tract infection (ARI) at the community level for children below five years.
Concerns at the Beginning of the year The main concerns are shortage of drugs, poor monitoring and supervision, Poor case assessment by CBAs and Inadequate health education carried out by CBAs
Key Activities Carried out Activities carried out were iCCM Review meeting, Bottle Neck Analysis training for all 11 districts form 22nd-24th June, 2015, iCCM Monitoring and data validation to all the districts - 4th-7th August, 2015
Integrated Community Case Management (iCCM) The Community Base Agents (CBAs) are principally to do health education, home visit and early identification of cases at the community level for management and/or referral. Some of the cases the CBAs manage include simple or uncomplicated malaria,diarrhoea and ARI cases in children 2 to 59 monthsusing peadiatric ACT, ORS/zinc and amoxicillin respectively.
Table 42: Malaria cases managed by districts – 2013- 2015
Districts 2013 2014 2015 DBI 998 734 87 Jirapa 1375 1805 976
81 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Lambussie 692 703 612 Lawra 415 381 228 Nadowli 945 1194 1136 Nandom 427 1438 710 Sissala East 232 234 392 Sissala West 591 442 585 Wa East 974 715 365 Wa Municipal 410 652 457 Wa West 2106 3330 987 Regional 9165 11628 6535
The number of malaria cases in children 2 – 59 months seen and managed by the CBAs for the period under review dropped significantly compared to 2014. This is attributed to the inconsistent supply of medicines. A total of 6,535 cases were managed in 2015 as compared to 11,628 cases managed in 2014.
Table 43: Diarrhoea cases managed by districts - 2013 – 2015
Districts 2013 2014 2015 DBI 2144 385 127 Jirapa 2558 1015 208 Lambussie 864 347 387 Lawra 390 161 82 Nadowli 896 353 349 Nandom 276 212 56 Sissala East 355 141 157 Sissala West 522 357 441 Wa East 2317 587 247 Wa Municipal 385 314 289 Wa West 1502 1208 174 Regional 12209 5080 2517
The reported number of diarrhoea cases managed continues to drop from 12209 in 2013 to 5080 in 2014 to 2517 in 2015. It must be added that most of the diarrhoea cases managed were managed using ORS because the supply of zinc has not been consistent.
Table 44: ARI cases managed by districts - 2013 - 2015
Districts 2013 2014 2015 DBI 2461 160 7 Jirapa 836 998 301 Lambussie 277 289 356 Lawra 281 62 72 Nadowli 461 312 406 Nandom 329 200 49 Sissala East 280 88 81
82 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Sissala West 584 398 364 Wa East 602 315 153 Wa Municipal 207 219 433 Wa West 1030 770 260 Regional 7,348 3,811 2,482
Following the shortage of Amoxicillin, affected the number of ARI cases managed every year. Beads and timers were given to CBAs to enable them identify ARI cases and mange. Amoxicillin has been out of stock for about a year among most CBAs. Apart from that some cannot correctly assess a child for ARI let alone to talk about management. They therefore need some refresher training.
Logistics The Regional Health Directorate did not receive any logistics for the year under review though commodity forecasting was done. As a result, most of the CBAs had run out of all the drugs except ORS since the quantities received were not enough. This unfortunately affected their performance in terms of service delivery.
Constraints Some of the major challenges include; poor quality of data in DHIMS2, lack of community support, erratic supply of logistics, poor supervision to CBAs, gradual loss of skills of CBAs in case management, lack of motivation and many others
Recommendation There should be quarterly maternal and neonatal death meetings, quarterly technical support visits to districts, Intensify health education messages, Fresh/refresher training for CHOs/CBAs on iccm, CHOs to follow-up to CBAs to support summarize monthly reports and Liaise with NMCP/UNICEF for drug supply
Expanded Programme on Immunization The major objective of the EPI programme is to increase the coverage of all antigens to at least 95%, reduce the morbidity and mortality, control, eliminate or eradicate vaccine preventable diseases through immunization as an essential component of primary Health Care.
Concerns at the beginning of the year Key challenges at the beginning of the of the year include; inadequate cold chain facilities as a result of frequent breakdown of fridges and solar batteries and some due to aging and power outage, Failure of staff to enter EPI logistics component data into DHIMS2, Internet connectivity a major challenge to data entry and transmission to the next higher level and inadequate transport/fuel allocation for outreach service delivery and monitoring at all levels.
83 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
EPI Activities Carried Out Logistics
Supported districts with immunization logistics and devices (Vaccines, syringes and needles, cotton wool, vaccines carriers and cool boxes etc.), Conducted 2 rounds of cold chain inventory, Provided some facilities with immunization tools and charts for monitoring their monthly performance
Mass Campaigns
Celebrated Child health promotion week alongside with African vaccination week, Conducted one round of Polio (1) SNIDs in September 2015 in ten (10) of our districts, Conducted one round of micro planning and post campaign review at districts, region and also regional team attended national planning & reviews
Training
Benefited from Trainers Training on Bottleneck Analysis Tool (BNA) and further scaled down BNA training for six low performing districts with funding support from UNICEF, Supported all six (6) Districts identified issues using BNA tools and developed strategies to improve immunization coverage.
Monitoring and supervision
Carried out four quarterly monitoring and supervision to the DHMTS/CHPS zones, Conducted on the job training and on-site coaching for some low level staff on calculation of dropout rates, Proper charting of Child Health Record during visit.
Data Quality
Monthly feedbacks were provided to districts and facilities to improve on the data quality and timeliness of reporting and Districts and facilities league table of performance were sent to districts and quarterly basis geared towards improving the data quality.
Achievements In terms of antigen percentage coverage slightly decreased since 2012 possibly due to population denominators and decline in financial support. However, there has been an increase in absolute figures over the same periods.
84 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
BCG In 2015 the regional total eligible children immunized with BCG was 84.4% (26,030) compared
Figure 62: Percentage BCG Coverage in Upper West Region - 2003 to 2015
Percentage BCG coverage by districts in Upper West Region - 2015 Performance 150 136.5
102.4 91.7 83.7 84.3 100 82.9 74.1 74.2 62 66.4 49.6 57.5
50 Coverage
0 Figure 63: PercentageDBI BCGJirapa coverageLambussie byNo LawradistrictsNadowli in UWRNandom Sissala East Sissala West Wa Wa East Wa West Upper West Dat a District with 84.2% (25,485) in 2014 shown in the chart below.
Percentage BCG Coverage in Upper West Region - 2003 to 2015
127.0 127.0
140.0 111.5 35000
105.1
104.7 104.7
98.6
98.3 98.3
95.1
120.0 30000
85.6
84.4 84.4
84.2 84.2
82.7 82.7
77.9
100.0 25000
80.0 20000
60.0 15000
40.0 10000 Number
coverage
-
26,030 26,030
20.0 25,485 5000
24,588 27500 25943
23904 22,715
32970
26376 28,095 25,974 23,596 - 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
No. Cov. Target
Distributing the above coverage by districts indicates a very poor below 50% performance by Lambussie Karni 49.6% (1,129).
Wa Municipal recorded the highest 136.5% (6,433) followed by Sissala East with 102.4% (2,543)
Penta3
85 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Coverage of Penta3 vaccination shows an improvement of three data points from 2012 with a
Figure 64: CoveragePenta3 of coveragePenta3 in Upper by districts West Region in Upper 2003 West - 2014 Region - 2015 performance 120 110.7 Coverage of Penta 3 in Upper West96.1 Region 87.9 2003 - 201494.7 96.3
100 83.7 74.5 75.7 80 86.8166.5 92.83 6487.8 92.4 94 92.266.9 90.8 100.00 55.6 83 81.5 79.5 81.0 83.6 30000
60 72.1
25000
80.00
40
Coverage 60.00 20000
20 28411 No 15000
40.000 24,521
Dat 24,176 10000
22814
23,615 23,615
24,539 24,539
22542
22890
21638
21047
Coverage
21,013 21,013 22,403 20.00 DBI Jirapa Lambussie Lawraa Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper5000 - West West0 2003 2004 2005 2006 2007 2008 District2009 2010 2011 2012 2013 2014 2015 Year No. cov. Target coverage of 83.6% (24,521) in 2015 from 81% (24,539) in 2014.
The above distribution by districts indicate only four districts achieved coverage above the expected target thus Wa municipal attained 110.7% (4,955), followed by Wa West attaining 96.3% (3,291), Sissala East with 96.1% (2,262) and wa East with 94.7% (2,753) coverage.
The least was recorded in Lawra with a coverage of 55.6% (1,289)
Figure 65: Penta3 coverage by districts in Upper West Region - 2015 performance
OPV3 The table below gives summary of OPV3 coverage by districts showing a 79.1% coverage compared to 83.7% Penta3 coverage
2012 2013 2014 2015 District IMM % IMM % IMM % IMM % DBI 1009 73.2 1005 71.3 1012 70.7
Jirapa 2,278 91.9 2379 63.6 2343 61.8 2434 62.7 Lambussie 1,379 95.2 1413 64.6 1520 67.7 1380 60.8 Lawra 2,580 91.2 1412 60 1334 62.1 1293 52.9 Nadowli 2,669 100.9 1903 72.8 1971 73.9 1953 71.9
86 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Nandom 1444 75.3 1279 65.5 1279 64.3
Sissala East 1,902 120 2259 94.4 2448 100 2239 90.1 Sissala West 1,663 119.6 1643 78.3 1809 84.6 1816 83.4 Wa East 2,528 125.1 2554 83.7 2590 83.7 2780 87.8 Wa Mun. 4,312 143.4 4631 102.1 5072 109.7 4955 105.2 Wa West 2,778 121.8 2963 86.1 3161 90.1 3264 91.3 Total 22,089 112.2 23,610 79.5 24,532 81.7 24,405 79.1
Rota2 Table 45: Rota2 Coverage by districts in UWR - 2012 - 2015
Rota 2 2012 Rota 2 2013 Rota 2 2014 Rota 2 2015 District IMM IMM IMM % IMM % IMM % DBI 1057 119.3 967 70.1 1077 76.6 1016 71 Jirapa 2366 93.7 2347 62.7 2422 63.5 2403 61.9 Lambussie 1400 94.9 1415 64.7 1546 69.4 1415 62.3 Lawra 1347 98.4 1392 59.1 1366 63.6 1324 54.2 Nadowli 1933 106.7 1974 75.5 2032 76.2 1953 71.9 Nandom 1288 85.1 1337 69.8 1243 63.6 1265 63.5 Sissala East 2169 134.3 2075 86.7 2403 98.6 2187 88 Sissala West 1984 140.1 1659 79.1 1817 84.6 1839 84.4 Wa East 2466 119.8 2441 80 2526 81.9 2670 84.3 Wa Mun. 4635 151.3 4616 101.7 5116 110.6 5085 107.9 Wa West 2884 124.1 2941 85.4 3031 86.4 3094 86.5 Total 23,529 117.3 23164 78 24579 81.9 24251 78.6 There was a decline in Rota2 coverage for the period under review
PCV-13 3 Table 46: PCV -13 3 Coverage by district in UWR -2012 to 2015
PCV -13 3 2012 PCV -13 3 2013 PCV -13 3 2014 PCV -13 3 2015
District IMM % IMM % IMM % IMM % DBI 1057 119.3 1055 76.5 1005 75.1 1009 74.2 Jirapa 2366 93.7 2366 63.2 2363 65.2 2451 66.4 Lambussie 1400 94.9 1411 64.5 1520 71.8 1380 64 Lawra 1347 98.4 1421 60.4 1355 66.4 1289 55.5 Nadowli 1933 106.7 1911 73.1 2030 80.1 1955 75.8
87 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Nandom 1288 85.1 1297 67.7 1279 68.9 1265 66.9 Sissala East 2169 134.3 2186 91.4 2401 103.7 2262 95.8 Sissala West 1984 140.1 2003 95.5 1799 88.6 1816 87.7 Wa East 2466 119.8 2568 84.2 2581 87.8 2753 91.5 Wa Mun. 4635 151.3 4655 102.6 5072 115.5 4955 110.7 Wa West 2884 124.1 2884 83.8 3165 95 3291 96.9 Total 23,529 117.3 23,757 80 24,570 86.1 24,426 83.3 From performance indicated above, PCV3 coverage is consistent with Penta3
Measles Generally there has been a slight improvement in coverage, the review period recorded 83.3% (24,430) against the previous 80.7% (23,012) in 2014
Figure 66: Measles (0-11 months) Coverage in Upper west Region - 2010 to 2015
Measles (0-11 months) Coverage in Upper west Region - 2010 to 2015 92.2 100.0 86.9 83.0 80.7 83.3 30,000
73.4
80.0
20,000
60.0
40.0
10,000 Number
coverage 20.0
22,415 22,415 24,430 24,430
18,990 18,990
23,012 23,012
20,686 20,544
- - 2,010 2,011 2,012 2,013 2,014 2,015 Period no. cov. Target
Distributing the above performance by districts shows only wa municipal, Sissala East, Wa East S. East, Wa East, Wa Municipal and Wa West could achieved above the 85% coverage.
Figure 67: Performance of Measles (0-11 months) coverage by districts
88 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Performance of Measles (0-11 months) coverage in Upper west Region -2015 Performance 150 110.7 100.3 91.2 86.9 91.5 83.3 100 71.7 69.7 79.6 65.7 56.1 62.3
50 Coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District
Table 47: YF Coverage by District 2012-2015
2012 2013 2014 2015 District IMM % IMM % IMM % IMM % DBI 894 64.8 1003 71.4 967 71.1 Jirapa 2,202 88.9 2196 58.7 2264 59.4 2540 68.8 Lambussie 1,385 95.6 1386 63.4 1469 66 1416 65.7 Lawra 2,644 93.4 1279 54.3 1204 50.2 1283 55.2 Nadowli 2,668 100.8 1801 68.9 1888 70.8 2056 79.7 Nandom 1338 69.8 1154 59.1 1182 62.5 S. East 1,896 119.6 2206 92.2 2185 89.6 2380 100.8 S. West 1,708 122.9 1664 79.3 1671 78.2 1887 91.2 Wa East 2,488 123.1 2491 81.7 2423 78 2625 87.2 Wa Mun 4,012 133.5 4344 95.7 4773 103.2 4958 110.8 Wa West 2,723 119.4 3025 87.9 3039 86.6 3107 91.5 Total 21,726 110.4 22624 76.1 23073 80.4 24401 83.2 The regional performance in the case of Yellow Fever immunization improved from 22, 624 in 2013 to 23,073 in 2014 through to 24,301 in 2015 in almost all districts with the exception of
89 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Lambussie/Karni district which decreased from 1,469 t0 1,416 in the 2015 performances.
TT2+ TT2+ performance for the region has slightly increased with the exception of Jirapa, Lambussie/Karni and Nandom districts which have further decreased from the previous
Coverge of OPV during mass Immunization days in Upper West Region
107.1 107.1
110
104.7
103.7
103.1
102.8
102.7
102.6
102.5
101.7 101.5
105 101.4
100.9 100.9
100.6
100.2
99.6
99.3
98.3 98.3
100 96.4 95 95
coverage 90 85 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West
Sep-14 Oct-Nov-14 coverage as shown in the table below.
Table48: TT2+ Coverage in Upper West Region
2012 2013 2014 2015 District IMM % IMM % IMM % IMM % DBI 609 44.2 762 54.2 859 60 Jirapa 1,725 69.6 1942 51.9 1896 49.7 1734 44.6 Lambussie 1,178 81.4 1183 54.1 862 38.7 763 33.6 Lawra 1,943 68.7 1034 43.9 930 38.8 1082 44.3 Nadowli 2,246 84.9 1650 63.1 1553 58.3 1922 70.8 Nandom 773 40.3 1110 56.8 1094 55 Sissala East 1,732 109.3 1850 77.3 2231 91.5 1902 76.6
Figure 68: Coverage of OPV during mass Immunization days in Upper West Region
Sissala West 1089 78.3 1179 56.2 1236 57.8 1290 59.2 Wa East 1,470 72.7 1355 44.4 1027 33 1395 44 Wa Mun 3,622 120.5 3343 73.7 3710 80.2 4363 92.6 Wa West 1,388 60.9 1512 43.9 1601 45.6 1609 45 Total 16,393 83.3 16430 55.3 16918 55.9 18013 58.4
National Immunization Days Four (4) districts ( Jirapa, Nadowli,Wa East & Wa Municipal) performance in the second round of the 2014 campaign decline from the first round performance of 0.6% ( 84 eligible children of 0-59mths OPV) lower in Jirapa to 4.5% (740 eligible children 0-59mths OPV) highest in Wa East.
90 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Vitamin A Coverage during NIDs
Figure 69: Vitamin A Coverage by Districts Compared - October, 2013 & Oct-Nov, 2014
EPI Challenges A lot of challenges were encountered during the review year period, significant among the among them include;
Transportation difficulties
Almost all districts had most of their motorbikes broken down while the few that were on the road break down almost every time they are in use. This leads to increased running and maintenance cost of service provision the rural populace.
Performance of Vitamin A Coverage during Mass Campaigns in Upper West Region - October
2013 & Oct-Nov. 2014 Compared
150
115
102.6
102.1
101.7
101.6
100.4
100.3
100.5
99.6
98.4
98.1
97.9
96.6 96.6
95.9 95.9
95.2
94.8
93.9
92.4 85.5 100 82.5
50 Coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West West
Oct-13 Oct-Nov-14 Cold Chain/Logistics
Most facilities had their vaccine fridge broken down especially the solar fridges, coupled with the frequent power outage during the year.
91 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The region was also challenge with inadequate tally books and other EPI logistics as the country medical stores was burnt. Therefore facilities at some point in time have to resort to improvised record books to supplement to the schedule.
Improper use of EPI tally booklet at facility level for daily data capture (inadequate documentation of service provided). This let to officers using pieces of papers to do documentation instead of approved sheet insertions until later the region receive some copies from national.
Threat of Disease Outbreaks
The Increasing number of unimmunized children in the region posing future threat of VPD outbreak. There is declining trend of immunization coverage in districts yet high negative dropout rates
Irregular supervision and monitoring of service delivery at the district and facilities level as a result of inadequate funds and resources (e.g. Motor bike & fuel) for regular supervision and monitoring at lower level.
Poor Data Quality
Poor EPI data quality in DHIMS2 e.g. instances where data fields requiring doses are entered as in vials and vice versa.
Cheating the system by only completing forms without actual data is also a serious challenge.
The poor nature of the internet connectivity often a problem coupled with frequent editing and update of the data thus result in DHIMS2 and DVD-MT template disparities.
High Staff attrition
High staff attrition at some sub districts leaving new staff who couldn’t ride motorbikes on their own and those who were not conversant with the vaccinations on the ground affected EPI services.
Strategies to address challenges
Monitoring and Support
The outlook of the EPI unit for the upcoming years is to hold onto writing proposals for funding to support regular supervision to the lower levels, supporting outreach services, Improve on monthly and quarterly monitoring and facilitative supportive supervision to low performing
92 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys sub- districts, Conduct onsite training and coaching to lower levels, Intensify education on data use to improve proper documentation/storage of data,
Ensuring data Quality
Conduct monthly and quarterly data validation with districts staff on, providing monthly feedback on DHIMS2 and produce fact sheet on districts performance,
Capacity Building
Linkage with the DHAs to identify some outreach point and make regular visits to support the staff and give on the job coaching and trainings, Train staff on the on proper usage of DVD and Vaccine report template and ensure its proper from district, The DHAs together with the region to orient staff especially new ones on ways of providing integrated services address the transportation and other services issues, identify some outreach points and make visits to support the staff and give on the job trainings by District officers.
Logistics
The region will liaise up with national and other stakeholders to help address the cold chain situation, continuously impress on national to print EPI tally booklet for use by facilities. Districts to intensify monthly maintenance of motorbikes seriously in order to avoid regular breaking downs.
Malaria Control Programme Ghana has a stable transmission of malaria and all age groups are affected. Plasmodium parasites (P. falciparum, P.ovale, P. malariae) are known to cause malaria in Ghana with Plasmodium falciparum accounts for about 90% malaria cases and also the cause of severe malaria. It is linked with poverty with highest rates seen in countries with extreme poverty (e.g Ghana). Deaths do occur due to the lack of life- saving drugs (ACTs), access to health care and Insecticide treated bed nets.
In 2014, the National Malaria Strategic Plan (2014-2020) was revised to include; diagnostic test required for all suspected malaria cases in all ages at all levels of care (T3 initiative-test, treat track), revision of Antimalarial Drug Policy to include the Use of Injection artesunate for managing severe malaria and Intermittent Preventive Treatment in pregnancy (IPTp) schedule recommended for up to maximum of 7 doses after 16weeks of gestation
93 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Malaria Control Program Goals and Objectives The overall goal of the malaria control program is to facilitate human development by reducing malaria morbidity and mortality burden by 75% (using 2012 as baseline) by the year 2020
The objectives to protect at least 80% of the population with effective malaria prevention interventions by 2020, Provide parasitological diagnosis to all suspected malaria cases and provide prompt and effective treatment to 100% of confirmed malaria cases by 2020, Strengthen and maintain the capacity for programme management, Partnership and coordination to achieve malaria programmatic objectives at all levels of the health care system by 2020,Sstrengthen the systems for surveillance and M&E in order to ensure timely availability of quality, consistent and relevant malaria data at all levels by 2020 and increase awareness and knowledge of the entire population on malaria prevention and control so as to improve uptake and correct use of all interventions by 2020.
Malaria control activities carried out During the review period a series of activities were carried were; the use of Rapid Diagnostic Testing (RDT) of all clinical malaria cases/microscopy, Continuous distribution of long lasting insecticide treated nets (LLINs), Chemoprophylaxis for pregnant women (IPT), Outreach Training and Supportive Supervision (OTSS), training of staff on case management and prescription of ACT to all malaria cases, Implementation of Seasonal Malaria Chemoprevention, BCC initiative for the promotion of RDTs/Microscopy – ISRAD and Indoor Residual Spraying – (Anglo Gold, Agamal)
Logistics Supply and Distribution The region conveyed and distributed malaria medicines to districts and further to the health facilities (RDTs, Sulfadoxine Pyrimethamine etc). However, LLINs were not received from NMCP for continuous distribution strategies to registrants at ANC and Children 18+ at CWC sessions.
LLIN Continuous Distribution Strategies Table49: Total number of Beneficiaries of LLIN continuous distribution exercise per district
LLIN to Children (18+ ) Pregnant Women Districts 2014 2015 2014 2015 Daffiama-Bussie-Issa 848 780 951 856 Jirapa 1,733 1,804 1,401 1,260 Lambussie-Karni 1,221 1,291 1,045 1,039 Lawra 1,314 1,151 1,148 1,154 Nadowli-Kaleo 1,367 1,390 1,094 1,094 Nandom 1,260 1,032 978 639
94 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Sissala East 1,769 1,419 1,695 1,046 Sissala West 1,137 1,464 1,510 1,177 Wa 2,820 2,083 3,854 2,321 Wa East 1,995 1,442 1,921 1,164 Wa West 2,017 1,523 1,304 1,020 Total 17,481 15,379 16,901 12,770
Figure 70: LLIN distribution to target groups by Districts in UWR - 2014 to 2015
LLIN distribution to target groups bt Districts in Upper West Region- 2014 to 2015
8000 6,674
4,856
6000
3,916
3,464
3,321 3,321
3,190
3,134
2,905 2,801
4000 2,728
2,647
2,587
2,574
2,461
2,462
2,438
2,266
2,238
1883
1,867 1799
Number 2000 0 DBI Jirapa Lambussie-K. Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West District 2014 2015
The above distribution gives a percentage regional coverage of 52.5% (34,382) nets were distributed in 2014 against 47.5% (31,150) nets in 2015 compared. The reduction was attributed to the program not receiving LLINs for the period under review.
Malaria Case Management A number of Clinicians (640) / Health Care Providers were trained on effective diagnosis and treatment of cases emphasizing on the review policy on the three (3) “T” approach thus Test, Treat & Track and Rapid Diagnostic Tests kits/Microscopy
A total of 320 CHOs were trained on malaria case management and Integrated Community Case Management (ICCM). CBA’s totaling 670 were trained to revamp their activities since they are the front line health aiders in their respective communities. Their capacities were built in
Figure 71: Trend of Malaria Cases against OPD attendance in Upper West Region
Trend of Malaria Cases against OPD attendance in Upper West Region - 2010 to 2015
1,500,000
1,086,175
957,466
947,782
939,695
855,888
850,659
851,238
814,406 779,868
1,000,000 758,084
598,533 587,025
500,000 Number 0 2010 2011 2012 2013 2014 2015 95
OPD Attendance OPD (malaria) Period Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Trend of Malaria Diagnosis in Upper West Region - 2014 to 2015
600000
400000
200000
489351
273832
433925 373149
399940 213494
Performance 0 Malaria Suspected Suspected Malaria Tested Tested Positive 2014 2015 Indicator
Figure 73: Trend of Malaria Diagnosis in Upper West Region identifying eligible children that require immediate attention
OPD cases due to malaria reduced in 2015 compared to 2014 across the districts. The reduction may be attributed to NHIS services provided to the populace.
Figure 72: Distribution of OPD attendance against OPD Malaria cases by Districts in UWR
The above data gives a tested positivity rate of 68.5% in 2014 against 57.2% in 2015.
Distribution of OPD attendance against OPD Malaria cases by Districts in UWR - 2015
Performance
300,000
193751
176833
200,000
101271
93917
91345
85421
84880
83915
80894
74958
Cases
71371
68573
68072
62637 58461
100,000 54502
52415
46072
44312
43872
38,704 30371
0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West
Malaria cases 2015 OPD 2015
Distributing the above performance by districts for the review period
Figure 74: Malaria Diagnosis by districts - 2015 Performance
96 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The SMC strategy it is believed that death due to malaria among children below the age it is expected to decline though data in the distribution above indicates an increase over previous year
Figure 76: Distribution of Malaria <5 Case Fatality Rate by districts - 2015 performance
Distribution of Malaria <5 Case Fatality Rate by districts in Upper West Region - 2015 performance
Figure 4 75: rend of Children3 Malaria < 5 Case Fatality Rates in Upper West Region - 2002-2015 3 2 0.75 0.87 0.65 0.57 1 0 0 0.4 0.24 0 0 0 0
malaria< CFR 5 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West
Malaria Diagnosis by districts in UWRDistrict - 2015 Performance
100000
82315
78262
47583
47500
45029
44349
40039
39831
38394
37437 36211
50000 33583
31753
29932
28971
27995 27843
25739
24438
24415
23017
21790
20873
20564
20047
19242
19049
18146
16667
15557
Number
12205
11737 10055 0 DBI Jirapa Lambussie-K. Lawra Nadowli-K. Nandom Sissala East Sissala West Wa Wa East Wa West District uncomplicated malaria suspected uncompli malaria suspect tested Malaria Tested Positive
The distribution above indicate the need for an intervention by Jirapa district
Trend of Children Malaria < 5 Case Fatality Rates in Upper West Region - 2002-2015
4 3.1 3.0 2.7 2.7 2.6 2.5 2.4 Inception of Seasonal Malaria Chemoprevention 2 1.6 0.9 0.7 0.76 Missing or 0.44 0.57 No Data cases fatality cases rate 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
< 5 CFR
97 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Sulfadoxine Pyrimethamine to Pregnant Women
Figure 77: Trend of IPTp Coverage in Upper West Region - 2011 - 2015
Trend of IPTp Coverage in Upper West Region - 2011 - 2015
20000 17201
16383
14918
14630
11923
15000 11911
10698
10000 7610
4269
2994
coverage
5000
1008
558
134
0 0 0 IPT 1 IPT 2 IPT 3 IPT 4 IPT 5 2013 2014 2015
There was erratic supply of SP the review period under review but much better than 2014. Intensified health education on early antenatal registration, advocacy for Male involvement including many others should be key strategies.
Malaria out Reach Training and Supportive Supervision (OTSS) This strategy was supported by Malaria Care in partnership with the NMCP with the aim of building the capacity of the health staff in Malaria diagnostics, Treatment, Monitoring and evaluation
Outcome of OTSS Implementation Through OTSS, there is High knowledge on the procedure and use of the RDTs by staff, improved adherence to treatment protocols (malaria and other protocols), Proper storage of all commodities including malaria drugs in all the facilities visited (Good store management) and Physical stock corresponded with the ledger balances
Seasonal Malaria Chemoprevention The Seasonal Malaria Chemoprevention (SMC) is a strategy involving intermittent administration of full treatment courses of an antimalarial medicine during the raining season. It has an objective to maintain therapeutic antimalarial drug (Sulfadoxine–pyrimethamine-amodiaquine) concentrations in the blood to prevent malaria illness during the period of greatest malarial risk. The target population for the program is children 3-59 months in sahel regions
98 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The Objective of SMC is to maintain therapeutic antimalarial drug (Sulfadoxine –pyrimethamine- amodiaquine) concentrations in the blood and prevent malaria illness during the period of greatest malarial risk.
Targeting children 3-59 months of the population in Sahel regions
SMC Activities carried out
Trainings/Meetings
There was regional implementation planning meeting, regional training of trainers (TOT), Orientation of regional staff, District staff and Volunteers training
Social mobilization
There were Radio discussions, Radio announcements, Development of Jingles and airing them on 4 radio stations, Development and hanging of banners in all district at vantage points, Use of mobile van at the regional, district and community levels
Banner Developed for SMC
SMC Implementation Successfully implemented four (4) rounds from July to November, 2015.
99 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 50: Children 3-59 months Dosed during SMC in 2015 using Registered population
Round 1 Round 2 Round 3 Round 4 District # Dosed % # Dosed % # Dosed % # Dosed % DBI 4,481 98.8 4650 93.3 4591 89 4743 86.2 Jirapa 10,608 56.7 10476 92.7 12701 85 11200 93.9 Lambussie-K. 6,233 99.7 6519 95.4 6785 92.7 7025 90.4 Lawra 6,029 98.9 6353 93.7 6639 91.2 6850 92.7 Nadowli-K. 11,173 99.4 8294 92.4 8824 87.8 9699 88.3 Nandom 6,234 98.7 5830 96.1 6287 93.2 6331 94.3 Sis. East 10,700 99.6 12131 100 12070 99 11946 98.4 Sis. West 9,244 88.6 9574 98 10026 98 9689 95.4 Wa East 11,160 98.2 11806 96.3 12583 95.4 12675 95.8 Wa 20,077 98.9 21971 99.5 20660 92.7 20712 95.1 Wa West 15,654 99.2 15778 97.7 16887 98.5 17338 99 Total 111,593 91.6 113,382 96.6 118,053 93.3 118,208 94.5
All the districts in the region were able to achieve the set target of 80% for the program. This was due to the staff zeal and motivation by all as this program is the first of its kind to be implemented in the region and the country Ghana as a whole.
Figure 78: Regional percentage representation of Children dosed during rounds of SMC
% Chn 3- 59 Months Dosed with SMC Medicines in Upper West Region - 2015 98 96.6 94.5
96 93.3 94 91.6
92 Coverage 90 88 SMC 1 SMC 2 SMC 3 SMC 4 Round There regional attained coverage above 90% throughout the rounds of the program with the lowest performance in the first round and round three recording 93.3%
100 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 79: Adverse Drug Reaction during implementation Round 1- 4
No. of ADRs recorded during rounds of SMC implementation in Upper West Region - 2015 110 103 100 90 80 70 56 60 48 50 42 40 Number 30 20 10 0 Round 1 Round 2 Round 3 Round 4 Round
Some reactions were recorded during the implementation but were quickly mobilized to the facilities were these cases were identified. Staff were trained adequately to determine and manage such cases.
BCC initiative for the promotion of RDTs/Microscopy – Institute for Social Research and Development (ISRAD) The region welcomed a new NGO (ISRAD) for the period under review who were into Behaviour Change Communication initiative for the promotion of RDTS/Microscopy usage before treatment. Their program of work was in accordance with the National Malaria Policy of Test, Treat and Track. Activities such as Community durbars in some districts, Video shows, Radio discussions in all the fm stations and house to house education by volunteers were embarked by the team in the region.
Malaria Program Challenges There Is Inadequate RDTS, SP and erratic supply of ICCM commodities eg. Zinc, Amoxy, AA etc, Inappropriate care seeking attitude of some caretakers of children under five years and Attitude
101 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys towards the changing trends in malaria case management - testing and trusting the test results are some of the major setbacks confronting malaria control in the region.
Recommendations
There should be Liaison with National on the regular supply of RDTs and other commodities for ICCM interventions, Continuous IE&C on malaria key interventions, Strengthening facilitative monitoring and supervision to the facility level, Encourage service providers on the 3 “T” and effective collaboration with stakeholders
Ways of addressing malaria control challenges The region to Improve on monitoring and supervision at least ones a quarter, Improve on feedback on monitoring and monthly reports to facilities, Organize review meetings with other stake holders and Plan and budget for malaria control activities.
Nutritional Health Improved nutrition is the platform for progress in health, education, employment, female empowerment, and poverty and inequality reduction. In turn, poverty and inequality, water, sanitation and hygiene, education, food systems, climate change, social protection, and agriculture all have an important impact on nutrition outcomes.
Recently, the importance of good nutrition contributes either directly or indirectly to many morbidities and mortalities in the world over. The result of bad nutrition manifests itself as either over-nutrition or under nutrition which has immediate and far reaching consequences.
The Upper West Regional Health Directorate Nutrition unit seeks to provide timely preventive and curative nutrition services to the vulnerable population particularly children under five years, pregnant and lactating women.
102 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The objectives for the 2015 year period were to help address the challenges and to improve CMAM service performance, scale up training of health staff on Community Infant and Young child Feeding (C-IYCF) practices and CMAM, increase SAM case detection by health staff and Community Volunteers (SAM Treatment Coverage target = 50%), improve on CMAM performance indicators (Target for Cure Rate > 90%; Defaulter Rate < 10% and Death Rate < 5%), intensify mentoring and support visits to facilities on nutrition interventions and conduct monthly excel data validation on nutrition interventions against DHIMS figures.
Key concerns
Major limiting factors is inadequate or weak monitoring to lower levels by district and regional staff, the late entry of nutrition data into DHIMS 2, low case detection at the facility level – Low SAM Coverage (30.6%), Weak monitoring to lower levels by district and regional staff, Sub-standard data collection materials (CMAM Registers and Monitoring Charts), Poor performance of CMAM indicators by some districts and the Poor quality and irregular reporting in the NACS Programme.
Nutrition activities carried out
Training
The unit trained 30 newly posted Nutrition staff and Nutrition Tutors on Out-patient Management of SAM, a total of 66 sub-district in-charges were orientated on Nutrition Interventions, Trained 280 Community Volunteers on SAM case detection and referral, 180 health service providers were trained on Out-patient Management of SAM, then 30 clinical and Nutrition staff were trained from 7 hospitals on CMAM IPC and trained 275 Frontline health staff, selected SHEP coordinators, WIAD and Community Development Officers on C-IYCF Counselling package.
Case search and Monitoring
The unit Conducted Mentoring and On-site Coaching to all facilities implementing C-IYCF, CMAM (OPC & IPC) and other nutrition interventions, conducted two sets of active case search for SAM in 110 communities each, provided mentorship and support visits to frontline staff and other untrained staff at all OPC and IPC sites on CMAM services, and organized Sensitization for communities with high incidence of SAM cases on CMAM and IYCF services.
Growth monitoring and promotion
The main aim of GMP is to monitor the growth pattern of under 5 for detection of early signs of malnutrition and other diseases in order to prevent their effects on health especially from
103 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys conception up to 24 months. Underweight, which is a composite indicator for both acute and chronic malnutrition is the indicator measured under malnutrition during routine growth monitoring and promotion sessions.
Table 51: Children registered and weighed at Growth Promotion sessions in UWR
Registrants 2010 2011 2012 2013 2014 2015 0-11 Months 29,073 22,839 23,455 28,699 25,090 28,415 12-23 Months 9,956 4,974 9,564 9,613 7,068 10,436 24-59 Months 11,057 6,545 9,883 9,826 7,417 10,695 Total Weighed 50,086 34,358 42,902 48,138 39,575 49,546
Table 52: Total children weighed at growth Promotion by attendants in UWR
Attendance 2010 2011 2012 2013 2014 2015 0-11 Months 162,499 153,347 172,292 192,771 202,074 199,037 12-23 Months 137,095 129,511 144,334 157,700 170,348 181,335 24-59 Months 170,379 155,683 173,789 176,728 194,034 209,142 Total Weighed 469,973 438,541 490,415 527,199 566,456 589,514
From the distribution tables above shows increase in numbers over the
Prevalence of underweight among children (GMP) Growth monitoring and promotion is a preventive activity that uses measuring weight and comparing with age to interpret growth. Thus aid communication and interaction of nutritional status with caregiver and helps to generate appropriate actions in order to prevent poor child growth and its associated consequences. Underweight is the most commonly collected growth index and is a composite indicator that does not distinguish between acute and chronic malnutrition. There has been significant
Nutritional Health: Proportion of Children 0-23 months Underweight in UWR 2001 - 2015 34.5 Significant 40 Figure 80: Distribution30.8 of Children 0-23 Months underweight in UWR Improvement over time 26.8 25.5 26.4 24.1 21.8 21.9 20.4 19.3 21.9 20 12.2 13.8 8.9 8
0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 104
% (0-23 mths) Under Weight Median Line = 21.9 Target = < 10 percentage underweight percentage Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys progress in the reduction of the underweight situation in the region with a coverage 7.7 in 2015 indicates positive trend towards combating malnutrition in the region.
The lowest proportion was 2.7 recorded by Lawra which is acceptable and highest was 17.8 in Nadowli which is serious by WHO classification. The regional underweight prevalence is also acceptable as shown in the Performance by districts.
Figure 81: Percentage of children 0-23 months underweight by districts
Percentage of Children 0-23 months Underweight at Static and Outreach points in Upper West Region - 2015 performance 17.8 20 10.1 10.3 8 9.9 8 10 7.1 6.2 7.5 7.5 2.7 3.8 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West
% underweight % West District
Low birth weight (LBW)
Low birth weight (LBW) is weight at birth of less than 2.5 kg (5.5 pounds) irrespective of gestational age. This is based on evidence that infants weighing less than 2,500g (2.5 kg) are approximately 20 times more likely to die compared to heavier babies. An estimated 20 million infants every year are born with low birth weight (LBW; < 2500 g).
The primary causes of LBW are preterm birth (before 37 weeks of gestation), intrauterine growth restriction (IUGR), or a combination of the two. LBW has both short and long-term health consequences like increased mortality and nutrition related non-communicable diseases (NCDs) respectively. Foetal and neonatal morbidity and mortality, repressed growth and cognitive development, chronic diseases like diabetes and respiratory diseases later in life are among the consequences of low birth weight. Reduction of low birth weight forms an important contribution to sustainable development. The indicator is a good synopsis measure of a multifaceted public health problem that includes long-term maternal malnutrition, ill health and poor pregnancy health care. In West Africa, the
105 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys prevalence is about 15.0% though accurate data collection is a big issue in developing countries like ours where coverage for hospital deliveries are low. Regionally, there is a slight decrease in the LBW from 2014 (10.3%) to 2014 (6.1%). However, facility deliveries for the year under review has increase relative to previous years. Below is the individual district performance for 2015. Table 53: Prevalence of Low Birth Weight (LBW)
No of Prevalence of low birth weight Births District 2015 2012 2013 2014 2015 Number % % % No.LBW % Dbi 773 N/A 12.4 11.3 55 7.1 Jirapa 2215 9.6 23.4 10 155 7 Lambussie 747 5.9 31.6 6.7 39 5.2 Lawra 1068 3.4 3.9 11.5 62 5.8 Nadowli-k 1987 2.6 16.2 9.5 121 6.1 Nandom 1749 N/A 3.8 15.4 182 10.4 Sissala east 1744 3.7 9.9 7.8 75 4.3 Sissala west 898 8 18.3 8.9 69 7.7 Wa east 886 9.1 10 9 35 4 Wa muni 5667 11.1 8.2 11.2 303 5.3 Wa west 1524 4.7 9.7 14.6 74 4.9 Region 19258 8.7 8 13.8 1170 6.1
Micronutrient Deficiency Micronutrient deficiency also referred to as “hidden huger”. Prevalence is still high among children, adolescent and women across the globe, though regional and country dichotomies exist. Three micronutrients of public health importance in Ghana are vitamin A, iodine and iron. Supplementation, fortification and food diversification are the approaches the region uses to reduce their contribution on morbidity and mortality especially among the vulnerable groups thus Women in reproductive age and Children less than five years.
Vitamin A supplementation (6-59 Months) Vitamin A deficiency is an important contributor to both morbidity and mortality of children under five years .Improving the vitamin A status of deficient children through supplementation enhances their resistance to disease and can reduce mortality from all causes by approximately 23%. The region recorded 92.3 % coverage during SNID in 2015 and 57.7% through routine supplementation. Though the number of children dosed with vitamin A during SNIDs has reduced relative to 2014, the percentage of children dosed has increased slightly 96.5% against 92.2% in 2015.
106 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 54: Routine Vitamin A Supplementation (6-59months) – 2015
Target (pop. 6-59 2014 Coverage District population Total dosed months - 18%) (%) DBI 35,799 6,444 3,716 57.7 Jirapa 97,125 17,483 7,179 41.1 Lambussie-Karni 56,751 10,215 5,609 54.9 Lawra 61,123 11,002 5,440 49.4 Nadowli-Kaleo 67,903 12,222 7,776 63.6 Nandom 49,766 8,958 3,988 44.5 Sissala East 62,106 11,179 10,420 93.2 Sissala West 54,465 9,804 6,403 65.3 Wa Municipal 117,794 21,203 12,652 59.7 Wa East 79,186 14,254 8,015 56.2 Wa West 89,375 16,088 8,896 55.3 REGION 771,394 138,851 80,094 57.7
Table 55: Children who received At Least One Dose of Vitamin A (SNIDs Performance)
SNIDS District target Children Dosed Coverage (%) 2015 2012 2013 2014 2015 2012 2013 2014 2015 DBI 5,845 N/A 5541 5,367 5,504 N/A 92.4 95.2 94.2 Jirapa 11,848 20,582 9798 11,119 11,230 124.6 82.5 93.9 94.8 Lambussie 9,528 14,565 9337 9,400 8,643 150.9 102.6 100.3 90.7 Lawra 8,924 16,894 8730 8,557 7,961 89.6 100.5 98.4 89.2 Nadowli 11,431 13,533 10505 11,009 10,545 76.7 115 101.6 92.2 Nandom 8,046 N/A 7685 7,981 6,916 N/A 102.1 101.7 86 Sissala e 12,395 9,793 10864 11,526 11,743 92.7 96.6 95.9 94.7 Sissala w 10,684 12,322 9340 9,784 10,172 133 96.6 98.1 95.2 Wa east 15,009 23598 13497 12,837 13,768 133.9 94.8 85.5 91.7 Wa mun. 18034 25201 25,166 80.7 97.9 95.9 * Wa west 21,147 16164 19186 20,129 19,482 106.3 100.4 99.6 92.1 Total 114,856 145,485 129,684 132875 105,964 110.9 98 96.5 92.3 Wa municipal did not take part in SNID because they did not meet the criteria
Postpartum Vitamin A Supplementation
107 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Postpartum vitamin A supplementation by coverage has increased significantly over the years indicated by the coverage in the figure below
Figure 82: trend of Post-partum mothers dosed with Vitamin A in UWR
Proportion of Postpartum Mothers dosed with Vitamin A in Upper West Region from 2003 to 2015 30,000 83 100
74.3 74.3 70.4 64.7 61.4 58.2 58.7 56.2 55.7
20,000 48 48.8 54.2
50
10,000
25,600 25,600
2,950
22507
22076
No. dosed No.
% coverage %
15756 16234
10,111
15640
12,626
8611 14796
6,196 16264 0 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
women Dosed cov. Median =58.5 Target = > 60
Generally, more can be achieved if facilities improve upon documentation, postnatal and supervised deliveries services. With a target of 60% means that Lambussie performed significantly below the expected target with the lowest coverage of 38.5% as indicated in the distribution below.
Figure 83: Postpartum Vitamin Coverage by districts in UWR
Postpartum Mothers dosed with Vit A by districts in UWR -2015 performance 187.3
200 133 150 83 100 61.5 77.1 78.6 78.6 61.8 55.4 38.5 50.1 50.6
50 coverage 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
Iodine Deficiency The most common preventable cause of brain damage is iodine deficiency with more than 2 billion people from 130 countries at risk. It is especially damaging during early pregnancy and
108 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys childhood. Hidden consequences of iodine deficiency disorders (IDD), which can start before birth, endangers children’s mental development and often their very survival. Universal Salt Iodization (USI) is recommended as a safe, cost-effective and sustainable strategy to ensure sufficient intake of iodine by all individuals. USI target of 90% household salt iodization is recommended which is adopted as the target for Ghana.
Activities carried out to achieve universal salt iodization for the year under review was mainly health education. Research was done at the market and household levels to measure level of iodine in the salt. The analysis of the data revealed the level of iodine in the salt is lower at the household level compared to the level at the market. Handling of the salt to prevent the evaporation of iodine is the key message we need to intensify to the populace at the market and household level. Below are the results of the market and household surveys.
Figure 84: Three year household Salt survey report
Results of Household Salt Survey in Upper West Region from 2013 to 2015
100
58 44.2 47.3 50 26.4 32.7 26.3
18.9 18 24 Percentage 0 0PPM <15PPM ≥15PPM 2013 2014 2015
Community-Based Management of Severe Acute Malnutrition (CMAM)
The CMAM outpatient care facilities increased from 208 in 2014 to 280 with inpatient care facilities from 6 to 7, of which only 6 are reporting. The programme is aimed at identifying Severely Acute Malnourished (SAM) children with or without medical complications and rehabilitation. Cases without medical complications are treated at Outpatient Care (OPC) and those with medical complications are managed at the Inpatient Care (IPC) and later referred to continue treatment at the outpatient care. The overall goal of this programme is to reduce under five morbidity and mortality resulting from Severe Acute Malnutrition (SAM). The programme, since its inception has achieved the SPHERE standards for cured, defaulted, died and non-recovery in most of the years, especially for the past 4 years. However, coverage has been generally low, but even with the low coverage, there has been an increase since 2012.
CMAM Admissions and Discharges
109 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Below is the trend of admissions into the CMAM programme from 2012 to 2015. Figure 85: Distribution of CMAM Admissions
DISTRICT 2012 2013 2014 2015 DBI 10 35 35 Jirapa 50 87 124 80 Lambussie 79 97 133 Lawra 81 36 44 77 Nadowli 37 21 56 51 Nandom 63 73 87 Sissala e 48 69 109 Sissala w 38 34 106 Wa east 51 76 108 111 Wa mun. 81 56 97 73 Wa west 181 179 238 164 Region 481 693 975 1026 Note: Districts with blanks indicates they were not providing services at that time A total of 1026 new cases were enrolled into the CMAM programme in the year under review. This was an improvement over subsequent years. The admissions have been increasing over the years because SAM prevalence has been increasing in the region, but case detection has rather been improving with time. It is evident from surveys that the SAM prevalence in the region has been improving: 18% from Multi Indicator Cluster Survey (MICS, 2011) and 1.4% from GHANA Demographic and Health Survey (GDHS, 2014). The increase in the case detection is largely due to the quarterly exhaustive case finding conducted by districts. Frequent home visits by Community Health Workers and other front line staff would go a long way to increase SAM case detection in the ensuing year.
SAM Treatment Coverage
The CMAM programme generally has lower coverage of SAM cases, even though coverage has been increasing. Table 56: SAM Treatment Coverage
DISTRICT 2012 2013 2014 2015 DBI 6.9 23.7 26.9 Jirapa 12.9 22.1 30.9 25.1 Lambusie 34.3 41.4 71.5 Lawra 33.3 14.5 17.4 44.6 Nadowli-K. 13.7 7.6 20 24.4 Nandom 31.2 35.5 45.6 Sissala East 19.1 26.9 53.6 Sissala West 17.2 15.1 59.4 Wa East 16.2 23.7 33 42.8 Wa Municipal 17.3 11.7 19.9 18.9
110 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Wa West 50.9 49.4 64.4 56 REGION 15.7 22.1 30.6 40.6 Note: District with blanks means that particular district was not implementing CMAM that year. SAM treatment coverage is the proportion of SAM cases that receives CMAM services. This is calculated using the population of children 6-59 months, prevalence of SAM and incidence of SAM among the target population within the period under review. The SAM treatment coverage has been increasing thus 15.7% to 2015 40.6%. The increase could partly be attributed to the fact that not all the districts were implementing CMAM in 2012. However, the increase in SAM treatment coverage is largely due to the active case search that was instituted by the region in collaboration with UNICEF. All the districts made gains in their SAM treatment coverage looking at the trend from 2012 to 2015. Sissala West and Lambussie made the highest jump 17.2% in 2013 to 59.4% by sissala west 34.3% in 2013 to 71.5% in 2015 by Lambussie with Sissala West having the highest change in percentage 44.3% compared to Lambussie 30.1%. Three districts thus Jirapa, Wa Municipal and Wa West had a reduction from 2014
Met Need of the CMAM Programme
CMAM Met Need is the extent to which the CMAM programme is meeting the need of the population it is serving. To ensure a maximum impact in CMAM, there is a need to balance both the social and clinical focus. Social focus ensures a population level impact (SAM Treatment Coverage), which focuses on early presentation, access to services and compliance with treatment. Clinical focus ensures individual level impact (Cure Rate), which focuses on efficient diagnosis, effective clinical protocols and effective service delivery.
CMAM Met Need is calculated as the product of the two main quality indicators (Cure Rate and SAM Treatment Coverage). The ideal need for every CMAM programme is to detect all the SAM cases in the population Treatment coverage = 100% and Cure Rate = 100%. In a perfect situation, the met need is 100%.
Table 57: Met Need against Unmet Need in the CMAM programme
2015 performance 2014 Met 2014 Un Cure Rate Met Need District Sam Coverage Un met Need met Need (Target= (Target = (Target = 50%) Need 90%) 45%) DBI 22.7 77.3 88.1 29.8 26.3 73.7 Jirapa 29.2 70.8 97.7 25.1 24.5 75.5 Lambusie-Karni 36.4 63.6 93.7 71.5 67 33
111 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Lawra 15 85 80.3 38 30.5 69.5 Nadowli-Kaleo 16.6 83.4 88.9 22.9 20.4 79.6 Nandom 34 66 90.4 49.7 44.9 55.1 Sissala East 25.6 74.4 92.9 53.6 49.8 50.2 Sissala West 7.6 92.4 91.1 59.4 54.1 45.9 Wa East 28.8 71.2 89.1 41.6 37.1 62.9 Wa Municipal 16.9 83.1 92.6 18.9 17.5 82.5 Wa West 60.1 39.9 92.2 53.3 49.1 50.9 Region 27.4 72.6 91.2 40.6 36.4 63.6
The CMAM programme service need increased from 27.4% in 2014 to 36.4% in 2015 36.4% using 2015 Cure Rate of 91.2% and Treatment Coverage of 40.6%. The increase in the Met Need occurred as a result of a general increase in the treatment coverage in 2015 compared to 2014. Generally, there was no significant change in the cure rate of the various districts. CMAM is a proven intervention and so when protocols are followed, most of the children in the programme will be cured. Only 4 districts were able to meet the target of 45% whiles the remaining 7 districts did not. These are Lambussie 67.0%, Sissala West 54.1%, Sissala East 49.8% and Wa West 49.1%. Nandom district 44.9% almost reached the target. The low met need recorded by most of the districts, which also translated into the regional aggregate could be attributed to the low treatment coverage recorded by the districts. Treatment coverage is one of the most important indicators of how well a service or programme is meeting the need. A service or programme with a high coverage rate and a low cure rate might be better at meeting the need than one with a low coverage rate and a high cure rate.
Discharge Outcomes in the CMAM Programme
The programme managed a total of 1,326 SAM cases in the year under review. 300 out of the total were brought from the previous year and 1026 were new cases. Out of the total SAM cases managed, 976 were treated and discharged. The performance of the programme is broken down into the various indicators as follows: 890 (91.2%) cured, 68 (6.8%) defaulted and 18 (1.4%) died. All districts with the exception of Sissala West, met all the SPHERE standards for Cured (> 75%), Defaulted (< 15%) and Died (< 10%). Sissala West did not do well in the treatment outcomes due to their low admission and high defaulter cases.
Table 58: Treatment Outcomes in the CMAM Programme
% % No. No. No. No. non % Non- DISTRICT Cure Defaulte % Died Cured Defaulted Died recovered recovered rate d
112 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Dbi 37 88.1 3 7.1 2 4.8 0 0 Jirapa 85 97.7 1 1.1 1 1.1 0 0 Lambussie 119 93.7 7 5.5 1 0.8 0 0 Lawra 61 80.3 13 17.1 2 2.6 0 0 Nadowli 32 88.9 3 8.3 1 2.8 0 0 Nandom 75 90.4 3 3.6 4 4.8 1 1.2 Sissala east 91 92.9 7 7.1 0 0 0 0 Sissala west 92 91.1 6 5.9 2 2 1 1 Wa mun. 63 92.6 5 7.4 0 0 0 0 Wa east 82 89.1 9 9.8 1 1.1 0 0 Wa west 153 92.2 9 5.4 4 2.4 0 0 Region 890 91.2 66 6.8 18 1.8 2 0.2
CMAM Performance Indicators
Cured Rate:
A SAM case is discharged as cured when the MUAC measurement reads at least 12.5cm for three continuous visits. The region has since 2011 been achieving the SPHERE Standard for cured cases. There was an increase in cure rate from 85.8% in 2013 to 89.7% 2014 and 91.2% in 2015. Cure rate increased in all districts with the exception of Lawra, Nadowli and Sissala West which had lower cure rates in 2014 compared to the previous years.
Figure 86: CMAM Cure rates in UWR
Trend of CMAM cure rate in Upper West Region 2012 to 2015
100.0 91.2 85.5 89.7 91.2
50.0 rate
0.0 2012 2013 2014 2015
Cure rate target= 75
113 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 87: CMAM cure rate by districts
Distribution of CMAM cure rate in UWR -2015 Performance 150 97.7 93.7 88.9 90.4 92.9 91.1 92.6 89.1 92.2 91.2 100 88.1 80.3
50 cure rate cure 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala Sissala Wa Wa East Wa West Upper East West West District
Defaulter Rate Defaulter cases in the CMAM programme are cases that absent themselves from outpatient sessions for three continuous visits. The defaulter rate for the region decreased from 5.9% in
2012 to 6.8% in 2015. In all cases the SPHERE Standard of less than 15% was achieved. Lawra district has consistently recorded high defaulter rate for the past three years. Greater attention should be directed to Lawra facilities to improve quality of services delivered.
114 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 88: CMAM Defaulter rates in UWR
Trend of CMAM Defaulter rate in Upper West Region - 2012 to 2015
20.0 15.0 11.8 8.0 10.0 5.9 6.8 5.0
deaulterrate 0.0 2012 2013 2014 2015 Period Defaulter rate target= 15
Figure 89: CMAM Defaulter rate by districts in UWR
CMAM Defaulter rate by districts in UWR - 2015 Performance
20 17.1
8.3 9.8 10 7.1 7.1 5.9 7.4 6.8 5.5 3.6 5.4 1.1
Defaulterrate 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West Upper West District
Death Rate The target for death rate in the CMAM programme is < 10% and all districts achieved the target. Death rate has been on the decline from 2012 to 2015 in almost all districts. The region did not record a significant decrease in the death rate comparing 2.5% in 2012 and 1.8% in 2015.
115 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 90: Trend of CMAM death rate in UWR
Trend pf CMAM death rate in Upper West Region form 2012 to 2015
15.0
10.0
5.0 2.5 1.2 1.9 1.8 deathrate 0.0 2012 2013 2014 2015
CMAM Death rate Target =10
Distributing the 2015 performance by districts shows Daffiama Bussie Issa and Nandom districts recorded high cases of deaths 4.8 respectively, with Sissal East and Wa Muicipal recording no deaths for the period.
Figure 91: CMAM Death rate by districts in UWR
Community Management of Acute malnutrition Death rate by districts in UWR - 2015 performance 6 4.8 4.8 5 4 2.6 2.8 2.4 3 2 1.8 2 1.1 0.8 1.1
Death rate Death 1 0.0 0.00 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West Upper West West District
116 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Nutrition Assessment, Counseling and Support (NACS)
Persons living with HIV and/or TB are highly susceptible to infections and high energy expenditure. These predispose them to symptoms like weight loss, loss of muscle tissue and body fat, vitamin deficiencies and reduced immune function and competence.
Nutrition care and support for people living with HIV and/or TB can improve nutritional status, ensure adequate food intake, and enhance quality of life. Nutrition care and support includes assessment, counseling, interventions, and follow-up. These interventions enable care providers to counsel clients on how to improve diet, manage symptoms, and avoid infections. It also targets malnourished clients for therapeutic and supplementary feeding.
Supplementary Feeding Programme (SFP) The supplementary feeding programme is a community-based programme supported by the World Food Programme (WFP) and technical support from Ghana Health Service. The programme targets deprived, vulnerable and disadvantaged population groups to improve household food availability, food safety, and other food-based approaches to address malnutrition including micronutrient deficiencies. The package includes take home ration for pregnant and lactating mothers and People Living with HIV.
The food support to the vulnerable groups targets clients with moderate Acute Malnutrition (MAM) for the TSFP, but the support for PLHIV is spread to cover all clients even though it was originally supposed to be for PLHIV who are MAM. This is to ensure compliance to treatment by all the PLHIV clients, since some of the clients refused to adhere to the scheduled ART sessions because they were not included previously in the food support.
Infant and Young Child Nutrition (IYCN) Major cause of under nutrition among children under five years globally and in the Upper West Region is the Poor infant and young child feeding practices, coupled with poor maternal and child care practices. Therefore accelerating interventions aimed at improving infant and young child feeding (IYCF) at community level is a key priority in the effort to improve survival, growth, and development of children. However, in many communities IYCF practices remain far from optimal. Caregivers often lack the practical support, one-to-one counseling and correct information. Community-based IYCF counseling and support can play an important role in improving these practices: it can ensure access to these services in the poorest and the most vulnerable communities with limited access to health care, and therefore become an important strategy for programming with an equity focus.
117 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
UNICEF recently developed a new set of generic tools for programming and capacity development on community based IYCF counseling. Aimed for use in diverse country contexts, the package of tools guides local adaptation, design, planning and implementation of community based IYCF counseling and support services at scale. It contains training tools to equip community workers (CWs), using an interactive and experiential adult learning approach, with relevant knowledge and skills on the recommended breastfeeding and complementary feeding practices for children from 0 up to 24 months, enhance their counseling, problem solving, negotiation and communication skills, and prepare them to effectively use the related counseling tools and job aids.
Counseling of women is one-on-one interaction with women to discuss IYCF practices and challenges, and support them in finding solutions to the identified challenges. IYCF counseling is normally given to women from pregnancy until their children turn 24 months.
In 2015, a total of 42,021 women were given IYCF counseling across the region. A total of 2,159 IYCF Support groups were formed and all of them were facilitated on IYCF modules. The action- oriented group discussion strategy was adopted by the counselors to facilitate 1,735 discussions at the community level. Wa East(7245) Jirapa (5921), Wa Municipal (6697) and DBI (4944) counseled more women on IYCF practices with Wa East recording the highest.
Table 59: Infant and Young Child Feeding Activities Carried Out
IYCF Support Group Action-Oriented District # Women # of Groups # of Groups Group (# of groups Counseled Formed Facilitated Facilitated) DBI 4,944 70 348 311 Jirapa 5,921 178 363 166 Lambussie 3,071 51 118 68 Lawra 385 129 93 35 Nadowli 2,812 274 295 178 Nandom 1,554 96 73 62 Sissala east 2,390 160 176 109 Sissala west 4,795 378 300 209 Wa east 7,245 367 398 328 Wa municipal 6,697 218 8 137 Wa west 2,207 238 222 132 Region 42,021 2,159 2,394 1,735
118 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Collaboration
The Regional Health Directorate through the Nutrition Unit collaborated with sister organizations to scale up nutrition interventions in the region.
UN-REACH Collaborated to organise regional nutrition review and planning meeting through the Nutrition Coordination Mechanism instituted in the region with RCC.
DA Collaborated with MEDA to sensitize selected frontline health staff and MEDA Key Facilitating Partners (KFPs) on Community IYCF for them to organise sensitization for MEDA lead farmers in implementing districts
IITA/UDS Project Supported the organisation of IYCF training for health staff and volunteers from Wa West and Nadowli districts.
Challenges
Challenges that militated against the implementation of nutrition interventions in the region in the year under review conflicting unplanned national programmes, inadequate collaboration with Ghana School Feeding Programme (GSFP), Internal Transfer of health staff without considering equitable distribution of staff trained in specific interventions, Inadequate trained staff to manage SAM cases at CMAM OPC and IPC.
There is slow pace in the implementation of IYCF services at facility level, non-availability of standard data collection tools (registers) for nutrition data collection especially, CMAM and IYCF programmes, difficulty in teasing out children 6-59 months dosed with at least one dose of vitamin leading to doubled counting.
There is the problem of districts mostly transmitting nutrition data without analyzing, interpreting and using it for decision making, frontline staff not very sensitive towards passive SAM case search, Infrequent submission and poor quality of NACS report by facilities and delays in the release of funds (internal and external) to carry out planned activities.
119 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Strategies to address challenges
The unit would Improvise registers for data capture, facilitate the implementation of C-IYCF services in all facilities, to allocate trained IYCF Counselors to IYCF Facilitators to mentor throughout the year, to allocate pregnant women and women with children (0-23) to trained IYCF Counselors to guaranteed essential service delivery to them, coaching of facility staff to capture Vitamin A doses as Vitamin A1 and Vitamin A2 in order not to count some of the children twice at the end of the year. There is need to coach facility staff to monitor/chart IYCF services delivered to caregivers, districts to submit monthly reports on CMAM treatment coverage in addition to the other performance indicators, conduct quarterly active case search to detect SAM children, conduct CMAM and IYCF trainings for frontline staff and Volunteers, collaborate with MEDA to organize C-IYCF sensitization for MEDA lead farmers in their implementing districts, lobby for printing of standard registers for C-IYCF services and increase regional and district support visits to frontline staff and Community Volunteers.
Tuberculosis Control The objective of the Tuberculosis Control Programme is to decrease morbidity and mortality due to tuberculosis. This is attained through universal case detection of existing cases based on population.
The 2013 Prevalence survey findings peg the disease burden at an estimated 290 cases per every 100,000 population which suggests that there is much higher TB burden than has been targeted over the years.
The strategy is taking a paradigm shift to ‘End TB‟ to be achieved by ‟90-90-90‟ Approach; which requires at least 90% detection of existing TB cases, 90% treatment success and 90% reaching of Key Affected Populations.
The strategies employed by the region include implementation of SOPs for case detection with particular focus on facility-based case detection with emphasis on MDR-TB, building of capacity to diagnose, manage cases and provision of adequate logistics.
120 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 60: Funds and Logistics received for Tuberculosis Activities
Description Amount Living Support for TB clients and Health staff Ghs 9,701.00 New Funding Model (NSP) Interventions Ghs121,880.00 Living Support for Paediatric Ghs 1,680.00 Living Support for MDR-TB Ghs 5,000.00 Desktop computers and accessories for NFM implementing districts 3
Key Concerns
The issue of low case detection, poor documentation of activities, weak monitoring and supervision at lower levels, late receipt of result from samples sent to national for suspected Multi Drug Resistant TB and data inconsistencies in DHIMS2 were the major priorities.
Activities carried out Collaboration Conducted end of year and first quarter review meetings with stakeholders, successfully held two integrated support visits to all districts and a dissemination meeting on New Concept Note on TB and HIV.
Monitoring
There were four onsite coaching on TB microscopy for laboratory staff as well as collection of slides for quality improvement to 18 diagnostic facilities, carried out two pre-visits with national to three TB high burden districts thus Wa Municipal, Lawra and Sissala East towards high impact interventions and financial monitoring to all BMCs to collate financial returns for the programme
Training
There was orientation of health staff on NSP interventions, Sensitization of health staff and clinicians on MDR-TB.
Case Search
Screened 61 presumed cases of MDR-TB; three turn out to Rifampicin resistant, successfully initiated three confirmed MDR-TB clients onto treatment and Follow-up visits to MDR-TB cases and contacts.
121 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 61: Trend Analysis of TB Indicators
Indicator 2010 2011 2012 2013 2014 2015 Expected Targets 1425 758 773 683 696 2237 Case Notification 270 283 316 328 307 343 Percentage of target achieved 19 37 41 48 44 15.3 Positive cases 152 167 169 156 198 229 Cure rate (%) 61 62 68 71 70.3 72 Treatment success (%) 74 75 83 88 87 87 Death rate (%) 14.1 8.1 12 11.9 11.1 Failure rate (%) 3.3 1.8 1.6 1.5 0 Defaulter (%) 8.9 3.5 3.8 1.2 2
*Case Notification target has been reviewed by NTP from 92 per 100,000 population in 2014 to 290 per 100,000 population based on 2013 Prevalence Survey.
Table 62: Categories of TB Cases reported by Districts: 2015
Return New Treatme After Pulmona Extra Smea Smear Othe District Relaps nt After Lost to ry Smear Pulmon r not Total Positiv r e Failure Follow- Negative ary TB done e up DBI 6 1 0 0 0 0 0 0 7 Jirapa 20 0 0 0 9 2 2 1 34 Lambussie 26 0 1 0 0 0 0 0 27 Lawra 19 1 0 0 8 5 0 1 34 Nadowli-Kaleo 29 0 0 1 13 0 0 1 44 Nandom 30 2 1 0 3 4 0 0 40 Sissala East 12 0 0 0 1 3 0 0 16 Sissala West 2 1 0 0 0 0 0 0 3 Wa East 10 0 0 0 0 0 0 0 10 Wa Municipal 9 0 0 0 0 0 0 0 9 Wa West 23 1 0 0 0 0 0 0 24 Regional Hosp. 50 5 5 2 25 14 2 1 104 Region 235 11 7 3 57 20 4 4 352
122 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 63: Trend of TB Notification all cases
Trend of Tuberculosis Case Notification in Upper West Region 2003 - 2015 Global Fund Round 10 in
400 Global Fund Round 5 in 2005 2010 343 316 328 307 200 270 283 218 234 230
208 181 183 204 casesnotified 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Cases All forms
The above current year 343 cases distributed by districts shows Regional hospital recorded the highest 104 cases followed by Nadowli with 44 cases. The least recorded was 2 from Sissala West District
Table 64: Tuberculosis all cases by Districts
Tuberculosis all cases by Districts in UWR- 2015 Performance 120 104
100
80 60 44 34 33 40 40 28 TBcases 14 12 19 20 8 2 5 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Reg. Wa East Wa West West Hospital District
123 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 65: Treatment Outcome of All Cases Recorded in 2014
No. of Lost to Completed Cure Success Adverse District Cases Cured Died Follow- Failed Treatment Rate Rate Outcomes (2014) up
Daffiama-Bussie-Issa 3 3 0 0 0 0 100 100 0
Jirapa 32 17 4 10 1 0 70.8 66 34.4
Lambussie-Karni 18 15 0 2 1 0 83.3 83 16.7
Lawra 29 16 12 1 0 0 84.2 97 3.4
Nadowli-Kaleo 28 4 24 0 0 0 21.1 100 0
Nandom 40 9 22 7 2 0 40.9 78 22.5
Sissala East 18 7 8 3 0 0 63.6 83 16.7
Sissala West 10 6 3 1 0 0 75 90 10
Wa East 6 6 0 0 0 0 100 100 0
Wa Municipal 9 6 3 0 0 0 66.7 100 0
Wa West 18 14 4 0 0 0 77.8 100 0
Regional Hospital 96 47 37 10 2 0 83.9 88 12.5
Region 307 150 117 34 6 0 70.4 87 13
The overall death rate for cases recorded in 2014 cases Jirapa has been leading records.
It is disturbing to note that Nadowli-Kaleo recorded as low as 21% cure rate and Nandom recorded 53%. However, the absence of microscopy does not actually convey the good picture of treatment success even if all the cases complete treatment.
Multi-Drug Resistance The region intensified its alertness on MDR-TB and so conducted sensitization for district and health facility staffs. Algorithm on eligibility for Gene Xpert test was disseminated and emphasis was laid on collecting sputum from all follow up smear positive results. Screening HIV clients with Gene Xpert was initiated. However the issue of transporting samples to Accra for Culture and DST is a major challenge.
In all, 61 persons were presumed to have MDR-TB and therefore screened with the use of Gene Xpert and as a result, we had 4 Rif resistance. Samples were further picked and forwarded for Culture and DST while we commenced the second line medication for three of them.
124 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
On the 15th of April, 2015, a four member team comprising the Regional TB coordinator, Institutional
TB coordinator, a Health promotion officer and service personnel conducted a follow-up on a TB patient who was treated in 2013 and relapsed in 2014 with positive smear. She was put on re-treatment but sputum never get converted at each stipulated time of sputum examination and so her sputum sample was taken for molecular and culture test at Chest Clinic, Korle-Bu on 16th February, 2015 and confirmed to be multi-drug resistance TB.
The immediate contacts were the mother and three junior brothers whose ages were 8, 10 and 12 years respectively. They were all screened, sputum sample collected and results were negative.
In the meantime patient routine first line treatment has been stop while waiting to receive treatment for MDR from National.
Table 66: Regional Multi-Drug Resistance Management Team
No. Name Facility Responsibility Contact 1 Dr. Mathias Tengan Regional Hospital Referral Clinician 209194278 2 Mintah Yeboah RHA TB Coordinator 0249443932 / 207447127 3 Aabalekuu Simon Regional Hospital TB Coordinator 207447446 4 Faustina Salifu Regional Hospital Inst.TB Coordinator 206351762 5 Felix Berewono RHA HIV Coordinator 248961266 6 Afful Emmanuel Regional Hospital Pharmacist 201704729 7 Alhassan Abdul-Nasir Regional Hospital Lab TB focal person 203663590
Quality Assurance on Microscopy
The region has 21 diagnostic facilities 15 facilities visited doing sputum smear microscopy. The
region supported all the newly constructed polyclinics including Daffiama and Wellembelle to commence diagnostic services.
Findings on quality Assurance
It was realized that 85% of TB request forms were filled completely with 90% accuracy. Missing
data on request forms was mainly house address or contact of patient. 92% of the lab registers
were filled completely with 85% accuracy. The other details that were missing were the
125 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
signature of the laboratory staff to authenticate results entered in the register and 13.3% did not report their positive cases in red ink.
On the part of logistics 80 % of the diagnostic Centre’s had adequate volumes of TB reagents with full complement of laboratory supplies needed for TB microscopy, 80% of diagnostic
centers had their reagents properly labelled and within the expiry date and 20 % neither indicated date of preparation nor expiry dates making it difficult to tell when the reagents actually expires.
Assessing the bio safety level of the diagnostic centers, 50% including all the recently commissioned polyclinics do not have the appropriate bio safety level/ standard to support
sputum smear preparation and staining, 95% had a clean environment, 50% had good
ventilation at places where sputum smears were prepared and 60 % had a separate area for
smear preparation and staining, 38% of the centers are still not using the appropriate disinfectants needed for TB work in the Laboratory.
All diagnostic centers stored their microscopes well protected from high humidity and 100% had clean lens for good microscopy. However apart from the regional Hospital, there is no documented evidence of microscope maintenance in any of the laboratories. Only 33.3% of diagnostic centers performed and documented internal quality control procedures.
Diagnostic Centre’s with slides accurately filed in slide boxes in accordance with entries in the register was 80 %.
All the facilities had qualified personnel with competence in ZN staining technique and microscopy, but mostly lack competence in fluorescent microscopy.
Table 67: The overall performance of diagnostic centers.
Sputum Staining Cleanliness Thickness Size Evenness Average Laboratory quality (%) Good (%) Good (%) Good (%) Good (%) Good (%) Good (%) Reg Hosp 80 93 60 80 93 53 76.5 Nadowli 73 87 87 87 87 67 81.3 Jirapa 73 80 67 67 87 87 76.8 Lawra 53 67 53 73 100 53 66.8 Nandom 20 67 13 40 80 67 47.8
126 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Funsi 77 77 69 77 100 77 79.5 Average 62.7 78.5 58.2 70.7 91.2 67.3 71.5 Challenges
There is data inconsistencies with DHIMS2, Irregular internet service to verify reports, Shortage of some logistics – e.g. Gene Xpert cartridge, Transport of specimen to Korle-Bu Chest Clinic as well as delay in release of results and the High cost of monthly laboratory investigations for the MDR-TB case on treatment
Suggestions to address challenges
There is need to intensify EQA supervision to improve the Quality of TB microscopy services, Continuous surveillance on probable Drug Resistance, intensified monthly data validation, rroutine facilitative supervision to facilities including the private facilities and enforcement of community-based TB Care to improve treatment outcomes
HIV, AIDS and STI Control The objectives of the Programme are to decrease the spread of infection, properly manage Sexually Transmitted Infections (STI), and decrease the impact of positive HIV status on the individuals, families and communities. The target is to achieve 90% coverage in PMTCT, HIV Pregnant women on ART and Early Infant Diagnosis (EID) service provision
During the period under review, the focus was on the unstable prevalence rates, inadequate counselors/prescribers in facilities and the Poor access to ARVs by pregnant women hence the need for PMTCT scale up
Activities carried out The unit carried out three integrated monitoring to all districts and some selected facilities. Held one Data managers quarterly data validation meeting, Held four TB/ HIV review meetings with DDHS, biomedical scientist, districts and facility coordinators etc. Dissemination of 2013 HSS Reports to districts, facilities and Stakeholders, Conducted training on HTC/PMTCT /EID for 142 staff in the region and Conducted HIV Sentinel Survey for 2014
127 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
HTC/PMTCT service data
There have been an increase in client load over same period last year. Positive clients were linked to ART sites for further management. It was realized that most clients referred did not report at the receiving facility. The client load for the period under review is as below:
Table 68: HTC Service Data by Sex- Annual 2013 - 2015, UWR
2013 2014 2015 Category M F Total M F Total M F Total # given Pre-test Information 2119 3055 5174 2947 4162 7109 3892 5707 9599 # Tested 2104 2933 5037 2915 4129 7044 3779 5558 9337 # Positive 172 525 697 179 237 416 195 280 475 # Post-test Counselled 1948 2781 4729 2716 3820 6536 3666 5357 9023 % Tested 99.3 96.0 97.4 98.9 99.2 99.1 97.1 97.4 97.3 % Positive 8.2 17.9 13.8 6.1 5.7 5.9 5.2 5.0 5.1
Though there has been an increase in numbers tested from 7,044 to 9,337 in 2015, there is a reduction in the percentage coverage as shown in the table above. The region conducted fresh and refresher training for staff who were of help in increasing the number tested.
Table 69: PMTCT Service Data, Annual 2013-2015 UWR
Category 2013 2014 2015 ANC Registrants 26,054 25,577 25,659 No of clients Tested for HIV 21,576 21,690 22,139 % Tested 82.81 84.80 86.28 No positive for HIV 167 124 126 Positivity rate 0.8 0.6 0.6 No Post- test counselled for HIV 20817 20912 22139 No screened for Syphilis 18306 12503 17434 No Positive for Syphilis 99 119 185 No Treated for Syphilis 96 89 102
Health promotion activities are on-going to promote safe sex practices to reduce the spread of the infection in the region. More staff have also been trained and refreshed to improve on the
128 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys coverage of PMTCT in the region.
Antiretroviral Therapy All the hospitals in the region provide ART services. The client load is as below:
Table70: Clients on HAART, Annual 2014– 2015, UWR
2014 2015 Adults Paediatric Adults Paediatric Indicators Total Total Male Female Male Female Male Female Male Female # on clinical care 110 207 13 7 337 174 284 11 16 485 No Screened for TB 364 1,265 37 37 1,703 509 1,604 34 28 2,175 # on ART 87 227 5 7 326 146 320 7 7 480 # with change 4 0 of regimen 3 1 0 0 0 0 0 0 No. of deaths 24 32 1 0 57 15 35 0 0 50 # lost to follow-up 53 153 0 1 207 69 209 0 0 278 # on second line 0 0 0 0 0 4 6 0 0 10 # New clients on co-trim. 95 161 10 6 272 141 203 9 15 368 Prophylaxis
There is still a challenge of lost to follow up as clients provide addresses and phone numbers that are untraceable. More clients were enrolled to care in 2015 compared to 2014
Opportunistic Infections (OI) A total number of 597 clients with Opportunistic Infections were treated in the year 2015 compared to 323 in 2014 and 6,673 in 2013
People Living with HIV Association (PLHIV) There are 20 PLHIV associations in the region. These associations hold monthly meetings on Saturdays in the month. One meeting was held with the executives of the associations to discuss issues relating to election of new executives, NHIS and accessing care. During meetings membership are advised to avoid stigma among themselves.
HIV Sentinel Survey (HSS) The prevalence of HIV infection was 1.2% in 2012, 0.8% in 2013 and 1.3% in 2014. In the trend
129 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys analysis, the region is in an unstable HIV prevalence state among pregnant women as seen below:
Site 2006 2007 2008 2009 2010 2011 2012 2013 2014 Jirapa 3.5 1.4 2 4.5 1.4 1 0.8 0.6 1.5 Wa 3.2 5.8 2 2 2 0.8 1.8 1.4 1.1 Nadowli 0.7 1.9 0.3 2.6 1.6 1.2 0.8 0.5 HIV prevalence among preg. women 3.2 2.6 2.2 2.9 2 2.1 2.1 1.9 1.6 HIV prevalence among adult pop. 1.9 1.7 1.9 1.5 1.5 1.37 1.3 1.3 Upper West RegionHIV Prevalence2.5 rates3.3 from HIV1.6 Sentinel 3.1 Survey1.7 in UWR1 2004 1.2- 2014 0.8 1.3
4 3.3 3.1 2.6 2.5 3 2.1 1.7 1.6 1.7 2 1.2 1.3 1.3 1.0 0.8 1
Prevlalence rtae Prevlalence 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Prevalence rate (HSS) Median Prevalence = 1.7 Linear (Prevalence rate (HSS))
Figure 92: Trend of HIV Prevalence rates in UWR Table71: HIV Sentinel Surveillance, 2005 - 2014, UWR
The 2015 prevalence rate is at 1.3 shown in the trend above
Blood Safety As a national policy, all blood and blood products meant for transfusion are tested for HIV antibody among other tests. In line with this all Laboratories in the region were provided with the necessary test kits for HIV screening. The table below shows the prevalence of HIV among donors.
Sexually Transmitted Infection (STIs) Vaginal discharges and urethral discharges were the commonest condition
130 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 72: STI cases reported – Annual 2012 to 2014
Condition 2012 2013 2014 Urethral discharge 765 404 315 Male Genital Ulcer 44 53 71 Female Genital Ulcer 215 272 257 Vaginal Discharge 5251 6255 6576
Challenges There is slow pace in PMTCT scale up at the lower level, Poor linkages – Some positive clients still referred to ART sites (pregnant women), sshortage of chemistry and CD4 reagents, High defaulter rate of clients on ART, Poor documentation of OIs at the lower levels, No transport for data managers and service providers to do follow up to clients and dilapidated regional hospital ART Centre.
Steps towards Challenges There is need for continuous follow up to facilities on HTC/PMTCT and EID, orientation for medical Assistants on updated guidelines, facilitative supervision to facilities including private facilities, Hold quarterly TB/HIV stakeholders meeting and data validation, continuous monitoring of DHIMS2 entries and giving feedback to reporting facilities.
131 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Chapter6: Intensifying the prevention of and control of communicable and non- communicable disease
Disease Surveillance and Response The disease control unit is to support Communities, facilities and districts to promptly identify cases and events using standard case definitions, identifying priority diseases, conditions and events. Report all suspected cases or conditions or events to the next level. If this is an epidemic prone disease or a potential Public Health Emergency of International Concern (PHEIC), or a disease targeted for elimination or eradication, respond immediately by investigating the case or event and submit a detailed report. For events to be notified under IHR use the decision instrument is use to identify any potential PHEIC.
Disease Surveillance is an important component on disease control and prevention activities. It involves both passive and active systems in health facilities and community levels. Records were reviewed at the facilities for targeted diseases and Community Based Surveillance Volunteers also reported suspected cases and events from their communities for follow-ups by their respective Sub-district staffs and districts staff.
The objective of diseases Surveillance and control is to investigate 100% of all reported epidemic prone disease, help reduce morbidity and mortality due to vaccine preventable diseases, maintain a polio free status in the region, maintain zero mortality for measles and promote healthy life style of the people living in the region.
Disease surveillance activities carried Activities were carried out to address surveillance objectives during the review period include:
Active Case Searches
Conducted AFP active case search during the Child Health Promotion week and Sub polio NID rounds in September October 2015
Other activities of significance during the year were surveillance for cases of flu, but none was positive.
CSM Monitoring
132 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Monitored CSM/meningitis thresholds throughout the year with recorded number of 203 suspected cases 17deaths for the region. Lumber puncture rate was 98 % (199 cases) an improvement over last year 92.2% thus 172 cases had their lumber puncture performed. During the meningitis season 67CSF were sent for confirmation as compared to 31 CSF were sent to zonal public health reference laboratory in Tamale for PCR 2014. Four were confirmed as S. Pneumonia where as the previous year 7 were confirmed as S. pneumonia all from Lawra and 1 confirmed positive for N. meningitis w135 from Wa Municipal and the remaining negatives for 2014, the rest were negative and 4 had no lumber done on them.
Supervision and support visits
Quarterly monitoring and supervisory visits were carried out to all the eleven districts
Supervision and monitoring visits was carried out during the One (1) round of Sub- National Immunization Days (NIDs) in September /October, 2015.
Ebola sensitization activities were implemented where the general public were provided with health promotion tips and education on epidemic prone disease and other disease of public health importance.
Weekly reporting and routine feedback on general performance on IDSR systems was intensified throughout the 2015 year period
Specimen collection and Transportation
A total of thirty two (32) blood sample were collected in 2015 as against ninety five (95) blood samples (serum) were collected from suspected measles and yellow fever cases for laboratory confirmation or further analyses. Out of the number none was confirmed for measles IgM positive or confirmed yellow fever cases.
No suspected Ebola case thus no sample was collected. Two stools Specimen on twelve (12) of the suspected AFP cases were also collected totaling forty two (42) were sent to Nugochi. Two stool samples were also collected for suspected cholera cases and both the culture and rapid diagnosis test came out to be negative for vibrio cholerae
Table73: Monthly IDSR Reporting Rates
Timeliness Rank Completeness Rank # District (2013- (2013- 2013 2014 2015 2015) 2013 2014 2015 2015)
1 DBI 43.1 83.7 85.8 8th 59.8 65 88.2 9th 2 Jirapa 100 90.6 93.8 1st 100 92 99.3 3rd 3 Lambussie 88.4 88 99.5 2nd 88.9 92 100 4th 4 Lawra 62.5 81.3 100 4th 74 91 100 6th 5 Nadowli 73.3 77.2 91.3 6th 82.4 84 95.6 7th 6 Nandom 46.7 71.7 91.1 9th 78.9 79 100 8th
133 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
7 Sissala East 27.2 44.4 49.5 11th 46.6 58 77.7 11th 8 Sissala West 50 83.9 100 7th 100 100 100 1st 9 Wa East 81.1 89 91.7 3rd 100 99 100 2nd 10 Wa Municipal 84 76 85.5 4th 88.3 88 99.8 5th 11 Wa West 45 66.7 76.4 10th 60 69 78.8 10th
Table74: Weekly IDSR Reporting rate
Timeliness Rank Completeness Rank # District (2013- (2013- 2015) 2013 2014 2015 2013 2014 2015 2015) 1 DBI 15.8 8.7 48.2 7th 60.6 65 85 8th 2 Jirapa 32.3 14 33 6th 46.2 77 95 7th 3 Lambussie 44 53.5 72.3 4th 86.8 89 93 2nd 4 Lawra 8.1 14.1 30.1 9th 64.1 54 61 10th 5 Nadowli 45.4 65.7 69.9 2nd 78.1 84 95 6th 6 Nandom 45.9 78.6 93.3 1st 78.2 85 98 4th 7 Sissala East 8 16.5 23.7 10th 46 57 74 11th 8 Sissala West 17.6 60.7 93 3rd 97.8 98 98 1st 9 Wa East 6.4 20.6 33.3 8th 97.9 77 86 4th 10 Wa Municipal 46.1 34.7 37.7 5th 86.6 87 93 3rd 11 Wa West 7 9.9 13.1 11th 58.8 66 79 9th The table below shows the proportion of districts reporting at least one case of epidemic prone disease with case based form and samples.
Table75: Percentage of Districts reporting at least one priority diseases in UWR
Disease 2010 2011 2012 2013 2014 2015 AFP 55.6 100 77.8 90.9 90.6 63.6 Measles 55.6 77.8 100 90.9 90.9 72.7 Yellow fever 55.6 100 88.9 100 72.7 63.6
134 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Meningitis Table76: Meningitis surveillance (Both suspected and Confirmed cases
Meningitis Districts 2010 2011 2012 2013 2014 2015 DBI 1 3 32 Jirapa 1 29 23 9 126 46 Lambussie 0 9 9 9 14 66 Lawra 2 30 33 7 5 11 Nadowli 2 34 15 5 9 8 Nandom 3 11 7 S. East 0 18 31 2 1 3 S. West 0 25 13 3 4 0 Wa East 0 9 8 3 2 2 Wa Municipal 13 27 22 1 15 10 Wa West 4 10 12 5 2 7 Sawla/Kalba (N/R) 3 1 2 0 OthersBole etc 1 0 0 0 Total 478 195 166 69 192 203
Table 77: Trend of Reported Cases of Suspected Meningitis in Upper West Region - 1999 to 2015
Trend of Reported Cases of Suspected Meningitis in Upper West Region - 1999 to 2015 (W135 Outbreak in Jirapa 600 475 478 ( Mass Vaccination Carried out in 2010 ) 368 400 183 195 166 192 203 135 105 109 cases 200 60 80 98 69 86 69 0 1999 2001 2003 2005 2007 2009 2011 2013 2015 Cases period
135 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Measles
Table78: Measles Samples collected from Districts to NPHRL for 2010-2015, UWR
Measles Districts 2010 2011 2012 2013 2014 2015 DBI 1 8 0 Jirapa 1 5 6 0 5 1 Lambussie 0 0 38 2 4 2 Lawra 2 1 5 2 3 0 Nadowli 2 4 6 6 23 3 Nandom 6 1 1 S. East 0 3 2 4 2 4 S. West 0 1 5 2 5 0 Wa East 0 3 3 6 5 1 Wa Municipal 13 22 21 12 8 1 Wa West 4 0 7 29 0 1 Sawla/Kalba (N/R) 0
Trend of Measles Cases notified , no. of Samples Collected and Number positive in Upper
150 West Region - 2003 to 2015 18 20
15 108 9393 15 Figure100 93: Trend of Measles Cases notified and results of sample collection - 2003 to 2015 70 70 7 64 59 10 4 4444 50 27 14 20 2216 1614 1818 2222 2 1414 5
cases notified cases 1
0 0 80 0 0 0 0 PositiveSample 5 5 4 0 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
cases Notified Sample collected positive (1gm+)
Others 0 Total 22 44 93 70 64 14
136 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Yellow fever
Tabl Yellow Fever Districts e 2010 2011 2012 2013 2014 2015 79: DBI 5 3 0 Yell Jirapa 11 9 3 10 4 1 ow Lambussie 1 9 1 4 9 1 Feve Lawra 0 10 6 7 3 1 r Nadowli 1 23 4 4 12 4 Sam Nandom 1 1 0 ples 0 3 1 2 0 6 S. East coll S. West 0 4 0 2 0 1 ecte Wa East 0 41 4 13 1 4 d Wa Municipal 2 29 3 2 0 0 fro Wa West 1 21 2 4 3 0 m Sawla/Kalba (N/R) 1 0 Dist Others 0 0 ricts Total 16 149 24 55 36 18 to NPHRL in UWR
Figure 94: Trend of Jaundice Syndrome sample collected for Suspected Yellow fever
Trend Jaundice Syndrome sample collected for Suspected Yellow fever in Upper West Region - 2003 to 2015 753
800 588
600 469 249 207 400 No 121 data 16 24 55 36 18 Samples 200 10 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Period 137
Blood Samples for suspected Yellow Fever Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
AFP Table80: AFP Samples collected from Districts to NPHRL for 2010-2015, UWR
AFP cases Districts 2010 211 2012 2013 2014 2015 DBI 2 1 0 Jirapa 5 3 2 1 2 1 Lambussie 3 2 1 1 3 2 Lawra 2 1 1 0 1 1 Nadowli 0 1 2 2 5 1 Nandom 1 3 0 S. East 0 2 0 3 2 1 S. West 0 1 2 1 0 0 Wa East 1 3 5 3 1 5 Wa Municipal 1 2 1 3 2 1 Wa West 0 1 0 4 1 0 Total 12 16 14 21 21 12 Below is a chart indicating the trend of AFP cases notified and non-polio AFP rates in the region
Figure 95: AFP Cases notified and Non - Polio AFP Rates in UWR 2005 - 2015
Trend of AFP Cases notified and Non - Polio AFP Rates in UWR 2005 - 2015
8 6 6 25 5 20 6 4 4 4 3.3 15 4 3 2 2 2 21 21 10 14 16 14 AFP AFP rates 2 12 12 7 7 7 10 5 0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year AFP cases notified non polio AFP rate
138 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Disease Surveillance challenges Districts Failing to submit hard copies of weekly IDSR report and copies of case based forms as well as investigation reports to the region. Submission of hard copies of Monthly IDSR reports to the RHA surveillance unit has been stopped due to the reporting in the DHIMS2 platform and Difficulty accessing DHIMS2 software due to poor network connection couple with failure to pay internet connectivity fees for the unit and district officers
There is difficulty transporting specimen and blood sample to PHRL labs after sample collection from suspected cases, inadequate test kits/ reagents for confirmation of suspected meningitis case cases e.g. Latex Agglutination test, etc and inappropriate use of sample containers due to non-availability of such container e.g. Sample bottle for CSF, cryo-tubes, TI bottles
Strategies to address Disease Surveillance Challenges Reminders
The unit will keep Sending alerts and reminders to districts demanding to submit hard copies and soft of monthly reports
Monitoring and Feedback
Continuous Provision of monthly feedback and league table of DHIMS2 performance to districts and hospitals, dialogue with management for payment of internet bills to ensure internet connectivity, Discuss with management on better ways to improve monitoring and supportive supervision at the lower level due to Vehicular challenge
Sample collection
Discuss sample transportation issue with management and national level on better ways of transporting samples/getting right sample containers and then ensuring regular availability of drugs, replacement fluids and other logistics for the management of cases since this initially was difficult.
139 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
NEGLECTED TROPICAL DISEASES (NTDs) NTDs is a group of about 17 infectious diseases which affect over a 1 billion people worldwide and most of whom live in extreme poverty, Severely debilitating and disabling, Endemic in poor communities, Promotes poverty and intense stigma, Concentrated in remote rural areas and urban slums or conflict zones.
These diseases include; Lymphatic Filariasis, Onchocerciasis. Schistomiasis, Soil Transmitted Helminthes, Trachoma, Buruli ulcer, Dracunculiasis, Leprosy, Rabies, Human African Trypanosomiasis , Leishmaniasis, Cysticercosis , Echinococcosis, Dengue, Chaga‟s disease, Food borne trematode infections
The Programme employ Preventive Chemotherapy Strategy as a main control measure and targets 5 NTDs as; Lymphatic filariasis, Onchocerciasis, Schistosomiasis, Soil-transmitted helminthes and Trachoma
Main activities include: Integrated control (Mass Drug Administration), Health education and Surveillance
Primary Goal is to reduce the prevalence of Neglected Tropical Diseases in Ghana to levels that is no longer of public health significance by 2020.
Lymphatic filariasis Commonly known as elephantiasis, occurs when filarial parasites are transmitted to humans through infected mosquitoes. There is deposition of parasites (larvae) in the skin where the infected mosquito bites. The larvae migrate to the lymphatic vessels where they develop into adult worms in the human lymphatic system.
Infection is usually acquired in childhood, but the painful and profoundly disfiguring visible manifestations of the disease occur later in life. Whereas acute episodes of the disease cause temporary disability, lymphatic filariasis leads to permanent disability.
Lymphatic filariasis afflicts over 25 million men with genital disease and over 15 million people with lymphoedema.
The recommended regimen for treatment through Mass Drug Administration (MDA) is a single dose of two medicines given together - albendazole (400 mg) plus either ivermectin (150-200 mcg/kg) in areas where onchocerciasis (river blindness) is also endemic or diethylcarbamazine citrate (DEC) (6 mg/kg) in areas where onchocerciasis is not endemic. These medicines clear microfilariae from the bloodstream and kill most of the adult worms.
140 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
In a bit to control the disease in the region, all districts except Sissala East and Sissala West embarked on the Mass Drug Administration in their respective communities to eligible target populations. The strategy was house to house dosage of eligible with ivermectin tablets and albendazole based on their respective heights.
Table 81: Number of some structures by districts during MDA -2015
No. of No. of health workers Name of No. of No. of CDDs trained NO. Sub- trained District Communities districts
Male Female Male Female 1 DBI 5 40 8 2 59 19 2 Jirapa 7 131 17 8 125 27 3 Lawra 5 96 7 9 56 41 4 Lambussie 6 84 15 19 72 14 5 Nadowli 8 126 11 5 123 65 6 Nandom 5 78 15 9 72 26 7 Wa Municipal 6 120 6 11 112 99 8 Wa West 6 226 24 17 160 57 9 Wa East 7 134 23 11 223 47 10 Region 55 826 126 91 1002 395
The Objectives are to achieve 100% and 80% geographical and therapeutic coverage respectively in the region, reduce the micro-filarial load in the blood of infested individuals, reduce the burden of Lymphatic Filariasis among people in the region, sensitize/inform media men on the implementation of the Mass Drug Administration in order to ensure adequate and accurate information to public on MDA, achieve media and GHS collaboration for health and Improve case management for affected people
Activities carried out
To better achieve the objectives as stated above, various activities were carried out at different levels (Regional, District, Sub-district and the community levels). Some of these activities include:
Trainings
Following a national training at Kumasi on 18th – 22nd May, 2015, the Regional Health Directorate held its TOT on 30th July, 2015 with 3 participants (District NTD coordinator, District Health Information Officer and District Health Promotion Officer) from each district. Supported by two member team from national level.
141 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Social mobilization
Varied forms of social mobilization strategies were employed across all districts in the region in June 2015 after the national TOT. Some of the strategies adapted were: sensitization of Community Based Volunteers to mobilize communities and update their community registers for the impending exercise, community wide durbars, Beating of gong- gong, Health Promotion Officers and other key service staff made health talks and announcements at outreach sessions, OPD, ANC and other service delivery points, Information van announcements in communities and market centers, announcements in all Churches, Mosques, organizing meetings with social groups such as Mother –To-Mother Group as using men as partners and Radio discussions and announcements
Logistics distribution
Registers, Posters, Drugs (Albendazole and Ivermetin), Funds were distributed to all districts and further to drug administration points in the region
Table82: Distribution drugs and posters
Albendazole PARAZ Required At risk Eligible No District Qty in Population Population Qty of IVM Qty in QTY of Register Bottle Posters tabs Bottles Alb tabs s s 1 DBI 35,799 28,639 71,598 143 31,503 158 25 100 2 Jirapa 97,125 77,700 194,250 389 85,470 427 40 120 3 Lambussie 56,751 45,401 113,502 227 49,941 250 30 150 4 Lawra 61,123 48,898 122,246 244 53,788 269 35 160 5 Nadowli 67,903 54,322 135,806 272 59,755 299 37 170 6 Nandom 49,766 39,813 99,532 199 43,794 219 28 140 9 Wa East 79,186 63,349 158,372 317 69,684 348 40 180 7 Wa 117,794 94,235 235,588 471 103,659 518 55 250 8 Wa West 89,375 71,500 178,750 358 78,650 393 42 200
142 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
10 Region 654,822 523,858 129,356 259 82,257 411 68 30 TOTAL 1,309,644 1,047,715 1,439,000 2,878 658,500 3,293 400 1,500
Implementation
The strategy was House-To-House distribution of drugs to eligible individuals by trained volunteers in their respective communities.
The region embarked on this year’s MDS across nine districts officially from 10th -15th August, 2015. Lambussie-Karni district however started a day late because the district did not take the drugs on time. Wa east started about two weeks later due to their earlier Oncho MDA in the district. However, all the nine districts successfully implemented the activity as planned.
Monitoring and supervision
Teams were formed at regional, district and sub district levels to ensure successful distribution of the drugs (Ivermectin and Albendazole) by Community Drug Distributors (CDDs) in their various communities. Checklist was developed at the regional level for use for supervision at various levels.
Findings during Mass Drug Administration Some of the key results from filed visits, supervision and feedback from drug distribution points were; some people had taken alcohol before the arrival of the CDDs hence their dosage was postponed to the second day, High migration factors, Rain destructed the work on the first day, Volunteers demanded for pencils and erasers, some volunteers were using improvised sticks, Refusals, teachers orientated to assist CDDs, High absenteeism due to senior high schools on holidays, Mal- distribution of drugs/logistics in some sub-districts due to poor micro planning resulting in „artificial‟ shortages, Few volunteers identified treating without taking measurement in Jirapa district and Pre filling of albendazole column before visiting houses in Jirapa district
143 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Some Best Practices
Some clear innovations identified during drug administration were; CDDs visiting households early for dosing before people leave to their farms and late in the evening/night when people had returned from the farms/workplaces, Tracing missed household members to their farms/ specific locations within the community to dose them and Booking appointment with missed household members and dosing them before the end of drug administration.
Summary of treatment outcomes Table 83: Therapeutic Percentage Coverage by Districts
Population by Total Treatment by Total Name of Total pop. NO. Gender populatio Gender Number District Coverage n treated M F M F 1 DBI 15259 17324 32583 11958 13542 25500 78.3 2 Jirapa 36304 41527 77831 28536 31588 60124 77.2 3 Lawra 23297 25629 48926 18823 20804 39627 81 4 Lambussie 21442 22281 43723 17229 18289 35518 81.2 5 Nadowli 32736 36118 68854 23352 25979 49331 71.6 6 Nandom 22969 23954 46923 17952 18795 36747 78.3 7 Wa 39027 44485 83512 33303 38175 71478 85.6 8 Wa West 35187 43879 79066 29703 37414 67117 84.9 9 Wa East 40521 36098 76619 34257 30061 64318 83.9 10 Region 266742 291295 558037 215113 234647 449760 80.6
From the distribution above, four districts covered less than 80% and the regional coverage stands at
Distribution of Lymphatic filariasis Mass Drug Administration Coverage by districts in Upper West Region - 2015 Performance Figure 96: MDA Therapeutic Percentage Coverage by Districts 100 85.6 78.3 77.2 81.0 81.2 78.3 84.9 83.9 80.3 80 71.6
60 % 40 20 0 DBI Jirapa Lawra Lambussie Nadowli Nandom Wa Mun. Wa West Wa East Reg Coverage TARGET
80.3%. Wa municipal has the highest coverage of 85.6 and Nadowli covered the least of 71.6%.
144 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 84: Table 6: Geographical Percentage Coverage by Districts
No. of communities ( No. of communities Geographic NO. Name of District c ) treated coverage
1 DBI 40 40 100 2 Jirapa 131 131 100 3 Lawra 96 96 100 4 Lambussie 84 84 100 5 Nadowli 126 126 100 6 Nandom 78 76 97.4 7 Wa Municipal 120 120 100 8 Wa West 226 226 100 9 Wa East 134 134 100 10 Region 1035 1033 99.8
Adverse drug reactions/events Monitoring of ADRs was incorporated in the social mobilization massages, during Supervisors/ CDDs training and during implementation.
Health staffs were taken through the various ADEs, its management should they occur and channels of reporting.
During the implementation, few cases were reported to the various health facilities. The ADRs ranged from mild to moderate but were managed within the districts. No Serious Adverse Drug Event was recorded during the exercise.
Insert is ADR case at Lambussie district which occurred as a swollen eye three days after drug administration.
145 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Follow up visits were made to all ADR cases after management at the health facilities from the day of reporting to the health facility till recovery. During the visit the individual/ households were sensitized according to the type of ADE and reassurance was made to clients.
Lessons Learnt
Some the lessons were that; early distribution of logistics reduced pressure on the DHAs, Poor remuneration does not encourage effective work/coverage and dry season campaigns are better than the raining season
Challenges of the L F Programme Some key challenges are; Inadequate measuring poles, Inadequate funds, Absenteeism as most students had gone back to schools, Some CDDs refusal to work being trained because of small per diem, high absenteeism/migration, Difficulty in tracing some volunteers during monitoring, high illiteracy among volunteers resulting in poor documentation, Rains made house to house movement difficult, Some registers were not updated and poor remuneration for CDDs
LF Programme Recommendations From the conclusions above it is recommended that: National should come out with a fixed period for Community Mass Drug district and it should be inculcated into the GHS annual work plan, Drug balances at various regions should be assessed and the required quantities of drugs allocated to avoid shortages, The funds allocation to regions should be clearly indicated to avoid under funding to districts.
Guinea worm Eradication Following the certification of Ghana as a Guinea Worm free country, several strategies have been kept in place to strengthen post-certification surveillance across the country. To this effect, the RHA-Wa with support from GWEP organized a training and a follow-up monitoring for staff in the Wa East District (one of the previous most endemic districts in the region).
The Wa East district was the most endemic district in the region from the inception of the Guinea Worm Eradication programme, but succeeded in breaking indigenous transmission in the district in 2007. Due to the rivers and poor road network nature of the district, it is sometimes impossible for one to go round the district by one route and most health staff often refuse postings to the district as it is deprived with remote communities. The objective of the intervention is to; Strengthen Post Guinea worm certification surveillance and IDSR in the Wa East district, improve IDSR reporting especially from the sub districts and CHPS zones, Build capacity of staff in IDSR to increase index of suspicion for Guinea Worm, intensify
146 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys integration of Guinea Worm activities into the routine surveillance system and intensify monitoring and supervision to the lower levels of service delivery.
Guinea Worm Activities Training
Health staff training was organized at SemB from 24rd to 25th November, 2015. It covered various categories of staff from sub-district, district and regional levels.
The training content was based on practical application of strategies to strengthen surveillance (IDSR) and increase the index of suspicion for Guinea Worm Disease and other priority diseases of public health concern. Centered on 7 functions of IDSR for effective surveillance systems with emphasis on rumour detection, notification and investigation as well as early detection of suspected cases.
Training modules were; Identifying and reporting cases of priory diseases/conditions, data Analysis, Investigating suspected outbreaks/other public health problems, Response to outbreaks/other public health problems, providing feedback, Evaluate and improve surveillance and response, Proper use of Line listing and rumour registry, Use of Checklist, Documentation including storage for easy retrieval and Investigating a suspected Guinea Worm case (rumour)
Participants were taken through the key definitions of terms used in the GWEP and the three levels of surveillance. The cash reward was emphasized to encourage people to report rumours.
Follow-up field supervision and monitoring follow-up supervisory visits were made a week after the training from the region to the district, sub districts and CHPS zones to ensure next steps discussed during the training have been
147 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys implemented as well as fill gaps where necessary.
As part of the follow-up visits, a team was constituted and investigated a rumour at Wogu shown in the picture below
Table 85: Trend of Guinea Worm cases UWR
Trend of Recorded Guinea Worm Cases in Upper West Region 1989-2015
4000 3174 2918 Last indigenous case In 2011 3000 recorded in November 2007 *Hosted the National Pre-certification in Chawuli – Wa East District Team visits **Inauguration of Guinea Worm Communication Task Force 2000 1417 833 1000 411 162 186 222 333 reported cases reported 53 39 74 74 69 88 128 122 93 23 0 0 0 0 0 0 0 0
0
2011
1991
2013
2015
2012
1997
1993
1995
1992
2001 2010
2014
1996 1999
1989 1990 1998
1994
2007
2003
2005
2002
2009
2006
2000
2004 2008
In 2012 *Institution of cash reward for Guinea Worm Cases any report of a hanging worm
Onchocerciasis
Onchocerciasis is an eye and skin disease caused by a worm (filaria) known scientifically as Onchocerca Vulvulus. Transmitted to humans through the bite of a black fly (simulium species). These flies breed in fast-flowing streams and rivers, increasing the risk of blindness to individuals living nearby, hence the commonly known name is “River blindness”. In some West African countries, men over the age of 40 years had been blinded by the disease.
The only endemic district Oncho is Wa East. As part of the efforts to controlling Oncho in the district, two rounds of MDAs for Oncho were carried out within the year. The first round was on 7TH -14TH July, 2015 and the second round was on 10TH -15TH December, 2015.
The Objective of the Oncho drug administration is to; achieve 100% and 80% geographical and therapeutic coverage respectively in the region, reduce the micro-filarial load in the blood of infested individuals, reduce the burden of Onchocerciasis among people, sensitize/inform media
148 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys on the implementation of the Mass Drug Administration in order to ensure adequate and accurate information to public on MDA, and achieve media and GHS collaboration for health
Activities carried out to ensure effective implementation of the exercises are:
Trainings
Trainings were organized at various levels. There was a regional TOT for district staff followed by district TOT for sub-district staff and the CCDs training at the sub-district level supported by district staff.
Social Mobilization
The specific activities carried out on social mobilization include: Use of Community Based Volunteers, Organizing of community wide durbars, Beating of gong- gong, Use of posters, Use of health workers and Health Promotion Officer to make announcements at outreach sessions, OPD, ANC and other service delivery points, Use of information van to make announcements in the communities and market centers and Announcements in all Churches, Mosques and also organizing meetings with social groups such as Mother –To-Mother Group as using men as partners.
Actual implementation
The first round was on 7TH -14TH July, 2015 and the second round was on 10TH -15TH December, 2015.
Monitoring and Supervision
Teams were formed at regional, district and sub district levels to super see the distribution of the Ivermectin by the CDDs in their various communities. This was to assess the availability of drugs at all levels and the preparedness of each facility before the implementation and issues during the implementation.
Main findings during MDA Implementation There was Intensive monitoring and supervision at all levels of implementation, improved social mobilization, Availability of some committed CDDs for the implementation.
149 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Arrival of logistics was timely especially drugs and funds to facilitate the programme activities, Early departure to the field improved coverage and some volunteers work early mornings and late evenings
Table 86: Oncho round one therapeutic coverage
Population by Total Name of Total Treatment by Gender Total pop. NO. Gender Number Sub-district population Coverage treated M F M F 1 Baayiri 4718 4666 9384 4095 4265 8360 89.1 2 Bulenga 15571 12528 28099 13960 10585 24545 87.4 3 Funsi 5399 4824 10223 4826 4262 9088 88.9 4 Holomuni 2059 1892 3951 1753 1475 3228 81.7 5 Loggu 8043 8297 16340 6786 6940 13726 84 6 Kundungu 2226 2350 4576 1864 1965 3829 83.7 7 Yaala 2499 1541 4040 2149 1237 3386 83.8 Total 40,515 36,098 76,613 35,433 30,729 66,162 86.4
Figure 97: Oncho Round one Therapeutic coverage
Distribution of Oncho roiund one therapeutic Coverage by districts in Upper West Region- 2015
100 89.1 87.4 88.9 81.7 84.0 83.7 83.8 86.4
% 50
0 Baayiri Bulenga Funsi Holomuni Loggu Kundungu Yaala DISTRICT
Coverage TARGET
150 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table87: Oncho round one (Non-Eligible and Clinical state)
N Non-Eligible Clinical state O. Mothers Und Refus Abse breastfee Seriou Skin Sub- Pregn er ed nt Hydroc Elephanti Blindn ding sly Disord district ant Heig ele asis ess children < Sick ers ht 1week 1 Baayiri 106 9 18 267 109 515 0 0 0 0 Buleng 585 69 123 788 505 2365 7 4 0 0 2 a 3 Funsi 95 29 7 539 94 371 0 0 0 0 Holom 62 25 5 144 15 271 0 1 0 0 4 uni 5 Loggu 208 31 57 615 178 1502 5 0 0 0 Kundu 54 19 9 164 7 487 0 7 0 0 6 ngu 7 Yaala 32 5 3 142 46 425 1 0 0 0 DISTRICT 1142 187 222 2659 954 5936 13 12 0 0
Table88: Table 33: Oncho round two therapeutic coverage
Total Total NO. Sub-district Number Coverage Population by population Treatment by Gender Gender treated M F M F 1 Baayiri 4044 4711 8755 3478 4240 7718 88.2 2 Bulenga 14248 13648 27896 11890 12041 23931 85.8 3 Funsi 4535 4711 9246 3818 3908 7726 83.6 4 Holomuni 2140 1733 3873 1909 1555 3464 89.4 5 Loggu 8220 8753 16973 7228 7687 14915 87.9 6 Kundungu 2361 2524 4885 1971 2219 4190 85.8 7 Yaala 1870 1784 3654 1532 1592 3124 85.5
151 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
DISTRICT 37418 37864 75282 31826 33242 65068 86.4
Figure 98: Oncho round two therapeutic coverage
Distribution of Oncho Round Two Therapeutic Coverage by districts in Upper West Region - 2015 performance 100 88.2 85.8 83.6 89.4 87.9 85.8 85.5 86.4 80
60
% 40 20 0 Baayiri Bulenga Funsi Holomuni Loggu Kundungu Yaala DISTRICT
Coverage TARGET
Table89: Oncho round two (Non-Eligible and Clinical state)
NO. Non-Eligible Clinical state
Mothers Refus Abse breastfe Under Skin Sub- Serio ed nt Hydroc Elephanti Blindn Preg. eding usly Heigh Disord district ele asis ess children Sick t ers < 1week 1 Baayiri 109 31 11 248 50 585 0 0 0 3 2 Bulenga 366 340 26 834 83 2312 2 4 0 0 3 Funsi 136 68 12 535 36 733 0 0 0 0 Holomun 4 i 55 34 3 65 16 235 0 1 0 0 5 Loggu 236 100 30 422 82 1184 3 1 0 0 Kundung 6 u 54 37 13 140 2 406 0 3 0 0 7 Yaala 30 5 3 133 24 334 1 0 0 0 DISTRICT 986 615 98 2377 293 5789 6 9 0 3
152 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 90: Drug Records
Ivermectin
NO. Sub-district Received Used Balance Round 1 Round 2 Round 1 Round 2 Round 1 Round 2 1 Baayiri 30160 17930 25510 14919 4650 3011 2 Bulenga 72383 63346 69383 61166 3000 2180 3 Funsi 30000 27500 27793 26776 2207 724 4 Holomuni 11500 12000 8991 11680 2509 320 5 Loggu 48300 33917 42875 33570 5425 347 6 Kundungu 13900 10715 12656 10533 1244 182 7 Yaala 13000 5000 10697 4929 2303 71 DISTRICT 219243 170408 197905 163573 21338 6835
School deworming impact assessment survey The school deworming impact survey is carried to ascertain the impact of the deworming exercise on the school children’s health. It is done in selected schools to identify children that still have parasites in them and also give an informed decision as way forward for the school deworming exercise.
This exercise was carried by teams comprising both national and regional staff. It took in October, 2015. Table 13 shows the schools that were involved in the exercise.
Table 91: Schools visited for deworming impact assessment survey
S.N School District Community School 1 115 Bagri Bagri Baptist Prim Lawra 2 116 Eremon Eremon Tangzu R/C Prim 3 117 Kaleo Kaleo R/C Prim Nadowli 4 118 Dupuoh Dupuoh R/C Primary 5 119 Kojokperi Kojokperi L/A Prim Sissala East 6 120 Nabugubelle Nabugubelle D/A Prim 7 121 Sakalo Sakalo Basic Sissala West 8 122 Fielmua Fielmua D/A Prim 9 123 Kusali Kusali D/A Primary Wa Municipal 10 124 Nyagli Nyagli D/A Primary 11 125 Ga Ga D/A Prim Wa West 12 126 Wechiau Wechiau D/A Prim
153 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The target population for the exercise is class six pupils but if the sample size is not met, the remaining are sampled from class 5, 4, down until the sample size is reached. The sample size was 50 children (25 girls and 25 boys) from each school.
The samples were taken from urine, stool and prepared in the various schools visited. The specimen that were taken from the children were:
After preparing and examining the samples (urine and stool), 10 positive cases were identified shown in table below
Table92: Positive cases from the survey by schools
Result School Sex Age Class (Parasite) Count Kojokperi D/A Primary Male 14 P6 Hook worm 24epg Male 12 P6 SH 230eggs/10mls Male 12 P6 SH 309eggs/10mls Male 14 P6 SH 107eggs/10mls Fielmuo D/A Primary Male 15 P6 SH 302eggs/10mls Male 13 P6 SH 61eggs/10mls Male 12 P6 SH 356eggs/mls Female 16 P6 SH 2eggs/mls Wechiau D/A Primary Female 12 P6 SH 75eggs/10mls Nyagli D/A Primary Male 15 P6 SH 69eggs/10mls
As shown in table 14, four out of the 12 schools visited recorded positive cases with Fielmuo D/A Primary having most (7) of the cases (Schistosoma Haematobium). Only Kojokperi D/A Primary recorded one case of Hook worm.
154 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
School based mass drug distribution campaign In view of the undesirable social and economic consequences including serious disability and deformities that school children suffer from Filariasis, Onchocerciasis, Schistosomiasis Soil Transmitted Helminths and Trachoma infection and the potential threat of spread that these diseases pose if not controlled over time. The Upper West Region continues to attach great importance to the school deworming exercise which forms part of the NTDs control programme.
Campaign activities Social Mobilization
Teachers, health workers and school children were empowered to sensitize and create awareness on the campaign in their respective schools and communities before and during the training. Religious houses were also reached out to through letters at the various levels to sensitize their worshippers and congregations towards the campaign. Training
Training was organized on 24/11/2015 for teachers in 151 schools in Sissala East district. Issues emphasized during the training were: Dispensing of the Praziquantel to children base on their height, Proper documentation, Effective social mobilization for high coverage, Early reporting of ADR and Accountability of the drugs used
Implementation
Implementation commenced officially on the 30th November to 4th December 2015 but some schools did mop ups on 7th-8th December, 2015 since some children absented themselves from school within the actual period.
Monitoring and supervision
National, Regional and District officers undertook monitoring and supervision to circuits to observe the administration and outcome of the drugs.
155 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Table 93: School Deworming Exercise
Total number of schools in the District 151 Total number of schools Participated 151 M 10385 Total number of children from register F 9233 M 8212 Total number of children treated F 7692 Coverage 81.1 School Drop-Ups M 82 Total number of out of school children treated F 41
Table 94: School Deworming Exercise drug records
Albendazole Number of Tablets Received 19788 Number of Tablets Used 16805 Number of Tablets Returned 2983 Praziquantel Number of Tablets Received 39932 Number of Tablets Used 35397 Number of Tablets Returned 4535
Adverse Drug Reactions Minor reactions occurred across district as there was no case that required hospitalization. The cases that were reported complained of drowsiness, few vomited, few had headache and abdominal pains.
156 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Challenges of School based drug administration Refusal by some children to take the drugs, In-adequate funds for teacher’s remuneration and Mal-distribution of drugs by some teachers resulting
NTDs Recommendations Level Item1 Item 2 Item 3 Way forward Provide T-shirts for Increase CDDs Build capacity of National Provide measuring Poles CDD’s allowances documentation Solicit for more support Intensify monitoring Region from partners to lower levels Ensure Community Intensify Ensure CDDs return drug District Registers are rumour balances updated reporting
Leprosy Control The Leprosy Elimination Programme in the Upper West Region covers all the districts with a population of 771,394 and has for the past years attained the WHO elimination target of less than one case per ten thousand population 1/10,000. The Region started the year 2015 with 33 cases of leprosy, a prevalence rate of 0.44 per 10,000 population and currently has 29 registered cases of leprosy 26 MB and 3 PB with a prevalence rate of 0.37/10,000 population as compared to 0.46/10,000 population at the end of 2015.
157 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The objectives of the leprosy Programme are to intensify health education through community durbars and schools in the districts, Intensify both passive and active case searches at all levels, Reduce disability Grade 2 through patient counselling and public education to less than 5% among all cases, ensure all health workers and other health agents are equipped with basic diagnostic skills, make leprosy treatment available at all health facilities that have registered cases and ensuring regular availability of anti-leprosy drugs.
Activities Implemented
Activities carried out during the year 2015 were the management and Treatment of identified Leprosy cases on register with MDT, Training of health workers on early manifestation of leprosy, Carried out Integrated case search in selected communities, Confirmation and registration of suspected leprosy cases in five districts, One- on –one technical support to sub district health staff on early manifestations of leprosy and review of registered leprosy patients in the districts
Carried out contact examination and tracing of defaulters, Delivery of health education talks and physical examination in OPDs, prison inmates and prison officers, Compilation and submission of monthly returns and participated in the annual review for Leprosy Technical Officers at Ankaful from 25TH – 31ST January 2015
Leprosy Prevalence Total patients brought forward from 2014 were 33 Patients, made up of 32 multibacillary and 1 paucibacillary patient.
Total patients as at the end of the year 2015 were 29 made-up of 26 multibacillary cases and 3 Paucibacillary cases. The review period saw was a reduction of 13.3% compared to last year 2014 a reduction of 34.1%.
The regional prevalence rate decreased from 0.43/10,000 to 0.37/10,000 population in 2015. All districts have achieved the WHO elimination target of less than 1/10,000 except Wa Municipal with 1.18/10,000.
Table 95: Cases of Leprosy 2010-2015
District Population 2010 2011 2012 2013 2014 2015 PR/10,000
DBI 35,792 0 0 0 0 3 2 0.55 Jirapa 97,105 9 4 3 8 5 9 0.92 Lambussie 56,739 1 4 8 4 0 0 0 Lawra 61,110 9 6 9 4 10 1 0.16 Nandom 49,755 1 0 0 Nadowli 67,888 7 9 5 5 0 2 0.29 Sissala East 62,093 0 2 0 1 1 0 0 Sissala West 54,453 5 11 7 5 2 1 0.01
158 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Wa east 79,169 2 1 1 2 0 0 0 Wa municipal 117,769 15 40 25 22 7 14 1.18 Wa west 87,694 13 1 0 3 4 0 0 Regional Total 771,394 61 78 58 54 33 29 0.37
Total new cases registered during the year under review decreased from forty-two (42) in 2014 to 36 in 2015 shown in the chart below
Table 96: Trend of new Leprosy cases and Leprosy prevalence in UWR
Trend of Leprosy Case Detection and Leprosy Prevalence in Upper West Region -1995 to 2015
400 300
250 300 200 200 150 100 100
50 Prevalence Leprosy cases Leprosy 0 0 1995 1996 1997 1998 199920002001200220032004200520062007200820092010 2011 2012 2013 2014 2015 New Cases 98 129 210 302 274 160 125 130 61 66 90 58 51 63 83 64 73 60 50 42 36 Prevalence 143 164 230 248 170 132 121 109 56 54 73 56 45 58 80 61 78 58 58 33 29
Figure 99: Trend of Leprosy Prevalence and rates
Trend of Leprosy Prevalence and prevalence rate/10,000 in UWR from 2010 to 2015
100 1.5
0.87 1 0.83 0.75 78 1 50 0.43 61 58 58 0.37 0.5 Rates
Prevalence 33 29 0 0 2010 2011 2012 2013 2014 2015 Period Prevalence Rate/10,000
159 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
The Regional case detection rate decreased from 5.4 for 2014 to 4.6 per 100,000 population in 2015 shown in the chart below
Figure 100: Trend of Leprosy Case Detection Rates in UWR
Trnd of Leprosy Case Detection Rate/100,000 in UWR from 2010 to 2015 11 12
8.59 10 8.21 8 6.46 5.4 4.6 6 4
CDR/100,000 2 0 2010 2011 2012 2013 2014 2015 Period
Figure 101: Leprosy Case Detection Rate by Districts
Leprosy case detetion Rate/100,000 by districts in UWR- 2015 Performance 20 16.1 15 9.2 10 4.6 2.8 2.9 3.7
cdr/100,000 5 2 2 0 1.6 0 0.14 0 D B I JIRAPA LAMBUSSIE LAWRA NANDON NADOWLI SISSALA SISSALA WA EAST WA WA WEST REGIONAL EAST WEST MUNICIPAL Districts
Wa Municipal registered the highest, 19 new cases followed by Jirapa district with 9. Four districts, Lambussie, Wa East, Sissala East and Nandom, recorded no new cases.
Table 97: Summary of Leprosy Indicators
Indicators 2010 2011 2012 2013 2014 2015 Population 702,110 715,450 729,044 742,896 756,882 771,394 Districts 9 9 11 11 11 11 New Cases detected 64 73 60 50 42 36 Case Detection/100,000 8.21 11 8.59 6.46 5.4 4.6 # of children among new cases 1 4 2 5 0 0 Completed treatment (RFT) 83 65 78 56 73 42 Cases on Register at the end of Year 61 78 58 58 33 29 Prevalence rate/10,000 0.87 1 0.83 0.75 0.43 0.37 New cases with Disability GD 2 4 (3.6%) 4 (5.0%) 4 (6.6%) 4(8.0) 2(4.7%) 2(5.5) Cure rate (Cohort) MB 57.63% 38% 100% 100% 96% 97% Cure rate (Cohort) PB 100% 100% 100% 100% 100% 100% Defaulter rate 0% 0% 3 (3.0%) 12 (9.8%) 2(3.4%) 1(1.3)
160 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Death rate 2 (3%) 3 (4.0%) 1.60% 2 (1.6 ) 2(3.4%) 0
The Regional disability Grade 2 among new cases was 2 (4.7%) in 2014 and 2(5.5%) in 2015. Wa Municipal and Sissala West recorded one Disability Grade 2 each giving a total of 2 among new cases registered during the year. No patient reported with re-activation of lesions after discharge from treatment.
Wa Municipal and Nadowli district during case search and defaulter tracing recorded 5 cases that did not complete treatment. These patients were re-additions to continue with treatment during the year under review. No deaths were recorded.
Cases released from treatment during the year period were 42 made up of 34 MB and 8 PB cases. One defaulter was reported from DBI district during the year under review
Cure rate achieved based on 2014 new cases was 96%. The cure rate of MB patients who started MDT from January to December in the previous two years was 96% and PB patients in 2014 were also 100%
Activities Carried Out
Training The region was able to strengthen case search activities with the support of Headquarters. Two batch of trainings were held at Lawra and Wa West on the 10th and 11th August 2015 comprising a total of 62 people.
Case search Some districts carried out integrated case search in communities to detect cases. However, Suspects referred were not cases of leprosy but other skin conditions that were managed at the facilities. Wa Municipal detected 10 leprosy cases through active case search in selected communities
Health Education Posters showing early presentation of leprosy and facts about leprosy were received from headquarters and distributed to all districts to help in case search activities. The use of laminated cards and posters for health education talk in schools, community gatherings and for the use of Volunteers in communities.
Monitoring/Support visits Monitoring and support visits were done in all districts except Nandom and Sissala East. Apart from confirmation of suspects and review of patients on register, other case search activities such as community durbars and health education in schools with leprosy coordinators in the districts and sub district levels was done.
161 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Chemotherapy The region had enough anti leprosy drugs throughout the reporting year. Drug balance at the end of December 2015 were 0 MB children, 10 MB adults, 0 PB children and adults making a total of 10 MB PACKS
Challenges The low leprosy case detection in most of the districts and late/incomplete submission of monthly reports
Steps to address Challenges Continuous training of more health workers on early manifestation of leprosy is key, awareness creation through community durbars and health education in schools, intensified integrated case search in formally endemic communities of silent districts and ensuring timely and complete submission of reports by districts
Non communicable diseases Non-communicable diseases mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are the world’s biggest killers and is now a public health canker. More than 36 million people die annually from NCDs (63% of global deaths), including more than 14 million people who die too young between the ages of 30 and 70.
Obesity is the central risk factor for most NCDs. The impact of NCDs on low and middle income countries is rising steeply. Life-course approach is the sure way to reverse the increasing prevalence of NCDs and its associated mortality. It is evident that children who suffer under nutrition have an increased risk for NCDS in later years. This makes it imperative as a region to act now as still have poor nutritional status indicators. If nothing is done, high NCDS prevalence can be predicted in this region in years to come. The routine data revealed an increase in prevalence of hypertension and diabetes in the region.
162 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Healthy living activities which includes: increasing intake of fruits and vegetables, physical activity for at least 30 minutes daily, minimize intake of alcoholic drinks, cessation of cigarette smoking is the proven ways of reducing the prevalence of NCDs in the population.
Figure 102: Trend of recorded Hypertension cases
Trend of Hypertension cases recorded in Upper west Region 2012 to 2015
15000 12593 13169 12801
8849 10000
cases 5000
0 2012 2013 2014 2015 Period
Figure 103: Distribution of Hypertension cases by districts
Hypertension dy districts in UWR - 2015 Performance 6000 5212 5000
4000 3000
cases 1546 1543 2000 1035 834 525 910 1000 119 502 172 403 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala Sissala Wa Wa East Wa West East West Axis Title
163 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 104: Trend of Diabetic cases reported in UWR
Trend of Diabetes Mellitus cases reported in Upper West Region 2012 to 2015 1400 1254 1200 1000 681 761 800 552 600
diabetes 400 200 0 2012 2013 2014 2015 Period
Diabetes cases by districts in UWR -2015 Performance
600 488
500 400 300 245 155 200 149 Diabetes 52 100 17 24 38 38 7 41 0 Figure 105: DiabeticDBI casesJirapa by districtsLambussie in LawraUWR Nadowli Nandom Sissala Sissala Wa Wa West East West District
164 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Health Promotion Health Promotion is the breast milk for health interventions as it serves as the conduit to improve the health of the people through a number of strategies to communicate health and information to the populace. When a health intervention is well packaged and communicated to the people, it leads to better health outcomes. But when communicated poorly, it yields unsatisfactory results.
The work of Health Promotion Unit cut across Nutrition, Disease Control and Surveillance and the Reproductive and Child Health services. Basically the unit communicates the interventions through drama, video, posters, flyers and flipcharts just to mention a few.
Planned activities carried out the unit organized start-up meeting on C4D with District, Regional staffs, carried out CBA review meeting at the district level, Editing and Production of video on CHN trainees field work activity introduction for JICA/CHPS, radio programmes on issues of public health concern including communicable and non-communicable diseases, street and market sensitization on key behaviours in the C4D communities.
The unit organized religious and traditional leaders’ forum on key behaviours at the district level, Developed community Health Action plan in addressing the key behaviours in C4D districts, Followed up on the developed of community health action plan at the community level, Distribution of IEC Materials, Monitoring of Health Education and Promotion activities in the districts, IPC Training of Health Staff at the District and community Level, Monitoring of CBAs at the Community Level
Conducted media briefing to correct misconceptions on Ebola and Cholera, organized world malaria celebration activities in the best three LLIN utilization communities, Community sensitization on Ebola and Cholera at the approved and unapproved borders and training of health promotion officers on the effective utilization of I E & C materials
Development of Community Health Action Plan in (60) Selected Communities
The purpose was to sensitize community members on how to identify health issues affecting them, help communities come out with top most prioritized problems for redress and empower community members come out with an Action Plan to help them address the challenges
A total of 60 communities were covered in 6 districts thus Wa West, Wa East, Wa Municipal, Jirapa Sissala East and Lambusie Karni.
Wa West communities were; Jenbob, Chogsia, Metteu, Manyanyiri, Kuuchiliyiri, Da-e-yiri, Dabo, Varimperi, Talawonaa, Ga, Buli, Siiriyiri, Dornye, Buli and Ga.
165 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Wa East communities were; Chaggu, Gbari, Yaala, Kundungu, Mamwe, Bulenga, Sagu, Kparisaga, Kpaglaghi and Gonnuo.
Sissala East Communities were; Taffiasi, Bandei, Dolibizon, Lilixia, Kunchogu.Banu, Mwanduanu, Yigantu, Kulfuo and Kassana.
Lambussie Karni Communities were; Lambu, Sina, Tapumu,Koro,Hiineteng, Haakyeg, Kulkarni, Naawie, Sentu and kokuo.
Wa Municipal Communities were; Boli, Kunfaabiela, Busa, Nyagli, Gbegru, Mangu no.1, Kumbiehi, Biihee.
Jirapa Communities were; Guri, Kure, Sobariyiri, Katang, Saawie, Kul-ora, Nyenvaare, Baguu, Tikpi and Orhphani
A total of 14, 936 participants at the community level were reached involving 5, 051 men, 8, 554 women, 679 boys and 652 girls shown in the table below
Table 98: Target Audience Reached in the six C4D districts 2015
Target people Men Women Boys Girls Total No. Of people met 5, 051 8, 554 679 654 14, 939
166 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Night video shows in selected communities
The objective of this activity isto empower communities for behaviour change on the five key behaviors. The communities were; Taffiasi, Nabugubelle, Lilixia, Kowie, Kassana, Peing, Tarsaw, Mwanduonu, Challu and Sakai under Sissala East. Gurungu, Dorimon, Wechiau, Ponyentaga, Eggu, Lassia Tuola, Ga, Piisie, Buli and Tokale under Wa West. Naaha, Chaggu, Kulanjung, Gbari, Funisi, Yaala, Kundungu, Mamwe, Goripie Bulenga, Sagu and Kparisaga under Wa East. Charingu, Danko, Tahgazu, Sagu, Dapuoha, Zingu, Chansa, and Jahan under Wa Municipal. Then Guri, Kuree, Sobariyiri, Katang, Saawie, Kul-ora, Nyenvaare, Baguu, Tikpi and Orphani under Jirapa district.
Table 99: Outcome of Video Shows in selected communities 2015
Target Audience Men Women Boys Girls Total No. of people reached 3,569 3, 576 2, 581 1, 208 10,934
A total of 10, 934 people were reached during the videos in selected communities in the six districts
Advocacy meeting with religious, traditional, queen mothers
The objectives were to impart Knowledge and skills onto Religious, Traditional, and Queen mothers in Advocating for change towards Maternal and Child Health activities, use communication forums to influence community members towards positive behavior outcomes and to whip up the commitment and support of religious and traditional leaders towards addressing the C4D five key behaviors and other behaviours through effective dialogue
These activities took place between 25th March, 2015 and 25th April, 2015
167 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
A total of 341 people across the six districts participated out of which 252 of the participants
were males and 81 were females. The participants comprised of traditional authorities, religious leaders, opinion leaders, queen mothers, and mangazias in some communities in the districts.
Startup Meeting
The start- up meeting was aimed at discussing issues based on the implementation of the C4D strategy to improve maternal and infant health based and other key behaviours within the Region. The activity took place @ GNAT HALL BOARD ROOM in the Upper West Region on 10th and 11th February, 2015 with a total 25 participants
Table 100: Distribution of participants at the startup meeting
GHS GHS GHS Staff(Health staff(Public Category of Participants Staff(District Total Promotion Health Unit Directors)- Officers) members) Number 3 11 11 25
The meeting touched on the addition of the three new districts to the traditional C4D districts, the best LLIN utilization competition among all districts in the Upper West Region and the C4D activities carried out during the year 2014 some of which include Advocacy with religious, traditional leaders (district), Street/Market sensitizations (district), Monitoring of drama rehearsals (district), Night video screening (district), CBAs Performance Review meeting (district) and many others
The challenges are the short period of time for programmes implementation at the district level, failure of district officers to distribute Good life flip chart to CBAs, Some CBAs do not
168 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys know the total number of houses and households they serve in their respective communities including many others.
Training of district Health Promotion Officers
The objective of the training was to improve the skills and capacity of district health promotion officers and HP focal persons on the use of SBCC materials, help DHPO know how disseminate SBCC materials at the district and community level, help them understand the role of the health promotion officer at the district and community levels and to increase awareness on the repositioning of health promotion
Radio Programmes
The radio programme took place at all the radio stations in Wa thus Radio Progress, Radio Upper West, WFM and Sungmaale radio. Radio RADFORD in Tumu and VON FM in Nandom between January to June, 2015.
Topics covered during airtime were; CSM, Ebola, Cholera, Obstetric fistula, effects of smoking/second hand smoking. Messages on Child Health Promotion Week, teenage Pregnancy, and Female genital mutilation were channeled through the media.
A total of 40 visits were made to the radio stations on the above topics. There was phone in calls where listeners contributed significantly
169 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
C4D Annual Review
A total of 51 Participants attended the one day review meeting comprising Acting Regional Director Of Health Services, District Directors of Health Services, Regional Public Health Unit Members, District Health Promotions Officers, District Nutrition Officers, CNC, Literacy Bridge, Innovation for Poverty Action (IPA), Ghana Community Radio Network (GCRN members), Media, Plan Ghana, Department of Community Development, UNICEF communication officer and a member from the Regional Health Committee, etc.
There were presentations form partners on the activities they carried out with support from UNICEF followed by photo presentations of activities by districts displayed on walls for
participants
The Challenges enumerated from the presentations were that the districts highlighted inadequate working logistics such as motor bikes, camera for (4) districts, PA system for (4) to enable them reach out to communities for the C4D programme.
Regional Health Promotion unit also requested for office computer and its accessories and CNC outlined the need for support for their old vehicles (Tyres, Engine etc)
Strategies to address the challenges participants suggested need for follow up on the CHAP activities, Sensitization on the TIP-IT-UP for hand washing in the households, training of health staffs on the appropriate recording and reporting of all C4D activities
170 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Performance of Health promotion activities Education among pregnant women
Maternal and neonatal health education were carried out throughout the districts in the region. A total of 12,763 pregnant mothers were reached with health promotion messages in 2013, 14,049 in 2014 and 120,208 in 2015. Distributing the current year performance by districts gives wa municipal reaching more people followed by Wa East with Nandom recording the least as
Figure 106: Pregnant women reached through Health promotion by districts
Pregnant women reached through Health Promotion Messages by districts in UWR- 2015 Performance
6000 5425
4000 2706 1413 1409 1303 1293 1335 Total 1038 2000 879 840 460 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala Wa Wa East Wa West West District indicated in the figure below
Generally, it is important for all districts to intensify their education for pregnant women as a way of reducing maternal and child death. It is significant to note that, the year 2015 registered a highest compared to previous years within the same period.
Health Promotion among Adolescents
A total of 22,025 of these adolescents were contacted for various health promotion activities in 2015 compared to 15,490 in 2014 and 14,618 same period in 2013. Districts performing better were 7 out of the 11 in the region compared with the same period previous years.
Distributing the current year performance by districts gives wa municipal recording the highest number followed by Nadowli and Wa East with Sissala West recording the least as indicated in the figure below
171 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Figure 107: Adolescents reached through Health promotion by districts
Adolescents reached with Health Promotion messages by districts in Upper West Region- 2015 performance
10000 7653 5000 3047 3348 1530 1043 1160 489 618 721 457 1959 0 Total Total 2015 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala Sissala Wa Wa East Wa West East West Districts
Health Promotion among in School Pupils
A total of 55,937 school pupils were met during health promotion activities from a total of 28,363 in 2014 and 34,414 reached in 2013. Performance by district for the 2015 year period is shown the figure below.
Figure 108: School Pupils reached with Health Promotion by district
School Pupils reached with Health promotion messages in Upper West Region - 2015 performance 12000 10705 10780 10000 8149 7537 8000 6000 3472 4000 2680 2918 2701 2740 2547 Number 1708 2000 0 DBI Jirapa Lamb Lawra Nadowli Nandom S.E S.W Wa W.E W.W District
172 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Health Promotion in Households
A total of 34,542 people were reached in their households during the 2015 year period compared to 16,998 reached in 2013 and 18,621 covered in 2014, with the distribution given by districts shown in the figure below.
Figure 109: People reached in households through Health promotion by districts
people Reached in households with Health Promotion Messages by districts in Upper West Region- 2015 Performance 8000 6594 5368 6000 4113 3215 3304 2654 2870 3260 4000 1645 Total Total 2000 858 661 0 DBI Jirapa Lambussie Lawra Nadowli Nandom Sissala East Sissala West Wa Wa East Wa West District
Table 101: of I E & C Materials received and distributed.
Item Quantity Source Remarks
Code Of Ethics 27 BCS Distributed Chps Hand Book 172 BCS Distributed Planning Your Family Flip Chart 10 BCS Distributed Community Action Kit 236 BCS Distributed Health Information Cards 150 BCS Distributed Life Choices 4 BCS Distributed Kwame And Friends 160 BCS Distributed Activity Cards 20 BCS Distributed Are You A Real Man Leaflet 1000 BCS Distributed Drive Malaria Away 28 BCS Distributed Good Life 2 BCS Distributed Good Life Stickers BCS GHS/HPU Distributed
173 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
2015 Calendars 20 UNICEF Distributed
Health Promotion Challenges
Some of the challenges faced by the unit within the period under review were inadequate staff at the health promotion unit resulting in pressure on the staffs as well as delay in meeting deadlines in report submission, Delay in submitting monthly and activity reports by the districts and delay in assessing transport for C4D activities especially during monitoring.
Suggestions to address challenges
Continuous Editing and Production of video on CHN trainees field work activity introduction for JICA/CHPS, Continue with radio programmes on issues of public health concern including communicable and non-communicable diseases across the Region, Carry out religious and traditional leaders forum on key behaviours at the district level, Develop community Health Action plan in addressing the key behaviours in C4D districts
There is the need to conduct follow up on the developed community health action plan at the community level, Providing communication support for National celebrations (world malaria day, SMC), Carry out IPC Training for Health Staff and CBAs at the District and community Level, Conduct quarterly media briefing to correct misconceptions on Ebola and Cholera, IPC TOT for non- C4D districts, Carry out comprehensive monitoring and supervision to districts, sub districts and community level in the C4D districts
174 Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
175
Standard Indicators Definitions
Indicator Definitions Numerator Denominator Factor Proportion of pregnant women Number of women delivering in the Total number of expected specified time period who had attended Antenatal Care Coverage receiving antenatal care during pregnancies of the catchment area antenatal services (at least once). pregnancy within the specified period. % Proportion of Women making at least Number of pregnant women who made ANC 4th Visit their 4th visit to ANC sites in a specified time Total number of antenatal registrants 4th visit period. within the specified period. % Total number of antenatal Total number of antenatal registrants in a attendances (all visits to ANC sites) Average ANC Visit per client specified period within the specified period. No. Proportion of deliveries supervised by Number of women who deliver in the Skilled Delivery Rate a trained skilled attendant (midwives, specified time period who were attended by Total number of births in the specified doctors/obstetricians) a trained health worker time period % Proportion of deliveries conducted in Number of deliveries conducted in a Percentage total Deliveries Total number of expected deliveries a specified time period specified time period within the specified period % Proportion of pregnant women Number of pregnant women in a specified time period who had been adequately receiving at least 2 doses of Tetanus Tetanus vaccination coverage vaccinated with tetanus toxoid (at least 2 Total number ANC registrants in the vaccination before delivery doses) specified time % ANC Syphilis Screening Proportion of pregnant women who Number of pregnant women in the specified time period who had been tested for syphilis were screened for syphilis at the ANC Number of registrants in the specified Coverage during the pregnancy clinic in a specified period of time time period % Proportion of pregnant women who Syphilis infection among were screened of syphilis and tested Number of pregnant women screened for syphilis in the specified time period who Number of pregnant women who pregnant women positive at the ANC clinic in a tested positive for syphilis were tested for syphilis in the specified period of time specified time period % Proportion of women with obstetric Number of women with obstetric Percentage obstetric emergencies who are treated in a timely and Total number of women with emergencies treated appropriately emergencies managed appropriate manner in a specified time obstetric emergencies within the and timely according to protocol period specified time period % Percentage knowledge of Proportion of women of reproductive age with knowledge on at least two Number of women of reproductive age who danger signs on obstetric can name at least two danger signs of danger signs of obstetric obstetric complications Number of women of reproductive complications complications age % Proportion of deliveries performed by Caesarean section at acceptable Number of women delivered by Caesarean Percentage Caesarean Section standards (depending on the physical section in the specified time period Total number of deliveries within the characteristics of the women) specified time period %
CLX XVI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Incidence of and Proportion of pregnancies loss due to Number of unsafe and spontaneous abortions before 22 weeks of gestation or spontaneous abortion before 22 Number of live births in the specified Rate spontaneous/induced/elective below 500g in the specified time period weeks of gestation time period (1,000) Proportion of women with complications due to unsafe and Number of women with complications due Management of complications to abortions who are treated in a timely and spontaneous abortions treated in a due to abortions appropriate manner, in the specified time Total number of women with timely and appropriate manner period complications due to abortions within according to protocol the specified time period % Proportion of women who delivered Number of women who have delivered in the specified time period who made at least and attended postpartum clinic twice Postnatal Care Coverage 1 postpartum visits within 42 days after Total number of expected deliveries in within the first 42 days. delivery. the specified time period % Proportion of postnatal care mothers Number of women who have delivered in the specified time period who made at least who had their first postnatal visit Early Post natal care coverage 1 postpartum visits within 7 days after Total number of expected deliveries in within the first 7 days after delivery delivery the specified time period % Proportion of postnatal care mothers Number of women who have delivered in who had their first postnatal visit the specified time period who made at least Late Post natal care coverage within the 8th and 42nd day after 1 postpartum visits within 8th and 42nd day Total number of expected deliveries in delivery after delivery the specified time period % Percentage Postnatal care Proportion of postnatal care mothers Number of postnatal mothers with no previous antenatal care visit to the time of mothers with no previous ANC who did not make any antenatal visit Total number of postnatal registrants delivery in a specified period visit till delivery within the specified period Proportion of mothers who were Number of women who were given Vitamin A just after delivery and 24hours after Postpartum Vitamin A coverage given Vitamin A just after delivery and Total number of postnatal registrants delivery in a specified period 24hours after delivery within the specified period % Proportion of reported maternal deaths that are investigated Number of reported maternal deaths which Percentage Maternal Deaths are investigated according to established according to established guidelines, Audited guidelines, and the results of which are and the results are disseminated to disseminated to health staff Total number of reported maternal health staff deaths within the specified period % Number of maternal deaths for every Number of maternal deaths reported in a Maternal Mortality Ratio Ratio 100,000 live births during the year specified time period Total live births in a specified period (100,000) Proportion of pregnant women who Percentage Hb checked at Number of pregnant women with Hb had their Hb checked at the time of registration checked at registration in a specified period Total number of ANC registration registration within the specified period % Proportion of pregnant women who Percentage Anaemic at Number of pregnant women anaemic at the were found anaemic at the time of registration time of registration in a specified period Total number of ANC registration registration within the specified period %
CLX XVII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Proportion of pregnant women who Number of pregnant women with Hb had their Hb checked at 36 weeks of Percentage Hb checked at term checked at 36 weeks in a specified period Total number of Hb checked within gestation the specified period % Proportion of pregnant women who Number of pregnant women found anaemic were found anaemic at 36 weeks of Percentage Anaemic at term at 36 weeks in a specified period Total number of Hb checked within gestation the specified period %
Proportion of ANC attendants Proportion of ANC attendants by a Number of ANC attendants by TBAs in a Total number of ANC attendants by TBAs trained traditional birth attendants specified period within the specified period % Proportion of total deliveries Number of deliveries conducted by a Percentage TBA deliveries conducted by a trained traditional traditional birth attendant in a specified Total number of deliveries from all birth attendant period sectors within the specified period % Percentage 1st trimester proportion of pregnant women Number of pregnant women making their making their first ever visit to the first ever visit to the ANC in their 1st registration Total number of ANC registrants ANC in their 1st trimester trimester of gestation in a specified period within the specified period % Percentage 3rd trimester Proportion of pregnant women in Number of pregnant women making their their 3rd trimester at the time of first ever visit to the ANC in their 3rd registration Total number of ANC registrants registration trimester of gestation in a specified period within the specified period % Proportion of Pregnant Women with Percentage Pregnant Women Number of pregnant women with parity 5+ parity 5+ at the time of ANC at the time of ANC registration in a specified with parity 5+ Total number of registrants within the registration period specified period % Percentage Pregnant Women Proportion of Pregnant Women less Number of pregnant women less than 5 feet Total number of registrants within the with height less than 5 feet tall than 5 feet at the time of registration in a specified period specified period %
Percentage Pregnant Women Proportion of Pregnant Women 35yrs Number of pregnant women aged 35years and above at the time of registration in a Total number of registrants within the 35yrs and above and above specified period specified period % Percentage of health facilities Proportion of health facilities Number of health facilities providing integrated package of PMTCT services in providing integrated package of providing integrated package of Total number of health facilities in a period a given PMTCT services PMTCT services given period % Percentage of health facilities Proportion of health facilities Number of health facilities providing EID providing EID services using providing EID services using DBS services using DBS in a specified period Total number of health facilities in a DBS given period % Percentage of pregnant women Number of ANC clients who were tested for Proportion of pregnant women tested Total number of ANC clients who HIV and received result in the specified time tested for HIV and received were tested for HIV in the specified for HIV and received results period results period of time % Proportion of HIV negative women Percentage of HIV negative Number of HIV negative women counselled Total number of pregnant women counselled and provided information women counselled in a specified time period who tested negative for HIV within on HIV and STI prevention, and how the specified period %
CLX XVII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor to remain HIV free
Percentage of infected Proportion of infected pregnant pregnant women assessed for Number of pregnant women who tested women assessed for ART eligibility positive for HIV and assessed for ARV Total number of pregnant women ART eligibility (CD4 count or (CD4 count or clinical staging) eligibility within a specified period who tested positive for HIV within the clinical staging) specified period %
Percentage of infected women Proportion of infected women who Number of HIV positive pregnant women who were assessed for ARV and put on ARV Total number of HIV positive women who received ARVs for PMTCT received ARVs for PMTCT within a specified period within the specified time period % Percentage of eligible infected Proportion of eligible infected Number of eligible infected pregnant women received HAART for own health in a pregnant women received pregnant women received HAART for Total number of HIV positive women given specified period HAART for own health own health within the specified time period % Percentage of eligible infected pregnant women on co- Proportion of eligible infected Number of eligible infected pregnant pregnant women on co-trimoxazole women on co-trimoxazole in a given trimoxazole prophylaxis (20% prophylaxis (20% of total) specified period Total number of HIV positive women of total) within the specified time period % Percentage of infected women Proportion of infected women Number of infected pregnant women who received counselling and support on provided counselling and provided counselling and support on Total number of HIV positive women maternal feeding in a given specified period support on maternal feeding maternal feeding within the specified time period % Percentage of HIV infected pregnant women counselled on Proportion of HIV infected pregnant Number of HIV infected pregnant women women counselled on infant feeding who received counselling on infant feeding infant feeding by a trained by a trained counsellor by a trained counsellor in a given period Total number of HIV positive women counsellor within the specified time period % Percentage of HIV infected pregnant women provided with Proportion of HIV infected pregnant Number of HIV infected pregnant women women provided with family planning provided with family planning services after family planning services after services after delivery delivery in a given period Total number of HIV positive women delivery within the specified time period % Percentage of exposed infants Proportion of exposed infants Number of infants receiving ARV Total number of infants born to HIV receiving ARV prophylaxis for receiving ARV prophylaxis for PMTCT prophylaxis for PMTCT in a given period positive women within the specified PMTCT time period % Percentage of exposed infants Proportion of exposed infants started Number of infants born to HIV positive started on co-trimoxazole mothers who started receiving co- on co-trimoxazole prophylaxis within Total number of infants born to HIV trimoxazole prophylaxis within 2 months of prophylaxis within 2 months of positive women within the specified 2 months of age age in a given period age time period %
CLX XIX Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Percentage of exposed infants Proportion of exposed infants Number of infants born to HIV positive Total number of infants born to HIV mothers who received first virological test receiving first HIV virological received first HIV virological test positive women within the specified within 2 months of age in a given period test within two months age within two months age time period %
Percentage of HIV exposed Proportion of HIV exposed infants Number of HIV exposed infants who are on Total number of infants born to HIV infants who are on EBF, Penta 3 who are on EBF, Penta 3 visit EBF, Penta 3 visit in a given period positive women within the specified time period % Percentage of HIV exposed Proportion of HIV exposed infants infants who are breastfeeding Number of HIV exposed infants who are who are breastfeeding and covered breastfeeding and covered by ARV Total number of infants born to HIV and covered by ARV by ARV prophylaxis prophylaxis in a given period positive women within the specified prophylaxis time period % Percentage of HIV exposed Proportion of HIV exposed children Number of HIV exposed children who test Total number of infants born to HIV children who test positive by who test positive by DNA PCR positive by DNA PCR in a given period positive women within the specified DNA PCR time period % Percentage of infected children Proportion of infected children (0-14) Number of HIV positive children (0-14) Total number of infants born to HIV receiving Antiretroviral treatment (0-14) receiving Antiretroviral receiving ARV treatment in a given period positive women within the specified treatment (ART) (ART) time period % Percentage of male partners Proportion of male partners Total number of male partners counselled and tested for HIV in ANC setting in a given counselled and tested for HIV in counselled and tested for HIV in ANC Total number of antenatal registrants period ANC setting setting within the specified time period % Proportion of babies born who Number of live born infants weighing<2,500 Total number of live births (with birth weighed less than 2,500 gm at birth in Percentage Low Birth Weight grams in the specified time period weight recorded) in the specified time a specified period period % Proportion of babies born who Percentage of Very Low Birth Number of live born infants weighing<1,500 Total number of live births (with birth weighed less than 1,500 gm at birth in Weight g, in the specified time period weight recorded) in the specified a specified period period %
Proportion of children under 1 year Number of children under 1 year receiving OPV1 Coverage receiving Oral polio (OPV1) vaccine the OPV1 vaccine in the year Number of children under 1 year (estimated as 4% of the population) % Proportion of children under 1 year Number of children under 1 year receiving receiving Oral polio (OPV 3) vaccine OPV 3 Coverage the OPV 3 vaccine in the year Number of children under 1 year during the year (estimated as 4% of the population) % Proportion of children under 1 year Number of children under 1 year receiving receiving Penta1 vaccine during the PENTA 1 Coverage the Penta 1 vaccine in the year year Number of children under 1 year %
CLX XX Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Proportion of children 0-11 months Number of children 0-11 months receiving receiving Penta3 vaccine during the PENTA 3 Coverage the Penta 3 vaccine in the year year Number of children 0-11 months % Proportion of children 0-11 months Number of children 0-11 months who have received BCG and minus the number of who do not complete their Immunization Drop Out Rate children 0-11 months who have received Number of children 0-11 months who immunization schedule measles rubella 1 have received PENTA 1 % Proportion of children 0-11 months Number of children 0-11 months receiving receiving their Measles Vaccine Measles 1-Reubella Coverage the Measles vaccine in the year Number of children 0-11 months during the year within the specified period % Percentage CWC coverage in Proportion of children 0-11 months Total number of registrants (children 0-11 months) who visited the Child welfare clinic who visited the Child welfare clinic Target population of children 0-11 children 0-11 months site site months % Proportion of children 12-23 months Percentage CWC coverage in Total number of registrants (children 12-23 months) who visited the Child welfare clinic who visited the Child welfare clinic Target population of children 12-23 children 12-23 months site site months % Percentage CWC coverage in Proportion of children 24-59 months Total number of registrants (children 24-59 months) who visited the Child welfare clinic who visited the Child welfare clinic Target population of children 24-59 children 24-59 months site site months % Proportion of children aged 6–59 Percentage children receiving Number of children between 6-59 months months who received a high-dose Vitamin A Supplementation who receive Vitamin A supplementation Total number of children between 6- vitamin A supplement 59 months %
Proportion of newborn deaths Number of live born infants who die from 0 - Early Neonatal Mortality rate Rate occurring between 0 - 6 days of life 6 days of life Total number of live births within the specified period (1,000) Proportion of deaths of a newborn occurring during or pertaining to the Number of newborn deaths occurring during or pertaining to the phase surrounding the Perinatal mortality rate phase surrounding the time of birth, time of birth, from the 22nd week of Rate from the 22nd week of gestation to gestation to the 7th day of newborn life the 7th day of newborn life Total deliveries in a specified period (1,000)
Proportion of newborn deaths Number of live born infants who die from 0 - Neonatal mortality occurring between 0 - 28 days of life 28 days of life in a specified period Total number of live births in the Rate specified time period (1,000)
Proportion of newborn deaths from Number of live born infants who die from the 7th day to the 28 days of life in the Late Neonatal mortality rate Total number of live births in the Rate the 7th day to the 28 days of life specified time period specified time period (1,000)
CLX XXI Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Proportion of infant deaths occurring Number of infant deaths occurring between 28 days and 11 months of life in a specified Post neonatal mortality rate between 28 days and 11 months (29- Total number of births in the Rate period 364 days) of life specified time period (1,000) Proportion of babies born with no Number of baby born with no signs of life at or after 28 weeks' gestation in the specified Stillbirth Rate signs of life at or after 28 weeks' Total births in the specified time Rate time period gestation period (1,000)
Proportion of child deaths occurring Number of deaths occurring between 1 - 4 Child mortality between 1 - 4years of life years of life in a specified period Total number of live births in the Rate specified time period (1,000)
Childhood Mortality Proportion of infant deaths occurring Number of deaths occurring between 0 - 59 Rate Rate/Under-Five/Infant Deaths <5 years (0 - 59 months) of life months of life in a specified period Total number of live births in the specified time period (1,000) Proportion of pregnant women within Percentage Early teen Number of pregnant women within the ages of 10 - 14 years at the time of registration in the ages of 10 - 14 years at the time of Total number of ANC registrants pregnancies a specified period registration within the specified period % Percentage Late teen Proportion of pregnant women within Number of pregnant women within the ages of 15 - 19 years at the time of registration in the ages of 15 - 19 years at the time of Total number of ANC registrants pregnancies a specified period registration within the specified period % Proportion of schools within the Number of schools visited in a catchment catchment area visited or reached by Percentage of schools visited area in a specified period Total number of schools within a outreach teams catchment area in a specified period % Proportion of schools within the Percentage of schools current Number of schools with current environmental certificate within a catchment area with currently Total number of schools within a Environmental Certificate catchment area in a specified period approved environmental certificate catchment area in a specified period % Proportion of school children visited Percentage of Schools Children Number of School children examined within Total number of school children by outreach teams within the Examined a catchment area in specified period enrolled within a catchment area in a catchment area specified period % Proportion of School children who Percentage of School Children were examined but referred to a Number of school children referred within a Total number of School children referred higher level for treatment due to catchment area in specified period examined within a catchment area in condition seen specified period Percentage Percentage of Schools Proportion of Schools receiving at Number of schools receiving at least 3 health educational talks within a catchment area in Receiving 3+ Health Total number of schools within a least 3 health Educational talks a specified period Educational Talks catchment area in a specified period Percentage
CLX XXII Upper West Regional Health Services Data Sources: GHS Annual Reports, DHIMS2 & Surveys
Indicator Definitions Numerator Denominator Factor Proportion of women of reproductive age who are using (or whose partner Total number of family planning acceptors Contraceptive Prevalence in a given period is using) a contraceptive method at a Target population within the specified given point in time period Percentage The measure to contraceptive Contraceptive Method Number of contraceptive acceptors to a method use and uptake in a given Preference specific method in a given period Total number of family planning period acceptors within the given period %
Contaceptive Acceptor Proportion of the target population Number of family planning acceptors in a rate/Family Planning Coverage using family planning method specified period WIFA % Percentage Postnatal care Proportion of mothers who were Number of mothers who received mothers counseled on family given counsel on family planning counseling on family planning during their postnatal visit in a specified period planning during their postnatal visit Total number of postnatal registrants % Percentage Postnatal care Proportion of mothers who were given counseling and accepted to use Number of family planning acceptors in a mothers accepting family a family planning method during their specified period planning Total number of postnatal care postnatal visit registrants % The estimated protection provided by * CYP for short term methods is estimated contraceptive methods during a one by dividing the total number of commodities Family Planning Couple Years year period based upon the volume of dispensed by the CYP factor. * CYP for long term methods is estimated by multiplying of Protection all contraceptives sold or distributed the total number of free of charge to clients during that commodities/procedures/method by the Factor period CYP factor Commodity CYP Factor based
CLX XXII