University of GhanaF http://ugspace.ug.edu.gh ill UNIVERSITY OF GHANA LIBRARY RA552.G5 Ar 2 bIthrC.l G347522 University of Ghana http://ugspace.ug.edu.gh AN EXPLORATORY STUDY INTO THE USEFULNESS OF THE DISTRICT HEALTH ANNUAL REPORT TO THE DHMT* IN THE MANAGEMENT OF THE DISTRICT HEALTH SYSTEM BY DR. A.A. ARDE-ACQUAH A DISSERTATION SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH, LEGON IN PARTIAL FULFILMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH OF THE UNIVERSITY OF GHANA DECEMBER 1995 (* DISTRICT HEALTH MANAGEMENT TEAM) University of Ghana http://ugspace.ug.edu.gh 347522 a University of Ghana http://ugspace.ug.edu.gh 11 DECLARATION I declare that lall the work in this study has been the result of my own research, except where specific references have — been made; and that it has not been submitted towards any other degree, nor is it bein g submitted concurrently in candidature for any other degree. W— jL(z_ —) 1. Signed: Candidate: 2. Signed: • t-A 4 Supervisor: 3. Signed: ...... Supervisor: . feriJk . ' .V'.\ . 4. Signed: ... Supervisor: 5. Signed: ... Supervisor: i University of Ghana http://ugspace.ug.edu.gh ii DECLARATION I declare that all the work in this study has been the result of my own research, except where specific references have been made; and that it has not been submitted towards any other degree, nor is it being submitted concurrently in candidature for any other degree. 1. signed: ....... ................................... candidate.......£«■. .. 7 A . .. i W ? " . 2. Signed: ... Supervisor: 3. Signed: ... Supervisor: 4. Signed: ... Supervisor: 5. Signed: Supervisor: University of Ghana http://ugspace.ug.edu.gh DEDICATION This study is dedicated to Cecilia, my wife, and to Timothy, Beryl, Phoebe, and Paul in acknowledgement of the immense support and encouragement given to me during the entire duration of my study course. University of Ghana http://ugspace.ug.edu.gh iv TABLE OF CONTENTS Title Page i Declaration ii Dedication iii Table of Contents iv Acknowledgements v List of Abbreviation vi Executive Summary viii CHAPTER ONE: INTRODUCTION 1 Foreward/Preface 1 Framework of the Study 4 Problem Statement 5 Hypothesis 6 Objectives of the Study 6 CHAPTER TWO: LITERATURE REVIEW AND THEORETICAL BACKGROUND 7 CHAPTER THREE: METHODOLOGY AND WORK DESIGN 12 CHAPTER FOUR: RESULTS AND OBSERVATIONS 20 CHAPTER FIVE: DISCUSSION AND COMMENTS 67 CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS 78 RERERENCES 84 APPENDIX 86 University of Ghana http://ugspace.ug.edu.gh V ACKNOWLEDGEMENTS I acknowledge with special thanks the advice and suggestions offered by my Supervisors, namely: Professor S. Ofosu-Amaah, Dr. Z. Batse and Dr. Gerard de Vries, with whom I discussed the study at every stage. I am very grateful to them. My deepest thanks go to Dr. Gerard de Vries who provided his office, transport and the necessary introductory protocols for me to reach all the DHMTs whom I had to interview. He was personally also interviewed by me; and he willingly offered his time, home, literature and every advice to see me complete the work. To him and his family I say 'Thank you'. I am also grateful to the entire management and staff of the Catholic Hospital for hosting me so hospitably during my entire field placement period. They have really taken good care of me. I am grateful to Mr. Mintah of the Catholic Hospital, Assin Foso, and also to Ms. Maud Tamakloe of RIPS for the typing work. I owe a big debt also to the entire Central Regional Health Administration, and to the Regional Director of Health Services, Dr. E.K. Sory, who welcomed me to his region and willingly gave me the permission to freely conduct my study in the districts. To the many whom I cannot mention for space, I say 'I am aware of and grateful to you all for all your help. B u t ..... to God be all the gloryl University of Ghana http://ugspace.ug.edu.gh vi LIST OF ABBREVIATIONS AR - Annual Report of the District Health Service CD & SW - Community Development and Social Welfare CHAG - Christian Health Association of Ghana CM - Communicy Mobilisation CR - Central Region DA - District Assembly DDHS - District Director of Health Services (same as District Medical Officer of Health DMOH) DHMT - District Health Management Team ECG - Electricity Corporation of Ghana EHO - Environmental Health Officer EPI - Expanded Programme on Immunization EPID - Epidemiology FE's - Financial Encumbrances FGD - Focus Group Discussion FP - Family Planning GWSC - Ghana Water and Sewerage Corporation M/A - Medical Assistant MCH - Maternal and Child Health MIS - Management Information system M.O - Medical Officer Min. of Agric - Ministry of Agriculture MOE - Ministry of Education MOH - Ministry of Health NFED - Non-Formal Education Division NGO - Non-governmental Organisation PEM - Protein Energy Malnutrition PHC - Primary Health Care University of Ghana http://ugspace.ug.edu.gh vii RDHS - Regional Director of Health Services RHMT - Regional Health Management Team SDHT - Sub-District Health Team TB - Tuberculosis TBA - Traditional Birth Attendant T.O - Technical Officer WHO - World Health Organization UNICEF - United Nations Children's Fund University of Ghana http://ugspace.ug.edu.gh viii EXECUTIVE SUMMARY I. INTRODUCTION For a developing country like Ghana, which has chosen the PHC strategy to achieve health for all by 2000 AD, the management of the district health system is understandably of vital importance. The government's support of its health policy is shown in its decentralization moves on the past few years. In 1995, not only personnel, but now, the financial administration has been brought to the district level. Health managers and teams therefore now bear the responsibility of managing the district health system. To do this successfully, information generation as well as its use in the widest sense is very essential. It is necessary to find out if this realization is present, for indeed a lot of data and information is commonly being already generated in the health system. II. PROBLEM STATEMENT The Annual report production, and indeed data collection and information generation, is very expensive and time consuming. The logistics and effort expended must be justifiable to all, if it is to continue. It is necessary therefore to explore and describe the extent to which the Annual Report, in particular, and the available data and information in general, are put to use by the DHMT in the management of the district health system. HYPOTHESIS There is the unproven feeling that while a wealth of information exists and is being generated in the health system, it is not being maximally used. University of Ghana http://ugspace.ug.edu.gh ix III. OBJECTIVES The main objective of the study was to explore and ide’rTETfy the uses that DHMTs are putting to their district annual reports. It touched also on the benefits that they derived themselves as far as producing, disseminating and utilizing it as a management tool are concerned. It is hoped that these findings will be an assessment of the present, but even more a spur to improve upon the management capability and output of the DHMT. IV. LITERATURE REVIEW Annual Reports on every aspect of the country were kept very regularly by the British Colonial government during the Gold Coast era. Reports dating as far back as 1948 on health and social welfare can be found in libraries today. In 1953, the first report on the Ministry of Health was put out - that was the very year the Ministry of Health was established. Since then annual reports have been written irregularly down the years but often with restarts. These restarts have often been stimulated from the central or national headquarters, which at the very least needed to collect information from the regions and districts to plan for the health caredelivery at the national level. 1978, when Ghana adopted the PHC strategy to help it implement its goal of health for all, annual reports have tended to extend their attention beyond the medical facilities to the wider field of public health. In 1990 with the promulgation of PNDC Law 207, on decentralization through local government, the district has been recognised as the level of implementation of health care University of Ghana http://ugspace.ug.edu.gh X delivery. The districts have been defined more clearly; more districts have also been created. The MOH has adopted these geographical districts to define its district health system. Now annual reports on the districts have a greater public health dimension, and the hospital and physical facilities are seen as part of an integrated whole - the district health system. To manage such a system, the information requirement is getting more widely defined. In 1995, the MOH headquarters prepared a format for health reporting at the regional level. This will also cause the regions to make a demand on the districts to report in a way that is meaningful to such a data compilation process. The use of such information at the national level is already well understood - policy formulation, planning, monitoring and evaluation. At the district, it will surely be needed for implementation. Therefore it is necessary to appraise the use of Annual Reports in implementing, at least, the recognised components of PHC (see appendix). V. METHODOLOGY The study was exploratory in design; and both secondary and primary data were collected through the use of the district's annual reports, and open ended questionnaires which were administered through focus-group discussions. Three(3) districts were selected purposively with the aim of arriving at a composite picture for the whole region. Two other districts were used for pre-testing the instruments of the study. VI. RESULTS Report writing is in various formative stages in all the University of Ghana http://ugspace.ug.edu.gh xi districts and reflects the level of stability, organization, and leadership in and among the DHMT members.