Upper West Regional Health Services 2008 ANNUAL REPORT Dr. Alexis Nang-beifubah Regional Director of Health Services 12 March 2009 Executive Summary This report is an embodiment of how the health sector faired in the Upper West Region in the year 2008. The records point to some achievement amidst serious constraints. Transport and communication networks are not the best in the region. The proliferation and expansion of mobile telecommunication and radio networks has enhanced communication and information dissemination in the region. Currently, there are five radio stations, two TV networks and three mobile telecommunication networks operating in the region. With regards to the road network, only two of the nine districts are linked to the regional capital by tarred roads. For the untarred roads, the least one probably talks about them, the better as they are mostly horrible to travel on especially, during the rainy season. To overcome the challenges encountered in 2007 and other emerging ones, the region’s outlined priorities were to: sustain the high impact rapid delivery interventions; increase access (scaling of CHPS and NHIS); strengthen monitoring, supervision and performance management systems; improve quality assurance and customer care; strengthen disease surveillance/disaster preparedness and response/control; strengthen regenerative health and nutrition programme in all districts; and campaign on alcoholism The region, during the year, implemented activities aimed at reducing the high maternal and child mortality rates. The achievements in service delivery were remarkable with the reduction or stagnation in coverage for some sector-wide indicators. Immunization coverage using the pentavalent 3 vaccine as proxy reduced from 109% in 2007 to 82% in 2008. Our participation in all the national exercises aimed at polio eradication and vitamin A supplementation achieved coverages of between 96%-103% for polio and 98.1% for vitamin A (IMCHC). The Surveillance Unit met its targets for detecting polio and measles cases. There were, however, some “silent districts” as far as surveillance for detecting and reporting certain diseases were concerned. The Sissala East and West Districts would be encouraged to intensify efforts towards disease detection and reporting. The outbreak of anthrax in the Wa West District claimed 8 lives out of 11 suspected cases. A total of 419 contacts were given prophylactic treatment with ciprofloxacin. In the same district, we recorded outbreaks of pertusis and meningitis which were brought under control. The regional epidemic preparedness committee met two times in the year and have drawn plans towards mitigating the effects of any meningitis epidemic. A total of Twenty-Seven Thousand, Four Hundred and Forty-One (27,441) insecticide treated nets were distributed for children under one year of age under the malaria programme, together with artesunate-amodiaquine for the home based care in malaria treatment. The number of malaria cases 2 amongst under fives rose from 172,906 in 2007 to 217,136 in 2008. This is attributable to increased access to health care from patronage of the health insurance scheme on one hand, and the fact that the first diagnosis of any case of fever is taken to be malaria under the integrated management of childhood illnesses programme (IMCI). Under five case fatality was 2.4 %; much below the 5% projection, which is an achievement. The HIV/STI/AIDS programme marked increases in the number of PMTCT/CT centres from 36 to 63 and the number of facilities providing ART services from three to six. The “know your status” campaign did not record encouraging numbers and would need much work to improve coverage to at least 30%. In line with involving communities in HIV/AIDs control, 378 wanzams, hairdressers and traditional healers were trained in infection prevention. Mass treatment exercises were conducted in the region for onchocerciasis, filariasis and other neglected tropical diseases. A case search for Yaws amongst children in schools discovered 201 cases out of 32,893 children examined. The leprosy prevalence rate increased slightly during the year from X cases in year Y to Z cases in 2008. A total of 58 cases were under treatment. There were however, no deaths recorded. The region achieved a 95% reduction in guinea worm cases. Only one imported case was reported within the year period and which was contained in the Jirapa/Lambussie District. The Wa East District has a number of endemic villages which need close surveillance. A water project at Ducie has been of tremendous support in efforts aimed at to improving access to potable water and reducing the incidence of guinea worm in the area. Notwithstanding current government policy that almost universalised antenatal attendance, skilled deliveries were only 42.2% as against a targetted 50%. Family Planning Acceptor Rate drastically reduced from 84.9% to 52.2%. School Health and Adolescent Health activities were low for the year and efforts are to be made to intensify the provision of these services in 2009. Only 47.8% of children aged 0-24months were examined under the Growth Promotion Programme. The underweight among them stood at 26.4%. The supplementary feeding programme is being implemented in 56 communities of the nine districts. The rate of malnutrition (underweight) among child beneficiaries is 7.2%. In terms of breastfeeding, we noticed that about 61.5% of infants were put to breast within 30 minutes after birth. This marks some improvement in feeding practices. A survey into complementary feeding practices however, identified that only 23% of children received appropriate complementary food. The kangaroo mother care programme started in all districts in the 3 course of the year. Unfortunately, no facility was designated as baby friendly though 20 of them had been prepared for designation. The nutrition and malaria programme started in two districts; namely Nadowli and Sissala East. It is expected that the rest of the districts would be brought on board this programme, which aims at contributing to reducing child mortality due to malnutrition and malaria. Alcoholism was identified as an underlying factor in poor health amongst the people of the region. The Health Promotion Unit held a stakeholders meeting to brainstorm plausible strategies that could be adopted to reduce alcoholism. The Health Promotion Unit played a lead role in meetings of the epidemic preparedness committee, the world TB day celebrations, sensitization of stakeholders in avian flu, improving community dialogue and encouraging communities to improve their utilization of bednets. Our partners in health care delivery, namely UNICEF, UNFPA, WHO and WFP have been very supportive in the area of the HIRD strategy, maternal and child health, surveillance and nutrition respectively. Their support has been strategic in sustaining the activities of the public health unit to achieve set targets. Key among HR challenges were staff complaints lodged on wrong grades and salary steps, unauthorized Ghana Medical Association (GMA) dues deduction, and deletion of names from the payroll. Strenuous efforts made yielded the reinstatement of all 34 affected staff on the pay roll and the stoppage of GMA dues deductions from 23 affected staff. Efforts are however being made to get the deducted amounts refunded to the affected persons. These challenges serve as demotivators for which efforts should be made to minimise their occurrence. During the period, the staff strength increased by 126 to register a total of 1,664. The posting of staff included nine newly qualified doctors, two of whom reported, and nine newly qualified pharmacists, none of whom reported. As staff remain the most essential resource of every organization, the service in the region identified screening for basic ailments as a fundamental measure to ensuring that staff stay healthy to deliver services. In the pursuit of this agenda, BMCs were entreated to ensure that their staff are screened to promote early case detection, prevention and management. Staff accommodation remains a dreaded constraint and a yardstick for refusal of staff residing in the south to accept posting to the region. Recent plans to mitigate this would be deliberated with Regional and Municipal/District Coordinating Councils for a way forward in our quest to attract the needed cadres of professionals. 4 In our efforts to keep staff abreast with current professional knowledge, continuous development and capacity building sessions were held for various categories of staff with support from the Global Fund, JICA, UNICEF, and World Bank. Part of the funding was from GOG and IGF. Some special training sessions were also held by JICA including technical skills training for CHOs, Facilitative Supervision for SDHMT/DHMT/RHMT and the Referral System; all which geared towards the scale up CHPS in the region. One challenge identified was the uncoordinated nature of the training programmes from the National to the District Levels as a result which there conflicting training schedules were. Transport in the region remains a daunting challenge in lieu of poor road network and the prevalence of a host of over-aged vehicles and motorbikes. As many as nineteen (19) vehicles and one hundred and twenty six (126) motorbikes were earmarked for auctioning as a necessary step to lessen the burden of host BMCs. While this is unarguably necessary for the protection of life and property, their replacement is a serious matter for consideration to boost service