upper east regional health administration ghana … · 2004 annual report, upper east region i...

2004 Annual Report, Upper East Region

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ANNUAL REPORT, 2004

UPPER EAST REGIONAL

HEALTH ADMINISTRATION

GHANA HEALTH SERVICE

MARCH 2005


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TABLE OF CONTENTS List Of Tables .................................................................................................................... iii Table Of Figures ............................................................................................................... vii Executive Summary........................................................................................................... ix Chapter One ........................................................................................................................ 1 1.0 Introduction................................................................................................................... 1

1.1. Vision....................................................................................................................... 1 1.2. Profile Of Region..................................................................................................... 1 1.3. Major Concerns At The Beginning Of The Year..................................................... 6 1.4. Policy Thrust .......................................................................................................... 9 1.5. Priorities.................................................................................................................. 9 1.6. Summary Of Key Activities.................................................................................. 11

Chapter Two...................................................................................................................... 16 2.0. Service Delivery......................................................................................................... 16

2.1. Public Health.......................................................................................................... 16 2.1.1. Integrated Disease Surveillance And Response (IDSR)................................. 16 2.1.2. Epidemic Prone Disease ................................................................................. 19 2.1.3. Control Of Other Priority Diseases................................................................. 24 2.1.4. Non-Communicable Diseases ......................................................................... 45 2.1.5. Reproductive And Child Health (RCH).......................................................... 46

Chapter Three.................................................................................................................... 62 3.0. Clinical Care .............................................................................................................. 62

3.1. Key Activities Carried Out ............................................................................... 63 Chapter Four ..................................................................................................................... 79 4.0. Special Initiatives To Increase Access...................................................................... 79

4.1. Accelerated Child Survival And Development (ACSD) ....................................... 79 4.2. National Health Insurance...................................................................................... 82 4.3. Community Health Planning And Services (CHPS) ............................................. 83 4.4. Food Assisted Child Survival (FACS)................................................................... 85 4.5. Integrated Disease Surveillance And Response (IDSR) Strategy.......................... 85 4.6. Intermittent Preventive Treatment Of Malaria In Pregnancy (IPT-SP)................. 85 4.7. Communication Network....................................................................................... 86

Chapter Five...................................................................................................................... 87 5.0 Support Services ........................................................................................................ 87

5.1. Estates .................................................................................................................... 87 5.2. Equipment Management ........................................................................................ 89 5.3. Transport ................................................................................................................ 89 5.4. Regional Medical Stores. ....................................................................................... 94

Chapter Six...................................................................................................................... 100 6.0. Human Resource Development And Management.................................................. 100

6.1. Human Resource Management ............................................................................ 100 6.2. In-Service Training .............................................................................................. 106

Chapter Seven ................................................................................................................. 114 7: 1. Collaboration ..................................................................................................... 114

Chapter Eight .................................................................................................................. 116 8.0. Health Training Institutions ..................................................................................... 116


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8.1. Bolgatanga Nurses Training College .................................................................. 116 8.2: Presbyterian Nurses Training College, Bawku................................................... 118 8.3: Midwifery Training School, Bolgatanga ............................................................ 121 8.4 Navrongo Community Health Nursing Training School. .................................... 123

Chapter Nine ................................................................................................................... 126 9.0. Financial Management........................................................................................ 126 9.1. Finance................................................................................................................ 126 9.2. Internal Audit ....................................................................................................... 139

Chapter Ten..................................................................................................................... 141 10.0 Summary Of Key Achievements …………………………………………….…...141 Chapter Eleven................................................................................................................ 145 11.0 Outlook For 2005.................................................................................................. 145 Annexes........................................................................................................................... 148

LIST OF TAB Table 1: Target Populations ............................................................................................... 3 Table 2: Health Status Indicators....................................................................................... 4 Table 3: Summary Of Ownership Of Major Health Facilities........................................... 4 Table 4: Timely And Completeness Of CD1 Returns By Districts .................................. 16 Table 5: Five-Year Trend Summary Of CD1 (Weekly) From Districts .......................... 17 Table 6: Timely Submission Of CD2 (Monthly) By Districts.......................................... 17 Table 7: Summary Of CD2 Report Performance By Districts ........................................ 17 Table 8: AFP Surveillance Performance........................................................................... 18 Table 9: Performance Of AFP Surveillance .................................................................... 18 Table 10: Five Year Trend Of Epidemic Prone Diseases ................................................ 19 Table 11: Five Year Trend Of Incidence Of Reported Cases Of Meningitis .................. 20 Table 12: Case Fatality Rates Of Meningitis By Districts Jan- Dec 2004........................ 21 Table 13: Analysis Of Causes And Deaths Of Reported Cases Of Meningitis. .............. 22 Table 14: Case Fatality Rates Of Meningitis ................................................................... 22 Table 15: Containment By District, 2004 ........................................................................ 24 Table 16: Trend Of Guinea Worm Cases By Districts 2000 - 2004................................ 25 Table 17: Insecticide Treated Nets (ITN) Distribution By Districts............................... 26 Table 18: Malaria, OPD, Admissions And Deaths .......................................................... 26 Table 19: Trend Of U 5 Malaria Case Fatality Rates 2001 - 2004, UER......................... 28 Table 20: Summary Of Performance ............................................................................... 30 Table 21: TB By Category: 2001 - 2004 ........................................................................ 30 Table 22: Case Load ........................................................................................................ 32 Table 23: VCT Centres .................................................................................................... 35 Table 24: PMTCT Sites ................................................................................................... 35 Table 25: Case Load By Districts .................................................................................... 36 Table 26: Distribution Of Cases By Age Group By Districts.......................................... 36 Table 27: Trend Of Prevalence Rate (Per 10,000 Population) By Districts .................... 37 Table 28: Treatment Coverage, Surgeries And Clinical Cases Treated, 2004. ............... 38


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Table 29: Results Of Epidemiological Survey Of Villages Sissili And White Volta...... 39 Table 30: Programme Coverage ...................................................................................... 40 Table 31: Health Education And Rations For Pregnant And Lactating Women............. 41 Table 32: Outcomes Of Admissions To Rehabilitation Centres....................................... 42 Table 33: Vitamin A Supplementation: Trend Of Performance By Districts................. 43 Table 34: Results Sentinel Market Survey: Iodated Salt Utilisation .............................. 43 Table 35a: Type Of Psychiatric Conditions Seen By Districts........................................ 44 Table 35b: Cases Load By Districts................................................................................. 45 Table 36: Summary Of Performance In Reproductive Health........................................ 47 Table 37: CYP Coverage ................................................................................................. 48 Table 38: Trend Of ANC Coverage By Districts............................................................. 49 Table 39: Supervised Deliveries By Districts .................................................................. 50 Table 40: Postnatal Care By Districts.............................................................................. 51 Table 41: IPT-P Coverage By District............................................................................. 53 Table 42: Summary Of VCT/PMTCT Performance In Bolga And Bawku Hospitals. .. 54 Table 43: Timeliness And Completeness Of EPI Reports By District, 2004 ................. 55 Table 44: EPI Performance, 2004.................................................................................... 55 Table 45: 2004 Antigen Drop Out Rate........................................................................... 57 Table 46: 2004 Results NID Campaigns. ....................................................................... 58 Table 47: School Health Coverage ................................................................................... 59 Table 48: Results Of U5 De-Worming By Districts....................................................... 60 Table 49: Results Of School De-Worming By Districts.................................................. 60 Table 50: Summary Of Childhood Diseases (Admissions) Regional -2004 ................... 60 Table 51: Trend Of Case Fatality Rates Of Common Childhood Diseases..................... 61 Table 52: Summary Of Health Facilities ......................................................................... 62 Table 53: Bed Complements Of Hospitals ...................................................................... 62 Table 54: Clinical Conferences: Performance Of Hospitals........................................... 63 Table 55: Compliance On Guidelines And Standard On The Management Of Malaria

And Diarrhoea In Children Under Five Years. ......................................................... 64 Table 56: Client Satisfaction Survey ............................................................................... 64 Table 57: Summary For The Upper East Region (All Institutions)................................. 65 Table 58: Regional Hospital, Bolga................................................................................. 65 Table 60: Summary Of District Hospitals ....................................................................... 66 Table 61: Summary Of Mission Hospital (Bawku) ......................................................... 66 Table 62: Trend Of Ten Top Causes Of Opd Attendance ............................................... 67 Table 63: Top Ten Diseases Seen At The OPD, 2004, Regional Summary And District

Contributions............................................................................................................. 68 Table 64: Trend Of Ten Top Causes Of Admission, UER.............................................. 69 Table 65: Top Ten Causes Of Admissions, 2004, Regional Summary And District

Contributions............................................................................................................. 70 Table 66: Trend Of Ten Top Causes Of Death, UER...................................................... 70 Table 67: Top Ten Causes Of Deaths, 2004, Regional Summary And District

Contributions............................................................................................................. 71 Table 68: Institution Maternal Death Audits ................................................................... 73 Table 69: Institutional Maternal Death Ratio .................................................................. 73 Table 70: Intra-Regional Outreach Services.................................................................... 76


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Table 71: External Specialists Services ........................................................................... 76 Table 72: Ownership Of Laboratories ............................................................................. 76 Table 73: Essential Investigations ................................................................................... 77 Table 74: Trend Of Results Of Epi Coverage Survey, UER ........................................... 81 Table 75: ITN Promotion................................................................................................. 82 Table 78: Status Of Chps By Districts............................................................................. 84 Table 79: Internal Projects ............................................................................................... 88 Table 80: Vehicles ........................................................................................................... 90 Table 81: Motorcycles ..................................................................................................... 90 Table 82: Running & Maintenance Cost (Actual) ........................................................... 90 Table 83: 4 -Wheel Vehicles............................................................................................ 91 Table 84: Motorcycle. ..................................................................................................... 91 Table 85: Number And Types Of Vehicle....................................................................... 91 Table 86: Makes Of Motorcycles .................................................................................... 91 Table 87: Make Of Vehicles ............................................................................................ 92 Table 88: Accidents ......................................................................................................... 92 Table 89: The List Of Auctioned Vehicles ...................................................................... 93 Table 90: Drugs................................................................................................................ 95 Table 91: Non-Drugs ....................................................................................................... 96 Table 92: Non-Drug Consumables .................................................................................. 97 Table 93: Purchases From 2002 – 2004 (Non Drugs) ..................................................... 97 Table 94: Financial Statement ......................................................................................... 97 Table 95: Expenditure Summary ..................................................................................... 97 Table 96: Payments Summary ......................................................................................... 98 Table 97: Summary Of Institutional Indebtedness .......................................................... 98 Table 98:Financial –Drugs................................................................................................ 98 Table 100: Clinical Medical Officers ............................................................................ 101 Table 101a: Distribution Of Nursing Staff, UER, 2004 ................................................ 102 Table 101b: Professional Nurses ................................................................................... 102 Table 102: Auxiliary Nurses.......................................................................................... 102 Table 103: Staff Recruitment......................................................................................... 104 Table 104: Promotions................................................................................................... 105 Table 105: Wastage........................................................................................................ 105 Table 106: Implementation Of IST Carried Out At The RHD ..................................... 108 Table 107: Implementation Rate Of IST At Regional And District Levels In 2004 ..... 109 Table 108: Planned/Executed IST Programs By BMCS ............................................... 109 Table 109: Categories Of Staff Receiving SIST In 2004 ............................................... 110 Table 110: Cost Of In-Service Training ......................................................................... 111 Table 111: Trend Of Cost Of IST ................................................................................... 111 Table 112: List Of Some Collaborators/Partners........................................................... 114 Table 113: Financial Statement ..................................................................................... 117 Table 114: Student Recruitment And Performance (Licensure Exams)........................ 119 Table 115: Population Of Students:............................................................................... 122 Table 116: Below is the Performance Of Students Between 1999 – 2004. ................... 122 Table 117: Finances-DPF .............................................................................................. 125 Table 118: GOG Admin................................................................................................. 125


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Table 119: GOG Service................................................................................................. 125 Table 119: Cash Flow Statements- 2004 Performance Review - Finance Unit. ........... 128 Table 120.: Cash Outflows By SOF ............................................................................. 129 Table 121: Consolidated Statement Of Revenue And Expenditure By BMC............... 129 Table 122: Summary Of Exemption Reimbursements .................................................. 136 Table 123: Funds For Free Maternal Deliveries (July 2003-December 2004)............... 137 Table 124: Consolidated Statement Of Assets And Liabilities ...................................... 138


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TABLE OF FIGURES Fig 1 Map Of Upper East Region ....................................................................................... 2 Fig 2 Spot Map Of Health Institutions, Upper East Region, 2004 ..................................... 5 Fig 3: Ownership Of Health Institutions, UER, 2004......................................................... 5 Fig 5: Trend Of Attack Rates Of Meningitis .................................................................... 20 Fig 6: Trend Of Annual Incidence Of Meningitis ............................................................ 20 Fig 7: Case Fatality Rates Of Meningitis By Districts ..................................................... 21 Fig 8: Five-Year Trend Of Incidence Of Measles ............................................................ 23 Fig 9: Reported Cases (Imported) Of Guinea Worm, 2000-2004 .................................... 25 Fig 10: Malaria Disease Burden; Malaria Morbidity And Mortality................................ 27 Fig 11: U5 Malaria Cases Fatality Rates By Hospitals, 2004........................................... 28 Fig 12: Trend Of U5 Malaria C/F Rates ........................................................................... 29 Fig 13: District Treatment Results - 2003......................................................................... 30 Fig 14: Cummulative HIV Cases, 1989-2004, Upper East............................................... 33 Fig 15: Age And Sex Distribution Of Cases..................................................................... 34 Fig 16: Trend Of Sero-Prevalence By Sentinel Sites........................................................ 34 Fig 17: Leprosy Elimination: Trend Of Performance By Districts................................... 37 Fig 18: Comparing Well Nourished And Under Weight Children ................................... 40 Fig 19: Level Of Stunting And Wasting Among Children ............................................... 41 Fig 20: Nutritional Status Of Lactating Women............................................................... 42 Fig 21: Trend Of F/P Performance ................................................................................... 47 Fig 22: Trend Of ANC Coverage...................................................................................... 49 Fig 23: Trend Of Institutional Supervised Delivery Coverage......................................... 50 Fig 24: PNC Performance By Districts............................................................................. 51 Fig 25: Trend Of PNC Coverage ...................................................................................... 52 Fig 26: Trend Of Safe Motherhood Performance Indicators ............................................ 52 Fig 27: IPT-P Coverage (3rd Dose) By Districts............................................................... 53 Fig 28: EPI Performance, 2004......................................................................................... 56 Fig 29: EPI Performance By Districts: PENTA 3 And Measles, 2004 ............................ 56 Fig 30: Trend Of EPI Performance, 2000-2004................................................................ 57 Fig 31: EPI Drop Out, BCG-Measles ............................................................................... 57 Fig 32: EPI Drop Out Rate, PENTA 1-PENTA 3 ............................................................ 58 Fig 33: Trend Of Institutional Maternal Deaths ............................................................... 73 Fig 34: Institutional Maternal Mortality Ratio.................................................................. 74 Fig 35: Major Causes Of Institutional Maternal Deaths................................................... 74 Fig 36:Direct Causes Of Institutional Deaths ................................................................... 74 Fig 37: Trend Of Still Birth Rates..................................................................................... 75 Fig 38: Still Birth Rate By Districts In 2004 .................................................................... 75 Fig 39: Age Groups Of All Nurses, UER, As At December 2004 ................................. 103 Fig 40: Age-Groups Of Clinical Nurses, UER, As At December 2004 ......................... 103 Fig 41: Age-Group Of Public/Community Nurses, UER, As At December 2004 ......... 104 Fig 42: Trend Of IST Implementation Rate.................................................................... 110 Fig 43: Category Of Staffs Receiving SIST In 2004 ...................................................... 111 Fig 44: Type And Cost Of Trainings .............................................................................. 112


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Fig 45: Trend Of Exemptions Claims............................................................................. 135 Fig 46: Proportion Of Exemptions Claims By Category................................................ 135 Fig 47: Cost Per Head Of Exemptions Category ............................................................ 136 Fig 48: Trend Of ADHA Claims .................................................................................... 136


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EXECUTIVE SUMMARY The 2004 Annual Performance Report is the output of the annual review process. The process involved peer reviews in all District Health Administrations, Hospitals and Training Institutions and finally the Regional Performance Hearing which brought together all the BMCs in the region, representatives of the Regional Coordinating Council, Municipal and District Assemblies, NGOs in health, UN Agencies and observer team from Ghana Health Service and Ministry of Health (GHS/MOH) Headquarters. Activities implemented during the year were aimed at addressing the seven strategic objectives of the Second Five Year Programme of Work (2002-2006) and the key concerns or issues identified during the 2003 performance review. These concerns include the following:

� Poor geographical and financial access to quality health services � Serious shortfalls in health professionals � High disease burden � Stagnating and poor quality public health interventions � Low utilisation of clinical services, high maternal death rate, weak management

of hospitals. � Numerous uncompleted capital projects, poor state of residential and office

accommodation including hospitals and health centres � Slow scaling up of special initiatives aimed at improving access and quality of

health services. These include: CHPS, MHOs, IDSR, ACSD, FACS, SFP, IPT-P, VCT/PMTCT e.t.c.

� Weak partnership and community participation in health service planning, implementation, monitoring and evaluation.

Below are the key achievements during the year:

Infant and Child Mortality:

There was dramatic improvement infant and child mortality indicators as shown by the 2003 DHS. Infant mortality reduced by 59.8% (from 82 to 33 per 1,000 Live Births) between 1998 and 2003. Similarly child mortality reduced by 49% (155 to 79 per 1,000 Live Births between the same period.

Expanded Progarmme on Immunisation-Plus (EPI) The following were achieved for the various antigens:

� Measles = 88.2% � Penta 3 = 86.9% � OPV3 = 87.1%. � Penta1 – Penta 3 Drop Out Rate = 11%. � Four rounds of NIDs with coverage of over 100% � No wild polio isolated from any child


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� Significant reductions in the incidence of EPI Target Diseases, for example 39 cases of measles were reported with no deaths in 2004 as against 62 cases in 2003, representing a reduction of about 37.1%.

� Vitamin A Supplementation: Coverage was about 85.9% � De-worming: Under five years coverage was 94.6% and School Children 82.0%

Malaria:- The under five malaria case fatality rate reduced from 3.2% in 2003 to 2.5% (21.9% reduction). The ITN distribution was stepped up through support from UNICEF in the Accelerated Child Survival Development programme. A total of 123,034 ITNs were sold to parents for children under five years, giving a coverage of 80% and 36,223 to pregnant, representing 94.2% coverage. Efforts are being made to promote their use. Intermittent Preventive Treatment of malaria in Pregnancy (IPT) was rolled out to all districts in the region by the close of the last quarter of the year. Disease Surveillance: - Training in Integrated Disease Surveillance and Response strategy was carried out in all districts. Timeliness and Completeness of reporting of the weekly and monthly reports of Communicable Diseases improved. Timeliness of weekly reporting (CD1) improved from 77.9% in 2003 to 92% in 2004 and completeness was 100.0% as in 2003. Completeness for monthly reports (CD2) equally improved from 98.6% in 2003 to 100% in 2004. Timeliness showed dramatic improvement 55.6% in 2003 to 80.6% in 2004. AFP Surveillance: Indicators of AFP surveillance equally showed improved. Non Polio AFP rate was 2/100,000 children below 15 years against target of more than 1/100,000 and 88.9% of the stools were collected within 14 days (target (80%). No wild polio was isolated. Epidemics: The region had a major Epidemic Meningococcal Disease epidemic in 1996/1997. However, yearly focal outbreaks continue to occur in some sub-district. The following focal outbreaks were rapidly contained:

• Epidemic Meningococcal Disease (EMD) in Kassena Nankana East (Late Dec.2003-Mid Jan. 2004)

• Anthrax at Kassena Nankana District: April 2004 • Measles and Anthrax at Bugri-Kuka and Worikambo respectively in Bawku East.

May 2004 • Rabies at Gagbiri in Garu (Now Garu –Tempane district). July 2004 • Suspected Yellow Fever in Bawku West district, July 2004. (Laboratory result

proved case not to be Y/F) Guinea worm: - No indigenous case was seen during the year. The region reported its last indigenous case in 1992. Since then all reported cases have been imported from either Northern or Brong- Ahafo regions. A total of 17 imported cases were seen in 2004 as against 23 in 2003. All were contained. Leprosy:- Leprosy elimination target of 1 case per 10,000 population was achieved : 1.34 cases/10,000 in 2001, 0.92 case /10,000 population in 2002 and 0.64 case/10,000


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population in 2003 and 0.81/10,000 However, two districts, namely Bolgatanga and Bongo did not achieve the elimination target (1.26/10,000 for Bolgatanga and 1.34/10,000 population for Bongo District) Tuberculosis Key performance indicators dropped in 2004 compared to 2003.

� Cure rate was 76.3% in 2004 against 69.6% in 2003 � Case Detection rate was 33.3% in 2004 against 35.0% in 2003 � Defaulter rate was 14.4% in 2004 against achievement of 6% in 2003.

Onchocerciasis:- No recrudescence detected and Ivermectin combined with Abendazole distribution by community members was carried out with a coverage of 66.4%. Lymphatic Filariasis: A coverage of 66.4% was achieved for mass treatment with Ivermectin and Albendazole. A coverage was 63% in 2003. About 80 million cedis was made available for institutions for hydrocoele surgeries. Soil-Transmitted Helminthiasis. A mass de-worming of under five year olds and school children was undertaken during the year. The coverage treatment was 94.2% for under fives and 82.0% for school children. HIV/AIDS: - A total of 318 cases reported in 2004 against 339 cases in 2003; this represents a decrease of about 6.2%. As in previous years many health personnel were trained in counselling, prevention and control. STI/partner notification counselling is ongoing; visits were made in search of commercial sex workers in hotels and drinking bars. The two PMTCT centres in Bolgatanga and Bawku hospitals reported a total 11,565 ANC registrants out of which 282 were counselled and tested; 13 were positive, given a prevalence of 4.6%. Mothers and their babies were put Nivaripin. All the six hospitals have VCT centres. A total of 448 clients were tested following counselling out of these 62 were positive, given a prevalence rate of 13.8%. Plans are advanced for rehabilitation works and refurbishment of the VCT centres in all hospitals in the region. Reproductive Health: Modest achievements were made in the following areas � ANC was 102 % in 2004 against 101.2% in 2003 � Average visits were 3.4 against 3.3 in 2003 � Supervised Delivery (Institutional) was 31.9% in 2004 against 23.9% in 2003.

The following Performance indicators however dropped in 2004 compared to 2003

� PNC was 48.4% against 50.2% in 2003 � Family Planning – 19.3% in 2004 against 22.5% in 2003.

There were also 47 maternal deaths and maternal mortality ratio of 398/100,000 Live Births in 2004 as against 42 and 248/100,000 Live Births in 2003. Clinical Care There was modest improvement in service utilisation in 2004 over 2003.


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� OPD Per capita was 0.6 in 2004 compared to 0.59 in 2003 � Bed Occupancy was 49.7% in 2004 as against 48.2% in 2003 � Death rate was 3.4% in 2004 as against 3.6% in 2003, a reduction of 5.6%. � 91.5% of all maternal deaths were audited.

Health Infrastructure: Physical infrastructure received considerable attention during the year. Twelve (12) projects were approved under our capital investment plan. Technical and financial evaluations were carried out and all awarded to deserving contractors. Works are various stages of completion. The Regional Health Directorate carried out the following:

� Major rehabilitation/renovations on five (5) senior staff bungalows including Boys’ quarters.

� Renovations works at three (2) Health Centres Fumbisi and Kulungugu and minor repair works at Paga Health Centres.

� Construction of four (4) Community Health Compounds (CHCs) throughout the region.

� Installation five solar invertor systems for CHO Compounds � Procurement of medical equipment: Ten (10) Delivery Beds and ten (10) Blood

Pressure

Motorola communication equipment installed in three districts (Kassena Nankana, Bolgatanga and Bawku West) bringing the total f districts with equipment to four.

Transport: The region procured fifteen (15) motorbikes and received twelve others from motorbikes from HQ. For the first time, an HND graduate was posted to the region as a substantive Regional Transport Officer

Drugs and Non-Drug Consumables: Drugs:

� Tracer Drug Availability was 94.1% in 2004 compared 92.2% in 2003. � Networth as at 31st December 2004 was ¢1,950,253,153.48

Non-Drugs:

� Availability was 89% in 2004 as against 86% in 2003

� Networth as 31st December 2004 was ¢118,000,000.00

Finances: There was improvement in timeliness of financial releases from HQ in 2004 compared 2003. On the whole, Cash inflows was higher than expected, for example, ¢40.39 Billion was realised in yr 2002, ¢50.18 Billion in 2003 and ¢65.23 Billion in 2004, these translated in percentages are an increase of 24.2% in 2003 over 2002 and an


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increase of 30.0% in 2004 over 2003. All BMCs were reimbursed their exemptions claims

The outlook or focus for the year 2005 in the following: 1. Improve geographical access to quality health services

� Scaling up CHPS � Increasing primary health care outreach services � Improve Specialist Outreach Services � Staff training � Strengthening collaboration with communities, private health service providers

(for profit and Not for profit including quasi-government) � Provision of essential drugs and supplies and equipment

2. Improve financial access � Operationalisation of Mutual Health Insurance Schemes in all districts and

Municipalities in the region � Strengthening the implementation of the exemptions schemes for the poor and

vulnerable 3. Public Health

� Sustain the modest gains made in some public health programmes (surveillance, containment of epidemics, disease control and reproductive and child health)

� Strengthen the implementation of Child Survival Initiatives: ACSD and FACS, SFP etc

� Mainstreaming Adolescent Health; orientation and dissemination Adolescent Reproductive Health Policy.

� Strengthen Safe motherhood, Essential and Emergency Obstetric Care (Improve care of newborn, improved management of labour and pueperium, improved maternal death audits)

� Scale up and improve quality of IPT-P, VCT/ PMTCT for HIV, including management of STIs)

� The control of Malaria, TB, HIV/AIDS, Soil transmitted helminthiasis, Lymphatic Filariasis and Onchocerciasis

� The Eradication of Guinea Worm Disease and Polio. � Elimination of Leprosy and Maternal Neonatal Tetanus � Health Promotion � Strengthen Nutrition Interventions:

a. Exclusive Breastfeeding b. Complementary Feeding c. Supplementary Feeding, d. Micronutrient deficiency Control,(Vitamin A, Iodine, Iron, Folic Acid)

4. Clinical Care � Strengthen Management of Emergencies and Trauma; � Strengthen Quality Assurance


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• QA committees • Drug and Therapeutic Committees, • Infection Prevention Committees, • Maternal Audits, • Referrals, • Tracer Drug Availability and Non-Drug Consumables • Clinical conferences • Patients Charter • Code of Ethics • Code of Conduct and Disciplinary Procedures • Specialist Outreach Services • Patients satisfaction surveys

� Training in: • Rational drug use • Standards of pharmaceutical care • Standard treatment Guidelines •

• Strengthen Hospital Improvement Management.

5. Human resource development and management

• Training o In-Service, o Expanding intake of Community Health Nurses Training School o Scaling up Health Aides Training o Enrol Nurses training to started this year

• Monitoring and supervision • Staff motivation, attraction and retention • Staff re-distribution to needy areas

6. Health Infrastructure and support services

• Completion of all on-going projects • Rehabilitation of Existing structures • Construction of CHPS Compounds • Provision of Residential Accommodation • Continue upgrading of three district hospitals:- Zebilla, Bongo and

Sandema • Procure radio communication equipment for the two remaining districts:-

Bongo and Builsa districts.

7. Strengthening Health Information Management System

• Training


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• Use of information for planning and implementation • Monitoring and supervision

8. Financial Management in Budget Management Centres

• Training in ATF rules/ FAAR, BPEMS, new Procurement Act, Internal Audit Agency Act

• Internal Control mechanisms • Timeliness and completeness of financial reports • Prompt response to audit reports • Improving Exemptions implementation • IGF

9. Improving monitoring and supervision

• Facilitative supervision • On the spot coaching and on-the-job training.

10. Collaboration

• Strengthening linkages with District Assemblies & decentralised departments • Collaboration with NGOs in health • Collaboration with communities • Strengthen partnership with private Mission and Private for-profit service

providers • Collaborate with quasi-government service providers • Strengthen Regional, District and Institutional Health Committees to support

health service delivery


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CHAPTER ONE

1.0 INTRODUCTION This report is a summary of the policy thrust, priorities, key activities, achievements and constraints in 2004 and outlook in 2005. Similar to the previous year, this report is the output of the annual review process. The process involved dissemination of guidelines to all Budget and Management Centres (BMCs), peer review process in all District Health Administrations, Hospitals and Training Institutions and the finally the Regional Performance Hearing which brought together all the BMCs in the region, representatives of the Regional Coordinating Council, Municipal and District Assemblies, NGOs in health, UN Agencies and observer team from Ghana Health Service and Ministry of Health (GHS/MOH) Headquarters. 1.1. VISION The Vision of the Ghana Health Service is “A society in which preventable diseases and avoidable deaths are kept to the barest minimum and everywhere every citizen has access to quality driven, results oriented, close-to-client focused and affordable health service by a well motivated workforce”. Within the context of the GHS Shared Vision, we look forward to a future Regional Health Service with competent, committed and motivated health teams providing quality, affordable and client-focused services, which empower individuals, households and communities to take individual and collective responsibilities for their own health and development. 1.2. PROFILE OF REGION. The Upper East Region is located in the north-eastern corner of the country between longitude 0° and 1° West and latitudes 10° 30″N and 11°N. It has two international boundaries; namely Burkina Faso to the north and the Republic of Togo to the East. Peoples of these three countries share so much in common: language, socio-cultural and belief systems. There is intense cross border movement of people, goods and services at these borders. The challenges of disease surveillance and control in particular and health service delivery in general arising out of this geo-physical and social cultural associations cannot be over-emphasised. Surface area of the region is 8,842 sq.km (about 3.7% of the country).

• Rainfall short and scanty (800-900mm p.a) and long dry season with dry harmattan winds and hot periods – 40o C.

• Population from 2000 census is 920,089 (this about 4.8% of total population of country)

• Growth rate 1.1% • Projected Population for 2004 is 961,246. • Density 108 people/sq.km, range 35- 175 and compare national average of 77 • Population is largely rural (87%).


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• Settlement pattern is highly dispersed in 911 communities • Portable water coverage is about 66% in 2002 (national 44%), range 39 (Bolga–

96%-Bawku West) • Five main languages are spoken in the region (Gurune, Kusal, Kasem, Buili and

Bisa

Fig 1 Map of Upper East Region

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#

#

#

#

#

Burkina Faso

Upp

er W

est R

egio

n

Kassena-Nankani

Builsa

Bolgatanga

Bongo

Northern Region

Tog

o

Baw

ku W

est

Bawku East

BAWKU

BOLGA

BONGOZEBILLA

SANDEMA

NAVRONGO

DistrictBawku EastBawku WestBolgatangaBongoBuilsaKassena-Nankani

# Capital Towns

N

EW

S

20 0 20 40 Kilometers

Map of Upper East Region


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Table 1: Target Populations

GHANA HEALTH SERVICE, UPPER EAST REGION 2004 Total Population, Target Populations, and Sq. Km per Dist. BAWKU BAWKU BOLGA BONGO BUILSA KASSENA REGION TARGET POP. EAST WEST NANKANA TOTAL Children 0-11 months & Exp Pregnancy (4%) 12,868 3,368 9,562 3,255 3,150 6,247 38,450 Children 0 - 59 months (16%) 51,471 13,474 38,248 13,019 12,600 24,988 153,799 WIFA (24%) 77,206 20,211 57,372 19,529 18,899 37,483 230,699 TOTAL POP. 321,691 84,212 239,050 81,369 78,747 156,178 961,246 Square Km per District 2,067 1,009 1,444 460 2,205 1,658 8,842 Pop/Sq. Km 156 83 166 177 36 94 109

DISTRICT NO OF COMMUNITIES NO. OF SUB-DISTRICTS

BAWKU EAST 306 9 BAWKU WEST 114 6 BOLGATANGA 167 9 BONGO 53 6 BUILSA 120 6 KASSENA/NANKANA 151 6 911 42

Administration Region is divided into 6 administrative districts and 42 health sub-districts. Two new districts were created towards end of the year. These are Talensi-Nabdam from Bolgatanga Municipal, and Garu-Tempane from Bawku East Municipal, bringing the number of districts to eight in the Region.. The region lies within the Meningitis Belt of Africa. This belt is made up 21 countries with a population of 250 million in the age group 2- 29 years. This is the most vulnerable group with respect to CSM epidemics. Focal outbreaks and sometimes very widespread and devastating epidemics are commonplace events in the region each year. The Region also lies within the Savana blinding onchocerciasis belt of West Africa. Before the inception of OCP, blinding rates from onchocerciasis were as high as 10% in some communities. Even though the disease is practically controlled, the flies still pose serious nuisance to farming communities along the fertile river basins. In addition to mass distribution of ivermectin to communities with residual infections, we are also conducting active epidemiological surveillance for early detection of any recrudescence of the disease. Economic Activities Compounds are surrounded by relatively small farmlands. Crops grown year in and year out on these small farmlands include cereals (millet and guinea corn), groundnuts and onions. Rice and tomatoes are cultivated on both small and large scale using two irrigation


4

schemes (Tono and Vea Dams) and about 400 smallholder dams and dugouts. Animal rearing is also a major occupation of the rural population.

Table 2: Health Status Indicators

Indicator Regional Performance National Infant Mortality Rate (per 1,000 LB)

33 64 (DHS, 2003)

U5 Mortality Rate 79 111 (DHS, 2003) Maternal Mortality Ratio 600-800 (NHRC, 1992) 214 (DHS, 1993) Total Fertility Rate 4.7 4.4 (DHS, 2003) U5 underweight 32% 22% (DHS, 2003)

Table 3: Summary of Ownership of Major Health Facilities

Type of Institution Total Govt

Institutions Mission

Institutions Private Inst Regional Hospital 1 1 0 0 District Hospitals 5 4 1 0 Health Centres 26 18 8 0 Clinics 35 14 15 6


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KN DIST

BUILSA DISTBOLGA DIST

BA

WK

U W

EST

BAW KU EAST

BONGO DIST

Dist BoundaryBawku EastBawku WestBolgatangaBongoBuilsaKassena-Nankani

Roads

Type of InstitutionÑ Reg HospitalÑ District HospitalÑ Health CentreÑ Clinic

# Uedata.shp

10 0 10 20 Kilometers

N

Spot Map of Health Institutions, Upper East Region, 2004

Fig 2 Spot Map of Health Institutions, Upper East Region, 2004

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BONGO DIST

BAW KU EAST

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KN DIST

DistrictBawku EastBawku WestBolgaBongoBuilsaKassena/Nankana

Type of Ownership# Gov't Inst$ Mission Inst

N

Ownership of Health Institutions, UER, 2004

Fig 3: Ownership of Health Institutions, UER, 2004


6

1.3. MAJOR CONCERNS AT THE BEGINNING OF THE YEAR 1. Poor geographical and Financial Access Geographical Access

� Population within 8km H/F is about 61% � CHPS: Scaling Up facing serious challenges

o Slow pace of construction of Community Health Compounds (CHSs) o Logistics including motorbikes o Inadequate numbers and Commitment of staff

� Dispersed settlements pattern of population/communities � Poor road network � Referral systems poor � Seasonal floods with many riverine communities inaccessible during the wet

season � Poor communication network; no telephones network in some districts

Financial Access The region is the poorest among the ten regions of the country with about 88.2% population leave below poverty line as shown below Fig 4: Incidence of Poverty by Regions (1999, GLSS)

Incidence of Poverty by Regions (1999, GLSS)

88.2 83.969.2

48.4 43.7 37.7 35.8 27.7 27.35.2

39.5

020406080

100

UERUW

R NR CR ER VRBAR AR

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Region

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ow P

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7

Difficulties in Implementing the Exemptions: � Lack of uniformity in implementation � Inadequate funding and late release of funds � Delay and irregular release of funds � Abuses by some patients and health personnel � Difficulty in identifying paupers and declaration of wrong ages � Poor public awareness � Poor staff attitude towards clients/patients

Operationalization of NHIS

� Poor coordination � Start up funding - inadequate � Low awareness among both service providers and the general public � Readiness of Health facilities

2: Human Resource for Health

� Inadequate numbers of health personnel of all grades � Serious shortfalls of numbers of health professionals and specialists. � Mal-distribution � Difficulty in retaining products of the health training schools (4) in the region, � Refusal of postings � High attrition rate of health professionals due to “Push and Pull Factors” � Ageing health professionals

3: High Disease Burden

� Malaria: Highest Cause of morbidity and mortality � 40-50% OPD � 25-50% Institutional admissions � 10-40% Hospital Deaths

� Frequent due to Epidemic prone diseases: CSM epidemics (1983/84, 1991, 1996/7), Yellow Fever in 1996, Anthrax almost yearly, Cholera (1991, 1998)

� TB: Low case detection and cure rates and high defaulter rates � HIV/AIDS: Rising incidence: Stigmatisation of PLWHAs � Environmental/water-related diseases

� Guinea Worm � Onchocerciasis (“Blackspots and possibility of recrudescence � Lymphatic Filariasis � Schistosomiasis and Soil-transmitted heminthiasis

� Rising Incidence of Non-Communicable Diseases: � CVD including hypertension � Diabetes, � Bronchial Asthma � Substance abuse and other mental illnesses � RTAs


8

� High incidence of:

� Protein Energy Malnutrition (PEM) � Iodine Deficiency Diseases (IDD) � Vitamin A Deficiency (VAD) � Anaemia (Children and Pregnant Women)

4. Public Health Interventions � Stagnating public health service coverage � Poor Essential Obstetric Care � Low supervised delivery and PNC coverage � Weak involvement of males in Safe Motherhood programme � Poor quality of public health service (e.g. high EPI drop out rates, high TB

defaulter rates etc � Poor social mobilization strategies � Weak and inappropriate communication strategies

5: Clinical Care

� Poor internal management of health facilities � Low utilisation of clinical services (OPD per capita, Bed occupancy etc) � High institutional maternal deaths � Poor quality of maternal death audits and clinical conferences � Weak management of emergencies, especially obstetric emergencies and RTA � Poor and non-functional QA systems in health facilities � Poor specialist outreach services � Indequate and obsolete equipment

6: Health Infrastructure and Capital Investment

� Numerous uncompleted capital projects � Health facilities and residential accommodation in serious state of disrepair � Inadequate staff accommodation � Bongo, Sandema and Zebilla hosipitals are yet to be upgraded to District Hospital

status � Bawku Hospital needed urgent rehabilitation and refurbishment. � The infrastructure of the Regional Hospital do not befit the status of secondary

referral centre � Inadequate equipment � Most of the available equipment are obsolete or outdated or broken down

7: Scaling Up of Special Initiatives

� CHPS – Community Health Planning and Service � ACSD-IMCI P-Plus, EPI-Plus and ANC-Plus � IDSR Integrated Disease Surveillance and response � Supplementary Feeding Programme and Nutrition Rehabilitation Centres


9

8: Weak Management of Health Services � Poor supervision at all levels � Weak human resource, financial, transport, logistics management all levels � Weak health Information Management systems

9: Partnership and Community Participation

� Weak collaboration with District Assemblies and Health related MDAs � Poor co-ordination of activities of NGOs in health � High level poverty militate against community participation � Beliefs and socio-cultural practices affecting health-seeking behaviour

10: Coordination Poor Planning and Coordination of programmes between Regions and National Programme Managers / Coordinators. 11: Cash flow: Late release of funds from Headquarters to meet implementation dead lines. Short falls in cash flow against the approved budget 1.4. POLICY THRUST

� The strategic objectives outlined in the 5 Year POW II � The pro-poor agenda as outlined in the GPRS and the Framework of Health

response to the GPRS. � The regional agenda or priorities set for 2004 following the performance review � Strategic priorities recommended from the Health Summit

The Details are:

� Increasing geographical and financial access to health care � Improving quality of health care � Improving efficiency � Improve collaboration and partnership � Increasing financial resources for health service delivery � Bridging equity gaps in access to quality services � Ensuring financial arrangements that protect the poor. � Priority health interventions (priority diseases and health interventions etc.)

1.5. PRIORITIES 1. Improving Geographical and Financial Access

� Rolling out CHPS � Strengthening outreach services (including specialists outreach services) � Streamlining implementation of the exemptions policy � Facilitate and prepare facilities/staff for the NHIS


10

� Collaboration with other health service providers (quasi-, private, traditional), District Assemblies and decentralised departments to improve access to quality health services

2. Surveillance and Disease Control

� Strengthening surveillance systems for early detection, prevention and containment of epidemics (EMD, YF, Cholera, Anthrax etc)

� Rolling out IDSR � Improving strategies and building capacity to eradicate, eliminate and control

priority diseases;- � Eradication: Guinea worm and Polio � Elimination: Neonatal tetanus, Leprosy and Lymphatic filariasis � Control: Malaria, TB, HIV/AIDS, Soil transmitted helminthiasis � Emerging non-communicable diseases (Diabetes, Hypertension etc) � Oral health � Primary Eye Care � Mental Health

3. Reproductive and Child Health

� Strengthening reproductive and Child Health Initiatives � Safe Motherhood including strengthening essential and emergency

obstetric care (EOC) � Strengthening and Scaling up Child survival Initiatives (NIDS, SIAs,

ACSD, FACS, SPF, Nutrition Surveillance, Vit A and Iodated Salt programme etc)

� Mainstreaming Adolescent Health � Strengthening the School health programme

4. Improving Clinical Care

� Improving management of emergencies and trauma � Improving Quality Assurance Systems in health facilities � Improving Performance management in hospitals � Specialist Outreach Services (Intra and inter-regional and district) � Improve laboratory and diagnostic services

5. Improving Human Resource Management

� Pre, post and In-Service Training Programme � Expansion of intake and quota of health training institutions � Motivation/Incentives to attract and retain health professionals � Advocacy for support by Assemblies, NGOs. � Ensuring equitable distribution of available human resource for health

6. Improving Support Services

� Estates (Physical infrastructure) including � Completion of uncompleted projects � Rehabilitation of existing staff accommodation and offices


11

� Collaboration with RCC/DAs for accommodation � Improving communication network � Transport: Carry out regular PPM � Equipment: Repair and acquisition of new equipment � Procurement: Adherence to procurement procedures and plans

7. Scaling Up Special Initiatives

� Community-based Health Planning and Services (CHPS) � NHIS:- Mutual Health Organisations � Accelerated Child Survival and Development Programme (ACSD) � Supplementary Feeding Centres � Food Assisted Child Survival programme (FACS) � Intermittent Preventive Treatment of Malaria in Pregnancy (IPT-P) � Integrated Disease Surveillance and Response (IDSR)

8. Building Management Capacity of BMCs:

� Facilitative Supervision � Human Resource management and development � Financial management

� Compliance with ATF, FAA, IAA rules and regulation � Internal Controls � Capacity building of district financial and non-financial managers � Ensure prompt financial reporting for decision making

� Estate/transport/equipment � Health Information Management

� Improve quality of data collection at all levels � Build capacity for in-depth analysis of data for decision making � Expand scope of data collection and analysis at all levels to service

providers 9. Promoting Partnerships for Health

� Active involvement of other MDAs, NGOs, Civil society and communities in planning, implementation and evaluation of health services.

1.6. SUMMARY OF KEY ACTIVITIES The following key activities were undertaken 1. General

� Monitoring and facilitative supervisory visits and feedback on key findings and decisions at all levels

� Technical and management meetings at all levels (weekly, monthly quarterly etc) � Regional, District and Facility In-House Health Committee meetings � Review of 2003 Performance � Drawing of 2005-2007 MTEF Need Based Plans and Budgets


12

� Drawing/distribution of guidelines and standards � End of year Awards for deserving staff � Celebration of first Anniversary of the GHS launch.

2. Improving Access Community Health Planning and Services (CHPS)

� Strategic, programatic, CHO and Volunteer training and placement of CHOs at completed zones

� Construction of CHPS Compounds � Procurement of logistics including motorbikes for CHOs,

Mutual Health Insurance Scheme � Set up and strengthened Regional Health Team � Sensitisation (Health workers and general public) � Training of health service providers � Monitoring and supervision of schemes throughout the region

Outreach services

� Inter and Intra regional conduct of outreach services and specialist services to the region

Exemptions

� Public education on exemptions facilities carried out � Claims submitted by BMCs, validated by the Regional Team and payments made

3. Surveillance and Disease Control

� Roll out training on IDSR � Training of Community Based Surveillance Volunteers(CBSV) � Conduct of core and support functions of surveillance � AFP surveillance (Active and passive) � District Peer Review of AFP Surveilance � Case based-investigation of epidemic prone diseases � Outbreak/epidemic containments � Control of priority diseases: Malaria, Tuberculosis, HIV/AIDS, Guinea worm, LF,

Onchocerciasis, Schistosomiasis and soil-transmitted helminthes etc Malaria � Training in case management � Rolling out IPT-P training in all districts � Distribution and promotion of ITNs � Environmental Sanitation – Clean-up campaign by Assemblies etc. � Public education


13

Tuberculosis � Monitoring and supervision of DOTs centres � Half year review meetings of Districts and Institutional coordinators � Provision of drugs and logistics to centres � Refresher training for DOTS centres staff � Quality Control of TB microscopy � Quarterly Cohort analysis HIV/AIDS � Implementation of VCT/PMTCT in five hospitals � Training of Nurses and Midwives in STI � Training of health staff on VCT/PMTCT � Sensitization of opinion leaders and chiefs and the general public � Support PLWHA meetings and income generating activities � Conduct of 2004 sero-surveillance survey Lymphatic Filariasis (LF) � Albendazole and Ivermectin drug combination mass distribution � Free Hydrocoelectomy Onchocerciasis � Active epidemiological surveys � Public education Schistosomiasis and Soil-transmitted Helmintheses � Urinary and Intestinal Schistosomiasis � Hookworm, round worms etc

4. Reproductive and Child Health

Reproductive Health Services � Routine ANC, PNC, FP � Conduct of safe deliveries including assisted and C/S � Training and conduct of Maternal Death Audits � Emergency obstetric care � Training in Safe Motherhood Clinical Skills and Health Education � Training of TBA supervisors � Training and distribution of SP for IPT-P programme in all districts � Post-partum Vit A Supplementation � VCT/PMTCT � Special STI Clinics

Child Survival activities: Scaling Up ACSD EPI Plus

� Routine Immunisation


14

� NIDs � Measles SIAs � Vitamin A Supplementation � Mass De-worming (pre-school)

IMCI Plus

� Treatment, distribution and promotion of ITNs � Training in Management of children with malaria, diarrhoea, ARI in health

facilities and homes � Promotion Breastfeeding, complementary feeding, growth monitoring � Promotion of the use of Iodated salt

School Health � Registration and Screening of school children � De-worming of school children � Health education talks

Nutrition

� Nutrition surveillance (Growth monitoring etc.) � Monitoring and supervision of supplementary feeding centres � Monitoring and supervision of nutrition rehabilitation centres � Training in anaemia control and prevention � Provision of micro-nutrients � Nutrition education

5. Health Promotion � Public education on epidemic prone diseases � Launching of Special Days � Community Durbars

6. Quality Assurance / Clinical Services

� Provision of 24 hour OPD services � Provision of out and in patient care � Management of emergencies � Conduct of client satisfaction surveys � Maternal death audits and mortality conferences � Training in infection prevention and control � Survey of compliance of treatment guidelines � Specialist Clinical Care Outreach services

7. Human resources Development and Management

� Pre service training of Nurses (4 training schools), Laboratory Assistants and Health Aides

� In-service training: Structured and Remedial training of all categories of all staff � Post Basic / Post Graduate training for various cadres of health workers


15

� Promotion and upgrading of health staff � Staff posting and re-distribution � Motivation / Incentives (awards, ADHA, deprived area allowances) � Maintenance of staff accommodation, cars on hire purchase, maintenance

allowance etc. 8. Support Services Estate

� Completion of uncompleted projects � Rehabilitation of Residential and Office accommodation � Upgrading of health facilities � Construction of CHPS compounds

Transport management

� Fleet management � PPM and repairs � Interview and recruitment of drivers � Auction of unserviceable vehicles � Procurement and distribution of motorbikes and bicycles

Equipment Management

� Inventory taking � PPM – Cold Chain � Procurement of Medical Equipments, Computers and Accessories

Stores and Supplies Management

� Procurement and distribution of drugs and non-drugs consumables � Drug quality monitoring � Stock taking

9. Financial Management

� Training on financial management for non-finance managers � Conducted Regional financial validation of all BMCs � Sensitization of RHMT and DHMT members on the FA Act, the procurement Act

and the IAA Act � Monitoring and supervision of all BMCs in the region � Routine Audit inspection � Special Audit inspection � Pre-inspection of procurements � Facilitation of audit query responses


16

CHAPTER TWO

2.0. SERVICE DELIVERY 2.1. PUBLIC HEALTH 2.1.1. Integrated Disease Surveillance and Response (IDSR) The roll out training plan of IDSR was successfully carried out in all six districts. A total of 239 health workers were trained from all six districts. The course content included the core functions of surveillance:

• Case detection or identification • Recording and reporting • Analysis and interpretation of data • Case investigation • Response/action • Provision of feedback • Evaluation and improvement of the system.

Timeliness and Completeness of Surveillance Reports.

Table 4: Timely and Completeness of CD1 returns by Districts

Districts #Reporting sites

# Expected

# Timely received 2003


% Timely 2003

% Timely 2004

%Completeness 2003

%Completeness 2004

Bawku East

10 520 377 420 71.1 81.0 100 100

Bawku West

11 572 280 550 66.0 96.2 100 100

Bolga 21 1092 786 1039 94.0 95.1 100 100 Bongo 6 312 264 300 83.3 96.2 100 100 Builsa 6 312 239 282 75.2 90.4 100 100 KND 6 312 184 288 62.9 92.3 100 100 Region 60 3120 2136 2869 77.9 92.0 99.9 100 Over 90% of CD 1 reports were timely received in 2004 as against 77.9% in 2003. The target of 80% was achieved by all districts in 2004.


17

Table 5: Five-Year Trend Summary of CD1 (Weekly) from Districts

Year Timeliness Completeness 2000 70 86.0 2001 75.9 95.9 2002 79.6 95.8 2003 77.9 100 2004 92.0 100

Significant improvement in terms both timelines and completeness of reporting was made during the year under review.

Table 6: Timely Submission of CD2 (monthly) by Districts

Districts Reporting sites

Expected


#Timely received 2004

% Timely 2003

% Timely 2004

Completeness 2003 %

Completeness 2004 %

Bawku East

10 12 8 10 66.7 83.4 100 100

Bawku West

11 12 6 8 50.0 66.7 100 100

Bolga 21 12 4 11 33.3 91.7 97.7 100 Bongo 6 12 7 11 85.3 91.7 100 100 Builsa 6 12 10 9 83.3 75.0 100 100 KND 6 12 5 9 41.7 75.0 83.3 100 Region 60 72 40 58 55.6 80.6 97.2 100

Table 7: Summary of CD2 report performance by Districts

Year Timeliness Completeness 2000 56.9 94.5 2001 75.0 98.6 2002 84.7 100 2003 55.6 97.2 2004 80.6 100

Timeliness and completeness of CD2 reports were 80.6% and 100% respectively in 2004 as against 55.6% and 97.2% in 2003. Only two districts, namely Bawku West (66.7%) and Kassena Nankana (75%) did not achieve the recommended target of at least 80%.


18

AFP Surveillance: The table below shows AFP surveillance performance during the year.

Table 8: AFP Surveillance Performance

District Expected # AFP

# Reported

2 stools within 14days

60days Follow-up

Bawku East

1 1 1 1

Bawku West

1 2 2 2

Bolgatanga 1 2 2 2 Bongo 1 2 2 2 Builsa 1 0 0 0 KND 1 2 2 2 Region 4 9 9 9 Nine (9) cases against the expected 4 were seen. However Builsa district was silent during the whole year.

Table 9: Performance of AFP surveillance

District #Expected #Reported 2 Stool specimens with 14 days of onset

% Non polio AFP rate

Outcome

Bawku E 1 1 1 100 1.0 Discarded Bawku W

1 2 2 100 2.0 Discarded

Bolga 1 2 1 50 1.0 Discarded Bongo 1 2 2 100 2.0 * Builsa 1 0 0 0 0 KND 1 2 2 100 2.0 Discarded Region 4 9 8 88.9 2.0 *One discarded while one is pending Summary of Achievements.

• All planned visits (quarterly) were carried out. • IDSR roll out training carried out in all districts • AFP Surveillance targets (stool specimen with 14 days, non-polio AFP rate)

achieved


19

• Standard case definitions (SCD) were widely used, suspected cases followed up promptly and data analysis done at most levels.

2.1.2. Epidemic Prone Disease Focal Disease Outbreaks. Six different outbreaks were reported during the year 2004 in three districts. All were thoroughly investigated and rapidly contained. They included:


• Anthrax at Kassena Nankana District:- April 2004 • Measles and Anthrax at Bugri-Kuka and Worikambo respectively in Bawku East.

May 2004 • Rabies at Gagbiri in Garu (Bawku East district) - July 2004 • Suspected Yellow Fever in Bawku West district - July 2004. (Laboratory result

proved case not to be Yellow Fever)

Table 10: Five year Trend of Epidemic Prone Diseases

Disease 2000 2001 2002 2003 2004 Meningitis 345 705 747 464 514 Cholera 0 0 0 0 0 Yellow Fever

0 0 0 0 0

Measles 1861 1436 369 62 39 Anthrax 40 105 35 0 19 (1

death) Wild Polio 0 0 0 0 0 MENINGITIS/CSM-EMD Meningitis especially meningitis caused by Neisseria meningococcal meningitides (Epidemic Meningococcal Disease- EMD) is a major cause of serious epidemics in the region. Major epidemics occur in 8-10 year cycles; the last major epidemic was in 1996/7. Yearly focal outbreaks occur each year. The area of frequent outbreaks is enclave involving three contiguous sub-districts in three adjacent districts, namely Kassena-Nankana East in Kassena Nankana District, Sumburugu in Bolgatanga District and Zorkor in Bongo district. The emergence of epidemics since 2001 caused by sero-type W135 in neighbouring Burkina Faso poses serious challenge to our surveillance and containment preparedness. The current vaccine is effective against sero-types A & C. The vaccine against W135 is


20

expensive and not readily available. Thus the mainstay of prevention and control of W135 is early detection and effective case management.

Table 11: Five year Trend of incidence of reported cases of Meningitis

Year Pop # Cases Attack Rate (100,000 pop) 2000 920,089 345 37.5 2001 930,210 705 75.9 2002 940,442 747 79.4 2003 950,787 464 48.8 2004 961,246 527 54.9

Trend of Attack Rates of Meningitis

0

20

40

60

80

100

2000 2001 2002 2003 2004

Year

AR (p

er 1

00,0

00 P

op)

Attack Rate

Threshold

Fig 5: Trend of Attack Rates of Meningitis Annual Attack rates of 50-100 per 100,000 occur during epidemic periods in Meningitis Belt of Africa. In 2001, 2002 and 2004 there were focal outbreaks and thus rates of over 50/100,000 were reported. Fig 6: Trend of Annual Incidence of Meningitis

Trend of Annual Incidence of Meningitis

-20000

2000400060008000

10000120001400016000

1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

No.

Cas

es

1996/7 Epidemic


21

Table 12: Case Fatality Rates of Meningitis by Districts Jan- Dec 2004

Districts #Cases Deaths Case Fatality Rates % Bawku East 57 15 26 Bawku West 13 3 23 Bolgatanga 113 15 14 Bongo 16 2 13 Builsa 21 9 43 KND 296 10 3 Region 514 55 11 Case fatality rates were unacceptably high in three districts (Builsa, Bawku East and Bawku West). Kassena Nankana District however recorded the lowest (far below the acceptable rate of 10%) despite the focal outbreak experienced in one of its sub-districts. Fig 7: Case Fatality Rates of Meningitis by Districts With the exception of Kassena Nankana District, case fatality rates exceeded the acceptable level of 10% for EMD. Most of the deaths might be due to Streptococcal pneumonia. Meningitis due to Strept. Pneumonia has been shown to be more virulent than the other causative agents of meningitis.

Case Fatality Rates of Meningitis by Districts

01020304050

Bawku

East

Bawku

Wes

tBolg

a

Bongo

Builsa

KND

Region

District

C/R

(%)

C/R

Threshold


22

Table 13: Analysis of causes and deaths of reported cases of Meningitis.

Districts Nm Type A

Strep P Nm Type W135

H. Inf

C D C D C D C D Bawku East 5 1 3 1 0 0 0 0 Bawku West 1 0 2 0 0 0 1 0 Bolgatanga 13 0 10 3 1 0 0 0 Bongo 3 0 0 0 0 0 0 0 Builsa 5 0 2 2 0 0 0 0 KND 111 2 12 2 0 0 0 0 REGION 139 3 29 8 1 0 1 0 Three hundred and four cases (304) lumbar puncher (CSF taken) out of the five hundred and fourteen cases (514) during year; this gives rate of 59.1%. One case of Nm Type W135 was isolated from Bolgatanga

Table 14: Case Fatality Rates of Meningitis

Causative Agent Cases Deaths Case Fatality Rate (%) Nm Type A 139 3 2.2 Nm Type W135 1 0 0.0 Strep. Pnuemonia 29 8 27.6 Haemaphilus Influenza 1 0 0.0

Streptococcal Pneumonia continues to be a significant cause of meningitis (about 17% of cases) with very high cases fatality rate (27.6%) in the region. Most cases are seen during the cold period of the dry season and most patients are brought in unconscious state. MEASLES The incidence of measles continued to decline since the introduction of measles Supplementary Immunisation exercise (SIAs)


23

Five-Year Trend of Incidence of Measles

0

500

1000

1500

2000

2000 2001 2002 2003 2004

Year

No.

Cas

es

SIAS

�Fig 8: Five-Year Trend of Incidence of Measles The supplementary immunisation exercises since 2002 have in deed paid off as shown by the reduction in annual incidence of measles. All cases seen were investigated and blood specimens taken to Nogouchi for confirmation. Out of the 27 specimens that were submitted to Nogouchi, 13 (48.1%) were positive for measles. ANTHRAX Yearly outbreaks of Anthrax continue to be a challenge. The excellent collaboration between us and staff of the Vertinary Division of Ministry of Food and Agriculture contributes significantly to early containment of outbreaks of Anthrax in the region. �YELLOW FEVER One suspected case was promptly investigated and found not to be Yellow Fever. Case based investigations of all suspected cases were vigorously conducted. ACHIEVEMENTS 1. Focal outbreaks of the following were rapidly contained

� Epidemic meningococcal Disease (EMD or CSM) in Kassena Nankana East Sub-district

� Measles in Bugri-Kuka sub-district of Bawku East District � Anthrax in Kassena Nankana and Bawku East District � Rabies in Bawku East District


24

2. IDSR Roll out training successfully carried out in all districts Priorities for 2005 (Surveillance and Control of Epidemics)

• Organise IDRS training for the rest of facility staff that were not trained. • Strengthen collaboration with partners ( MOFA, PHR, WHO, NSU,

LABORATORY UNIT, GBC,) • Support districts to do case review, data analysis and interpretation and use of

data for decision-making. • Hold regular quarter review meetings with district staff • Strengthen capacity building of districts in surveillance activities • Strengthen monitoring and supervision to districts • Prompt districts on 60 days follow up including clinician reports • Organise data management training for district surveillance officers. • Collate, analyse and send regular feedback of surveillance reports all levels • Give Technical support to low performing districts • Train district officers on report writing.

2.1.3. Control of Other Priority Diseases GUINEA WORM Guinea worm cases seen over the past five years in the region have been imported from the Northern and Brong-Ahafo Regions Key activities included surveillance (by both health personnel and volunteers), containment/management of cases, community sensitisation and education and re-training of volunteers. Active case search was carried out in February, March, October and November 2004. Supervision of volunteers in all communities and follow up to communities that reported cases was carried out.

Table 15: Containment by District, 2004

District No. Cases

Number of cases meeting International Standards for

Intensified Case Management

Case Containment

Intensified case Containment

No. % No. % No. % Bawku East 1 1 100 1 100 1 100 Bawku West 0 0 100 0 100 0 100 Bolga 6 6 100 6 100 6 100 Bongo 7 7 100 7 100 7 100 Builsa 1 1 100 1 100 1 100 KND 2 2 100 2 100 2 100 Total 17 17 100 17 100 17


25

A total of 17 cases were reported from all districts except Bawku West. All were contained.

Table 16: Trend of Guinea Worm Cases By Districts 2000 - 2004

District 2000 2001 2002 2003 2004 Bawku East 1 2 1 1 1 Bawku West 0 0 0 2 0 Bolga 19 7 7 10 7 Bongo 11 3 11 9 6 Builsa 0 0 0 2 1 KND 0 1 0 0 2 Total 31 13 19 24 17

Reported Cases (Imported) of Guinea Worm: 2000 - 2004

31

1319

2417

0

10

20

30

40

2000 2001 2002 2003 2004

Year

Cas

es

Fig 9: Reported Cases (Imported) of Guinea Worm, 2000-2004 Achievements

� Maintained zero indigenous cases � Capacity built for both health staff and village volunteers � Dialogue and collaboration with District Assemblies and Community Water and

Sanitation Agency for Safe Water Supply Priorities For 2005

� Maintain zero non-indigenous cases for the region � Encourage DDHS to provide funding for guinea worm programme � Support districts to carry out effective supervision � Intensify educational activities in all communities reporting cases � Strengthen collaboration with District Assemblies, CWSA and GWCL and other

Agencies.


26

MALARIA As stated earlier key activities carried out were training of health workers in case management, distribution and promotion of ITNs, re-treatment of ITNs, public education and environmental sanitation campaigns in collaboration with Municipal and District Assemblies. IPT-P implementation also fully took off in all six districts during the year. The dosing of pregnant women with SP was preceded by training. Funding was supported by UNICEF and Global Fund in four and two districts respectively.

Table 17: Insecticide Treated Nets (ITN) Distribution By Districts

Children U 5 Pregnant Women District Qty Dist Coverage (%) Qty Dist Coverage (%)

Bawku East 27,668 57.3 13,869 107.0 Bawku West 18,437 146 5,190 154.0 Bolgatanga 34,900 97.3 3,562 37.0 Bongo 15,211 124.6 4,973 153.0 Builsa 11,334 96.0 3,146 99.9 KND 15,484 66.1 5,483 89.0 REGION 123,034 64.0 36,223 94.2

Table 18: MALARIA, OPD, ADMISSIONS AND DEATHS

Year OPD Attendance (% of total)

Admissions (% of total) Deaths (% of total)

2001 52.0 28.8 16.4 2002 56.2 30.7 17.2 2003 55.4 31.1 18.4 2004 54.0 35.2 20.9

Except OPD attendances, proportion of admissions and deaths from malaria has been on the increase since 2001. In 2004, malaria accounted for 54% of all OPD attendances, 35.2% of all admissions and 20.9% of all deaths. Except for OPD attendances, these figures represent increases in 2004 against 2003.


27

0102030405060

Pro

port

ion

(%) o

f To

tal C

ases

2001 2002 2003 2004

Year

Malaria Disease Burden: Malaria Morbidity and Mortality

OPD Attendance

Admissions

Deaths

Fig 10: Malaria Disease Burden; Malaria Morbidity and Mortality


28

Table 19: Trend of U 5 Malaria Case Fatality Rates 2001 - 2004, UER 2001 2002 2003 2004 Hospital Adm Deaths C/F Adm Deaths C/F Adm Deaths C/F Adm Deaths C/F

Bawku 1,453 15 1.0 2,168

13 0.6 2,869 50 1.7 2,759

50 1.8

Zebilla 242 20 8.3 324

17 5.2 313 16 5.1 495 6 1.2

Bolga Regional 630 38 6 656

44 6.7 783

43 5.5 837

40 4.8 Bongo 104 7 6.7 315 5 1.6

Sendema 176 2 1.1 465

15 3.2 552

24 4.3 844

18 2.1

Navrongo 787 28 3.6 1,348

64 4.7 1,420

52 3.7 S

1,173

40 3.4

Total 3,288 103 3.1 4,961

153 3.1 6,041

192 3.2 6,423

159 2.5 Only Zebilla Hospital in Bawku West District achieved the national target case fatality rate of 1.2%. The facilities with the worst performance were the Bolgatanga Regional Hospital (4.8%) and Navrongo Hospital (3.4%) Fig 11: U5 Malaria Cases Fatality Rates by Hospitals, 2004

U 5 Malaria Case Fatality Rates by Hospitals, 2004

1.8 1.2

4.8

1.6 2.13.4

2.5

1.2 1.2 1.2 1.2 1.2 1.2 1.20123456

Bawku

Zebilla

Bolga R

HBon

go

Sande

ma

Navrong

oTota

l

Hospital

C/F

(%)

C/F

TARGET


29

Trend of U5 Malaria C/F Rate

3.1 3.1 3.22.5

1.2 1.2 1.2 1.21

10

2001 2002 2003 2004

Year

C/F

(%)

C/F

Target

Fig 12: Trend of U5 Malaria C/F Rates Case Fatality rates reduced by about 21.8% in 2004 over 2003. C/F rates for the previous three years (2001 to 2003) were essentially the same. TUBERCULOSIS Concerns at the beginning of the year included the following:

• Low case detection rate • Low cure rates • Weak capacity at district and sub district levels • In adequate microscopic centres

Targets for 2004

• Increase treatment success rate from 65% to 75% • Increase case detection rate from 35% to 40% • < 10% defaulter rate

Key Activities

• Quarterly support visits to DOTS and Microscopic centres • Refresher training for 35 health workers at DOTS centres. • Five of the six districts also carried out DOTS training • Two review meetings held for District and Institutional TB Coordinators. • Worked out cohort analysis for 2003 case holding • Lab supplies replenished • Q/A: Slides picked for blinded rechecking for quality improvement • Drugs &logistics collected three times • Survey on HIV prevalence in among TB patients on going


30

Fig 13: District Treatment Results - 2003

Table 20: Summary of Performance

Indicator Target (%) 2001 2002 2003 2004 Cure Rate 85.0 56.6 66.4 69.6 67.3 Case detection 70.0 32.9 34.1 35.0 33.3 Defaulter Rate <10.0 5.1 4.2 6.0 14.4

Table 21: TB by Category: 2001 - 2004

Year CATEGORY SM+ Rel SM- EP. TB TOTAL % REL CDR 2001 212 9 51 49 321 2.8 32.9 2002 202 2 113 20 337 0.6 34.1 2003 153 3 164 33 353 0.8 35.3 2004 147 9 145 32 333 2.7 33.0


31

Achievements Case Detection Overall Case Detection (Finding) rate was 33.0% against the Regional and National Targets of 40% and 70% respectively. However, Bolgatanga Municipality achieved case detection rate of 63.8%. There was a drop of 5.7% in performance in 2004 (33%) against 2003 (35%). Cure Rate Again, the target of 85% for cure rate was not achieved. Cure rate achieved was 67.3%; this was also lower (3.3% reduction) in 204 against 2003 achievement of 69.6% Challenges

• Poor performance in 2004 as against previous year • Low cure and case detection rates and high defaulter rate • Weak capacity at district and sub-district levels • Poor community sensitisation • Inadequate microscopic centres

Outlook for 2005

• Strengthen microscopy at both public and private health facilities • Start additional DOTS centres at strategic areas • Strengthen capacity at both district and DOTS centres • Strengthen supervision • Pilot Community-based DOTS in two Districts • Intensify public education

BURULI ULCER Buruli ulcer is:

• Closely linked to TB • Cases in region often traced to the south • TB drugs used for management • Case management is strictly by DOTS

Activities Carried Out

• Surveillance • Treatment using DOTS • TOT training for doctor


32

Table 22: Case Load

District 2000 2001 2002 2003 2004 Bawku East 0 0 0 0 1 Bawku West 0 0 0 0 0 Bolgatanga 3 1 1 0 0 Bongo 0 0 0 0 0 Builsa 0 1 1 1 0 KND 3 2 1 1 0 Total 6 4 3 2 1

Outlook for 2005

• Surveillance and continuous case management • Public education • One medical officer to participate surgery training

HIV/AIDS Key Challenges and concerns

� High level of knowledge not translated into behavioral change � How to overcome certain customary practices that fuel the Epidemic e.g

widowhood marriages � Stigmatization and discrimination still high � Link between institutional and community -base care absent � Care and support for PLWHA & OVC inadequate � Access to ARV not available in region � Limited VCT/PMTCT Centres

Main Priorities for 2004

� Foster collaboration/Partnership for community education and sensitization � Support formation of PLWHA associations � Scale up VCT/PMTCT centres � Management of STIs � Build criteria for accreditation to access ARV

Summary Key Activities/Achievements

� VCT/PMTCT on going in Bolgatanga Regional Hospital and Bawku Hospitals � 24 midwives trained in STI Symdromic Management/introduction to

VCT/PMTCT � Special STI Clinics in Bolgatanga Regional Hospital and Bawku Hospital � Supported 3 PLWHA meetings and income generation � Carried out refresher training of 42 nurses on VCT/PMTCT at Bawku Hospital � VCT services being kick-started in 3 hospitals.


33

� Conducted 2004 HIV sero-survey at four sites � Partnership for education and sensitization of House of Chiefs &civil society � Radio discussions � Navrongo Health Research Centre started research protocol on VCT using Lay

Counselors in Kassena Nankana Districts with financial support from Ghana AIDS Commission

Fig 14: Cummulative HIV Cases, 1989-2004, Upper East A total of 308 cases were seen in 2004 against 339 in 2003. This represents a reduction of 9.1% in the number of reported.

Age and Sex Distribution of Cases

0

50

100

150

200

250

300

350

400

450

500

0-4 5--9 10--14 15-19 20-29 30-49 50-59 60+ NOT STATED

A GE GR OU P

MALE FEMALE


34

Fig 15: Age and Sex Distribution of Cases Over 90% of cases are in the age group 20- 49 years. Females especially in the younger age group are still marginally more affected than males.

Trend of Sero-Prevalence by Sentinel Site Fig 16: Trend of Sero-Prevalence by Sentinel Sites The region has four sentinel sites; the fourth one, Wiaga representing a rural site was added in 2004. The 2004 results were pending at the time compilation of this report. Results of the original three sites are shown above. The Sero-prevalence for Bolgatanga site has been on the increase since 2000. Sites at Navrongo and Bawku reported marginal reductions in 2003 as against 2002. Blood Screening A total of 5,905 blood donors were screened for HIV. Out of this 151 were positive, giving a prevalence of 2.6%. In 2003, the prevalence among blood donors was 2.7%

0

1

2

3

4

5

6

YEAR

HIV

PRE

VA

LEN

CE

(%)

BAWKU M 1.6 1.6 3.6 3.8 3.2

BOLGA M 1.6 1 1 2.5 3

NAVRONGO 2.4 5.1 4.4

1999 2000 2001 2002 2003


35

Table 23: VCT Centres

District 2004 2003 No.

Tested No. Positive

Prev No. Tested

No. Positive

Prev

Bawku East 35 0 0.0 5 1 20 Bawku West

7 1 14.3 0 0 0

Bolgatanga 328 61 20.5 299 38 12.7 Bongo 54 0 0 0 0 0 Builsa 1 0 0 0 0 0 KND 23 0 0 0 0 0 Total 448 62 13.8 304 39 13.2

Table 24: PMTCT SITES

Site ANC Regist No Counselled

No Positive Prev.

Reg. Hospital

3,696 168 9 5.4

Bawku Hosp 7860 114 4 3.5 Total 11,556 282 13 4.6

Outlook for 2005

• Establish 3 more VCT/PMTCT centres • Create enabling environment for VCT/PMTCT • Increase access to ARV by establishing ARV treatment centre in the region. • Staff trainings to implement ART • Continue trainings in STI syndromic management • Provide technical and co-ordination/partnership role in HIV/AIDS education • Strengthen support visits • Initiate review meetings with partners and all stakeholders. • Link up with NGO/CBO to improve Community Based Care

LEPROSY Goal: To sustain elimination target of less than 1/10,000 populations Key Activities

• Supported Bolga and Bongo Districts to achieve elimination target


36

• Focused on disability prevention through intensification of awareness creation, case search and case management

• Capacity building through training for both health workers and community based agents

• Carried out supervision • Held quarterly review meetings

Table 25: Case Load by Districts

District/ Municipal

Brought forward

New cases

Other additions

Total cases

Cured RFT/ ODD

B/F to 2005

Bawku 10 12 1 23 13 10 Bawku West 5 7 0 12 6 6 Bolgatanga 27 46 15 88 57 31

Bongo 9 47 8 64 53 11 Builsa 2 9 4 15 10 5 KND 8 8 6 22 7 15

Region 61 129 34 224 146 78

TABLE 26: Distribution of Cases by Age group by Districts

District/Municipal 0 – 14yrs 15+ Total Bawku 0 23 23 Bawku west 0 12 12 Bolgatanga 7 74 81 Bongo 33 40 73 Builsa 0 15 15 KND 0 20 20 Total 40 184 224 A significant number of cases, 17.8% were children below 15 years with most cases (14.7%) from Bongo district and the rest from Bolgatanga.


37

Table 27: Trend of Prevalence Rate (per 10,000 population) by districts

District 2001 2002 2003 2004

Bawku 0.41 0.6 0.31 0.30 Bawku West 0.96 0.59 0.59 0.69 Bolgatanga 2.1 1.58 1.12 1.26 Bongo 5.04 2.0 1.13 1.34 Builsa 0.66 0.5 0.25 0.64 KND 0.52 0.33 0.53 0.99 Region 1.34 0.92 0.64 0.81 Even though the region as whole achieved the elimination target for the past two years, two districts, namely Bolgatanga and Bongo did not at the close of the year achieve the elimination target. Fig 17: Leprosy Elimination: Trend of Performance by Districts Achievements

• Elimination target sustained at 0.8 per 10,000 population • Support visits were successfully carried out • Nerve function assessment was done on all new cases • Bongo and Bolga Health Directorate were supported in areas of training and case

search activities • Review meetings were held • District leprosy drugs were available throughout the year

Leprosy Elimination: Trend of Performance by Districts

0

0.5

1

1.5

B/EAST

B/WEST

BONGO

BOLGA

BUILSA

KND

REGION

DISTRICT

PR

EV

(Per

10,

000

Pop

) PREV

TARGET


38

Outlook for 2004 • Provision of anti leprosy drugs • Conduct quarterly monitoring and supervision • Hold quarterly technical review meetings • Increase campaigns/awareness in communities • Identify endemic communities and organised volunteers for active case search • Submit monthly returns, quarterly written reports and annual reports • Intensify collaboration especially at the community level and NGOs • Talks on leprosy in various languages on URA Radio FM station

LYMPHATIC FILARIASIS Lymphatic Filariasis is a debilitating disease. It is hyperdemic in the region. Control involves the interruption of transmission with annual distribution of Ivermectin and Albendazole. In addition surgical removal of hydrocoels is also aimed at reducing disease morbidity.

Table 28: Treatment coverage, surgeries and clinical cases treated, 2004.

District Registered Pop No. Treated %

# Hydrocelectomies # Elephantiasis

Bawku East 353,562 218,617 61.8 1,036 647 Bawku West 95,028 63,869 67.2 286 110 Bolga 215,629 154,091 71.5 583 692 Bongo 86,151 59,749 69.4 433 526 Builsa 76,492 57,046 74.6 547 741 KND 145,748 92,089 63.2 414 617 Region 972,610 645,461 66.4 3,299 3,333

ONCHOCERCIASIS The strategy is to interrupt transmission through annual distribution of Ivermectin and Albendazole where Onchocerciaisis and Lymphatic filariasis co-exist and epidemiological surveillance for the early detection of recrudescence. Public education is being undertaken on the nuisance effect of the vector fly. As shown above, a coverage of 66.4% for mass distribution of ivermectin and Albendazone during the reporting period.


39

Table 29: Results of epidemiological survey of villages Sissili and White Volta

Community Name No. exam No. Positive % Nakong KND 162 0 0 Kayoro W KND 289 3 1.0 Achanga B/West 26 2 7.7 Tilli B/West 300 0 0 Widnaba B/West 290 0 0 Denugu Bawku E 300 0 0 Total 1,367 5 0.4 Five (5) people from two of the six selected communities were positive for micro-filarial of Onchocerca volvulus. The prevalence is within acceptable levels.

NUTRITION Key Activities � Vitamin A supplementation of children 6-59 months and post partum � Trained health staff (214) on Anaemia control in pregnancy � Conducted training (15 attendants) on Therapeutic dietary management for

nutrition rehabilitation centre attendants, � Monitored activities of the supplementary feeding programme in 36 feeding

centres � Monitored activities of the Community Based Nutrition Food Security Project

(CBNFSP) in Bongo District � Promoted exclusive breast feeding through Baby Friendly Hospital Initiative

(BFHI) � Promotion the use of iodised salt through surveys, dissemination of results and

education. Supplementary Feeding Centres � They are 36 in five districts and are under the support of the World Food

Programme (WFP). � Major activities that took place at the centres within the period include

-Daily provision of meals to children 0-5 years (pre-school activities), -Monthly growth monitoring of the children and women (lactating) -Nutrition/ Health Education. Data collected is used to calculate the following:

� Weight for height (wasting or acute malnutrition) � Height for age (stunting or chronic malnutrition) � Weight for age (underweight—both acute & chronic malnutrition) � Body Mass Index (BMI), that is, Weight (kg) / Height (m) ² of lactating mothers.


40

Table 30: Programme Coverage

District Children Mothers Pregnant Women Lactating B/East 690 511 97 414 B/West 263 245 47 198 Bolgatanga 1429 1985 274 1711 Bongo 1641 1998 530 1468 KND 1395 1232 195 1037 TOTAL 5418 5971 1143 4828

Fig 18: Comparing Well Nourished and Under Weight Children

53

37

63

35

48

32

56

43

76

14

0

10

20

30

40

50

60

70

80

%

Bongo Bolga Baw ku East Kassena Nankana Baw ku West

Districts

Comparing Well Nourished and UnderWeight Children

Well Nourished Under Weight


41

A significant number of the children were found to be underweight as shown in graph above. Fig 19: Level of Stunting and Wasting Among Children About 29% and 16% of all children were stunted and wasted respectively. The bulk of the malnourished children came from Bolgatanga Municipality. Proportion of the malnourished children who were stunted ranged from 4% in Kassena Nankana District to as high as 65% in Bolgatanga. Wasting ranged from 4% in Kassena Nankana and Bawku West districts to 36% in Bolgatanga.

Table 31: Health Education and Rations for Pregnant and Lactating Women

District No. Centres H/E Sessions Pregnant-Lactating women No. Received Dry

Ration/Month No. at H/E sessions per month

B/East 4 24 511 356 B/West 2 12 245 229 Bolgatanga 11 66 1985 1605 Bongo 10 60 1998 1997 KND 9 54 1232 1229 TOTAL 36 216 5971 5416 (92%)

27

18

65

35

14

7 4 4

11

4

0

10

20

30

40

50

60

70

%

Bongo Bolgatanga Baw ku East Kassena Nankana Baw ku West

Districts

Level of Stunting and Wasting Among Chn

Stunted Children Wasted Children


42

Fig 20: Nutritional Status of lactating Women Nutrition Rehabilitation Centres Eight (8) nutrition rehabilitation centres are being supported by World Food Programme (WFP) in the Region (3 in Bawku East, 1 each in Bolgatanga, Bongo, Kassena Nankana , Bawku West, and Builsa Districts.

Table 32: Outcomes of admissions to Rehabilitation Centres.

District No. Centres

Adm Deaths Marasmus Kwashiokor Marasmic-Kwashiokor

B/East 3 266 3 227 17 22 B/West 1 49 3 48 0 1 Bolga 1 80 8 71 5 4 Bongo 1 44 0 36 4 4 Builsa 1 61 2 48 22 1 KND 1 149 0 115 14 20 TOTAL 8 649 16 545 62 52

Most of the cases admitted were marasmus (84%) and the overall case fatality rate was 2.5%.


43

Community Based Nutrition And Food Security Project (CBNFSP) The project is being piloted in four districts in the country. These are: Bongo (Upper Region), Kadjebi (Volta Region), Commenda Edina Aguafo Abrem (Central Region), and Sefwi – Wiawso (Western Region). The aimed at testing strategies, models and implementation process that will help build capacities of District Assemblies and communities to enable them identify the causes of malnutrition and help remove these causes and improve upon food security at the household and community levels. Achievements

� Scaled up to cover up 10 communities � Training of 62 Community Based Volunteers in the selected communities

Vitamin A

Table 33: Vitamin A Supplementation: Trend of Performance by Districts

District 2002 2003 2004 Cov % (May) Cov % (Nov) Cov % (May) Cov %(Dec) Cov % (Nov) B/East 142.7 126.7 135.5 104.7 81.2 B/West 140.4 121.4 141.0 109.2 86.6 Bolgatanga 128.9 116.5 126.6 130.9 80.5 Bongo 145.8 137.1 135.1 138.8 86.7 Builsa 122.1 122.2 121.2 121.9 99.8 KND 88.6 109.2 157.0 100.2 100.2 REGION 128.9 121.4 136.0 115.1 85.9

One round of was carried out in 2004. The coverage for the round was also much lower than previous years’ coverage. Iodated Salt

Table 34: Results Sentinel Market Survey: Iodated Salt Utilisation

District Concentration of Iodine (PPM) 0 ppm < 30 ppm � 30 ppm B/East (n = 300) 268 (89.3%) 291 (97%) 9 (3.0%) B/West (n= 300) 280 (93.3%) 286 (95.3%) 14 (4.7%) Bongo (n= 300) 243 (78.6%) 293 (94.8%) 16 (5.2%) Builsa (n= 294) 122 (41.5%) 273 (92.9%) 21 (7.1%)

The proportion of samples that contained adequate iodine (passed Iodated Salt Test) from the four district Markey surveys ranged from 3 – 7.1%. This is indeed very grave despite


44

the fact a lot of education is on going and most importantly a Law on Iodated Salt had been passed. Outlook for 2005 � Intensify monitoring and supervision of nutrition activities at the district level. � Prepare and designate at least 8 hospital facilities as baby-friendly and revitalize

already existing facilities. � Assess activities of already existing facilities � Support form and train Mother-to-Mother support groups • Advocacy on exclusive breast feeding and appropriate complementary feeding � Conduct twice mass vitamin A supplementation of children 6 – 59 months � Conduct sentinel market salt survey � Strengthen advocacy on iodised salt usage through radio discussions

COMMUNITY PSYCHIATRY Objectives

• To increase geographical assess to the Mental Health Service • To sensitise the public about the effects of drug abuse

Key Activities

• Clinical services at static points • Outreach services • Mental Health Promotion Talks • Home visits • Defaulter tracing • Counseling • Supportive supervision • Referrals • Training and meeting

Table 35a: Type of Psychiatric Conditions seen by Districts

Condition B/East B/West Bolga Bongo Builsa KND Total Psychosis 385 22 345 61 45 109 967 Epilepsy 1538 66 372 151 75 165 2367 Neurosis 109 16 12 23 7 0 167 Subs. Abuse 12 6 33 6 17 49 123 Headaches 0 0 0 398 16 0 414 Others 0 16 107 0 0 36 159 Total 2044 126 869 639 160 359 4197

About 56.4% of the cases seen were epileptics with about 65% from Bawku East. The next most common cases were headaches with about 96% from Bongo district and the remaining 4% from Builsa district.


45

Table 35b: Cases Load by Districts

Condition 2003 2004 % Change: 2003 and 2004 Psychosis 732 967 32% Epilepsy 3549 2367 -33% Neurosis 298 167 -44% Subs. Abuse

81 123 52%

Headaches 197 414 110% Others 0 159 159% Total 4857 4197 -14%

There were increases in psychotics (32%), Substance Abuse (52%) and headaches (110%). As stated earlier almost all cases were reported from Bongo district. However there were reductions in numbers of Neurotics (44%) and Epileptics (33%). 2.1.4. Non-Communicable Diseases Concerns

• Little data on Non-Communicable Diseases • Lack of awareness by the public on risk factors that lead to NCD • No support for NCDs

Strategic Objectives

• Improve the capacity of health staff to promote healthy life style among general public

• Increase advocacy for non-communicable diseases • Encourage hospitals to establish Non-communicable disease centres

Activities

• Passive surveillance on NCDs • Management of NCDs

Achievements

• There were 3,372 cases of hypertension cases • 135 with other heart diseases • 6,164 rheumatic & joint cases • 2,186 accident cases • All accounted for 2.5% of new attendants


46

Outlook for 2004 • Improve data collection for NCDs • Lobby for the appointment of a designated officer at all levels • Create awareness on risk factors that lead to NCDs • Encourage the celebration of NCD-Days • Lobby with Regional hospital to revive diabetic and hypertension clinics • Encourage BMC heads to budget for NCD activities • Encourage monthly health walks

2.1.5. Reproductive and Child Health (RCH) Goal: The main goal is to reduce maternal and child morbidity and mortality rates. Objectives

� To improve coverage and quality of RCH Services. � To make reproductive health services accessible and affordable to all. � To improve the quality of service delivery through capacity building. � Collaborate with other health related agencies improving RH services.

Priorities in 2004

� Encourage Essential Obstetric Care. • Improve newborn care • Increase skilled delivery coverage. • Improve maternal audit system • IPT –Introduction • Increasing baby friendly facilities in the region. • Scaling up of Community -IMCI and training of prescribers in Clinical IMCI

Targets

� Increase F/P Acceptors Rate from 22% to 25% � Ensure ANC coverage reaches 95%. � Improve on 4 ANC visits � Increase skilled deliveries from 23.9% to 50%. � Ensure EPI coverage of Penta 3 and measles reaches 85%. � Reduce under 5 malaria case fatality rate from 1.5 to 1.2%


47

2.1.5..1. Reproductive Health

Table 36: Summary of Performance in Reproductive Health

INDICATORS TARGET FOR 2004

2002 2003 2004

ANC 95% 37099 (98.6%) 38122 (101.2%) 39235 (102.0%) Average Visit 4 3.4 3.3 3.4 TT2 + 90% 26,696 (71%) 25688 (67.5%) 25524 (66.4%) 3rd Trimester 15% 8621 (22.9%) 7756 (20.3%) 7129 (18.2%) Teenage Preg. <10% 5726 (15.2%) 5994 (15.2%) 6098 (15.5%) Over 35yrs <10% 4643 (12.3%) 4606 (12.1%) 4681 (11.9%) Parity 4+ <20% 10599 (28.2%) 10742 (28.2%) 10779 (27.5%) Supervised Dels 58% 8254 (21.9%) 9094 (23.9%) 12276 (31.9%) MMR 53 (340/100,000) 42 (248/100,000) 47 (398/100,000) Still Births 398 (2.5%) 370 (2.2%) 468 (3.8%) PNC 90% 18118 (48.1%) 19093 (50.2%) 18600 (48.4%) F/P 25% 19.80% 22.50% 19.30%

FAMILY PLANNING FAMILY PLANNING PERFORMANCE Fig 21: Trend of F/P Performance For the reporting year, the coverage for F/P was 19.3% as against 22% for last year. The target of 25% was also not achieved.

Trend of F/P Performance

0

10

20

30

Year

Cov

(%)

COV

TARGET

COV 19.8 22.5 19.3

TARGET 25 25 25

2002 2003 2004


48

Couple Years of Protection (CYP)

The most preferred method is still Depo Provera followed by Norplant Implants and Male Condoms. The two areas of lower performance were female and oral contraceptives.

Table 37: CYP COVERAGE

METHOD CYP-2002 CYP-2003 CYP-2004 REMARKS

Norigynon - 331.68 507.2 Increased

Female condoms 30.3 29.4 19.42 Decreased

Male Condom 1839.63 2082.33 3022.68 Increased

Orals 2104.19 2102.64 1653.1 Decreased

Spermicides 39.84 3.6 15.4 Increased

Depo Provera 14107.5 14969.1 16284.0 Increased

IUCD 895.5 715.2 755.0 Increased

Norplant 2216.0 3690.0 3828.7 Increased

Vasectomy 0 0 0 Same

Female Sterilisation 1069.0 550.0 462.5 Decreased

Total 22301.96 24473.95 26548.1 Improved Short Term Method = 5217.9 Long Term Method = 21330.2 Total = 26,548.1 ANTE-NATAL SERVICES The Antenatal service coverage for the last three years has been high. The region and all districts exceeded the set target. The challenge has been and continue to be the number of visits, parity of four and over, and teenage pregnancy among others. Most pregnant women report during the 2nd and 3rd trimesters (ref table 36) Inadequate and poor quality equipment, namely Blood Pressure apparatus and HB reagents at the peripheral service delivery points (outreach, community clinics) also continue to be major constraints.


49

Table 38: Trend of ANC Coverage by Districts

DISTRICT 2002 % 2003 % 2004 % Bawku East 13784 109.1 13874 109.0 14016 108.9 Bawku West 3422 102.8 3496 104.9 3611 107.2 Bolgatanga 8070 85.3 8707 92.1 8981 93.9 Bongo 3751 118.7 3145 97.7 3302 101.5 Builsa 2783 91.0 3069 98.5 3255 103.7 KND 5289 88.3 5831 94.4 6059 97.0 REGION 37099 98.6 38122 100.2 39235 102.0

Ante-natal coverage continued to be very high. All districts except Bolgatanga achieved coverage of over 95%. Fig 22: Trend of ANC Coverage MATERNAL DELIVERY SERVICES Essential Obstetric Care

The following is a breakdown of essential obstetric care coverage in the region during the year: Number of facilities conducting deliveries -55 Number of facilities with blood banks -6 Number of C/S done -397 C/S Rate -3.2% Number of vacuum deliveries -246 Number of forceps deliveries -0 Number of facilities with basic EOC -38 Number of facilities offering CEOC -5

Trend of ANC Coverage

98.6

101.2 102

95 95 95

90

9294

9698

100102

104

2002 2003 2004

Year

Cov

(%)

Cov

Target


50

Five of the six hospitals offer Comprehensive Obstetric Care. The C/S rate is unacceptably low. Recommended rate is 15% (WHO). SUPERVISED DELIVERIES

� The free maternal delivery package started in July 2003. � A systematic training of midwives in Life Saving Clinical skills supported by

UNFPA has been on course since 2002. At the close of 2004, over 30 midwives went through the training.

� TBA supervisors (28) were trained during the year.

Institutional Supervised Delivery Coverage was still far below target as shown below:

Table 39: SUPERVISED DELIVERIES BY DISTRICTS

2002 2003 2004 DISTRICT No % No % No %

Bawku East 3078 24.4 3528 27.7 4791 37.2 Bawku West 771 23.2 583 17.5 943 27.1 Bolgatanga 2211 23.4 2270 24.0 2802 29.3 Bongo 405 12.8 649 20.2 936 28.8 Builsa 520 17.0 658 21.1 974 30.9 KND 1269 21.2 1406 22.8 1860 29.8 REGION 8254 21.9 9094 23.9 12276 31.9

There was however an improvement, about 33.5% increase, in 2004 performance against 2003. This could largely be due to the free maternal delivery package introduced in July 2003.

Trend of Institutional Supervised Delivery Coverage

21.9 23.931.9

58 58 58

010203040506070

2002 2003 2004

Year

Cov

(%)

Cov.

Target

Fig 23: Trend of Institutional Supervised Delivery Coverage


51

TBA DELIVERIES TBAs delivered a total of 7,305; this gives a coverage of 19.0% (7305/38,450). POST NATAL CARE Post-Natal Service coverage also continues to be very poor as shown below

Table 40: Postnatal Care By Districts

2002 2003 2004 DISTRICT

No % No % No % Bawku East 4779 37.8 4862 38.2 4759 37.0

Bawku West 1510 45.4 2033 61.0 2745 81.5

Bolgatanga 5095 53.8 4849 51.3 4116 43.0

Bongo 1665 52.7 2157 67.0 2409 74.0

Builsa 1543 50.5 1770 56.8 1879 59.7

KND 3526 58.8 3422 55.4 2692 43.1

REGION 18118 46.3 19093 50.2 18600 48.4

PNC Performance by Districts

0

50

100

District

Cov

(%)

COV.

TARGET

COV. 37 81.5 43 74 59.7 43.1

TARGET 58 58 58 58 58 58

B/E B/W BOL BON BUIL KND

Fig 24: PNC Performance by Districts


52

Trend of PNC Coverage

46.3 50.2 48.458 58 58

0

1020

3040

5060

70

2002 2003 2004

Year

Cov

(%)

Cov

Target

Fig 25: Trend of PNC Coverage The target of 58% was not achieved. Three districts, namely Bawku West, Bongo and Builsa exceeded PNC set target. Performance of Bawku West and Bongo districts was particularly very encouraging.

Trend of Safe Motherhood Performance Indicators

020406080

100120

2002 2003 2004

Year

Cov

erag

e (%

)

ANC

SUP. DEL

PNC

F/P

Fig 26: Trend of Safe Motherhood Performance Indicators POST ABORTION CARE Reporting was very poor. Only 151 were registered for PAC during the year under review


53

Intermittent Preventive Treatment Of Malaria In Pregnancy (IPT-P) Intermittent Preventive Treatment of malaria in pregnant women using sulphadoxine pyramethamine, started around June 2004 in the region. Two districts namely Bongo and Bawku East are being supported through the Global Fund; UNICEF supports the remaining districts. The drop out rate from first to the third dose is very high. This is partly due to late reporting (second and third trimester) during Ante-natal period.

Table 41: IPT-P COVERAGE BY DISTRICT

DISTRICT 1ST DOSE 2ND DOSE 3RD DOSE Dewormer Bawku East 8418 4672 2245 4781 Bawku West 1196 583 212 0 Bolgatanga 3299 2453 1246 1570 Bongo 2337 1944 1462 244 Builsa 1529 741 529 404 KND 1504 757 107 1551 REGION 18283 11150 5801 8550

Fig 27: IPT-P Coverage (3rd Dose) by Districts VCT/PMTCT Two sites namely Bolga Regional Hospital and Bawku Presby. Hospital began the provision of VCT/PMTCT services for Ante-natal clients. The Navrongo Health Research Centre started VCT as pilot project. Lay counsellors and health workers were trained at three sites in the district.

IPT-P Coverage (3rd Dose) by Districts

17.4

6.313

44.9

16.8

1.7

15.1

0

10

20

30

40

50

B/East B/West Bolgat Bongo Builsa KND Region

District

Cov

erag

e (%

)


54

Table 42: Summary of VCT/PMTCT Performance in Bolga and Bawku Hospitals.

No. Reg. ANC clients

No. Pre- test counselled

NO. Tested for HIV.

No. Positive

No. Administered Niverapine

No. Opting for C/S

Reg. Hosp.

3696 168 168 9 4 1

Bawku Hosp.

7869 7869 165 2 1 0

Total 11565 8037 333 11 5 1 2.1.5.2. Child Health Expanded Programme on Immunization. (EPI) Major Concerns The major concerns at the beginning of the year were:

• Sustaining gains of the previous year • Low and stagnating service coverage • Poor quality of EPI data • Late submission f reports • Collaboration with GES, NGOs, Organizations, and other health related

organisations. • High drop out and wastage rates • Low TT coverage for pregnant women and MNT campaigns (TT SIAs). • Irregular and later submission of Cold Chain inventory by districts and region.

Activities Carried Out • Routine immunization, defaulter tracing and mop-up exercises • Conducted EPI coverage survey for year 2003 in all six district • Provided cold chain equipments and Vaccine / logistics to districts. • Provided feedback to districts on monthly and quarterly basis. • Supported districts conduct four (4) successful NIDs and Tetanus Supplementary

Immunization Activities. • Training district health personnel on EPI policy issues and other activities. • Carried out Child Health Week activities. • Provided districts with monitoring indicators (charts) and copies of reporting

forms.


55

Achievements:

Table 43: Timeliness and Completeness of EPI Reports by District, 2004

DISTRICT

Expected Returns

No.Rec’d Timely

% Timely

Total No. Received

% Complete

Bawku East

12

11

91.7

12

100

Bawku West

12

8

66.7

12

100

Bolgatanga

12

7

58.3

12

100

Builsa

12

11

91.7

12

100

KND

12

10

83.3

12

100

Region

12

10

83.3

12

100

Only Bawku East and Builsa districts achieved the minimum target of 90% for both timeliness and completeness of report. However, all districts achieved 100% completeness of reporting.

Table 44: EPI Performance, 2004.

Target Pop Chn 0-11months No. Imm Achievement Target for 2004 (National)

Antigen 4% total Pop (%) BCG 38,450 41,528 108 87 Measles 38,450 33927 88 87 Penta 3 38,450 33395 87 85 OPV3 38,450 33471 87 87 YF 38,450 25524 66 87 TT2+ 38,450 25524 66 87


56

EPI Performance, 2004

0

20

40

60

80

100

120

ANTIGEN

CO

V (%

)

COV 108 88 87 87 66 66

Target-Nat. 87 87 87 87 87 87

BCG MEASLES PENTA 3 OPV3 YF TT2+

Fig 28: EPI Performance, 2004 Except two antigens, namely Yellow fever and TT2, targets for all EPI antigens were achieved.

EPI PERFORMANCE BY DISTRICTS: PENTA 3 AND MEASLES, 2004

020406080

100120

BEBW

BOLGA

BON

BUILSA KN

DISTRICT

CO

V. (

%) PENTA 3

MEASLES

TARGET

Fig 29: EPI Performance by Districts: PENTA 3 and Measles, 2004 The Graph above shows Penta3 and Measles coverage by districts for year 2004. All districts except Kassena Nankana achieved the national target.


57

Fig 30: Trend of EPI Performance, 2000-2004 Targets for measles and Penta 3 were achieved in 2002 and 2004. The 2004 performance was also an improvement over that of 2003; however, performance stagnated over the three year period.

Table 45: 2004 ANTIGEN DROP OUT RATE

BCG-Measles OPV 1-OPV 3 Penta 1-Penta 3 DISTRICT

TARGET No % No % No %

BE 12,868 5378 31 1695 13 1848 14 BW 3,368 695 22 427 14 443 14 Bolga 9,562 1207 12 733 8 841 9 Bongo 3,255 -53 -2 386 12 250 8 Builsa 3,150 386 13 77 3 128 5 KND 6,247 -12 0 468 10 433 9 Region 38,450 7601 18 3786 10 3943 11

Fig 31: EPI Drop Out, BCG-Measles

EPI DROP OUT: BCG-MEASLES

31

22

12

-2

13

0

18

10 10 10 10 10 10 10

-505

101520253035

B/EAST

B/WEST

BOLGA

BONGO

BUILSA

KND

REGION

DISTRICT

RA

TE (%

)

DOR

TARGET


58

Drop out rates for Bawku East and Bawku West Districts were unacceptably high. Bongo district recorded a negative rate (-2%). Fig 32: EPI Drop OUT Rate, PENTA 1-PENTA 3 Again Bawku East and West District recorded rates above the recommended target of 10%.

Table 46: 2004 Results NID Campaigns.

Feb Mar Oct Nov No % No % No % No %

BE 101,109 107 107,609 114 97,615 103 96,107 102 BW 28,433 103 29,696 108 28,816 103 29,233 103 Bolga 71,075 100 78,003 100 78,877 91 88,568 102 Bongo 31,355 106 29,698 100 29,704 101 29,782 100 Builsa 21,186 109 21,221 109 20,133 99 21,440 106 KND 38,682 82 39,408 83 42,238 104 40,367 99 Region 291,840 101 305,635 106 297,461 99 305,419 102

Coverage for U5 for NID was generally very high (99 – 106%) for all the four rounds during the year. EXCLUSIVE BREASTFEEDING Out of 11387 mother /infant pairs discharged, 10483 (92.1%) were exclusively breastfeeding. Only 5 facilities have been designated as Baby Friendly since 1995. Efforts at designating other facilities as Baby Friendly in the region were pursued throughout the year. Three District hospitals, namely Bongo, Zebila and Bawku Presbyterian and five health centers have been earmarked for designation as Baby Friendly by close of 2005.

EPI DROP OUT RATE: PENTA 1 - PENT 3

02468

10121416

B/EAST

B/WEST

BOLGA

BONGO

BUILSA

KND

REGION

DISTRICT

RA

TE 9

%)

DOR

TARGET


59

In the three hospitals, guidelines on Exclusive Breastfeeding (EBF) (Policies) have been developed. Proposal on training and refresher training for Facilitators of Mother-To-Mother Support Groups and health staffs have been written. 2.1.5.3. Adolescent Health The Adolescent Health Services have been subsumed under the general RCH services in the region. The orientation on the National Adolescent Health Policy could not come on during the year. The Ghana Red Cross Society, Rural Help Integrated, a Bolgatanga based NGO have trained and formed adolescent peer educators on HIV/AIDS and Female Genital Mutilation. Navrongo Health Research Centre is also implementing a pilot project on Adolescent Sexual Reproductive Health in two communities and six schools in Kassena Nankana District. Adolescents seen at ANC during the year were 6098 (15.5%) of the total ANC registrants. Adolescents who died during delivery were 6 (12.8%) out of the 47 maternal deaths. Seventy (70) reported at the STI and 30 at the F/P clinics respectively. 2.1.5.4. School Health

Table 47: School Health Coverage

Year No. Enrolled No. Exam. % Exam. 2000 70930 24146 34.0 2001 72034 22564 31.3 2002 78563 23556 30.0 2003 83549 50560 60.5 2004 83992 48479 57.7

There was a drop in the proportion of children examined in 2004 as against 2003. Out of 843 schools, health teams visited and delivered at least three health talks to 354 (42.0%) schools. Mass Anti-helminthiasis (de-worming) programme Under Five Year De-worming: The Region planned to de-worm children under five years twice within the year. This was successfully carried out. The first and second rounds were integrated into March and October NIDs with coverage of 102.3% and 94.6% respectively. Basic School Children De-worming. This was also carried out with a regional coverage of 82%.


60

Pregnant Women De-worming of pregnant women started this September but as at the time of reporting districts had not sent in their information.

Table 48: Results of U5 De-worming by Districts

DISTRICT

TARGET

NO. OF CHN. DEWORMED 1ST RUOND

% CHILDREN DEWORMWED

No. OF CHN. DEWORMED 2ND ROUND

% OF CHILDREN DEWORMED.

Bawku East 56,555 54,101 95.7 55,970 98.8 Bawku West 16,579 17,822 107.5 17,489 102 Bolgatanga 42,641 49,120 115.2 40,417 77.3 Bongo 17,737 16,073 90.6 16,073 90.6 Builsa 11,698 12,751 109 13,613 111.8 Kassena-Nankana

28,357 27,836 98.2 27,174 111.1

Regional Total

173,567 177,553 102.3 170,736 94.6

Table 49: Results of School de-worming by Districts.

DISTRICT

No. Chn enrolled

No. Chn De-wormed

% De-wormed

Bawku East 48,912 31,849 65 Bawku W Est 11,961 8,722 72.9 Bolga 49,099 46,056 93.8 Bongo 20,305 18,063 88.9 Builsa 15,096 11,864 78.6 Kassena-Nankana 28,543 22,871 84.0 Regional Total 173,916 142,657 82.0

Table 50: Summary Of Childhood Diseases (Admissions) Regional -2004 REGION UNDER FIVE YEARS U-5 YR CASES DEATHS CFR MALARIA 6423 159 2.5 ANAEMIA 2596 113 4.4 DIARRHOEA 219 9 4.1 ARI 704 22 3.1 MEASLES 9 0 0.0 MALNUTRITION 100 24 24.0

Case fatality rate from malnutrition is unacceptably high. Rates due to anaemia and diarrhoea are also very high.


61

Table 51: Trend of Case Fatality Rates of Common Childhood Diseases

2001 2002 2003 2004 MALARIA 8.3 3.1 3.2 2.5 ANAEMIA 3.2 4.8 3.6 4.4 DIARRHOEA 0.0 4.5 3.1 4.1 ARI 0.0 4.3 1.9 3.1 MEASLES 25.0 0.0 0.0 0.0 MALNUTRITION 33.3 16.2 15.0 24.0

Except Measles and Malaria, case fatality rates from the other common childhood illnesses got worse. No under five deaths from measles since 2001. Case fatality rates from malaria significantly reduced (21.9%) between 2003 and 2004.


62

CHAPTER THREE

3.0. CLINICAL CARE Clinical care is an integral component of priority health service intervention package in the region. Clinical services are offered in hospitals, health centres and clinics and community based outreach health services including CHOs in the the CHPS programme and Community Based Agents (CBAs) in Community IMCI. The table below shows major health facilities and ownership in the region.

Table 52: Summary of Health Facilities

Type of Institution Total Govt

Institutions Mission

Institutions Private Inst Regional Hospital 1 1 0 0 District Hospitals 5 0 1 0 Health Centres 26 18 8 0 Clinics 35 14 15 6

Table 53: Bed Complements of Hospitals

Hospital Bed Complement Bolgatanga Regional 189 Bawku Presbyterian 250 Zebilla 70 Bongo 38 Navrongo 140 Sandema 74 Bawku Presbyterian Hospitals provide services for a third of population of the region (about 350,000 people) including patients from neighbouring Togo and Burkina Faso. It is therefore not surprising that its bed complement is greater than Bolgatanga Regional Hospital. The three relatively smaller district hospitals, namely Zebilla, Bongo and Sandema are still being upgraded to the status of district hospitals which are expected to serve as primary referral centres in districts. Specialised Units: The Bolgatanga Regional Hospital and Bawku Presbyterian Hospital also provide specialist services as shown below:


63

Bolgatanga Regional Hospital � ENT ( with ENT Specialist) � Dental (Dental Surgeon) � Eye Clinic (run by eye technicians � Diet therapy (with Dietician) � STI Clinic (with public health Nurse in-charge) � Physiotherapy (no physiotherapist)

Bawku Presbyterian Hospital

� Ophthalmology (with two Ophthalmologists) � Orthopaedics � Audiology � STI � Physiotherapy

3.1. Key Activities carried out The following are among key activities carried out in health institutions during the year:

� Routine Out and In-patient Care � 24 hour OPD services � Emergency care (obstetric and accidents � Specialist clinical outreach services- intra and inter regional � Implementation of quality assurance activities (waste management, infection

prevention, client/patient satisfaction surveys, establishment of information/complaints desks

� Conducted maternal death audits � Clinical conferences � Quarterly support visits of Clinical Care Unit to health facilities � In-service training of clinical staffs (maternal mortality audits, infection

prevention, quality assurance, National Health Insurance etc) Summary of performance

Table 54: Clinical Conferences: Performance of Hospitals

Facility/Indicators Target No held Percentage held

Bolgatanga Regional Hospital 12 NIL 0

Bawku Hospital 12 10 82

War Memorial Hospital 12 1 8

Sandema Hospital 12 3 25

Zebilla Hospital 12 4 33

Bongo Hospital 12 Nil 0


64

No Clinical conferences were held in two hospitals (Bolgatanga Regional and Bongo Hospitals).

Table 55: Compliance on guidelines and standard on the management of malaria and diarrhoea in Children under five years.

Hospital Weight Taken

Temperature Taken

Diagnosed Written

Oral Chloroquine Given

Correct Dosage

Injection Chloroquine Given

Bolga Regional Hospital

71 78 100 94 84 23

Bawku Hospital. 86.8 83.0 92.5 54.7 49.1 32.1

Navrongo Hospital. 0.0 63.9 85.6 76.3 76.3 14.4

Sandema Hospital 96.2 96.2 93.3 94.2 51.0 96.2

Zebilla Hospital 64.6 63.6 78.8 74.7 66.7 55.6

Bongo Hospital 5.5 15.1 98.6 98.6 86.3 65.8

REGIONAL 54.2 68.1 91.1 83.8 69.6 48.9

Documentation continued to be a challenge. Diagnosis of about 8.9% of malaria cases was not written. Over 30% of cases of malaria in the under five old were not given correct dosage of ant-malaria.

Table 56: Client Satisfaction Survey

Facilty/Indicator Target No. carried out

Cov (%)

Region Hosp 4 1 25 Bawku Hosp 4 2 50 War Mem. Hosp 4 3 75 Sandema Hosp 4 1 25 Zebilla Hosp 4 1 25 Bongo Hosp 4 1 25 Total 24 9 38

The quarterly patient satisfaction surveys were not carried out by hospital managers as shown in table 56. .


65

Health Service Utilisation.

Table 57: Summary for the Upper East Region (All Institutions)

Indicator 2001 2002 2003 2004 Remarks

OPD attendance

480,328

604,645

561,455

576,556 2.7% Increase

Admissions

33,508

37,118

39,164

41,695 6.5% Increase Bed Occupancy 48.6 51.1 48.2 49.7 3.1% Increase Bed Turnover 50.3 53.1 52 55.2 6.2% Increase

OPD per capita 0.52

0.64

0.59

0.60 1.6% Increase

Admission rate

36.0

39.5

41.2

43.4 5.3% Increase Deaths 1539 1515 1428 1438 0.7% Increase

Death Rate

4.6

4.1

3.6

3.4 5.4% Decrease In all there was some modest improvement in health service utilisation in 2004 as against 2003.

Table 58: Regional Hospital, Bolga


OPD attendance

61,341

68,937

63,207

63,655 0.7% Increase

Admissions

6,604

7,489

7,053

7,983 13.2% Increase Bed Occupancy 45.5 46.3 46.9 52.1 11.1% Increase Bed Turnover 35.3 39.6 37 42.2 14.1% Increase

OPD per capita

0.27

0.29

0.27

0.27 No Change

Admission rate

28.5

32.0

29.8

33.4 12.0% Increase Deaths 506 539 457 431 5.7% Decrease

Death Rate

7.7

7.2

6.5

5.4 16.7% Decrease


66

Table 60: Summary of District Hospitals


OPD attendance

142,158

190,206

182,393

192,218 5.4% Increase

Admissions

26,904

29,629

30,911

32,102 3.9% Increase Bed Occupancy 49.8 53.7 48.6 48.9 0.6% Increase Bed Turnover 56.4 62.6 57.5 59.7 3.8% Increase

OPD per capita

0.15

0.20

0.19

0.20 4.2% Increase

Admission rate

28.9

31.5

32.5

33.4 2.7% Increase Deaths 1033 976 971 962 0.9% Decrease

Death Rate

3.8

3.3

3.1

3.0 4.6% Decrease

Table 61: Summary of Mission Hospital (Bawku)


OPD attendance

79,679

105,464

92,822


Admissions

15,721

16,996

17,079


Bed Occupancy

48.0

50.5

54.4

53.5 1.7% Decrease Bed Turnover 58.9 67.1 67.5 72.4 7.3% Increase

OPD per capita

0.26

0.34

0.29

0.31 6.6% Increase

Admission rate

50.5

54.0

53.7

57.3 6.8% Increase Deaths 464 381 408 436 6.9% Increase

Death Rate

3.0

2.2

2.4

2.4 1.0% Decrease


67

Table 62: Trend of Ten Top Causes of OPD Attendance

No. DISEASES DISEASES DISEASES DISEASES No. % No. % No % No %

1 Malaria 206,847 52.0 Malaria 272,327 56.2 Malaria 257,897 55.4 Malaria 267,155 54.6

2 Upper Resp. Tract Infection 29,119 7.3

Upper Resp. Tract Infection 36,377 7.5 Other ARI 32,433 7.0 Other ARI (Acute Respiratory Infection)38,857 7.9

3 Diseases of Skin & Ulcer 18,593 4.7

Diseases of Skin & Ulcer 22,500 4.6 Diarrhoeal Diseases 22,220 4.8 Diarrhoea Diseases 21,449 4.4

4 Diarrhoea Diseases 12,868 3.2 Diarrhoea Diseases 20,439 4.2 Skin Diseases & Ulcers 19,846 4.3 Skin Diseases & Ulcers 20,067 4.1

5 Acute Eye Infection 9,161 2.3 Pneumonia 11,643 2.4 Acute Eye Infections 11,789 2.5 Acute Eye Infection 11,630 2.46 Pneumonia 8,950 2.3 Acute Eye Infection 10,660 2.2 Pneumonia 8,715 1.9 Pneumonia 9,924 2.0

7 Rheumatism & Joint Pains 8,772 2.2 Anaemia 8,655 1.8 Anaemia 7,909 1.7 Typhoid Fever (TYPHOID) 6,622 1.4

8 Preg. & Related Complications 7,192 1.8 Intestinal Worm 7,252 1.5 Rheumatism & Joint Pains 6,534 1.4 Anaemia 6,584 1.3

9 Intestinal Worm 6,984 1.8 Preg. & Related Complications 6,142 1.3 Intestinal Worms 6,341 1.4 Rheumatism & Joint Pains 6,164 1.3

10 Anaemia 6,659 1.7 Rheumatism & Joint Pains 5,767 1.2 Preg Related Comps 5,711 1.2 Pregnancy and Related Complication6,057 1.2

11 All Other Diseases 82,345 20.7 All Other Diseases 83,174 17.2 All Other Diseases 86,067 18.5 All Other Diseases 95,141 19.412 Total 397,490 100.0 Total 484,936 100.0 Total 465,462 100.0 TOTAL NEW CASES 489,650 100.0

2004200320022001


68

Table 63: Top Ten Diseases seen at the OPD, 2004, Regional Summary and District Contributions

Diseases No. % No. % No. % No. % No. % No. % No. %

1 Malaria 267,155 100.0 95,990 35.9 19,401 7.3 76,285 28.6 16,391 6.1 27,892 10.4 31,226 11.7

2 Other ARI (Acute Respiratory Infection) 38,857 100.0 13,330 34.3 959 2.5 8,760 22.5 1,515 3.9 8,543 22.0 5,733 14.8

3 Diarrhoea Diseases 21,449 100.0 8,419 39.3 1,627 7.6 6,033 28.1 1,028 4.8 1,383 6.4 2,959 13.8

4 Skin Diseases & Ulcers 20,067 100.0 4,160 20.7 1,679 8.4 7,581 37.8 955 4.8 2,295 11.4 3,397 16.9

5 Acute Eye Infection 11,630 100.0 7,493 64.4 306 2.6 2,012 17.3 43 0.4 453 3.9 1,058 9.1

6 Pneumonia 9,924 100.0 2,707 27.3 833 8.4 2,094 21.1 141 1.4 377 3.8 470 4.7

7 Typhoid Fever (TYPHOID) 6,622 100.0 1,245 18.8 792 12.0 3,184 48.1 176 2.7 3,861 58.3 666 10.1

8 Anaemia 6,584 100.0 2,233 33.9 512 7.8 2,268 34.4 225 3.4 756 11.5 590 9.0

9 Rheumatism & Joint Pains 6,164 100.0 786 12.8 220 3.6 1,428 23.2 6 0.1 3,606 58.5 118 1.9

10 Pregnancy and Related Complication 6,057 100.0 4,762 78.6 149 2.5 793 13.1 53 0.9 141 2.3 159 2.6

TOTAL NEW CASES 489,650 100.0 169,938 34.7 31,088 6.3 143,208 29.2 24,946 5.1 63,869 13.0 56,601 11.6

No. Regional BE BW BOLGA BONGO BUILSA KND


69

Table 64: Trend of Ten Top Causes of Admission, UER

No.

DISEASES No. % DISEASES No. % DISEASES No. % DISEASES No %

1 Malaria 9,656 28.8 Malaria 11,391 30.7 Malaria 12,162 31.1 Malaria 14,801 35.5

2 Anaemia 3,352 10.0 Anaemia 3,906 10.5 Anaemia 3,468 8.9 Preg related compl 3,641 8.7

3 Pneumonia 1,863 5.6 Pneumonia 2,799 7.5 Pregnancy Related

Complications 3,255 8.3 Anaemia 3,415 8.2

4 Other Diarrhoea Diseases

1,370 4.1 Preg. & Related Complications

1,232 3.3 Typhoid Fever 1,468 3.7 Pneumonia 1,822 4.4

5 Preg. & Related Complications

962 2.9 Typhoid Fever 1,155 3.1 Pneumonia 1,350 3.4 Typhoid fever 1,442 3.5

6 Upper Resp. Track Infection

857 2.6 Other Diarrhoea Diseases

1,064 2.9 Other Diarrhoeal Diseases

1,030 2.6 Other Diarrhoeal dis 1,382 3.3

7 Hernia 791 2.4 Upper Resp. Track

Infection 999 2.7 Cataract 821 2.1 ARTI 1,285 3.1

8 RTA 695 2.1 Meningitis 723 1.95 RTA 791 2.0 Cataract 1,137 2.7

9

Cataract 646 1.9 Cataract 716 1.93 Acute Respiratory Infections

719 1.8 RTA 1,061 2.5

10 Meningitis 605 1.8 Hernia 712 1.92 Hernia 645 1.6 Hernia 765 1.8

11Others 12,711 37.9 Others 12,421 33.5 Others 13,455 34.4 Others 10,944 26.2

12 Total 33,508 100 Total 37,118 100 Total 39,164 100.0 Total 41,695 100.0

20022001 2003 2004


70

Table 65: Top Ten Causes of Admissions, 2004, Regional Summary and District Contributions

Diseases No. % No. % No. % No. % No. % No. % No. %

1 Malaria 14,801 100.0 7,405 50.0 845 5.7 1,727 11.7 688 4.6 1,681 11.4 2,455 16.6

2 Preg related compl 3,641 100.0 2,897 79.6 138 3.8 131 3.6 - - - - 475 13.0

3 Anaemia 3,415 100.0 1,592 46.6 304 8.9 867 25.4 148 4.3 172 5.0 332 9.7

4 Pneumonia 1,822 100.0 380 20.9 200 11.0 583 32.0 169 9.3 262 14.4 228 12.5

5 Typhoid fever 1,442 100.0 1,092 75.7 55 3.8 176 12.2 64 4.4 - - 55 3.8

6 Other Diarrhoeal dis 1,382 100.0 625 45.2 77 5.6 198 14.3 41 3.0 305 22.1 136 9.8

7 ARTI 1,285 100.0 956 74.4 31 2.4 85 6.6 37 2.9 - - 176 13.7

8 Cataract 1,137 100.0 1,053 92.6 23 2.0 7 0.6 - - - - 54 4.7

9 RTA 1,061 100.0 491 46.3 87 8.2 243 22.9 14 1.3 - - 226 21.3

10 Hernia 765 100.0 101 13.2 33 4.3 205 26.8 - - 246 32.2 180 23.5

Total New Cases 41,695 100.0 18,433 44.2 2,831 6.8 7,983 19.1 1612 3.9 4,076 9.8 6,760 16.2

Bongo Builsa KND No. Region Bawku East Bawku West Bolga


71

Table 66: Trend of Ten Top Causes Of Death, UER

No.

DISEASES No. % DISEASES No. % DISEASES No. % DISEASES No. %

1 Malaria 252 16.4 Malaria 261 17.2 Malaria 278 18.4 Malaria 310 21.6

2 Anaemia 199 12.9 Anaemia 201 13.3 Anaemia 127 8.4 Anaemia 154 10.7

3 Pneumonia 120 7.8 Pneumonia 157 10.4 Meningitis 108 7.2 Pneumonia 135 9.4

4 Meningitis 118 7.7 Meningitis 133 8.8 Pneumonia 102 6.8 Septicaemia 64 4.5

5 Other Diarrhoea Diseases

52 3.4 Septicaemia 44 2.9 Typhoid Fever 63 4.2 Meningitis 61 4.2

6 Hepatitis 44 2.9 Typhoid Fever 43 2.8 Septicaemia 57 3.8 Tuberculosis 51 3.5

7 Malnutrition 35 2.3 Other Diarrhoea Diseases

42 2.8 Tuberculosis 49 3.2 Typhoid fever 44 3.1

8 Septicaemia 32 2.1 Hepatitis 40 2.6 Other Diarrhoeal Diseases

44 2.9 Hepatitis 31 2.2

9 Typhoid Fever 27 1.8 Malnutrition 31 2.0 Hepatitis 40 2.6 AIDS 28 1.9

10 RTA 24 1.6 Tuberculosis 31 2.0 RTA 22 1.5 Other Diarrhoeal Diseases

27 1.9

11 All other diseases 636 41.3 All other diseases

532 35.1 All other diseases 620 41.1 All other diseases

533 37.1

12 Total 1,539 100.0 Total 1,515 100.0 Total 1,510 100.0 Total 1,438 100.0

2001 2002 2003 2004


72

Table 67: Top Ten Causes of Deaths, 2004, Regional Summary and District Contributions

Diseases No % No. % No. % No. % No. % No. % No. %

1 Malaria 310 100.0 100 32.3 14 4.5 47 15.2 19 6.1 56 18.1 74 23.9

2 Anaemia 154 100.0 63 40.9 12 7.8 49 31.8 1 0.6 9 5.8 20 13.0

3 Pneumonia 135 100.0 22 16.3 13 9.6 63 46.7 3 2.2 16 11.9 18 13.3

4 Septicaemia 64 100.0 43 67.2 7 10.9 12 18.8 - - - - 2 3.1

5 Meningitis 61 100.0 19 31.1 2 3.3 27 44.3 2 3.3 2 3.3 11 18.0

6 Tuberculosis 51 100.0 11 21.6 3 5.9 27 52.9 - - - - 10 19.6

7 Typhoid fever 44 100.0 28 63.6 - - 14 31.8 - - - - 2 4.5

8 Hepatitis 31 100.0 7 22.6 4 12.9 12 38.7 1 3.2 4 12.9 3 9.7

9 AIDS 28 100.0 5 17.9 2 7.1 12 42.9 - - 1 3.6 8 28.6

10 Other Diarrhoeal Diseases

27 100.0 - - 2 7.4 21 77.8 5 18.5 - - 3 11.1

Total No. of Deaths 1,438 100.0 436 30.3 99 6.9 431 30.0 45 3.1 152 10.6 275 19.1

Region Bawku East Bawku West KND Bongo Bolga Builsa


73

MATERNAL MORTALITY AND FOETAL WASTAGE Institutional Maternal Mortality Ratio continues be of major public health concern. A total of 47 women lost their lives in our institutions. Out of this 41 (91.5%) were audited.

Table 68: Institution Maternal Death Audits

Name of Hospital No. Deaths No. Audited % Audited Bolga Regional Hosp 18 16 89% Bawku Presby 14 12 86 Zebilla 2 2 100 Bongo 1 1 100 Navrongo 6 6 100 Sandema 6 6 100 Total 47 43 91.5

Table 69: Institutional Maternal Death Ratio

Name of Hospital No. Maternal

Deaths No. Live Births Maternal Mortality Ratio (Per 100,000 LB)

Bolga Regional Hosp 18 2685 670.4 Bawku Presby 14 4591 304.9 Zebilla 2 868 230.4 Bongo 1 924 108.2 Navrongo 6 1795 334.3 Sandema 6 945 634.9 Total 47 11808 398.0

The maternal mortality ratios in Bolgatanga Regional Hospital and Sandema Hospital were unacceptably too high

Trend of Institutional Maternal Deaths

53 51 53

4247

0

10

20

30

40

50

60

2000 2001 2002 2003 2004

Year

No.

Dea

ths

Fig 33: Trend of Institutional Maternal Deaths


74

Institutional Maternal Mortality Ratio

0100200300400500600700800

Bolga Hos

p

Bawku

Hos

p

Zebil

la Hos

p

Bongo

Hos

p

Navro

ngo Hos

p

Sande

ma H

osp

Hospitals

MM

R (p

er 1

00,0

00)

Hospitals

Regional

Fig 34: Institutional Maternal Mortality Ratio Maternal Mortality Ratio in Bolgatanga Regional Hospital (670.4/100,000 LB) and Sandema Hospital (634.9/100,000 LB) were well above the regional average Fig 35: Major Causes of Institutional Maternal Deaths Haemorrhage and sepsis account for almost 50% of all the maternal deaths. Fig 36:Direct Causes of Institutional Deaths The two major direct causes of deaths are sepsis, 45%, and haemorrhage (APH and PPH) 36%. The two account for about 81% of all the maternal deaths.

Direct Causes of Institutional Maternal Deaths

45%

27% 14%

9%

5%

Sepsis

PPH

Ruptured Uterus

APH

Abortion

Major Causes of Institutional Maternal Deaths

25%

20%7%2%10%7%

5%

24%

Sepsis

Haemorrhage

Ruptured Uterus

Abortion

Anaemia

Hepatitis

SCD

Others


75

STILL BIRTHS. Still birth rates have been unacceptably high. The year under review with a rate of 3.8% (468/12,272 ) was worse than the previous two years (see graph below).

Trend of Still Birth Rates

2.52.2

3.8

00.5

11.5

22.5

33.5

4

2002 2003 2004

Year

SB

Rat

e (%

)

Fig 37: Trend of Still Birth Rates Still birth rate is on a sharp rise. There was a dramatic increase of about 72.7% in Still Birth Rate in 2004 compared to 2003. Records indicate that over 50% of the Still Births were fresh SBs.

Still Birth Rate by Districts in 2004

0123456

B/EB/W

BOLGA

BONGO

BUILSA

KND

DISTRICT

RA

TE (%

)

District

Region

Fig 38: Still Birth Rate by Districts in 2004 Rates in Bawku East, Bawku West and Bolgatanga districts were well above the regional rate. The lowest (1.3%) was in Bongo district.


76

SPECIALIST OUTREACH SERVICES

Table 70: Intra-Regional Outreach Services

Specialist Service No. Visits Patients Ophthalmologists - 4,837 Orthopaedics 2 86 Psychiatry 48 798

Table 71: External Specialists Services

Specialist Services No. of Visits No. of Clients

Dermatologist 6 534

Psychiatrist 1 457

Christian Mission (Surgical)

1 127

LABORATORY SERVICES

Table 72: Ownership of Laboratories

2003

2004

District

Public

Private

Public

Private Bolgatanga

1

2

1

2

Bawku East

1

0

1

1

Bawku West

1

1

1

1

Kassena Nankana

1

0

1

1

Builsa

2

0

2

0

Bongo

1

0

1

0

Total

7

3

7

5


77

Table 73: ESSENTIAL INVESTIGATIONS

2004

2003

Investigation

No

Pos

%

No

Pos

%

HIV (Donors)

5,905

151

2.6

5,112

140

2.7

HIV (Patients)

759

295

39.0

683

206

30.2

HIV (VCT)

448

62

13.8

304

40

13.2

HIV (PMTCT)

225

13

6.0

25

2

7.1

HBsAg (Donors)

6,336

772

12.2

5720

608

10.6

Jaundice Patients

1,019

364

35.7

925

353

38.2

CSF

352

104

40.6

304

98

32.2

Haemoglobin

26,386

-

-

22,496

-

-

Blood transfusion

7,685

-

-

6,824

-

-

Blood Film for malaria parasite

18,375

13,194

71.8

16,731

12,240

73.2

The prevalence of HIV and HBsAg among blood donors was 2.6% and 12.2% respectively. Constrains (Lab)

� Serious shortfalls in numbers of technical staff; three technicians and one Technologist suddenly left for school during the year

� A number of key health centres are still lacking Laboratory services. � Large number of broken down microscopes.

Way Forward (Laboratory services)

� Strengthen the Quality Assurance system to improve on the quality of results � Strengthen the supervision of Laboratories including private Labaratory. � Open two new Laboratories in Talensi-Nabdam district and Kassena Nankana

East Health Centre � Provide in-service training for Laboratory Assistants on basic Laboratory

procedures. � Navrongo Health Research Centre contacted to do PCR on all CSF specimens

in the region. � Arrange for the servicing of all microscopes in the region at a central point.


78

Summary of Achievements- Clinical care � Guidelines and procedures for referrals developed and disseminated. � Reconstitution of Quality Assurance teams in the 6 districts and hospitals. � Training of staff on Quality Assurance (War Memorial, Zebilla Hospital and

Bawku West Hospital) � Establishment of Information/Complaints � Maternal Death Audits: 91.5% of the 47 maternal deaths were audited. � Marginal increases in service utilisation (OPD Per capita, Bed Occupancy etc

(ref tables above) � Clinical Conferences held in some facilities

Outlook for 2005.

1. Strengthening Hospital Management 2. Capacity building through IST 3. Continue orientation of Patient Charter and Code of Conduct 4. Training/Orientation Clinical Care Unit to support clinical care services 5. Strengthen Quality Assurance systems 6. Strengthen specialist outreach visits 7. Accident and emergency care - capacity building 8. Support facilities in their readiness for successful NHIS implementation 9. Improve quality and ensure that all facilities conduct audits to all maternal

deaths 10. Monthly clinical conferences to be held in all hospitals 11. Partnership with private sector 12. Establish collaboration between traditional and orthodox medicine 13. Research;- Quarterly Client/patient satisfaction surveys to be conducted in all

hospitals 14. Develop and disseminate guidelines and standards for clinical services


79

CHAPTER FOUR

4.0. SPECIAL INITIATIVES TO INCREASE ACCESS 4.1. ACCELERATED CHILD SURVIVAL AND DEVELOPMENT (ACSD) ACSD is a four country UNICEF-CIDA supported child survival initiative. The countries are:

• Ghana, Mali, Senegal and Benin. Criteria for selection of countries: • Targets districts located in rural areas of countries with high U5MR (>200) or

in most disadvantaged regions of countries with lower U5MR. These districts are termed “High Impact Districts”.

Goal Goal is to achieve and demonstrate a reduction of under-five mortality by:

• 15% (on average) in the intervention districts after 3 years of full implementation of the full intervention packages and operational strategies and

• 25% after 5 years of full implementation in the programme districts Timeline:

• Implementation began during the last quarter of 2002 in the Upper East Region

• Covers all 6 districts in Upper East and 13 in Northern Regions

• It is to complement and accelerate child survival activities in these districts� OVERALL STRATEGIES 1. Health Centre Based Strategy

� Integrated delivery of all priority interventions to 25-50% of population with access to HC.(<5km)

� Community based strategy for IMCI+ (home based prevention and care) for 50-75% of population without access to HC

2. Outreach Strategy

� For example, three monthly delivery of EPI+ and ANC services to 50-75% of population without access to HC (>5km.)

3. Support Strategies Social mobilization & communication to improve service use and family care A results based approach to financing service delivery including performance-based incentives (monetary or in kind),performance contracting with community groups, CBOs, health staff etc.


80

Community based monitoring & micro-planning to increase effective coverage and empower communities Package of Interventions, Strategies and Activities EPI PLUS: Objective To prevent immunizable diseases, Vitamin A deficiency and Intestinal parasites: Strategies: 1. Immunization: Routine, mop-up and defaulter tracing 2. Twice yearly Vitamin ‘A’ Supplementation 3. Distribution of ITNs to under five year 4. Twice yearly deworming through provision of anti-helminthic drugs (under five and school aged children) Activities Micro-planning Routine immunization,mop ups and defaulter tracking. Distribution, treatment and re-treatment of ITNs to to pregnant women/children < 5 years through ANC, PNC, CHOs, CWC and CBAs Deworming of under-five integrated into NID Deworming of school aged children through School Health Programme Vit. A supplementation IMCI PLUS Objective To prevent and care for pneumonia, diarrhoea, malaria and malnutrition Strategies 1. Distribution and promotion of use ITNS for under fives 2. Promotion of exclusive breastfeeding for six months and timely complementary feeding, 3. Promotion of hygiene 4. Promotion of household consumption of iodised salt 5. Improved and Integrated Management at the health centre and family levels of children with malaria, pneumonia and Diarrhoea (Community- IMCI). Activities Capacity building: Training of Sub-districts, Families and Community Based Agents to manage: Malaria, Diarrhoea, ARI at home and to give health education messages on: Iodated Salt Sanitation Exclusive Breastfeeding.


81

ANC PLUS: Objective To prevent maternal and neonatal tetanus and low birth weight resulting from malaria and severe anaemia in pregnancy as well as mother to child transmission of HIV/AIDS Strategies 1. Distribution and promotion of use of ITNs to pregnant women 2. TT immunization 3. Intermittent preventive treatment of malaria in pregnancy (IPT-P) 4. Iron/Folic Acid supplementation during pregnancy and Vitamin A post-natal. 5. Promotion of VCT& PMTCT Activities ITN distributed at ANC, CWCs and Community levels TT2: Immunization TT SIAs conducted IPT-P – TOT training, training of health workers and distribution of SP at ANC�� Achievements EPI Plus

• Routine immunization and tracking of defaulter supported by trained Community based Surveillance Volunteers on course

• One round Vitamin A Supplementary undertaken with coverage of 85.9% • Twice yearly de-worming of children under five with coverage of 102.3% and

94.6%. • Once round of de-worming of basic school children with coverage of 82%

Table 74: Trend of Results of EPI Coverage Survey, UER

Antigen Year of Survey 1999 2000 2002 2003 2004 BCG with Card 81.7 92.6 89.2 95.3 99.3 DPT3 with Card 73.0 82.6 83.2 88.7 42.6 OPV3 with Card 81.7 - 81.9 89.1 41.6 Measles with Card 63.7 70.5 76.8 73.7 77.4 Fully Immunised by age 52 weeks 53.0 58.3 48.7 53.6 12.5 IMCI Plus Training of sub-district health workers and about 1,600 Community based Agents carried out for Community IMCI. CBAs have been supplied with bicycles and boxes with chloquine and ORS for the management of malaria and diarrhea. CBAs are also referring cases of ARI and complicated malaria and diarrhea; health education, promotion of exclusive breastfeeding, iodated salt and ITNs are also being carried out by CBAs.


82

ANC Plus

Table 75: ITN Promotion

ITN Districbution Coverage District Chn < 5 yrs Pregnant

women Chn < 5 yrs Pregnant

women BAWKU EAST 27,668 13,869 57.3 107 BAWKU WEST 18,437 5,190 146 154 BOLGA 34,900 3,562 97.3 37 BONGO 15,211 4,973 124.6 153 BUILSA 11,334 3,146 96 99.9 KASSENA-NANKANA

15,484 5,483 66.1 89

TOTAL 109,579 36,223 76 94 TT SIAs Two rounds were conducted with coverage of 46% and 62% respectively in four silent districts. IPT-P Training was rolled out in all districts and active distribution SP began during the year Post Partum Vitamin A Mass treatment also began in all districts at PNC and Child Welfare clinics VCT/PMTCT All hospitals began providing VCT services. Two hospitals also began counselling and screening of pregnant women and administration of Niverapine to positive mothers and their babies. 4.2. NATIONAL HEALTH INSURANCE In 2003 the Parliament of the Republic of Ghana passed the National Health Insurance Act 650 to introduce a National Insurance Scheme that aims to improve financial access to quality of basic health care services in Ghana through the establishment of mandatory district level mutual health organizations. In Upper East Region, realising the existence of a number of solidarity groups which in a way already contribute to their welfare other than health care, the need to take advantage and pursue the regions objective of establishing Mutual Health Scheme became a matter of course. Key Activities � Formation and training of Regional Task Force � Appointment of a permanent Regional Coordinator � Provision of office, computer and accessories for the Regional Coordinator � Formation and training of District Task Force � Regular briefing of the Regional Coordinating Council and District assemblies

and their Roles in the establishment of the Schemes � Monitoring and supervision of processes of schemes establishments � Community Education in creating Public Awareness


83

� A five member Task Force Team was sent from the Region for a TOT training in Accra.

� Training of Health Staff by taskforce: A total of 1,092 different categories of health staff were given orientation in NHIS.

Outlook for 2005.

1. Orientation/training of rest of health workers 2. Training of student nurses (Bawku, Bolga, Navrongo nursing training

institutions) 3. Monthly review meetings with Facility Focal Persons, and Scheme Managers. 4. Under take a Study Tour to a functional MHO Scheme 5. Assist health workers and other civil servants register with their District –

Wide MHOs 6. Radio discussion – Intensive radio publication on National Health Insurance

Scheme in English, Bissa, Buli, Gurune, Kasim and Kusal at the two FM stations in the region

7. Surveys – Conducting of client satisfaction survey in the health facilities 8. Undertake quarterly assessment of District Wide Mutual Health Insurance

Scheme 9. Monitoring and supervision – conduct monthly visits to all district and health

facilities to assist them in their National Health Insurance activities.

4.3. COMMUNITY HEALTH PLANNING AND SERVICES (CHPS)

CHPS is a process of sector-wide health system change and development that aims to provide accessible primary health care to all communities of Ghana. It is a national programme for reorienting and relocating primary health care from sub-district health centres to convenient community locations. It is a “Close-to –Client” health service

Table 77: Implementation Status Checklist For District –Wide MHO

Form

ed

Trai

ning

Dra

fted

Dis

sem

inat

ed

Form

ed

Trai

ned

Off

icer

s R

ecru

ited

Off

icer

s Tr

aine

d

Bolga 1 53 0 8 64 0 0 0BE 0 190 0 0 0BW 10 10 0 30 0 0 0Bongo 0 36 0 0 0Builsa 2 46 0 75 0 0 0KND 14 14 0 112 0 0 0

Dis

tric

t

Con

tact

per

son/

Coo

rdin

ator

Sta

keho

lder

s M

eetin

g

Sen

sitis

atio

n C

ampa

ign

DIC1 Constitution CHIC'SchemeManager''

Impl

emen

tatio

n of

Ben

efits

/Mon

itorin

g

Ann

ual G

ener

al M

eetin

g

Off

ice

Sec

ured

Gov

erni

ng B

ody

Reg

. Lo

gist

ics

Pro

cure

d/T

rain

ing

of C

olle

ctor

s

Laun

chin

g

Hse

hold

/Due

s C

olle

ctio

n

Pic

ture

/ID

Car

ds/

Con

trac

t/D

ata

Ent

ry


84

delivery. Process relies on active community participation in planning, resource mobilisation, construction of compounds, service delivery and programme oversight

Goal To reduce health inequalities and promote equity of health outcomes by removing geographic barriers to health care. All six districts of the region carried out situational analysis, drew strategic plans and coverage plans for scaling up CHPS. Districts are various stages of the implementation stage, namely training and placement of Community Health Officers and Volunteers at the various zones. A number of Community Health Compounds were constructed with funds from the approved capital investment plan for the region for the year, deprivation funds for the region and HIPC/District and Municipal Assembly Common Fund. The region took delivery of twelve (12) motorbikes from Headquarters and procured additional fifteen (15) for CHOs throughout the region. Human Resource: The pioneers of the Community Health Nurses Training School, numbering 45, wrote their final examinations during the last quarter of the year. The construction of Hostel for the students is also completed. Permanent classrooms would be constructed in 2005. The human for CHPS programme, hopefully should not a major challenge to the implementation of the programme in the next few years.

Table 78: Status of CHPS by Districts

District/Municipal No Zones No Functional Zones

Estimated Pop in Functional Zones

Coverage (pop) %

Bawku East 35 5 20,611 6.4 Bawku West 15 3 22,232 26.4 Bolgatanga 25 8 37,065 11.5 Bongo 14 5 11,400 14.0 Builsa 13 4 6,279 8.0 KND 38 17 72,881 46.7 Total 140 42 170,468 17.7

Challenges The following continue to be among major challenges facing the implementation of the CHPS programme in the region:

• High level of poverty • Scattered rural settlement pattern • Low rate of construction of Community Health Compounds • Poor support by some District Assemblies • Inadequate transport (motor bikes and Bicycles very few and over-aged) • Inadequate logistics (Fridges, solar set-up, examination equipment etc.) • Low staff motivation • Poor commitment of some Health Managers.


85

Outlook for 2005. � Completion of the Hostel and Classrooms for the Day Community Health

School at Navrongo � Provision of adequate logistics. � Intensify efforts at resource mobilisation (from MDAs) � Strengthen collaboration and advocacy for the construction of CHCs and

provision of resources for CHPS. � Revision of CHPS plans and re-zoning in the light of the creation of addition

two new districts. � Intensification of supervision � Motivation and attractive incentive packages for CHOs

4.4. FOOD ASSISTED CHILD SURVIVAL (FACS) This initiative is being supported by CRS in two districts. The initiative started in Bongo and is being extended to Bawku West District.

FACS in Bongo District

� 35 communities (OP) supported by CRS under this project. � Volunteers are trained in each community to assist in

1. Growth Monitoring 2. Immunization 3. Health Education and 4. Food distribution

Material Support

� One Toyota Hilux Pickup � 7 Yamaha Motor bikes to support FACS and CHPS program � 23 bicycles � Building materials for feeding centres.

Bawku West District

� Baseline survey was conducted and results disseminated. � Health workers have been trained in community entry skills � Selection of beneficiary communities in progress

4.5. INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDSR) STRATEGY. Roll out training was conducted in all districts for good number of health personnel. The exercise will continue in 2005.

4.6. INTERMITTENT PREVENTIVE TREATMENT OF MALARIA IN PREGNANCY (IPT-SP). Two districts namely Bongo and Bawku East are among the Global Fund beneficiary districts for rolling out IPT-P. We secured funding from UNICEF under ACSD programme to carry out training and implementation of the programme in the remaining districts. Thus, except in three sub-districts in the Kassena Nankana


86

District where drug trial studies are ongoing, all six districts began implementation during the year. 4.7. COMMUNICATION NETWORK. Attempts at improving communication network in the region to facilitate referrals finally got a major boost during the year. At the close of 2003, only Bawku East District had communication equipment installed at the various health facilities. During the year three districts, namely Kassena Nankana, Bolgatanga and Bawku West had Motorala Equipment installed in all health centres and some CHPS compounds. Efforts are being made to get the two remaining districts (Bongo and Builsa) and District Hospitals and District Health Administrations networked.


87

CHAPTER FIVE

5.0 SUPPORT SERVICES 5.1. ESTATES The Upper East Region is one of the most deprived regions in the country in terms of health infrastructure. Staff accommodation and health facilities amongst others are woefully inadequate and in deplorable state. Objectives for 2004

• Ensure that all approved projects are procured and executed • Construction of Community Health Compounds under the CHPS Programme

for CHOs in selected communities in the region • Rehabilitation of staff residential accommodation • Monitor and support districts in health estates activities • Carry out preventive maintenance programmes in the region • Carry out site visits to project sites • Attend all site meetings • Co-ordinate all health estates activities

Procurement of 2004 Civil Works (Capital Investment) The region under the 2004 civil works programme received approval for the procurement and execution of eleven (12) projects for 2004. The projects are:

� Rehabilitation of Sandema District Hospital � Construction of Mortuary at Zebilla District Hospital � Rehabilitation of War Memorial Hospital � Completion of Works at CHNTS, Navrongo � Completion of Health Centre at Bongo-Soe � Completion of Health Centre at Kologo � Completion of Health Centre at Sapeliga � Completion of fence wall at Navrongo Hospital � Rehabilitation of Chiana Health Centre � Construction of 2No. CHPS Facilities with Borehole installation at selected

areas � Upgrading of Bolgatanga Regional Hospital – BADEA Project � Expansion of hostel and classrooms of Nurses Training College at Bawku

Status of Projects All projects have been awarded and civil works are at various stages implementation. Rehabilitation of Bolgatanga Regional Hospital The Bolgatanga Regional Hospital Rehabilitation works funded by BADEA suffered a delay in the execution due to litigation by Land owners over compensation for land. In addition funds were also not released timely to pay the contractors.


88

Internal Rehabilitation/Construction Works. The following were undertaken by the Regional Health Directorate during the year:

Table 79: Internal Projects

Project Location % Completion of works

1. Construction of CHPS facility Bachongsa, Builsa District 100 2. Construction of CHPS facility Bokko, Bongo District 100 3. Construction of CHPS facility Bansi, Bawku East Municipality 100 4. Construction of CHPS facility Agusi, Bolgatanga Municipality 100 5. Installation of small Solar, Invertor system to five CHPS Compounds At Selected CHPS Compounds

100

6. Rehabilitation 1No. 3-Bedroom bungalow and boys Medical Village, Soe, Bolga

100

7. Rehabilitation of bungalow with Boys quarters ( No. 12 Medical Village, Soe, Bolga

100

8. Rehabilitation Bung. For Municipal Health Director, Bawku Bawku East

100

9. Renovation of Bungalow for Medical Supt, Sandema Hospital Sandema, Builsa District

100

10. Rehabilitation Bungalow at GWCL for senior officers Bolgatanga

80

Japan Embassy Counter Value Funding The following projects were awarded during the last quarter of the year with funds from Japan Embassy.

1. Rehabilitation of Fumbisi Health Centre staff accommodation 2. Rehabilitation of Paga Health Centre staff accommodation 3. Rehabilitation of Kulungugu Health Centre staff accommodation 4. Procurement of weighing scales and Blood Pressure apparatus for four

districts (Bawku East, Bolgatanga, Kassena Nankana and Builsa Districts) 5. Rehabilitation/expansion of Supplementary Feeding Centres in the four

districts. Construction of Community Initiated Clinics (CICs) Construction of community initiated clinics under the support UNFPA has been on-going in two Districts since 2002. Projects are:

• Wagliga in the Bongo District and • Uasi in the Builsa District.

Projects are stages of completion. Modification Of Incinerators. Work on the modification of incinerators has been completed in the four (4) Districts and two (2) Municipalities of the Upper East Region. The incinerators have since been put to use by the various facilities.


89

Acquisition of Landed Properties.. The Regional Health Directorate continued its collaboration with the Land Valuation Board and other departments on the proper acquisition of the Regional Hospital and other landed properties of the Ghana Health Service in the Region. Training

� A team of artisans from the various hospitals in the Region were sent to Kumasi for a two-week training under the sponsorship of DANIDA/EMU.

� Carried out training in Environmental sanitation and minor maintenance for unit in-charges in Bawku East District/Hospital.

� User training for incinerator operators – 6 supervisors and 6 operators.

Suspended Projects Works on the under listed projects which were awarded under the capital investment plan have been suspended since 2000 due unavailability of funds:

1. Construction of DMO’s Bungalow at Zebilla 2. Construction of Maternity Unit at Fumbisi Health Centre 3. Completion of RHMT office/In-service Training Complex at Bolgatanga 4. Completion of Workshop at Bolgatanga

Constraints/Challenges

� Suspension of work on many projects � Regional priority projects not approved at HQ � Lack of maintenance culture. � Absence of adequate and qualified artisans in estates. � Un-availability of adequate funds for the rehabilitation of staff

accommodation and other facilities. Outlook for 2005

� Funds to be made available for the completion of all uncompleted project. � Intensify awareness creation on preventive maintenance culture to all health

workers. � To recruit more qualified artisans to take up the challenging task � Funds should be made available for the renovation of existing staff

accommodation and other facilities and to provide additional residential accommodation for staff

5.2. EQUIPMENT MANAGEMENT Equipment situation in the Region has not been the best. They are not adequate, broken down and obsolete. For many years there has not been a trained equipment manager to carry out basic maintenance of the available equipment. Replacement has been poor 5.3. TRANSPORT Transport exists primarily to provide spatial mobility for staff to deliver services to the population and ensure timely positioning of health logistics for effectiveness and efficiency of health provision.


90

The strategic intent of transport is not just to provide vehicles, but also to ensure that high availability and reliability of transport resources translate into improved health outputs. Drivers Situation Vehicle/Driver Ratio = No. of Vehicles = 62 = 1.8 : 1 No. of Drivers 34 There were 23 drivers as at November 2004. This gave a vehicle: driver ratio of 2.7:1. In December, however, 13 drivers were recruited and still awaiting financial clearance. Wastage: 1. Study Leave = 1 2. Two drivers were redeployed to the Regional Hospital as labourers following their recalcitrant drinking habits. Summary of Key Fleet Performance Indicators

Table 80: Vehicles

Fuel Cost ¢1,220,000,000.00 Maintenance Cost ¢2,714,400,000.00 Total Running Cost ¢3,934,400,000.00

Table 81: Motorcycles

Total No. of Motorcycles.

Total No. of Motors reported

Total KM Travelled

% Avail

% Util

% No of Bikes Reported

KM/L Maintenance Cost/ KM

Average Running Cost

131 3 3,930,000 93.4 90.8 2.3 12.6 782.6 1134.2

Fuel Cost ¢ 727,705,000.00 Maintenance Cost ¢3,497,700,000.00 ��

Table 82: Running & Maintenance Cost (Actual)

RUNNING COST MAINTENANCE COST TOTAL 1,530,679,729 1,432,433,817 2,963,133,546

No of 4 wheel vehicles

Total no of vehicles reported

% No of vehicles Reported

Total KM

% Avail

% Util

KM/L

Maintenance cost/km

Average Running Cost/km

62

14

22.6

265,525

94.0

85.6

7.2

422.8

961254


91

Fleet Inventory- By Age Block

Table 83: 4 -Wheel Vehicles

AGE No. Percentage Colour Code

1-5 year

33

66.00 Green

6 – 9 year 16 27.59 Amber 10 year and over 9 15.52 Red TOTAL 58 100.00

Table 84: Motorcycle.

AGE NO. Percentage Colour Code

1-3 years 37 28.24 Green 4-5 years 51 38.93 Amber 6 years and above 43 32.82 Red TOTAL 131 100.00

Table 85: Number And Types Of Vehicle

Motorcycle

Saloon

Pick-up

Station Wagon

Ambulance

Haulage Truck

Water Tanker

Bus

Communication van

131

1

43

3

5

2

-

3

1

Table 86: Makes of Motorcycles

NO. MAKE NUMBER % QUOTA

1 Yamaha 119 90.84

2 Jialing 12 9.16

TOTAL 131 100


92

Table 87: Make Of Vehicles

No. MAKE NUMBER % QUOTA

1 Toyota

11 18.97

Mazda 18 31.03 2

3 Nissan 20 34.48

4 Kia 1 1.72

5 Ford 1 1.72

6 Mitsubitsi 3 5.17

7 Isuzu 2 3.45

8 Renault 1 1.72

9 Land Rover 1 1.7

TOTAL 100.00

Table 88: Accidents

STATION

TYPE OF VEHICLE

REG NO.

INJURY/DEATH

RHD, Bawku East DHMT Bawku East DHMT RHD Builsa DHMT

Toyota Hilux 2.8D Mazda 2900 P/up Yamaha AG 100 Yamaha AG 100 Yamaha AG 100

GV 45 T GV 335 U GV 441 T GV 689 U GT 6011 F GV 696 V

Driver sustained neck injury. Passenger sustained chest

injury

Knocked down a pedestrian. Victim died about a couple a

weeks after he was hospitalized at KATH, Kumasi

-


93

Auctioned Vehicles

Table 89: The list of Auctioned Vehicles

S/NO REG. NUMBER

MAKE/TYPE CHASSIS NO

1 2 3 4 5 6 7 8 9 10 11 12 13

GV8851C GV2540D GV7202C GV7046C GV 7059 C GV 1841 D GV 7171 C GV 7061 C GV 7065 C GV 7139 C GV 1938 D GV 1940 D GT 4535 F ��

Nissan Patrol pick-up Mitsubishi D/C Pick-up Suzuki Jeep Nissan Cabstar Pick-up Nissan D/C P/Up Mitsubishi Canter P/Up Toyota Hilux D/C P/Up Toyota Hilux D/C P/Up Toyota Hilux D/C P/Up Toyota Hilux D/C P/Up Toyota Hiace Bus Kia Besta Ambulance Dodge Cheverolet Ambulance

VSKPG260U0592539 - SJ50-149295 MBH40-060484 URGD21-430183 FE434E-A52285 LN85-0063204 LN85-0063109 LN1060077236 LN105-0046557 LH114-0000905 KNFTPB152MS301433 IGCHD34JOFF427857 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Motorcycle GV 1936 D GV 1933 D GV 1934 D GV 3258 D GV 3399 D UE 330 A GV 3438 C GV 3951 C GV 1937 D GV1935 D GV 7134 C GV 7136 C GV 7133 C GV 7135 C GV 1760 C GV 7096 C GV 7095 C GV 7102 C ��

Suzuki 100 Suzuki 100 Honda 70 Yamaha 100 Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha Yamaha

A100-837188 A100-830052 CDYO-2127598 3HA-046849 3HA-046824 3HA-008688 3HA-046880 3GY-006771 3GY-008771 161-006084 3TT-031011 3TT-024180 3TT-029345 3TT-029213 3TT-632494 486-759089 486-771685 486-741226 18

Challenges/constraints

• Staff attrition • Lack of Adequate Maintenance (including PLANS)


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• Districts’ failure to send reports • High Vehicle: Driver Ratio • Lack of adequate capacity at Regional Mechanical Workshop (Human &

Infrastructure) • Theft of Motorcycles

Outlook for 2005

• Improving the Transport Office • Working visit to BMCs • Training for TOs and drivers • Monitoring and supervision to BMCs • Appeal to management to recruit more drivers • Capacity building at the RMW

5.4. REGIONAL MEDICAL STORES. The Upper East Regional Medical Store (RMS) is situated at Zuarungu, about five kilometres from the Bolgatanga Township. It is the Regional warehouse for the storage of all public sector health commodities; Drugs, Non-drug medical consumables, medical equipment and other logistics required for the provision of health care services in the region. The Medical Stores has a large capacity for the storage of health commodities made up of: • Four stores for the drugs section • Four stores for the non-drug medical consumables and equipment • A store for the nutrition division • A large receiving and dispatch bay. • Four offices housing; the head of the medical stores, the supply officer, an

accounts unit and a security unit. The building is fenced with a security wall and a transit accommodation unit is provided. Presently the building is in a high state of disrepair. Objectives/Targets: Against the backdrop of the achievements and challenges revealed during the review of the performance of the regional medical stores at the end of 2003 the following objectives were set for the year under review:

• To ensure timely quarterly procurement and distribution of health

commodities. • To increase tracer drug availability from 96% to 98% by the end of the year

2004. • To increase the percentage availability of essential non-drug consumables and

equipment to 80% by the end of the year 2004. • To reduce institutional indebtedness to the RMS to 5% of total sales by the

end of the year 2004. • To increase support and monitoring visits to health facilities to 24 visits by the

end of the year 2004. • To ensure the removal and appropriate disposal of all expired and

unserviceable health commodities by the end of the year 2004.


95

• To ensure complete and accurate documentation of all store records and to generate reliable information for management.

Strategies: Strategies included:

• Monthly stocktaking and updating of stock records to identify store items

close to expiry and those that require reorder. • Regular analysis of requisitions of health facilities to identify request that

could not be filled due to non-availability at the medical stores for inclusion in medical stores requirements.

• Timely execution of planned quarterly procurements as presented in the 2004 annual procurement and action plan.

• Ensure that the Regional Inspection team inspects all procured items before taking them into the stores.

• Ensure sound stock management and accounting via on-the-job training. • Conduct regular staff meetings and deliberate on issues affecting the RMS. • Monitoring and support visits to health facilities.

Activities: Some of the major activities carried out are as follows:-

1. Quarterly procurement of drugs and non-drug consumables 2. Quarterly stocktaking were carried out and data used to prepare quarterly

reports. 3. Disposal of unserviceable medical equipment and proceeds paid into the

rehabilitation accounts. 4. Paid supervisory visits to the BMCs. 5. Participated in other Regional Health Management activities. 6. Meetings were held on every Tuesday to inform staff about policy issues

arising from Regional Health Management Team meetings. Achievement and Challenges Procurement: Regional Medical Stores was able to carried out two procurements activities for the non-drugs and five activities for drug. Procurements were from the Central Medical stores and the open market as the table below shows.

Table 90: DRUGS

Value of purchase No. Source 2002 2003 2004 Percentage 1 CMS, Tema 561,808,570 28.64 2 Open Market 1,374,107,100 70.04 3 Purchases expenses (Fuel/Allowance 25,790,000 1.31 1,961,705,670 100


96

Table 91: NON-DRUGS

Value of purchase No. Source 2002 2003 2004 Percentage 1 CMS, Tema 318,983,869 280,136,000 199,527,108 27.3 2 Open Market 47,623,000 532,525,942 73 3 Purchases expenses (Fuel/Allowance 366,606,186 Nil Nil 732,053,050 100

From the procurement data provided from the above, both drugs and non-drugs recorded the higher purchases from the open market than from the Central Medial Stores. This was due to the fact that the Central Medical Stores was under going major rehabilitation and could not therefore meet the region’s requirements fully.

The projected procurement budget for non-drug was ¢813,742,832 and for drugs ¢1,969,869,423. Actual procurement for non-drugs for the year came to ¢732,053,050 forming 89% utilization. For drugs actual procurement for the year under review came to ¢1,935,951,670 also forming 98.3% utilization. This indicates our projected procurement is in line with our activities. The procurement activities during the year under review resulted in 89% for tracing drugs availability and 98% tracing drugs availability. Targets tracing availability for both non-drugs (80% and drugs 96%) have been reasonable achieved. Warehousing Despites the high state of disrepair of the Regional Medical Stores building, stores items were kept in a good state desired for used. Tally cards, stores ledger and other stores records were available regularly updated with records of daily receipt and issues. These were confirmed by the various auditors we received during the year. Regular quarterly stocktaking beside the monthly stock checks was also carried out for purposes of reconciliation and preparing of quarterly report. Distribution The Regional Medical Stores received requisition from public and private institution in the region. This were processed and filled out in accordance with the cash and carry system. To a large extend most requisition were fully filled. Non-availability certificates were however issued to institutions in the event of stock outs. Financial Management There is an accounts office, which received all cheques and keeps all basic records within the Regional Medical Stores. But the major cashbooks are under the supervision of the Regional Accountant. Financial performance and other performance target achievement over the past three-year are presented in the tables below.


97

Table 92: NON-DRUG CONSUMABLES

DESCRIPTION AS AT 31/21/02 AS AT 31/12/03 AS AT 31/12/04 Bank balance 226,582,013 468,571,896 1,199,930,236 Value of stock 851,497,788 639,375,314 1,062,790,643 Institutional indebtedness 758,575,405 884,801,522 312,955,522 Sub-total 1,836,655,206 1,992,748,462 2,515,676,402 Indebtedness to Suppliers 199,914,519 321,459,091 518,760,689 Net worth 1,636,740,687 1,671,289,641 1,996,915,712 % Tracer Non-Drug availability 79% 86% 89%

Table 93: Purchases From 2002 – 2004 (Non Drugs)

2002 2003 2004 Purchases 366,606,869 280,136,000 732,053,050 Sales 766,890,901 473,554,490 572,636,591

Payment 430,622,733 664,761,310 1,177,394,436 Cost recovery % 56% 65% 105% Expenses Nil Nil Nil Newt profit 43,062,273 66,376,131 118,000,000 Annual projected purchases 813,742,852 813,742,852 813,742,832 Utilization % 45% 49% 89%

Table 94: Financial Statement 1/1/2004 Balance 468,571,896 1/1/04 - 31/12/04 payment 1,177,394,436 Less expenditure 433,545,000 Balance 1,212,421,332 % Procurement from Central Medical Stores and other agencies is = 89%

Table 95: Expenditure Summary Non-Drug consumables 215,975,000.00 OPD/ID cards 208,470,000.00 ATF books 9,100,000.00 TOTAL 433,545,000.00


98

Table 96: Payments Summary Jan - March 324,918,825 April - June 242,540,841 July - September 299,526,945 October - December 310,407,827 TOTAL 1,177,394,438 Table 97: Summary of Institutional Indebtedness Consumables 119,632,878 OPD/ID Folders 138,728,652

ATF books 44,388,300 Yamaha parts 10,205,692 TOTAL 312,955,522

Table 98:Financial –DRUGS

DESCRIPTION AS AT 31/21/02 AS AT 31/12/03 AS AT 31/12/04 Bank balance 537,425,209.7 190,709,829.13 1897,666,144.83 Value of stock 538,424,026.00 705,106,163.80 940,061,582.65 Institutional indebtedness 337,415,884.00 126,481,701.00 34869,660.00 Sub-total 1,413,265,119.7 1,742,297,693.93 2,872,597,395.48 Indebtedness to Suppliers 239,028,866.00 334,392,456.00 922,344,242.00 Net worth 1,174,236,253.7 1,407,905,237.93 1,950,253,153.48 % Tracer Drugs availability 96.15 92.16 94.11

Growth between: 2002 – 2003 - 235,668,984.23 Growth between : 2003 – 2004 - 542,347,916.55 Challenges/Constraint Although the year 2004 has witness the number of achievement at the Regional Medical Stores, the were other difficulties en-counted as stated below 1. As stated earlier the Regional Medical Stores is in a serious state of disrepair:

� Leaking roofs � Crack wall and pillars � Routing ceiling � Poor air conditioning � Weak and shaky shelves

2. Lack of regular stock bulletin from Central Medical stores makes us enable to know what is available and at what prices at the Central Medical Stores to facilitate our procurement activities.


99

3. There is also the failure of health facilities to present their requirements in advance to enable the Regional Medical Stores meet their needs. Outlook for 2005

� To increase drug availability from 94 to 98 percentage. � To increase non-drug availability from 80 to 90 percentage � To institute schedule door-to-door delivery. � To organiser two In-service training for health commodities manager


100

CHAPTER SIX

6.0. HUMAN RESOURCE DEVELOPMENT AND MANAGEMENT 6.1. HUMAN RESOURCE MANAGEMENT Introduction: The objectives of the Human Resource Development and Management include the following:

� To recruit and select suitable job candidates � To equip employees with the competences required for current and future jobs � To help GHS to design and implement systems and strategies for utilizing

employee potential � To design and implement systems and strategies for rewarding and motivating

employees Challenges at the beginning of the Year

� Serious shortfalls of numbers of health professionals and specialists. � Mal-distribution � Difficulty in retaining products of the health training schools (4) in the region, � Refusal of postings � High attrition rate of health professionals due to “Push and Pull Factors” � Ageing health professionals

Manpower Levels The region had 1,742 staff as at 31/12/04 as against 1, 624 as at 31/12/03; this gives an increase of 1.1%. Table 99: Staff Strength by BMC BMC As at 31/12/03 31/12/04 Regional Health Directorate 100 104 Regional Hospital 320 314 Midwifery Training School 24 24 Nurses Training College 26 29 Builsa DHMT 60 80 Kassena-Nankana DHMT 102 114 Sandema Hospital 45 43 War Memorial Hospital 155 148 Health Research Centre 33 27 Bolgatanga MHD 134 171

Bawku West DHMT 48 40

Zebilla Hospital 42 54 Bongo DHMT 47 42 Bongo Hospital 30 48


101

Bawku East MHD 136 158 Bawku Hospital 280 302 Nurses Training College – Bawku 20 21 Cuban Medical Brigade 15 15 CHNTS –Navrongo 7 8 Total 1624 1742 MEDICAL OFFICERS

Table 100: Clinical Medical Officers

Hospital No. at post Catchment Pop Doc:Pop Ratio

Bolga Regional 6 239,050 1: 39,841

Bawku Hospital 5 (2 are Ophthalmologists)

321,691 1: 64,338

Zebilla Hospital 1 84,212 1: 84,212

Bongo Hospital 1 81,369 1: 81,369

Navrongo Hospital 2 156,178 1: 78,089

Sandema Hospital 1 78,747 1: 78,747

Total 16 961,246 1: 60,078

Medical Officers in Administration RHDS = 1 SMO-PH = 1 DDHS = 4 Total = 6 Total No. Medical Officers = 22 Doctor: Population Ratio : 1: 43,693 Medical Officers at Navrongo Health Research Centre = 10 Cuban Medical Brigade = 15


102

NURSES

Table 101a: DISTRIBUTION OF NURSING STAFF, UER, 2004

GRADE DHAPreby Hosp DHA

Zebilla Hosp DHA

Reg Hosp RHA DHA

Bongo Hosp DHA

Sandema Hosp DHA

War Mem Hosp

ProfessionalsDDNS 0 2 0 1 0 2 2 0 0 0 1 0 0 8PNO 1 1 1 0 4 4 5 0 1 0 0 1 6 24SNO 1 14 2 1 4 7 0 1 0 1 0 3 4 38NO 8 14 0 0 1 12 0 1 0 1 4 3 6 50SN 3 13 1 8 0 41 2 2 19 1 7 1 9 107MIDWIVES 10 20 6 5 13 30 0 10 4 10 7 21 24 160Sub-total 23 64 10 15 22 96 9 14 24 13 19 29 49 387

EN 15 37 1 2 5 22 0 0 2 3 3 6 14 110CHN 21 0 12 0 16 2 0 9 3 10 1 16 0 90Sub-total 36 37 13 2 21 24 0 9 5 13 4 22 14 200

Total 59 101 23 17 43 120 9 23 29 26 23 51 63 587

Wastage 10 21 5 3 9 12 1 1 0 8 9 14 5 98

Auxilliary

BONGO BUILSA KNDBAWKU EAST BAWKU WEST BOLGA

TOTAL

Table 101b: Professional Nurses

GRADE NUMBER DDNS 8 PNO 24 SNO 38 NO 50 SN 107 MW 160 Total 387

Table 102: Auxiliary Nurses

CATEGORY NUMBER EN 110 CHN 90 Total 200 Grand Total (Nurse) = 587 % Professional= 65.9% Nurse: Population Ratio: 1: 1,638 The total number of nurses at the close of 2003 was 662. The figure of 587 in 2004 represents a reduction of 11.3%.


103

AGE-GROUPS OF ALL NURSES, UER, AS AT DECEMBER 2004

11

92

60 60

75

180

160

70

11

0

20

40

60

80

100

120

140

160

180

200

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

AGE GROUP

NU

MB

ER

Fig 39: Age Groups of All Nurses, UER, As At December 2004 Majority of the nurse (59.1%) are in the age bracket 45 – 54 years and over 14% have reached their voluntary to compulsory retirement, 55 and 60 years respectively.

Age-groups of Clinical Nurses, UER, As At December 2004

4

5448 48 46

147143

63

9

0

20

40

60

80

100

120

140

160

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

Age

Nu

mb

er

Fig 40: Age-Groups of Clinical Nurses, UER, As At December 2004


104

Age-groups of Public/Community Nurses, UER, As At December 2004

7

38

22 22

29

33

17

7

2

0

5

10

15

20

25

30

35

40

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

Age

Num

ber

Fig 41: Age-Group of Public/Community Nurses, UER, As At December 2004 Majority the public/Community Health Nurses however fall in the age group 25 – 49 years with peaks in age groups 25 – 29 and 45-49 years. NURSES WASTAGE Leave with Pay 93 Leave Without Pay 2 Vacation of Post 1 Death 2 Total 98

Table 103: Staff Recruitment

CATEGORY AS AT 31/12/03 AS AT 31/12/04

Medical Doctors 1 0

Dispensing Technicians 1 10

Technical Officer (CDC) 1 6

Technical Officer (Information) 0 2

Community Health Nurse 16 32

Hospital Orderly 6 0

Asst. Nutrition Officer 0 1

Technical Officer (Nut.) 1 0

Technical Officer (Lab.) 1 2

Field Technician 1 0

Watchman 3 0


105

Contract Appointment 0 8

Total 31 61

Last year’s recruitment represents about 97%. This mainly came from Dispensing Technicians, Technical Officers (Disease Control) and Community Health Nurses.

Table 104: Promotions

CATEGORY AS AT 31/12/04 AS AT 31/12/04

Medical Doctors 1 1 Professional Nurses 103 88

Auxiliary Nurses 22 52 Technical Officers 6 27 Pharmacy 7 0 Others 18 12 Conversions 0 10 Total 157 190

Promotions in 2004 exceeded that of 2003 by about 21%.

Table 105: Wastage

TYPE OF WASTAGE AS AT 31/12/03 AS AT 31/12/04

Retirement 8 7 Transfer 11 17 Death 3 9 Vacation of Post 4 8 TOTAL 26 41 Staff wastage in 2004 was very high, exceeding that of 2003 by about 57.7%. Outlook for 2005.

1. Preparation of Human Resource Annual plans to determine gaps/excesses to be ready by beginning of 2nd quarter of the year

2. Financial clearance for appointments at regional level to be sought by end of 2nd quarter (i.e. 1st half)

3. Management to assist prepare Regional postings and transfers policy for implementation by August 2005

4. Prepare staff promotion list and schedule for 2005 by September 2005 5. Procure and distribute staff performance appraisal forms and conduct appraisal

for all staff (at least 60%) by June 2005 6. Upgrade skills of Managers on performance appraisals by April ending


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7. Coordinate the development of Disengagement Plan, list disengaged staff, notify them and liaise with IST Coordinator to organise a workshop for them by December 2005

8. To liaise with HRDD to have Records Management streamlined in the region by end of June 2005

9. To coordinate the development of selection criteria, select interview panel, conduct selection interview and orientate/admit staff and students into the Ghana Health Service

6.2. IN-SERVICE TRAINING Introduction: Developing human resource in the Ghana Health Service is one of the strategies of improving quality of care to patients, clients and the general populace as captured in the strategic pillars in the sectors five years program of work (POW). In addition to providing needed incentives to motivate, retain and attract qualified staff into the service, emphasis is placed on the development of skills, knowledge and attitude of health care providers through In-service training. In-service training (IST) is aimed at providing systematic continuing education which is linked up with the delivery and practice of quality care. The IST unit in the region has been established in line with the sector’s policy of developing human resource through continuing education. Its other functions include planning, organizing, implementing and evaluating IST activities in the region. Objectives for 2004 Taking into consideration the performance and challenges of the unit in 2003, the following objectives were set for 2004:

1. To increase the implementation rate of IST from 53.8% in 2003 to 60% by the end of December, 2004.

2. To strengthen TIS in districts and institutions through quarterly support visits 3. To press for the construction of the office complex of the IST unit. 4. To gradually equip the IST unit

Program Areas There are three main programme areas under IST namely, Public health, Clinical Care and Management. Some of the courses under these programme areas include the following:

1. Public Health � Reproductive Health. � Disease Surveillance/Control. � Child Health � Nutrition

2. Clinical Care � Case Management. � Nursing Care Practice.


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� Diagnostic Services. 3. Management

� Financial Management � Quality Assurance. � Resource Planning and Management. � Training Management and design

ACTIVITIES Regional level

Public Health: Structured IST:-

� Integrated SRH Counseling � Integrated Management of Childhood Illnesses (IMCI) � Norplant insertion and removal � Prevention of mother to child transmission of HIV and voluntary

counseling and testing � Therapeutic Dietary Management � Child Health (ACSD) � Disease Control/Surveillance

Public Health: Remedial

� Integrated Disease Surveillance and Response (IDSR) (3 training) � Intermittent preventive treatment (4 trainings) � Enhanced disease surveillance � DOTS (3 trainings) � Lymphatic Filariasis Control � Refresher on Norplant insertion and Removal � STD syndromic management � Malaria Case Management (5 trainings)

Clinical Care : Structured

� Safe Motherhood clinical � Identification and management of acute Psychiatric patients in the community

Clinical: Remedial

� Infection Prevention � Pre and post operative management � Ward management � Malaria case management (4 trainings)

Management: Structured

� Financial management for non accounting staff � Training Management and Design for IST Coordinators � Facilitative supervision

Management: Remedial:-

� Environmental sanitation and building maintenance � General Administrative practices � Administrative practices and procedures


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Table 106: Implementation of IST Carried Out at the RHD

Type of IST Program Area Structured Remedial

Total

Public Health 7 18 25 Clinical 2 6 8 Management 3 5 8 Total 12 29 41

From the table above, a total of 25 IST courses were carried out in the Public Health, 8 in Clinical, and 8 in Management areas, showing a skew towards Public Health. District Level

Public Health :Structured:-

� CHO Technical Trainings, total = 4

Public Health: Remedial � ACSD (2 trainings) � IDSR, Cold Chain Management, Epidemic Preparedness (2) � IPT � Maternal and Neonatal Tetanus (MNT) � Lactation Management and Behaviour change communication � TOT for community-based surveillances trainers � TB Management and Control � Anaemia Control in Pregnancy

Clinical Care: Structured � Quality Assurance ( 2 trainings)

Clinical: Remedial

� Home-based management of malaria � Guidelines for the Clinical use Blood and Blood products � Infection Prevention � Ward Management

Management: Structured

� Teaching Methodology Management: Remedial

� Client employee relationship � Staff performance appraisal


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Table 107: Implementation rate of IST at Regional and District levels in 2004

Type of Training Regional Districts Total Structured 12 7 19 Remedial 29 26 55 Total 41 33 74 Total IST Planned 45 74 119 Implementation Rate 91.1% 41.9% 62.18 For the year 2004, a total of 119 In-Service trainings were planned throughout the region. Out of this number, 74 were executed giving an implementation rate of 62.2%. Of the 74 In-Service trainings (I.S.T) 12 Sructured and 29 Remedial trainings were caaried out by the Regional Health Directorate. The rest of the trainings were carried out at the District Health Administrations and Hospitals.The region has thus archieved its target of 60% implementation rate for 2004. Table below shows the number of trainings planned and number carried out by various BMCs

Table 108: Planned/Executed IST Programs by BMCs

No. BMC No. Planned No. Executed % 1 Reg. Health Directorate 37 35 94.6 2 Regional Hospital 8 6 75.0

3 Municipal Health Directorate - Bolga 0 2 0.0

4 War Memorial Hospital 5 1 20.0 5 KND 17 6 35.3 6 Builsa DHA 5 3 60 7 Sandema Hospital 4 4 100.0 8 Bawku West District 14 3 21.4 9 Zebilla Hosital 5 3 60%

10 Municipal Health Directorate - Bawku East 9 2 11.1

11 Bawku Hospital 4 5 125.0 12 Bongo 11 4 36.4

119 74 62.2 From the table above, Bawku Hospital recorded the highest IST implementation rate of 125%. Sandema Hospital also recorded 100% while the Regional Health Directorate recorded 94.6%, Regional Hospital recorded 75%, Zebilla Hospital 60%. The rest of the BMCs ranged between zero and 36%.


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TREND OF IST IMPLEMTNATION RATE

0

20

40

60

80

2002 2003 2004

YEAR

PE

RC

EN

TAG

E

Fig 42: Trend of IST Implementation Rate There has been a gradual increase in the Trend of Implementation of IST rate in the Region from 33.3% in 2002 to 62.2% in 2004. This is as a result of the regular monitoring and supervisory activities of the unit to all districts/institutions

Table 109: Categories of Staff Receiving SIST in 2004

Category No. % Operational definition of category

Clinical 180 35.0% All Doctors, Nurses, MAs, M/wives providing Clinical Services

Managers 45 65.22% Sub-dist. Heads DDHs etc+

PH Personnel 103 44.40% All Public & CHNs, DCOs, Nut Officers etc.

328 40.25%

328 health staff received Structured In-Service Training (SIST). 103 (44.40%) Public Health personnel, 45 (65.2%) Managers and 180 (35.0%) Clinical staff as shown in the above table. These are the most important indicators of IST in the health sector in line with the IST policy.


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35

65

40

010203040506070

Per

cent

age

Staff

Categories of Staff Receiving SIST in 2004

Clinical Managers PH Personnel

Fig 43: Category of Staffs Receiving SIST In 2004

Table 110: Cost of In-Service Training Type of Training No. Total Cost % Structured 19 540,969,500 46.9 Remedial 55 612,809,500 53.3 Total Cost 74 1,153,500,000 100 The total cost of I.S.T.in 2004 was ¢1,153,500,000. Of this figure ¢540,969,500 (46.9%) was spent on SIST, and ¢612,809,500 (53.3%) on remedials as shown above. The cost of IST is higher in Remedials because of the high number of remedial trainings done.

Table 111: Trend of cost of IST

Type of Training 2002 2003 2004 Structured 564,523,250 801,692,550 540,969,500 Remedial 293,847,600 158,909,200 612,809,500 Total 858,370,850 960,601,750 1,153,500,000 The cost of IST rose from Nine hundred-sixty million, six hundred and three thousand, seven hundred and fifty-three (¢960,601,750) cedis in 2003 to One billion, twenty-six million, seven hundred thousand (¢1,077,893,000) cedis with an increase of about Sixty-six million, ninety-six thousand, two hundred and forty-seven (¢117,291,250) cedis in 2004.


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5 6 4 ,5 2 3 ,2 5 0

8 0 1 ,6 9 2 ,5 5 0

4 8 2 ,8 0 1 ,5 0 0

2 9 3 ,8 4 7 ,6 0 0

1 5 8 ,9 0 9 ,2 0 0

5 4 3 ,8 9 6 ,5 0 0

0

1 0 0 ,0 0 0 ,0 0 0

2 0 0 ,0 0 0 ,0 0 0

3 0 0 ,0 0 0 ,0 0 0

4 0 0 ,0 0 0 ,0 0 0

5 0 0 ,0 0 0 ,0 0 0

6 0 0 ,0 0 0 ,0 0 0

7 0 0 ,0 0 0 ,0 0 0

8 0 0 ,0 0 0 ,0 0 0

9 0 0 ,0 0 0 ,0 0 0

S tr u c tu r e d R e m e d i a l

2 0 0 2 2 0 0 3 2 0 0 4

Fig 44: Type and Cost of Trainings Other Activities Training Plans/Activities of the Unit At the beginning of the year, the Unit drew training plans and activities in line with the regional plans. 45 training activities were planned and 37 (94.6%) of these were executed. The unit also planned and coordinated a number of regional meetings and conferences throughout the year (2004) Training of Co-ordinators / Focal Persons All the Training Co-ordinators and Focal Persons were trained in Training Management and Design. This programme was organised by Regional Health Directorate – Training Unit. The objectives were:

� To review current training and management problems � Develop a framework for determining institutional training priorities � To identify district priorities and mobilise resources for smooth

implementation and evaluation of IST


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Regional Monitoring Regional Training Unit organised a number of monitoring visits to Districts and Hospital to interact with Co-ordinators and Focal Persons and their BMC heads with the objectives of;

� Building consensus on the number of trainings to be funded for 2005 � To update information on logbooks � To support Co-ordinators / focal persons draw their 2005 training plans

Visits The Unit received visitors from the following: EngenderHealth The programme Manager Mrs. Vic. Nighpence was in the region to support the unit in carrying out Sexual and Reproductive Health and Family Planning Counselling training and plan for the refresher in Norplant insertion and removal.

Team of evaluators from EngenderHealth, were in the region to evaluate the programs and activities of EngenderHealth since its inception in the 90s. The region is yet to receive the report.

JICA-HIST

JICA-HIST in conjunction with Human Resource Development Division of Ghana Health Service paid a visit to the Region/Unit update the software on the Human resource of TIS version 3.1.

Challenges

� Delays in submission of TIS Form III from Districts/Institution to the region � The commitment of funds for IST is still a problem for some BMC heads � Uncommitted IST Co-ordinators/Focal persons in Institutions/Districts � Poor recognition of the roles and responsibility of IST Co-ordinators in the

Institutions / Districts. � Congestion of Library located in the conference hall, making it not user

friendly. �

Priorities For 2005 • Continue to negotiate for the construction of the In service Training centre • Strive to increase IST implementation rate from 55.3% in 2004 to 60% in 2005 • Improve upon the submission of IST forms III from districts/Institutions • Improve and strengthen collaboration, coordination and support for the

implementation of IST activities with BMC Managers/program heads • Press for the recognition of IST Co-ordinators at the District and Institutional level • Improve upon monitoring/supervision of IST programs/activities • Strive to make the Library user friendly.


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CHAPTER SEVEN 7: 1. COLLABORATION Strengthening partnership and collaboration with Ministries, Departments and Agencies (MDAs), Regional Coordinating Councils, District Assemblies, Non-Governmental Organisations (NGOs), Civil Society Organisations (CSOs) and most importantly households and communities is one of the seven strategic objectives of the Second Five Year Programme of Work (POW II). Effective collaboration will improve service utilisation and ownership thereby ensuring sustainability. Areas of collaboration during the year included:

� Immunisation exercises (NIDs, routine and epidemic containment immunisations

� Capacity building � Radio/TV Broadcasting � Launching Special Programmes and Campaigns � Health service infrastructure (construction CHCs, health facilities)

Table 112: List of some Collaborators/partners

COLLABORATORS AREA OF COLLABORATION UNICEF Accelerated Child Survival and Development Programme UNFPA 1. Training in Safe Motherhood Clinical Skills for midwives

2. Training Maternal Death Audit 3. Zonal Meetings 4. Training of Males as Partners in RCH

WFP Supplementary Feeding Programme, Nutrition Rehab. Centres WHO 1. Surveillance and Disease Control

2. Teaching and learning materials for training institutions. 3. Construction of Incinerators 4. Cross border meetings

DANIDA 1. Fellowships for MIH programme in Copenhagen 2. Training in Hospital maintenance programme 3. Mutual Health Insurance Schemes

EngenderHealth 1. Training in COPE 2. Infection prevention 3. Norplant Insertion/removal 4. Mini-Lap

GRCS Child Survival programmes, Epidemics containment, Disasters NADMO Epidemics/Disaster management KNUST-Dept PH ACSD project PHR-Plus Roll out training in IDSR Global 200 Guinea worm eradication Basic Needs Mental Health: Capacity building MOFA Control of Schistosomiasis at dam sites GES School Health programme including control of intestinal worms in

school children


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CWSA Hand Washing Campaign RCC Construction of CHCs, NIDs, DRI, NHIS, Staff Accommodation DISTRICT ASSEMBLIES

Construction of CHCs, NIDs, DRI, NHIS

RHI Training of CBAs, and RCH activities WORLD VISION Capacity building and supply of medical equipment in Bongo

District CRS FACS project in Bongo and Bawku West Districts JICA MIS, IST JAPAN EMBASSY Funds for rehabilitation of infrastructure, procurement of medical

equipment LINKAGES Training in child feeding practices GBC and Private FM Sations

Broadcast of Health Messages

Outlook for 2005.

1. Training in effective collaboration for DHMTs and Local Government officials.

2. Effective use of Style Radio (Second FM station in Bolgatanga). 3. More involvement of DHMTs in the use of radio. 4. Revision of guidelines on the organisation of health durbars in the region. 5. Quarterly review of health promotion activities in the districts with District

officers.


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CHAPTER EIGHT

8.0. HEALTH TRAINING INSTITUTIONS There are four (4) Health Training Institutions. These are Bolgatanga Nurses Training College located in Bolgatanga, the regional capital, Bawku Presbyterian Nurses Training College (in Bawku), Bolgatanga Midwifery Training School and Navrongo Day Community Health Nurses Training School, located in Navrongo and the youngest of the four. 8.1. BOLGATANGA NURSES TRAINING COLLEGE Introduction:

• Oldest Health Training Institution in the Region. • Trained QRN in the 50s and 60s • Trained Enrolled Nurses in the 70s • Started the training of SRN in 1990 • Moved to new location in 1999 • Been training for Registered General Nursing Diploma ever since • Therefore contributing in the effort to provide qualified nursing staff to other

BMCs to assist in making quality nursing care available to all people living in Ghana.

Institutional Vision: College of academic and professional excellence in Basic Nursing and education. Mission: Training of Polyvalent General Nurses with Knowledge and Competencies to meet the Health/nursing needs of Ghanaians. Human Resource Tutors Tutors = 8 Tutor/Student ratio 1:24 Study Leave = 4 Part time = 5 Administrative Staff = 3 Accounting =1 Kitchen Cooks/Kitchen Staff 8


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Utility Night watchmen: =2 Labourers/day watchmen = 3 TOTAL (27) Casuals = 10 Student Population: (Male/Female F/M) 1st year students (D.7) - 28/32 (60) 2nd year students(D.6) -14/32 (46) 3rd year students (D.5) - 8/23 (31) Finalist ( D4) 7/23 (30) Referrals - (24) TOTAL 192 Tutor: Student Ratio - 1:24 Facilities Library - 1 Classrooms - 6 Demonstration room - 1 Hostels - 2 Dinning Hall - 1 Offices - 3

Vehicles: Motorcycles - 2 33-seater bus - 1 Pick-up (double cabin)- 1 Finances

Table 113: Financial Statement

ITEM

Balance Interest Amount Expenditure Balance

ADMIN - - 64,354,362.00 43,306,238.00 21,048,124 SERVICE (GOG 3)

23,489,680.07 123,084.86

98,543,764.93 88,197,738.00 10,345,936.93

DPF 33,188,640.55 945,013.34

608,975,152.34 337,125,832.59 271,848,319.75

IGF 33,753,483.79 - 71,648,883.79 110,778,173.69 60,870,710.10 Achievements

• Relatively peaceful atmosphere for academic work • Engagement of more part-time staff • Meeting held with clinicians and plans evolved for training of Preceptors for

clinical supervision • Staff meetings more regular


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• College Vision and Mission statement developed • Successfully met some accreditation criteria however some areas require

beefing up. • Received a number of visitors:

• RHA team on dissemination workshop on • Administrative procedures/code of ethics (GHS) • Accreditation team (5members of NAB)

Constraints Shortfalls - Anatomy Laboratory Computer Laboratory Library (expansion) Planned staff upgrading programme College security Recreational facilities Student housing 8.2: PRESBYTERIAN NURSES TRAINING COLLEGE, BAWKU Introduction: Established in 1956 under the management of the Basel Mission now known as the Presbyterian Church of Ghana for the training of:

� Qualified Registered Nurses:1956-1968 � Enrolled General Nurses:1969-1983 � State Registered Nurses:1988-2001 � Registered General Nursing(Diploma):1999-

Mission Statement: “Heal the sick” and say to them “the Kingdom of God has come near to you” (Luke 10: 9) Objectives for 2004

1. To increase access to training. 2. To improve quality of training. 3. To improve efficiency. 4. To foster intersectorial collaboration 5. To mobilize financial resources

Targets for 2004

� Index 46 students recruited in Oct 2003 � Improve & stabilize financial position � Acquire new teaching/learning materials � Obtain financial clearance for payment of trainee allowance to 46 students

recruited in Oct.2003 � Get college accredited by the NAB � Carry out planned preventive maintenance of estate, equipment, transport &

grounds. � To promote co-curricular activities � To get 81 students pass the End of Semester Exam. � To acquire a new 33 seater bus and 2 motorcycles


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� To renovate Hostel block � To construct additional infrastructure � To perform recruitment drive for 2004 admission

Human Resource Permanent Tutors - 5 Part-time Lecturers -10 Supporting Staff. -16 Student Population: Ref candidates - 14 D 4 =12 D 5 = 22 D 6 = 45 D 7 = 50 TOTAL =143 MALES -91 FEMALES -52 Ratio of tutors to students 1:29 Exam. Results For First & Second Semesters. D4 (12) - 1st Semester: CGPA – Highest - 3.7 Lowest - 3.0 -2nd Semester: CGPA – Highest - 3.7 Lowest - 3.0 D5 (23) - 1st Semester: CGPA – Highest - 4.0 Lowest - 2.9 - 2nd Semester: CGPA – Highest - Not yet ready Lowest - Not yet ready D6 (46) - 1st Semester:- CGPA – Highest - 4.0 Lowest - 2.0 - 2nd Semester: CGPA – Highest - Not yet ready Lowest - Not yet ready

Table 114: Student Recruitment and Performance (Licensure Exams)

Year 2002 2003 2004 No. Students 22 45 50 Achievements (passes

Feb- 3 (25%) Oct – 17 (68%)

8 (36.4%) 24 (Awaiting results)

Achievements

� All staff collaborated and carried out activities that were planned for the period under review

� 8 staff participated in various meetings/workshops organized by MOH, GHS, CHAG, PCG, Bawku Hospital


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� Staff were paid ADHA by MOH/GHS � Part-time lecturers were paid their allowances � 5 tutors paid Rural Incentive Allowance � Staff were provided with free medical care. � Students were fed with 3 meals a day � Preventive Maintenance was carried out on equipment, transport,

infrastructure and grounds. � 4 fire extinguishers were procured to protect assets � 1 tutor for Diploma in Health Sciences Education at UCC � 1 tutor for sandwich course in Post-Diploma Degree in Education � 1 tutor for sandwich course in Masters Degree in Educational Administration. � Two tutors appraised and promoted

o DDNS - 1 o PNO - 1

� College organized an Orientation Workshop for 2 new staff. � College was assessed by NAB for accreditation as a Diploma Awarding

Institution � 45 1st year students recruited in Oct 2003 have been mechanized and are

being paid trainee allowances monthly by C & A. G. � 1 workshop on financial management was organized for non-accounting staff. � College received the following donations:

o MOH – Jialing Motorbike - 1 o HRHD, MOH – Fax Machine - 1 o College chaplaincy – 21”colour T.V - 1 o PCG, Accra – Milk powder - 5 cartons o Former Hon. M.P. for Bawku Central - 1 21” Colour T.V.

Projects Construction of additional classrooms and hostels began in earnest. Constraints

� Inadequate number of tutors to match increased number of students � Inadequate accommodation for students � 1 tutor vacated his post under the pretext of following up on his marital

problem. � 1 tutor lost the wife after a short illness � 1 student in 2nd year (D5) withdrew from the course on grounds of mental ill

health � 1 student in 1st year (D6) absconded. � Delay in the release of funds for Service and Administration from Accra � Due to financial constraints the College administration could not

� Pay salaries of new staff on schedule. � Meet the demands from part-time lecturers for increase in allowances

per hour � Acquire computers and get college hooked on to the internet � Renovate the Hostel storey block. � Acquire a new bus.


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Outlook for 2005 � Accreditation of College by NAB � Establishment of Board of Governors for College � Identify and train preceptors in the clinical area � Acquisition of textbooks of current editions. � Acquisition of modern teaching/learning materials � Recruitment and retention of additional staff: Tutors - 5 Senior Resident Keeper - 1 Accounts Officer - 1 Night watchman - 1 Pantry maid - 2 Labourers - 2 � Construction of additional infrastructure:

Hostel (100 capacity), Classrooms (4 unit) Demonstration room (1), staff bungalows (4), Underground water tank (1), computer laboratory (1), staff common room (1) students common room (1), Tutors offices (2), KVIP(1).

� Obtain Financial Clearance to pay staff salaries & trainee allowances � Renovation of Hostel Storey block � Acquisition of new 60 seater bus (1) � Acquisition of computers (60) � Hooking College on to the internet � Acquire new equipment and furniture

8.3: MIDWIFERY TRAINING SCHOOL, BOLGATANGA The school was built in 1960 and straight Midwifery programme started in 1964. Then came the era of comprehensive Midwifery; this phased out in 2002. Currently, the school runs a four-semester 2-year programme, to train Enrolled and Community Health Nurses as Midwives

Objective

To train qualified and competent midwives for the three Northern regions in particular and the country as a whole in general.

Human Resource Tutorial Board

� Four (3 were pursuing B.Ed Sandwich Programme at UCC till August 2004. � Part time tutors - five (5)

Support Staff Auxiliary Staff Snr. House keeper - 1 House Keepers -2 Cooks -2 Staff Cook -1 Seamstress -1 Hostel Orderlies -3


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Utility staff Head Orderly -1 Labourer -1 Watchmen -2 Administrative Staff Driver GII -1 Typist GI -1 Typist GII -1 Store Keeper -1 Accountant -1

Table 115: Population of Students:

YEAR TOTAL NUMBER NO. OF EN’S NO. OF CHN’S 1st Year 32 students 3 29 2nd Year 27 students 6 21 Finalists 56 students 18 38 Resits 14 Students 2 12 TOTAL 129 29 100

Table 116: Below is the performance of students between 1999 – 2004.

YEAR MONTH CANDIDATES PRESENTED

NO.OF PASSES

NO. OF REFERRALS

PERCENTAGE PASS

May 29 8 21 27.6 1999 November 31 6 25 19.3 May 37 25 12 67.5 2000 November 36 14 22 38.8 May 35 10 25 28.5 2001 November 36 22 14 61 May 29 22 7 75.8 2002 October 43 18 25 42

2003 December 75 61 14 80 2004 Achievements

� Results of Final examination – 80% passed � Procured kitchenware for school kitchen. � Minor repairs done in school e.g. electrical, fittings etc. � Books from JHPIEGO. � Installed communication facilities.

Constraints

� The cost of charcoal too is very high and even makes the kitchen unsightly, therefore we need gas installation.

� Over crowding of tutors in one office. � Lack of demonstration room.


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� Lack of common room for students. � The miniature-dining hall is turned into a classroom but because of its

closeness to the kitchen there is always noise and destruction. � Lack of library and library facilities. � Lack of Preceptors. � Lack of TLM e.g. Overhead projector, LCD, Easel, Public address system, TV

and deck, photocopier and Educational cassettes. Outlook for 2005

• To continue negotiation for rehabilitation and expansion of existing structures, tutors quarters and accommodation for tutors.

• Procure immediate needs – Photocopier, 33-seater bus, LCD, Slide Projector, Fridges and Freezer, Computers, Teaching and learning materials.

• Get well-equipped library/library Assistant. • Computer literacy for staff and tutors

8.4 NAVRONGO COMMUNITY HEALTH NURSING TRAINING SCHOOL. The school was established in 2002 in response to the following:

� High attrition rate of health professional in the region. � Inadequate number of Community Health Nurses posted to the Region couple

with refusal of postings by Health Personnel to the region. � Need for more Community Health Nurses for the Community-Based Health

Planning and Services (CHPS) programme being advocated in the country. The school is currently housed in a temporary structure with the following facilities.

� Two(2) classrooms � One(1) office for the Principal � One(1) office for Tutors � One(1) store room � One(1) demonstration room � A small Library

At the beginning of the year-2004, the major problems include; � Lack of accommodation for both office and residential � Inadequate means of transport � Lack of office equipment � Inadequate staff � Inadequate learning and teaching material

Human Resource

� Tutors-5 and 1 on study leave � Driver -1 � Orderly-1 � Night watchman-1 ( from DHMT) � Accountant-1 ( from DHMT)


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Admissions The student population stands at one hundred (100) made of 32 males and 68 females. The pioneers of the students numbering 45 wrote their final examinations last November. The third batch of students , 61 in all were admitted in October 2004. The number of students admitted is sixty-one (61). This year’s admission is the highest since the school was established. Practically all students are being supported by District and Municipal Assemblies inn the region. Academic Activities All Tutors did well to finish their syllabus on schedule. Mid-semester and end of semester exams were conducted. Results were published. All the second batch of students passed and are in their second year of the programme. The Pioneers all passed except one student whose CGPA was below average. The said student was advised to repeat and was therefore not registered for the Licensure examination. Transport The school has the following:

� 8 Motorbikes � One Minibus

Achievements The school chalked the following successes:

� Increased tutorial staff by two (2) � Able to house 4 out of the 6 tutors � Organised an In-Service Training for Tutors on teaching methods- A

Consultant from Univ. of Education- Winneba was the main Facilitator. � On-going Construction of Hostel facilities for students � Prepared Pioneers to write their licensure exams in Nov.2004 � Procured Furniture for the Library, Tutors offices etc. � Replaced black boards with White boards in the classrooms. � Successfully recruited the third batch of students who have since started the

course and the number far exceeded the previous batch. � Procured some teaching and learning materials such as Overhead projector. Challenges � Inadequate library space and books � Inadequate computers for teaching purposes � Lack of a bigger bus for field trips � Lack of a pick-up for administrative work � Lack of teaching and learning materials such as LCD PROJECTOR � Lack of support staff of all categories � Rental premises for students accommodation and its attendant problems. Collaborators The school got the following support from the DANIDA � 2 AG Motor bikes � 1 Photocopier � 6 Computers and accessories


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� 2 Printers � 1 TV and Video Deck � Full Dummy

Table 117: FINANCES-DPF

Dpf 1st Qter ¢16,891,000 Dpf 2nd Qter ¢128,610,000 Dpf 3rd Qter ¢128,610,000 Dpf 4th Qter ¢100,612,000 Supplementary ¢ 66,450,000 Supplementary ¢ 50,100,000 Total ¢491,273,000

Table 118: GoG Admin

1st Quarter ¢18,352,144 2nd Quarter ¢13,488,140 3rd Quarter ¢13, 488,140 4th Quarter ¢4,738,936 Total ¢50,069,360

Table 119: GoG Service

1st Quarter 30,422,000 2nd Quarter 20,903,000 3rd Quarter 25,000,000 4th Quarter 25,000,000 Total 101,325,000 Total receipts for the year was ¢642,665,360 Outlook for 2005

� Hope to attain a boarding status by middle of this year. � Provision of quality tuition through out the year � Attachment of final year group to CHOs � Training of final year group (Group 2) on motor-bike riding � Supervision of students on practical attachment � Recruitment of fourth batch of students � Educational trips to relevant areas. � Indexing and registration of first and final year students respectively.


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CHAPTER NINE 9.0. FINANCIAL MANAGEMENT 9.1. FINANCE Responsibilities of finance unit:

• Management of financial transactions of all BMCs at the RHD • Supports and supervises all BMCs in the region. • Collates the financial returns from these BMCs for the Regional financial

reports to Headquarters (REPAC/PROAC). • All funds inflows are received by this division on behalf of the region and

subsequently disbursed and accounted for. The main Sources of funds for RHD are - DPF, GOG, IGF and Programme/Projects and Donations. Vision Setting the Pace in Public Sector Financial Management in the Ghana Mission Statement To strengthen the existing FM systems, improve upon the Financial Reporting and build a dependable management accounting system to facilitate management decisions at all levels using technology Challenges at the beginning of the year

• Late, incomplete and inaccurate Financial Reports/Returns from BMCs • Shortage of Finance Staff. • BMC heads are not performing their supervisory roles as required by the ATF • Delays – Funds disbursement and Liquidation.

• Responses to Audit Reports Cash flow Analysis • On the whole, Cash inflows was higher than expected, for example, ¢40.39

Billion was realised in year 2002, ¢50.18 Billion in 2003 and ¢65.23 Billion in 2004, these translated in percentages are an increase of 24.2% in 2003 over 2002 and an increase of 30.0% in 2004 over 2003.

• Specific areas of high inflows were:

o IGF – ¢8.08 billion for 2004 as against ¢5.50 billion for 2003 (46.9% increase)

o MDBS(DPF) - ¢13.51 billion in 2004 as against ¢5.24 billion in 2003 (an increase of 157.5%)

Out of Approved funding for new projects (HQ level) of ¢3.30 billion, ¢2.15 billion was paid to Contractors


127

Expenditure Analysis Out of total inflows of ¢65.23 billion, ¢61.37 billion was expended in the areas of:

� Salaries and wages � Administration Expenses � Service Expenses � Drugs and Non Drug Consumables � Free Medical Services etc.


128

Table 119: Cash Flow Statements- 2004 Performance Review - Finance Unit. Cash inflows and outflows

Table :- Cash inflows by SOF

2003 2004

SOF Budget Receipt Variance % Receipt Budget Receipt Variance % Receipt

Per/Emolums 12,445,437,204 11,314,033,822 1,131,403,382 90.9 11,717,469,519 11,309,073,144 408,396,375 96.5

GoG. 2 1,579,952,852 1,310,778,249 269,174,603 83.0 1,957,051,947 1,901,420,295 55,631,652 97.2

GoG.3 2,893,216,114 1,965,380,026 927,836,088 67.9 2,717,300,249 2,409,294,000 308,006,249 88.7

GPRS/Deprivation 0 4,808,800,379 -

4,808,800,379 0 2,152,465,600 -2,152,465,600

Invest.from HQ 0 0 0 12,194,849,201 13,505,697,000 -1,310,847,799 110.7

Health Fund 9,670,791,612 5,238,560,409 4,432,231,203 54.2 3,300,000,000 2,154,761,799 1,145,238,201 65.3

IGF(Facilities) 5,402,464,602 5,456,424,160 -53,959,558 101.0 8,083,641,129 8,083,641,129 0 100.0

RMS(Drugs) 2,335,840,520 2,335,840,520 0 100.0 2,273,703,103 2,273,703,103 0 100.0

RMS(Consum) 502,336,364 502,336,364 0 100.0 1,355,905,236 1,355,905,236 0 100.0

IGF(Micsll) 0 0 0 474,409,090 474,409,090 0 100.0

GHS Progs 3,051,591,198 3,051,591,198 0 100.0 4,546,721,866 4,546,721,866 0 100.0

Exemptions 2,238,128,030 2,238,128,030 0 100.0 1,648,509,208 1,648,509,208 0 100.0

ADHA 13,072,155,600 13,072,155,600 0 100.0 13,413,929,570 13,413,,929,570 0 100.0

Total 53,191,914,096 51,294,028,757 1,897,885,339 96.4 63,683,490,118 53,157,001,040 10,526,489,078 83.5


129

Table 120.: Cash outflows by SOF

2003 2004

SOF RECEIPT EXPENDITURE Variance %

Expenditure RECEIPT EXPENDITURE Variance %

Expenditure

Personnel Emolum. 11,314,033,822 11,314,033,822 0 100 11,309,073,144 11,309,073,144 0 100

GOG Admin Exp 1,310,778,249 1,310,778,249 0 100 1,901,420,295 1,900,210,000 1,210,295 99.9

GOG Serv. Exp 1,965,380,026 1,965,380,026 0 100 2,409,294,000 3,169,760,446 -760,466,446 131.6

GPRS/Deprivatin 4,808,800,379 1,242,242,214 3,566,558,165 25.8 2,152,465,600 3,976,175,152 -1,823,709,552 184.7

Health Fund (MDBS) 5,238,560,409 6,302,697,349 -

1,064,136,940 120.3 13,505,697,000 12,535,567,524 970,129,476 92.8

Invest. From HQ 0 0 0 2,154,761,799 2,091,171,799 0 97.0

IGF (Facilities) 5,456,424,160 4,181,873,250 1,274,550,910 76.6 8,083,641,129 5,554,366,996 2,529,274,133 68.7

RMS (Drugs) 2,335,840,520 1,752,679,230 583,161,290 75.0 2,273,703,103 2,257,763,281 15,939,822 99.3

RMS (Consumables) 502,336,364 164,990,000 337,346,364 32.8 1,355,905,236 219,350,000 1,136,555,236 16.2

IGF(Miscll) 0 0 0.0 474,409,090 56,753,778 417,655,312 12.0

GHS Programs 3,051,591,198 2,501,123,563 550,467,635 82.0 4,360,485,386 3,204,278,239 1,156,207,147 73.5

Exemptions 2,238,128,030 2,238,128,030 0 100 1,648,509,208 1,683,265,880 -34,756,672 102.1

ADHA 13,072,155,600 13,072,155,600 0 100 13,413,929,570 13,413,929,570 0 100

Total 51,294,028,757 46,046,081,333 5,247,947,424 89.8 65,043,294,560 61,371,665,809 3,671,628,751 94.35510028

Table 121: Consolidated Statement of Revenue and Expenditure by BMC group for the year ending 31 December, 2004

SOF Bku-East MHD Bku-West DHD Bolga MHD Bongo DHD Builsa DHD KN/DHD Total

Inflows

Personnel Emolument 281,506,654 228,923,884 254,198,476 219,772,739 242,868,486 225,292,477 1,452,562,716

GOG Admin 59,803,000 70,064,000 69,583,000 67,999,000 81,789,000 75,834,000 425,072,000

GOG Service 110,449,000 89,782,000 86,708,000 85,076,000 95,288,000 88,350,000 555,653,000

Health (MDBS) 771,287,818 361,833,000 401,835,000 606,370,446 384,024,000 356,063,000 2,881,413,264


130

GHS Programs 2,926,172,858 1,053,751,833 2,269,922,775 1,449,523,979 1,081,378,109 1,821,327,206 10,602,076,760

Total Inflows 4,149,219,330 1,804,354,717 3,082,247,251 2,428,742,164 1,885,347,595 2,566,866,683 15,916,777,740

Outflows

Item 1 Pers. Emolument 869,802,052 0 2,048,131,849 1,395,740,809 1,007,839,215 1,539,244,494 6,860,758,419

Item 2 Admin Expenses 1,035,944,691 418,016,923 538,794,804 679,994,649 542,652,949 585,394,417 3,800,798,433 Item 3 Service Expenses 191,636,425 263,599,994 615,006,567 109,197,716 234,865,487 190,046,551 1,604,352,740

Programs Expenses 2,838,750,577 962,907,356 2,206,838,428 1,422,386,952 1,023,192,125 1,689,942,230 10,144,017,668

Total Outflows 4,936,133,745 1644524273 5,408,771,648 3,607,320,126 2,808,549,776 4,004,627,692 22,409,927,260

Excess/Deficit -786,914,415 159,830,444 -2,326,524,397 -1,178,577,962 -923,202,181 -1,437,761,009 -6,493,149,520

% Excess/Dificit -19.0 8.9 -75.5 -48.5 -49.0 -56.0 -40.8

Consolidated Statement of Revenue and Expenditure by BMC group for the year ending 31 December, 2004

SOF Bku-East SD Bku-West SD Bolga SD Bongo SD Builsa SD K/N SD Total

Inflows

IGF Service 0 0 86,435,180 90,040,650 43,250,492 101,795,000 321,521,322

IGF Drugs 0 0 166,897,044 79,152,881 78,284,303 219,863,400 544,197,628

Int. on Invest 0 0 0 0 0 88,480 88,480

Personnel Emolument 773,835,835 629,290,648 698,768,168 604,134,994 667,623,073 619,308,245 3,992,960,963

GOG Admin 116,326,000 60,454,000 97,035,000 56,665,000 65,493,000 77,323,000 473,296,000

GOG Service 135,524,000 70,432,000 113,049,000 66,017,000 76,302,000 90,084,000 551,408,000

Health (MDBS) 546,179,000 283,847,000 455,604,000 266,059,000 307,506,000 363,052,000 2,222,247,000

Total Inflows 1,571,864,835 1,044,023,648 1,617,788,392 1,162,069,525 1,238,458,868 1,471,514,125 8,105,719,393

Outflows

Item 1 Pers. Emol 0 0 2,180,000 16,500,000 0 0 18,680,000

Item 2 Admin Exp 116,670,561 59,049,625 109,116,137 63,412,849 73,809,260 98,886,255 520,944,687

Item 3 Service Exp 107,247,933 38,857,322 121,047,939 56,859,731 60,495,987 99,721,441 484,230,353

IGF Drugs 0 0 68,293,540 53,714,153 16,193,899 190,784,470 328,986,062

Total Outflows 223,918,494 97,906,947 300,637,616 190,486,733 150,499,146 389,392,166 1,352,841,102


131

Excess/Deficit 1,347,946,341 946,116,701 1,317,150,776 971,582,792 1,087,959,722 1,082,121,959 6,752,878,291

% Excess/Deficit 85.8 90.6 81.4 83.6 87.8 73.5 83.3


SOF Reg. Hospital Bawku

Hospital Zebilla Hospital Bongo Hospital Sandema Hospital War Memorial, Nav. Total

Inflows

IGF Service 1,866,162,145 0 223,204,500 157,149,900 268,063,350 625,276,016 3,139,855,911

IGF Drugs 850,995,700 0 197,399,600 111,410,800 302,728,580 335,465,882 1,798,000,562

Int. on Invest 0 0 299,485 0 0 0 299,485

Personnel Emol 3,853,982,234 0 119,608,111 114,826,822 126,893,884 117,710,774 4,333,021,825

GOG Admin 233,548,000 0 69,912,000 78,928,000 87,106,000 82,336,000 551,830,000

GOG Service 272,092,000 0 168,828,000 142,051,000 165,560,000 240,390,000 988,921,000

Health (MDBS) 1,096,574,000 0 680,403,000 572,487,000 667,229,000 968,808,000 3,985,501,000

Total Inflows 8,173,354,079 0 1,459,654,696 1,176,853,522 1,617,580,814 2,369,986,672 14,797,429,783

Outflows

Item 1 Pers. Emol 4,775,387,746 4,619,730,596 0 87,560,660 778,596,103 0 10,261,275,105

Item 2 Admin Exp 2,036,093,975 14,823,771 750,787,031 655,990,305 476,469,534 1,357,530,560 5,291,695,176

Item 3 Service Exp 1,704,146,166 163,587,764 409,680,027 256,338,793 785,742,120 796,396,437 4,115,891,307

IGF Drugs 787,739,917 0 66,300,000 118,418,670 76,879,500 343,254,332 1,392,592,419

Total Outflows 9,303,367,804 4,798,142,131 1,226,767,058 1,118,308,428 2,117,687,257 2,497,181,329 21,061,454,007

Excess/Deficit -1,130,013,725 -4,798,142,131 232,887,638 58,545,094 -500,106,443 -127,194,657 -6,264,024,224

% Excess/Deficit -13.8 0 16.0 5.0 -30.9 -5.4 -42.3


132


SOF Bawku NTC Bolga NTC Bolga MTS CHNTS,

Navrongo Total

Inflows

IGF Service 0 126,646,172

202,400,511 0 329,046,683

Personnel Emolument 334,833,805 334,833,805 334,833,805 255,415,717 1,259,917,132

GOG Admin 31,617,793 97,328,119 64,376,430 50,580,605 243,902,947

GOG Service 48,152,202 93,145,552 93,456,244 78,625,712 313,379,710

Health (MDBS) 247,099,671 491,836,817 443,322,412 402,722,037 1,584,980,937

Total Inflows 661,703,471 1,143,790,465 1,138,389,402 787,344,071 3,731,227,409

Outflows

-

Item 1 Pers. Emolument 705,224,478 316,307,429 282,601,154 0 1,304,133,061

Item 2 Admin Expenses 180,255,616 551541163 389,752,480 264,180,567 1,385,729,826

Item 3 Service Expenses 191,338,885 336,519,766 401,725,051

93,871,328 1,023,455,030

Item 4 Investment Exp 10,700,000 0 0 0 10,700,000

Total Outflows 1,087,518,979 1,204,368,358 1,074,078,685 358,051,895 3,724,017,917

Excess/Deficit -425,815,508 -60,577,893 64,310,717

429,292,176 7,209,492

% excess/Deficit -64.4 -5.3 5.6 54.5 0.2


133


SOF ORD RSS RPH RCC Total

Inflows

IGF Service 1,830,031,326 0 0 0 1,830,031,326

IGF Drugs 2,273,703,103 0 0 0 2,273,703,103

Int. on Invest. 48,603,623 0 0 0 48,603,623

Personnel Emolument 128,797,359 393,545,538 130,046,816 26,617,170 679,006,883

GOG Admin 44,699,000 67,390,000 103,067,000 47,795,000 262,951,000

GOG Service 57,162,539 78,512,000 120,077,000 52,187,000 307,938,539

Health (MDBS) 510,047,000 316,413,000 483,926,000 210,321,000 1,520,707,000

GHS Programs 17,766,314,982 0 5,875,408,116 0 23,641,723,098

Investment from HQ 2,091,171,799 0 0 0 2,091,171,799 GPRS/ Deprivation Fund 2,152,465,600 0 0 0 2,152,465,600

Total Inflows 26,902,996,331 855,860,538 6,712,524,932 336,920,170 34,808,301,971

2004

Ann

ual R

epor

t, U

pper

Eas

t Reg

ion

134

Out

flow

s Ite

m 1

Per

s. E

mol

umen

t 31

1,10

0,08

0 16

9,00

2,18

2 10

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,498

66

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6

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83,5

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9,30

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8

Item

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vest

men

t 2,

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517,

363

0 0

0 2,

074,

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Ser

vice

27

6,10

3,77

8 0

0 0

276,

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778

IGF

Dru

gs

2,25

7,76

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1 0

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1

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s 25

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49

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2,99

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387,

514,

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26,9

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21

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1,46

1,61

9,90

5 36

5,66

7,54

6 1,

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-50,

594,

460

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2,59

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0

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135

GPRS/DEPRIVATION FUNDS

The Upper East Region, being one of the poor and deprived regions in the country, government has so far released a budgetary support amounting to ¢5,847,717,062.00 for 2003/4. This enabled the region to address some of its critical health needs. The receipts in 2004 amounted to 2,152,465,600 as against 3,695,251,462 in 2003; this represents a reduction of 41.8%. Exemptions For the year under review, Health facilities providing free health services have been reimbursed up to September. Funds are available and facilities will be reimbursed as soon as the necessary scrutiny procedures are completed.

TREND OF EXEMPTIONS CLAIMS

0

1,000,000,000

2,000,000,000

3,000,000,000

4,000,000,000

Year

Am

ount

Series1 1,236,315,85 2,964,954,43 2,238,128,03 2,997,935,04

2001 2002 2003 2004

Fig 45: Trend of Exemptions Claims

Fig 46: Proportion of Exemptions Claims by Category


136

Fig 47: Cost Per Head of Exemptions Category Fig 48: Trend of ADHA Claims

Table 122: SUMMARY OF EXEMPTION REIMBURSEMENTS

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10,000,000,000

15,000,000,000

YEAR

Am

ount

(Ced

is)

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2001 2002 2003 2004

0

50,000

100,000

COST (CEDIS)

CATEGORY

COST PER HEAD OF EXEMPTIONS CATEGORY

Series1 7,878 17,255 9,517 83,365

U 5 AGED ANC PAUPE


137

Free Maternal Delivery The free maternal deliveries funds lodged at the District Assembly are not fully utilised by facilities rendering these services

TABLE 123: Funds for free maternal deliveries (July 2003-December 2004)

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138

TABLE 124: CONSOLIDATED STATEMENT OF ASSETS AND LIABILITIES

Status of BMCs All BMCs have been Appraised and certified as Budget and Management Centres. However, one new institution (CHNTS – Navrongo) and the two newly created districts namely Talensi/Nabdam & Garu/Tempane are yet to be appraised. Challenges

• Inadequate Finance Staff to take up the workload of NHIS. There are presently 34 and request has been made to Headquarters for additional 45 accounting staff

• No Finance Staff at the Health Centre level to keep basic financial record • Late submission of Financial Reports. • BMC Heads are not interested in Financial matters • Unsavory audit reports.

Outlook for 2005

• More training to ensure that all BMCs follow their approved action plans. • Request for more staff and re-train the existing ones. • GHS HQ is taking up the issue of staffing at the HC level. • Financial Management training for Non-Finance Managers and

Management Teams. • Improve knowledge of managers on disbursement procedures,

procurement procedures, FAA, IAAA.

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139

• Intensify Monitoring and supervision at all levels

9.2. INTERNAL AUDIT Introduction The Internal Audit Division is established as an early warning service provider to management that seeks to hold BMCs accountable to good administrative procedures, and practices as well as the effective and efficient utilization of operational funds. The primary purpose of the Audit Division is to carry out professional evaluation of the activities of the GHS to ensure that internal controls put in place are adequate to provide reasonable assurance to Government, Donors, Collaborators and Partners that funds are safe guarded, programmes are carried out in accordance with standard accounting practices, programmes results are consistent with budgeted goals and errors and fraud are prevented or timely detected. Vision The vision of the Internal Audit Division is to attract and maintain highly competent and well motivated professional staff to audit and produce timely reports to management on weakness and deviations from instituted internal controls to effect the necessary corrective actions to ensure that the financial statements of GHS are free from any misstatement arising out of errors and or fraud to enhance its credibility for the acceptance of all stakeholders. Mission Statement The Internal Audit exist to make health facilities accountable in the utilization of funds, offer expert advice on financial and administrative matters and to assist management accomplish the planned objectives of the GHS through the conduct of audit and professional evaluation of GHS activities and timely reporting of audit results for management attention and action. Achievements

� Half year audit was successfully carried out at all BMCs by the end of August 2004. However, much emphasis was placed on Donor Pooled Fund

� The Internal Audit Division facilitated the responses of outstanding audit queries of Bongo DHA, Bolga MHA and the Regional Health Directorate. Audit reports of other BMCs were reviewed and supported with a circulated guide on the adequacy of audit responses and effective implementation of audit recommendations

� BMCs were audited in the light of compliance with ATF and procurement policies. A target of 80% compliance was achieved

� Our target of reporting all findings to management was met, similarly, adequate recommendations were made to management and a follow up indicates that most of the recommendations are being implemented

� In our monitoring process, it was observed that up to about 80% of funds allocated to BMCs were utilized in line with budget and action plans

� BMCs being much aware of the operations of the Audit Division were conscious of internal funds generation and cash management, though much


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still needs to be done in the area of monitoring Revenue Collectors and Cashiers about fraud and cash retentions

Challenges

� Poor staffing � Transport and other logistics � Difficulties of operating according to schedule due to BMCs

request for re-schedules � Resistance of some BMC management on the reporting of

some deviations � Difficult budgetary monitoring due to weak or confused

records on budgetary allocation to sub-districts by District � Health Directorates and Municipal Health Directorates

Delay in audit responses � Failure to meet all core management staff for both entry and

exist conference to discuss findings Outlook for 2005

� The Internal Audit division in 2005 will follow a drawn comprehensive annual programme of work to cover all BMCs throughout the year to facilitate the prevention and defection of errors and fraud and to ensure that funds are used for their intended purposes

� Audit will ensure that utilization of funds are in accordance with the strategic objective of the BMCs as outlined in their budgets and action plans. Thus Audit will seek to link activities with planned strategic objectives

� The Audit Division, prior to the commencement of every audit will access BMCs Annual Plans and Budgets as well as Action Plans to facilitate the monitoring of budget performance so as to avoid the misapplication of funds e.g. funds for service, used for investment items/activities

� Audit will place importance on the raising of Departmental Memo JVS according to specific budgets lines for the purpose of monitoring

� Expenditure budget ledgers of sub-districts will be inspected on their own merit and so should be kept separately by BMC Accountants for effective monitoring

� All BMCs are to put in place Procurement Committees and minutes of meetings, Procurement Plans, Registers and ensure that all procurements are well covered by LPOs and SRAs for audit interest

� There will be effective monitoring of revenue generation and cash management. GCRS used will be closely monitored

� Pay Rolls, Nominal Roll and the periodic reconciliation between the two will be monitored to avoid Ghost names

� Assets and Inventory Registers will be monitored and vehicle log books will be monitored and checked against fuel utilization


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CHAPTER TEN

10.0 SUMMARY OF KEY ACHIEVEMENTS Child Health:

Infant and Child Mortality:

There was dramatic improvement infant and child mortality indicators as shown by the 2003 DHS. Infant mortality reduced by 59.8% (from 82 to 33 per 1,000 Live Births) between 1998 and 2003. Similarly child mortality reduced by 49% (155 to 79 per 1,000 Live Births between the same period.

Expanded Progarmme on Immunisation-Plus (EPI) The following were achieved for the various antigens:

� Measles = 88.2% � Penta 3 = 86.9% � OPV3 = 87.1%. � Penta1 – Penta 3 Drop Out Rate = 11%. � Four rounds of NIDs with coverage of over 100% � No wild polio isolated from any child � Significant reductions in the incidence of EPI Target Diseases, for example 39

cases of measles were reported with no deaths in 2004 as against 62 cases in 2003, representing a reduction of about 37.1%.

� Vitamin A Supplementation: Coverage was about 85.9% � De-worming: Under five years coverage was 94.6% and School Children

82.0%

Malaria:- The under five malaria case fatality rate reduced from 3.2% in 2003 to 2.5% (21.9% reduction). The ITN distribution was stepped up through support from UNICEF in the Accelerated Child Survival Development programme. A total of 123,034 ITNs were sold to parents for children under five years, giving a coverage of 80% and 36,223 to pregnant, representing 94.2% coverage. Efforts are being made to promote their use. Intermittent Preventive Treatment of malaria in Pregnancy (IPT) was rolled out to all districts in the region by the close of the last quarter of the year. Disease Surveillance: - Training in Integrated Disease Surveillance and Response strategy was carried out in all districts. Timeliness and Completeness of reporting of the weekly and monthly reports of Communicable Diseases improved. Timeliness of weekly reporting (CD1) improved from 77.9% in 2003 to 92% in 2004 and completeness was 100.0% as in 2003. Completeness for monthly reports (CD2) equally improved from 98.6% in 2003 to 100% in 2004. Timeliness showed dramatic improvement 55.6% in 2003 to 80.6% in 2004. AFP Surveillance: Indicators of AFP surveillance equally showed improved. Non Polio AFP rate was 2/100,000 children below 15 years against target of more than 1/100,000 and 88.9% of the stools were collected within 14 days (target (80%). No wild polio was isolated.


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Epidemics: The region had a major Epidemic Meningococcal Disease epidemic in 1996/1997. However, yearly focal outbreaks continue to occur in some sub-district. The following focal outbreaks were rapidly contained:


• Anthrax at Kassena Nankana District: April 2004 • Measles and Anthrax at Bugri-Kuka and Worikambo respectively in Bawku

East. May 2004 • Rabies at Gagbiri in Garu (Now Garu –Tempane district). July 2004 • Suspected Yellow Fever in Bawku West district, July 2004. (Laboratory result

proved case not to be Y/F) Guinea worm: - No indigenous case was seen during the year. The region reported its last indigenous case in 1992. Since then all reported cases have been imported from either Northern or Brong- Ahafo regions. A total of 17 imported cases were seen in 2004 as against 23 in 2003. All were contained. Leprosy:- Leprosy elimination target of 1 case per 10,000 population was achieved : 1.34 cases/10,000 in 2001, 0.92 case /10,000 population in 2002 and 0.64 case/10,000 population in 2003 and 0.81/10,000 However, two districts, namely Bolgatanga and Bongo did not achieve the elimination target (1.26/10,000 for Bolgatanga and 1.34/10,000 population for Bongo District) Tuberculosis Key performance indicators dropped in 2004 compared to 2003.

� Cure rate was 76.3% in 2004 against 69.6% in 2003 � Case Detection rate was 33.3% in 2004 against 35.0% in 2003 � Defaulter rate was 14.4% in 2004 against achievement of 6% in 2003.

Onchocerciasis:- No recrudescence detected and Ivermectin combined with Abendazole distribution by community members was carried out with a coverage of 66.4%. Lymphatic Filariasis: A coverage of 66.4% was achieved for mass treatment with Ivermectin and Albendazole. A coverage was 63% in 2003. About 80 million cedis was made available for institutions for hydrocoele surgeries. Soil-Transmitted Helminthiasis. A mass de-worming of under five year olds and school children was undertaken during the year. The coverage treatment was 94.2% for under fives and 82.0% for school children. HIV/AIDS: - A total of 318 cases reported in 2004 against 339 cases in 2003; this represents a decrease of about 6.2%. As in previous years many health personnel were trained in counselling, prevention and control. STI/partner notification counselling is ongoing; visits were made in search of commercial sex workers in hotels and drinking bars. The two PMTCT centres in Bolgatanga and Bawku hospitals reported a total 11,565 ANC registrants out of which 282 were counselled and tested; 13 were positive, given a prevalence of 4.6%. Mothers and their babies were put Nivaripin. All the six hospitals have VCT centres. A total of 448 clients


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were tested following counselling out of these 62 were positive, given a prevalence rate of 13.8%. Plans are advanced for rehabilitation works and refurbishment of the VCT centres in all hospitals in the region. Reproductive Health: Modest achievements were made in the following areas � ANC was 102 % in 2004 against 101.2% in 2003 � Average visits were 3.4 against 3.3 in 2003 � Supervised Delivery (Institutional) was 31.9% in 2004 against 23.9% in 2003.

The following Performance indicators however dropped in 2004 compared to 2003

� PNC was 48.4% against 50.2% in 2003 � Family Planning – 19.3% in 2004 against 22.5% in 2003.

There were also 47 maternal deaths and maternal mortality ratio of 398/100,000 Live Births in 2004 as against 42 and 248/100,000 Live Births in 2003. Clinical Care There was modest improvement in service utilisation in 2004 over 2003.

� OPD Per capita was 0.6 in 2004 compared to 0.59 in 2003 � Bed Occupancy was 49.7% in 2004 as against 48.2% in 2003 � Death rate was 3.4% in 2004 as against 3.6% in 2003, a reduction of 5.6%. � 91.5% of all maternal deaths were audited.

Health Infrastructure: Physical infrastructure received considerable attention during the year. Twelve (12) projects were approved under our capital investment plan. Technical and financial evaluations were carried out and all awarded to deserving contractors. Works are various stages of completion. The Regional Health Directorate carried out the following:

� Major rehabilitation/renovations on five (5) senior staff bungalows including Boys’ quarters.

� Renovations works at three (2) Health Centres Fumbisi and Kulungugu and minor repair works at Paga Health Centres.

� Construction of four (4) Community Health Compounds (CHCs) throughout the region.

� Installation five solar invertor systems for CHO Compounds � Procurement of medical equipment: Ten (10) Delivery Beds and ten (10)

Blood Pressure

Motorola communication equipment installed in three districts (Kassena Nankana, Bolgatanga and Bawku West) bringing the total f districts with equipment to four.

Transport

The region procured fifteen (15) motorbikes and received twelve others from motorbikes from HQ. For the first time, an HND graduate was posted to the region as a substantive Regional Transport Officer


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Drugs and Non-Drug Consumables Drugs:

� Tracer Drug Availability was 94.1% in 2004 compared 92.2% in 2003. � Networth as at 31st December 2004 was ¢1,950,253,153.48

Non-Drugs

� Availability was 89% in 2004 as against 86% in 2003 � Networth as 31st December 2004 was ¢118,000,000.00

Finances There was improvement in timeliness of financial releases from HQ in 2004 compared 2003. On the whole, Cash inflows was higher than expected, for example, ¢40.39 Billion was realised in yr 2002, ¢50.18 Billion in 2003 and ¢65.23 Billion in 2004, these translated in percentages are an increase of 24.2% in 2003 over 2002 and an increase of 30.0% in 2004 over 2003. All BMCs were reimbursed their exemptions claims


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CHAPTER ELEVEN

11.0 OUTLOOK FOR 2005 1. Improve access to quality health services

� Scaling up CHPS � Increasing primary health care outreach services � Improve Specialist Outreach Services � Staff training � Strengthening collaboration with communities, private health service

providers (for profit and Not for profit including quasi-government) � Provision of essential drugs and supplies and equipment

2. Improve financial access through the operationalisation of Mutual Health Insurance Schemes in all districts and Municipalities in the region and strengthening the implementation of the exemptions schemes 3. Public Health

� Sustain the modest gains made in some public health programmes (surveillance, containment of epidemics, disease control and reproductive and child health)

� Strengthen the implementation of Child Survival Initiatives: ACSD and FACS, SFP etc

� Mainstreaming Adolescent Health; orientation and dissemination Adolescent Reproductive Health Policy.

� Strengthen Safe motherhood, Essential and Emergency Obstetric Care (Improve care of newborn, improved management of labour and pueperium, improved maternal death audits)

� Scale up and improve quality of IPT-P, VCT/ PMTCT for HIV, including management of STIs)

� The control of Malaria, TB, HIV/AIDS, Soil transmitted helminthiasis, Lymphatic Filariasis and Onchocerciasis

� The Eradication of Guinea Worm Disease and Polio. � Elimination of Leprosy and Maternal Neonatal Tetanus � Health Promotion � Strengthen Nutrition Interventions:

a. Exclusive Breastfeeding b. Complementary Feeding c. Supplementary Feeding, d. Micronutrient deficiency Control,(Vitamin A, Iodine, Iron, Folic Acid)

4. Clinical Care � Strengthen Management of Emergencies and Trauma; � Strengthen Quality Assurance

• QA committees • Drug and Therapeutic Committees, • Infection Prevention Committees, • Maternal Audits,


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• Referrals, • Tracer Drug Availability and Non-Drug Consumables • Clinical conferences • Patients Charter • Code of Ethics • Code of Conduct and Disciplinary Procedures • Specialist Outreach Services • Patients satisfaction surveys

� Training in: • Rational drug use • Standards of pharmaceutical care • Standard treatment Guidelines •

• Strengthen Hospital Improvement Management. 5. Human resource development and management

• Training o In-Service, o Training of Community Health School, o Health Aides o Enrol Nurses training to started this year

• Monitoring and supervision • Staff motivation, attraction and retention • Staff re-distribution to needy areas

6. Health Infrastructure and support services

• Completion of all on-going projects • Rehabilitation of Existing structures • Construction of CHPS Compounds • Provision of Residential Accommodation • Continue upgrading of three district hospitals:- Zebilla, Bongo and

Sandema • Procure radio communication equipment for the two remaining

districts:- Bongo and Builsa districts.

7. Strengthening Health Information Management System

• Training • Use of information for planning and implementation • Monitoring and supervision

8. Financial Management in Budget Management Centres


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• Training in ATF rules/ FAR and BPEMS • Internal Control mechanisms • Timeliness and completeness of financial reports • Prompt response to audit reports • Improving Exemptions implementation • IGF

9. Improving monitoring and supervision

• Facilitative supervision • On the spot coaching and on-the-job training.

10. Collaboration • Strengthening linkages with District Assemblies & decentralised departments • Collaboration with NGOs in health • Collaboration with communities • Strengthen partnership with private Mission and Private for-profit service

providers • Collaborate with quasi-government service providers • Strengthen Regional, District and Institutional Health Committees to support

health service delivery


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ANNEXES

upper east regional health administration ghana … · 2004 annual report, upper east region i...

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