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Upper West Regional Health Services 2012 Annual Report

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Upper West Regional Health Services 2012 Annual Report Upper West Regional Health Services 2012 Annual Report Dr. Alexis Nang-beifubah Regional Director of Health Services March 2013 FOREWORD The 2012 Annual Health Sector Performance report captures information on key health sector strategies and specific interventions that were implemented during the year in line with the sector policies. During the period under review the perennial shortage of critical staff such as midwives, medical assistants and doctors as well as poor health infrastructure still persisted. There was also the emergent problem of a prolong (5 months) delay in reimbursement of NHIS funds to health facilities bringing untold difficulties to management of hospitals and health centres that rely on IGF from the NHIS as their main source of income. The Regional Health Directorate and all BMCs also experienced erratic flow of funding from central government as well as a decline in donor support. Other issues of concern such as high infant and maternal deaths, inadequate monitoring and supervision, and weak clinical services also confronted the region in the year. The challenges in the detection and control of key epidemic prone diseases were also encountered. Despite these challenges, the Regional Health Directorate adopted several innovative strategies that brought positive results in most of the key service delivery areas such as Reproductive and Child Health, Disease Surveillance and control and Clinical Care services. Most of the Sector wide Indicators in these service areas have improved as captured in our routine service data for 2012 as well as corroborated in national surveys as the Multiple Indicator Cluster Survey (MICS). The modest achievements made can be attributed to our dedicated health staff, community based volunteers, local governments at all levels, the people of the Upper West region, our development partners such as UNICEF, JICA, , UNFPA, Plan Ghana, World Vision etc. This report is to serve as an immediate source of information as well as a reference guide for researchers who are advised to contact the various units and BMCs for more details. The report is arranged according to the main strategic objectives outlined by the Ministry of Health. The general health indices of the region are improving but not fast enough. It is my hope that this trend will continue through 2013 and beyond towards the achievements of MDG 4 & 5 by the target year of 2015 which is fast approaching. Thank you. Dr. Alexis Nang-beifubah (RDHS –UWR) i EXECUTIVE SUMMARY The 2012 Annual report of the Upper West Region covers all the key service delivery areas and in accordance with the five (5) strategic objectives of the Ghana Health Service. It enumerates the key activities undertaken during the year under the five (5) strategic objectives of the service and the outcomes as measured by the sector-wide indicators. It represents a summary of many processes and reports from all the BMCs. The region within the period under review had made some remarkable improvements in some of the sector-wide indicators; others however stagnated, whilst some actually declined. This is partly attributable to inadequate critical health personnel such as midwives and clinicians as well as erratic and inadequate flow of funding from routine funding sources such as GOG and donor support. The region in the year 2012 witnessed a massive increase in the number functional CHPS zones from 114 in 2011 to 166 in 2012 representing 45.6% increase over the 2011 number. Functioning zones with compounds also increased from 104 to 114 in 2012. 82 Community Health Officers were also trained and deployed. Antenatal registrants slightly improved from 23,943 in 2011 to 24,720 in the year under review. Total number of skilled deliveries conducted increased from 14,687 in 2011 to 15,389 in 2012. Total still births recorded reduced from 365 in 2011 to 334 in 2012 with a corresponding decrease in fresh still births from 127 in 2011 to 106 fresh still births in 2012. Post Natal registrants (PNC) marginally increased from 19,113 in 2011 to 19,199 in 2012 . The Region recorded 28 institutional maternal deaths out of a total of 15,212 live births (LB) for 2012. This is a drop from 29 deaths out of 14,322 LB in 2011 and 26 deaths out of 12,270 LB in 2010. This is due to the interventions put in place especially Community Ambulance and institutional arrangements to speed up attention and care for expectant mothers as well as telephone directory use. Total number of clients accepting family planning decreased from 81,234 in 2011 to 79,021 in 2012. This was due to shortage of some of the family planning devices in the course of the year. ii In the area of EPI number of eligible children receiving BCG increased from 23,596 in 2011 to 23,753 in 2012. Penta III coverage however, decreased from 22,403 in 2011 to 22,129 in 2012. Measles and yellow fever immunization also recorded a modest improvement in coverage with OPV3 recording a decline in coverage. Tuberculosis (TB) cure rate declined marginally from 62.5% in 2011 to 62.3% in 2012. The Success rate on the other hand improved from 69.0% in 2011 to 75.4% in 2012. The HIV/AIDs programme was confronted with challenges of dwindling support in the area of logistics and funding. These led to general decline in most of the HIV/AIDs indicators. Total number of clients undergoing HIV/AIDs Testing and Counselling (HTC) declined from 8,921 in 2011 to 7,274 in 2012. There was also general decline in number of pregnant women tested for HIV from 24,407 in 2011 to 21,940 in 2012. With regards to Know Your Status (KYS) campaign there has been a general decline in coverage in all districts in the region due to inadequate number of trained counsellors as well as the drop in funding. With clinical care OPD attendance per capita stagnated at 1.1 and hospital admission rate declined marginally from 89.6/1000 population to 87.3/1000 population in 2012. The region recorded a slight fall in percentage bed occupancy from 72.6% in 2011 to 69.7% in 2012. It is very encouraging that the region has continued to record a gradual decline in the death rate and average length of stay in the hospitals from 2.1% to 2.0% and 3.2 to 3.1 days respectively from 2011 to 2012. The improvement in the clinical care indicators may be attributed to expansion in the coverage of NHIS which currently covers 95.6% of OPD cases in 2012 as against 94.3% in 2012. NHIS also accounted for 94.2% of inpatient cases in 2012 as against 77.6% in 2011. The proportion of underweight declined from 14.4% in 2011 to 13.5%, in 2012. The proportion of children wasting also reduced from 7.8% in 2011 to 7.2% in 2011, whilst the proportion of children stunting also came down from 24.1% in 2011 to 22.3% in 2012. Human resource availability and management continued to pose a serious challenge to quality health services delivery in the region. The region continued to grapple with inadequate numbers of critical staff especially, midwives, medical doctors, pharmacists and x-ray iii technicians. The situation was compounded by large number of critical staff in all categories who are fast approaching their retirement age. The region has faced real challenge in getting the full complement of critical staff to operationalize the five (5) new polyclinics that were completed and handed over to the GHS in 2012. We are however, grateful to the Cuban medical brigade that continued to complement our work force in all hospitals. The region is now adopting a strategy of prioritizing sponsorship for staff that opt to undergo further courses in the critical health care areas. The region was however, fortunate to experience an improvement in the enrolment into health training institutions from 986 in 2011 to 1,195 in 2012 with an accompanying improvement in the pass rate of students. It is the hope of the RHA that some of the human resource needs of the region shall be catered for when these students pass out from these schools successfully. Internally Generated Funds (IGF) remains the primary source of funding to the region especially health facilities contributing about 84% of the total funds received in the year under review as against the previous year’s of 63.93%. The implementation of the National Health Insurance Scheme (NHIS) has seen consistent increase in the revenue generation by health facilities in the Region. In total terms, however, the contribution of the National Health Insurance decreased marginally by a percentage point in 2012. Programme funding by the Health Partners ranked second after IGF accounting for only 15% of the total amount received for the year but have also declined consistently since 2009. Government of Ghana funding in terms of items 2 & 3 and Sector Budget Support (DPF) came third but also showed a sharp decrease in year 2012. The region continue to grapple with high indebtedness of health facilities to the Regional Medical Stores (RMS) standing currently at 48.25% in 2012 as against 57% in 2011. This is due to the failure of the National Health Insurance to reimburse the health facilities for over five months in arrears. This has the potential of adversely affecting the smooth running of the RMS if not checked. We recommend separate reimbursement of medicine from non-medicine. Management will be encouraged to work at improving their claims management. iv TABLE OF CONTENT FOREWORD ................................................................................................................................. i EXECUTIVE SUMMARY ............................................................................................................... ii LIST OF TABLES .........................................................................................................................
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