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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.
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