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This report highlights some of the major health service activities and programmes carried
out in the Ashanti Region during the year under review.
The activities were largely determined by the priorities and action plans of the region in line
with the Ghana Health Service Strategic Objectives and New Paradigm of the Ministry of
Health. It also highlights the broad policy and operational direction of the Ashanti Regional
Health Directorate in 2010.
A detailed description of the key activities in the region has been expressed, though other
areas of service delivery have not been highlighted. It is hoped that the final report at the
end of 2010 would bring all into focus. Certain information has been added and other parts
have been documented in more detailed to make sure the report serves as a valuable
reference material.
We acknowledge with many thanks the contributions from all the Institutions,
Headquarters, Regional Coordinating Council, Health Partners, NGOs, DHMTs and units of
the Regional Health Directorate towards the overall service delivery in the region.

EXECUTIVE SUMMARY
The Regional Half Year Report 2010 reflects the major activities undertaken by the Regional
Health Directorate under the four health sector strategic objectives and its results as
measured by the key sector indicators. The Regional Health Directorate viewed the first six
months of the year 2010 as successful though challenging. The region appears to be on
course in achieving most of the set targets particularly in the areas of key priorities.
There was a conscious effort to sensitize the populace on healthy lifestyles and
environmental management and these were achieved through Radio shows, health
talks and durbars.
The District Health Information Management System (DHMIS) has been implemented
throughout the region though there are challenges with timelines and completeness
of reporting from the districts.
Though maternal deaths have reduced over the period, other indicators like postnatal,
TT2+, ANC coverage and Caesarean rate have reduced. Maximum effort would be put in
the second half of the year to ensure improvement in the maternal and child health
indicators as we push to achieve the MDGs 4 and 5.
There have been substantial improvements in the indicators of malaria leading to a
significant reduction in deaths in U-5. IPT coverage however deceased due to the erratic
supply of SP. The OPD per capita of 0.4 appears to be on course in line with that of 2009.
It is hoped that with increasing coverage of NHIS, OPD utilization would increase further.
However Hypertension is the third most reported disease at OPD and this call for more
efforts to address non communicable diseases in the region.
Routine EPI coverage has been impressive.The two NIDs during the half year also
recoreded coverage of more than 100% in both rounds. However the H1N1 vaccination has
received a lot of negative reports from the media with rumours of severe adverse reactions.
The region has officially recored 31 AEFIs and there are no reports of any severe reaction.
The region reported one outbreak of H1N1 in a secondary school and was well managed by
the District Epidemic Response Team with support from the Regional level.

The Leadership Development Programme has trained several key managers in the region
and it is hoped that the acquired leadership skills would impact greatly in the second half of
the year as the rest of the untrained manpower in the region are brought on board the
programme.
Financial support from central Government has continued to be below par and is greatly
affecting planned activities. Delayed payments to health facilities from the NHIA are also
impeding health service delivery at the hospitals and health centres. It is hoped that
financial inputs to health service would improve in the second half of the year to enhance
total health delivery.

INTRODUCTION
1.0 REGIONAL PROFILE
Ashanti Region lies approximately between longitude 0.15 to 2.25 west and latitude 5.50
to 7.40 north. It has common boundary with Brong Ahafo Region in the north, Central
Region in the south, Eastern Region in the east and Western Region in the west. The
Region has a land size of 24,390sq km representing about 10.2% of the land area of
Ghana.
Ashanti is the most heavily populated region in Ghana, with a population of 4,881,738 for
2009 (Projection from the 2000 Housing and Population Census, Ghana Statistical Service).
It has a population density of 169.3 per sq. km. The region has 27 districts and 132 subdistricts. Kumasi has the highest population of 1,559,807 (32.4%) of the regional total.
About 47% of the population are in the rural areas. The region has a large proportion of
hard to reach areas especially in the Afram Plains sections of Sekyere Afram Plains, Ejura
Sekyedumase, Sekyere Central and Asante Akim North districts.
There are five hundred and twenty-seven (527) health facilities in the region. The Ghana
Health Service operates about 33% of all health facilities in the region. Kumasi has the
highest number of facilities (29%) with Ejura-Sekyedumase having the least (2%). The
population hospital ratio is 48,276.
TABLE 1. 1HEALTH FACILITIES
TYPE

NUMBER

Government Hospitals and Health Centres

170

Mission Health Institutions

71

Private Maternity Homes and Clinics

278

Quasi Government

Total

527

PRIORITIES FOR 2010:


The regional priorities included the following:

Improvement of Staff and Management capacity through leadership and regular inservice training

Improve staff motivation

Ensure staff performance measurement

Strengthen health information system

Improvement of customer care

The activities carried out in respect of the above are well articulated in the respective
strategic objectives.
The Key Priorities for the year are:

Maternal Mortality

Low TB case detection

Stillbirth

Low AFP detection

Malaria

HIV

NTDs

Low EPI Coverage

School Health

Adolescent Health

Poor Data Management

Malnutrition in Children U-5

CHAPTER ONE
1.1.1 Strategic Objective
Healthy Lifestyle and Healthy Environment

1.1.2 Increase awareness on health promotion and protection


Various strategies were used by the region to increase awareness on health related issues.
In the hospitals, health education talks are being held on regularly basis at the Out Patient
Departments on selected diseases like malaria, H1N1, TB and HIV/AIDS and also
Regenerative Health.

For the period a lot of sensitization was also on the H1N1

vaccination. The RHD is collaborating with local FM stations particularly Angel FM and Hello
FM to promote health.
During the year under review, Health talks were given on the local FM stations i.e. Hello
Fm, Nhyira Fm, Angel Fm etc, churches, mosques, outreach points, facilities and other
social organizations to increase awareness on the new paradigm shift of Regenerative
Health and Nutrition, importance of optimal exclusive breastfeeding and benefits of iodated
salt and fortified products usage.
The general populace were educated on the importance to eat healthy meals, drink a lot of
water, exercise three times a week, as well as make time for recreation and to rest for at
least 8 hours a day. Discussions were centered on eating plant based diet and to limit the
intake of animal based food products which are high in fat, salt and sugar. Environmental
and personal hygiene were also stressed so that people would maintain a hygienic and
sanitary environment as well as live sensible lifestyles. Babies are to be breastfed
exclusively for six months, continued along side the introduction of appropriate
complementary feeding.

No.

Organization

Location

Topic Treated

1.

Methodist mens
Group

Effiduase

2.

Aboabo Mosque

Aboabo 1Kumasi

3.

Hairdressers
Association

4.

Boss, Ashh &


Angel Fm

Kumasi
Cultural
Centre
Boss-Adum,
Ashh-Stadium
& AngelAbrepo
junction

Iron Fortification
Programme & essence
of exclusively
breastfeeding babies
Regenerative Health &
Nutrition & importance
of iodated salt usage
Iodated Salt, Balance
diet and it importance
& Personal hygiene
Importance of
Exclusive
Breastfeeding for
children 0-6mths,
appropriate
complementary
feeding etc

Resource
Persons
Reg. &
Dist. Nut.
off

Date
April
2010

Reg. &
March
Metro Nut.
2010
Off
Reg. &
June
Metro Nut.
2010
Off
Reg. &
May 2010
Metro Nut.
Off

The Health directorate through the Health Learning Material unit (HLM) has also
organized health educational programmes on radio, in churches, communities and
schools.

The topics treated in the schools focused mainly on personal and

environmental hygiene as well as prevention of minor ailments. The topics treated in


the churches included; predisposing factors to lifestyle diseases such as
Hypertension, Diabetes, Malaria, Hepatitis, HIV/AIDS, TB and prevention of home
accidents among others.
As part of the efforts to prevent the spread of HIV, know your status campaign was
organized by the region in the course of the year under review. The target groups
included; students, beauticians, women and men groups in churches and
communities. The total number of people screened was 77,394. One thousand and
eighty three (1083) representing 1.4% out of the total number screened were
positive.

See Table 1.2

KNOW YOUR STATUS CAMPAIGN, 20092009-2010

Indicators

SEX

Jan- Dec
2009

20222221222
Jan- June
2010
422200

# Tested

33327

31,345

41879

46,049

310

326

792

757

33327

31,345

41879

46,049

75,206

77,394

# Positive
# Posttest
counselled
Total

1.1.3 Work with other stakeholders and communities to help members maintain
healthy lifestyle behaviours
Ghana Health Service in collaboration with other stake holders like Ministry of Agriculture,
Department of Social Welfare, Ghana Tourist Board, Food and Drugs Board, District
Assembles, Ghana Standard Board, Ghana Education Service, Womens Groups, Religious
Bodies etc., organized workshops, seminars, community durbars in March and May 2010
with the Regional Nutrition Officer, Regional Health Education Officer and Regional Tourist
Board as resource persons to educate food vendors, hoteliers, market women, school
children, health workers, teachers on the need to make the right choice of food, demand
for healthy environment, adopt healthy life styles to reduce the disease burden, be friendly
to water bodies that have become a major source of water borne and water related
diseases. Participants were made to understand the need not to take nutrition for granted
by eating all the wrong foods at the wrong times, at the wrong places, constipate heavily
and generate toxic waste in their bodies which also become the cause of many noncommunicable diseases.
Participants were informed to always make time for rest and recreation to refresh them for
the next production week and not to crowd their week ends with all kinds of unnecessary

activities. The three food groups were also discussed as well as their uses in the body,
food hygiene, food microbiology, oral hygiene were amongst the topics treated.
WORK WITH OTHER STAKEHOLDERS
Date

Programme

Resource Persons

March 10

Essence of
iodated salt
usage &
Regenerative
Health &
Nutrition
Iron
Fortification
Programme

Tourist Board, Reg. Nut.


Off & Reg. Health
Education Off

May 10

National Coordinators
(3) & Reg. Nut. Off

Target
Audience
Food Vendors
Market Women

No. of
Participants
102
40

Traditional
Caterers

25

1.1.4 Develop HR capacity to plan, implement and evaluate Regenerative Health


and Nutrition (RGN)
As part of measures to carry out the above, a five member team made up of, the regional
nutrition officer, the regional training coordinator, the regional DDNS, the regional Health
Educator and a representative from the sports council were invited to a trainer of trainers
workshops at cape-coast. Afterwards, the training was replicate at the Regional level for all
the 27 districts and five (5) sub-metros. Participants were put into four (4) major groups
being maternal and child health, healthy lifestyle, nutrition and practicals.
TOPICS TREATED AND DISCUSSED WERE CENTERED ON
1. Water and Nutrition
a) The health benefits of water
b) Nutrients
c) Food groups in Ghana
d) How to combine your food and plan your meals
e) Feeding the family
The practical sessions took participants through the preparation of regenerative health
diets. Questions posed by participants were answered to their satisfaction. A period within
the programme was allocated for exercise. In all about one hundred and eighty (180)
people participated in the category of nutrition, public health nurses, community health
9

nurses, disease control and health promotion officers. It was well attended, patronized and
successful.
1.1.5 Promote food safety
The regional health directorate in collaboration with School Health Education Programme
(SHEP) Coordinators, Nutrition Officers and the Environmental Health department organized
workshops for heads of schools and food vendors. The objective was to promote food
safety in schools.

Some of the topics treated include; food hygiene, personal and

environmental hygiene, cooking practices and food storage among others. A certificate of
participation was given to all the food vendors who attended the workshop.

1.1.6 Promote occupational health and safety


The goal of occupational health services is to establish and maintain a safe and healthy
working environment which will facilitate optimal physical and mental health in relation to
work. It is therefore imperative that workers are periodically given training on occupational
health and safety and also should be provided with protective equipment in order to control
risk and departures from health.
The RHD also ensured the regular supply of personal protective equipment to staff. These
included; wellington boots, goggles, gloves and gowns. The health facilities also have fire
extinguishers and smoke detectors.

1.1.7 Advocate for improved access to water and sanitation infrastructure


The Regional Health Directorate has always been advocating for safe water for drinking.
This is to reduce the number of water related diseases in the region especially in children
U-5.
Equally the Regional Health Directorate in collaboration with the Environmental Health unit
have been working to improve the health status of the people of the region through the
provision of quality environmental sanitation services that are accessible and affordable.

10

CHAPTER TWO
2.0 Strategic Objective 2- Health, Reproduction and Nutrition Services

2.1.1 Improve quality of clinical care


In order to improve staff capacity to provide quality care, a series of in-service training
sessions were organized for health workers during the year. Notable among these were;
prevention of injection abscess, management of post partum haemorrhage, hypertensive
states in pregnancy, neonatal resuscitation and management of diarrhoea.
2.2 Quality Assurance (QA)
Surveys were conducted in most health facilities on the rational use of medicines. Plans are
underway to meet all prescribers and dispensers in the region with the aim of improving
the indicators for rational use of medicines. See table 2.1 below for the results of the
survey.
TABLE 2.1 Rational Use of medicines indicators
PRESCRIBING
INDICATORS
Average number of medicines per encounter
% of medicines prescribed generic name
% of encounter with antibiotics
% of encounter with injection prescribed
% of medicine prescribed from EDL
PATIENTS INDICATOR
% of patient who understood drug instruction
FACILITY INDICATORS
% availability of tracer drugs

REGIONAL
AVERAGE
4.2
95.0
35.0
35.0
100

WHO
STANDARDS
2
100
20
20
100

91.0

100

100

100

Facilitative supervision undertaken during year revealed that most of the facilities had
quality assurance teams in place. In 2009, client satisfaction survey was conducted by
most hospitals. About 96% of clients indicated their satisfaction with services provided.
There is a need to revamp the quality assurance systems in all health facilities in the period
ahead.

11

Ownership of Health Facilities


Quasi-Govt, 8

Govt, 170

Private, 278

Mission, 71

OPD/CAPITA:

OPD Attendance Per Capita


0.9
0.8
0.8
0.7
0.6

Per Capita

0.6
0.5
0.4

0.4
0.3
0.2
0.1
0
2008

2009

2010 Half-Year

Year

12

OPD ATTENDANCE
Generally, OPD attendance has increased over the years. Districts with mission institutions
in the region contributed almost 60% of total OPD attendance See table 2.2 below.
FIGURE 2.1 OPD Attendance, 2008 2010 Half Year

OPD Attendance
Year

Out-Patients Visits

2010 Half-Year

2,046,993

2009

3,962,986

2008

3,140,880

MORBIDITY PATTERN
Table 2.3 shows the regional top 10 leading causes of OPD attendance for the past three
years. Malaria continues to be the leading cause of OPD attendance. Malaria alone
accounted for almost half (50%) of the total OPD attendance. Hypertension, URTI and

13

Rheumatism

have

also

featured

prominently

over

the

years.

Top Ten OPD Morbidity, 2008 - 2010


2008
No.

2010 Half Year

2009
CASES

DISEASE

CASES
DISEASE

Malaria

814,998

Cough (IMCI)

119,490

Hypertension

CASES
DISEASE

1,449,260

80,429

Malaria
Acute Respiratory
Inf.
Hypertension

Malaria

797,629

259,701

Acute Respiratory Inf.

148,366

125,453

Hypertension

66,098

Skin Disease

70,694

Diarrhoeal Disease

123,107

Diarrhoeal Disease

65,858

Diarrhoeal
Disease

57,252

Skin Disease

115,212

Skin Disease

62,839

Rheumatic
Conditions

42,617

Rheumatic Conditions

94,531

Rheumatic Conditions

51,229

Urinary Tract Inf.

33,900

Urinary Tract Infection

58,324

Intestinal Worms

34,102

Intestinal Worms

28,258

Intestinal Worms

54,719

Urinary Tract Infection

32,300

Home/Occup
Injuries

26,363

Acute Eye Infection

49,509

Acute Eye Infection

26,619

10

Chicken Pox

22,552

Home/Occup Injuries

43,820

Anaemia

21,574

Hypertension & Diabetes Mellitus cases Reported by District


2008 2010 Half Year (a)

District

2008

2009

2010

Half Year

Hypsion

Diabetes

Hypsion

Diabetes

Hypsion

Diabetes

38,388

6,118

36,605

8,200

15,721

3,677

2,092

559

2,855

899

7,581

4,101

20,614

5,310

26,750

6,087

7,121

1,691

Atwima Nwabiagya

3,363

930

7,555

2,217

4,564

448

Ejisu Juaben

3,588

581

5,304

1,247

4,101

1,144

Sekyere South

2,940

661

5,025

1,152

3,988

1,156

588

688

1,073

130

3,475

887

Sekyere East

3,672

960

4,389

920

2,734

465

Sekyere Afram Plains

2,339

467

4,728

587

2,221

227

Kumasi
Asante Akim North
Obuasi

Mampong Municipal

14

Hypertension & Diabetes Mellitus cases Reported by District


2008 2010 Half Year (b)

District

2008

2009

2010

Half Year

Hypsion

Diabetes

Hypsion

Diabetes

Hypsion

Diabetes

Adansi South

2,241

237

3,000

292

2,042

277

Afigya Kwabre

3,343

836

3,005

592

1,945

330

Mampong Municipal

2,003

688

2,210

899

1,540

571

Ejura Sekyedumase

1,320

234

1,181

65

951

46

Bekwai Municipal

3,315

600

2,759

422

903

216

Adansi North

1,380

189

1,818

152

898

86

1,678

111

801

60

Ahafo Ano South

1,257

326

1,081

258

752

177

Kwabre

1,159

60

1,711

99

671

62

Sekyere Central

Hypertension & Diabetes Mellitus cases Reported by District 2008


2010 Half Year (c)

District

2008

2009

2010

Half Year

Hypsion

Diabetes

Hypsion

Diabetes

Hypsion

Diabetes

Atwima Kwanwoma

1,431

62

1,794

40

618

11

Asante Akim South

2,348

660

5,015

1,214

594

62

Offinso Municipal

1,490

123

1,402

126

548

32

Amansie central

765

135

768

182

479

58

Bosome Freho

265

572

38

459

Amansie West

237

40

550

98

383

53

Offinso North

799

49

582

66

376

64

Ahafo Ano North

1,116

452

1,420

418

361

96

Atwima Mponua

261

21

216

62

136

23

15

Hypertension & Diabetes Mellitus cases Reported 2008 2010 Half Year
4.5

3.5

% of OPD Morbidity

2.5

1.5

0.5

2008

2009

Hy'sion

3.21

3.91

2010 Half Year


4.1

Diabe

0.64

0.83

0.99

Year

Hospital Admissions
Total Admissions 2008
107,743

2009
162,591

2010 Half Year


86,173

Hospital Admission Rate is 1.71 per 100 population


as against 3.33 per 100 in 2009
Bed Occupancy (Target
2010
2009
2008

= 80%)
=
56.7%
=
59.4%
=
37.4%
15

16

Inpatients:
Hospital Admissions have been increasing over the years, but the half year apperas to be
just marginally high. The Average bed occupancy rate also appears to be marginally similar
to the figure in 2009.
TABLE 2.4 Hospital Admission
Causes of Admission
Malaria, Diarrhoea, Hypertension, Aneamia, Gastritis, Asthma, Pneumonia, Abortion, Hernia
and Enteric fever were the ten top causes of admissions in the year under review. Malaria
was the highest among the ten leading causes of admissions accounting for over
30.1%.See table 2.5 below.
TABLE 2.5
Top 10 Causes of Admissions, 2008 2010 Half Year

Top 10 Causes of Admissions, 2008 - 2010


2008

2010 Half Year

2009

No.

DISEASE

CASES

Malaria

Diarrhoea

815

Diarrhoea

3,203

Diarrhoea

1,635

Anaemia

663

Anaemia

2,148

Anaemia

1,075

Hypertension

503

Hypertension

1,535

Hypertension

831

Pneumonia

308

Enteric
Fev./Typhoid

994

Enteric
Fev./Typhoid

576

Hernia Inguinal

303

Hernia
Inguinal

911

Hernia
Inguinal

564

Asthma

277

Pneumonia

709

Gastritis

373

Gastritis

272

Gastritis

691

Asthma

345

Enteric
Fev./Typhoid

244

Abortion

683

Pneumonia

333

10

Single Spont Del.

183

Asthma

643

8,914

DISEASE

Malaria

CASES

29,486

DISEASE

Malaria

Abortion

CASES

16,362

325
16

17

Causes of Death
The mortality profile shows Malaria, Anaemia, Hypertension, Pneumonia, Septicaemia,
Diarrhoea, HIV/AIDS, Diabetes, Bronchopneumonia and CVA as the ten leading causes of
deaths with Malaria accounting for over 30% cases. See table 2.6 below.
TABLE2.6
Top 10 Causes of Death, 2008 2010 Half Year

Top Ten Causes of Death, 2008-2010


No.

Diseases

2008

Diseases

2009

Malaria

2010
Half
Year

Malaria

67

Malaria

Anaemia

22

Anaemia

83

Anaemia

36

Hypertension

21

Hypertension

50

Diarrhoea Dis.

25

Diarrhoea

16

Septicemia

35

HIV/AIDS

22

Pneumonia

13

Pneumonia

34

Hypertension

20

HIV/AIDS

12

HIV/AIDS

34

Pneumonia

17

Diabetes Mellitus

Diarrhoea Dis.

33

C V A

16

Bronchopneumonia

Diabetes Mellitus

26

Diabetes Mellitus

12

C V A

Bronchopneumonia

25

Septicemia

Typhoid Fever

C V A

20

Cardiac Failure

10

226

Diseases

126

8
6
17

18

National Health Insurance Scheme


TABLE 2.7 NHIS Utilization

NHIS - Utilization
80

70

60

50

40

30

20

10

Out-Pat
In-pat

% Insured

% Non-Insured % Insured

% Non-Insured % Insured

% Non-Insured

2008

2008

2009

2009

2010 Half Year 2010 Half Year

61.34

38.66

69.58

30.42

75.92

24.08

57.2

42.8

68.46

31.54

70.78

29.22

Rational Use of Medicine


Indicator

2008

2009

2010

Ashanti

WHO

Av No. of Medicine Pres

4.2

4.2

3.8

4.0

2.0

% Generic

88.0

67.8

77.3

95.0

100.0

% Antibiotic

41.8

43.0

46.0

35.0

26.0

% Injection

36.0

18.9

22.0

35.0

20.0

% EDL

100.0

87.5

85.0

100.0

100.0

% Diagnosis

100.0

100.0

100.0

100.0

100.0

19

Drug Availability

2.1.2 Promote and facilitate physiotherapy services


Currently only KATH and Mampong hospital provide physiotherapy services in the region.
Mampong Municipal Hospital in the course of the year received and treated the following
types and number of case: Arthritis, CVA, Painful shoulder, Injection neuritis/paralysis and
Low back pain.

2.1.3 Promote and facilitate Prosthetics and Orthotics Services


Clients are referred to KATH for such services.

2.1.4 Improve early detection, reporting and management of communicable


diseases
The Region organized various health talks on TB/HIV at the local FM station, which aimed
at educating the public on signs and symptoms of the diseases, as well as their preventive
measures, Know your status campaign was also highlighted. 270 newly qualified Health
staff and laboratory technicians were trained on TB management care and control. Durbar
on awareness creation to increase case detection was also organized during the World TB
Day celebration. There were health talks at the local information centres to create
awareness on TB disease and the need for early reporting .Over 2000 cases were detected
over the period. See figure 2.3

20

Case search on some selected communicable diseases like AFP, Buruli Ulcer, Guinea worm,
Leprosy and Yaws was conducted by CBSVs in all the communities in the district to enable
them detect early and report suspected conditions to health facilities for management.
The key activities carried out included:

Sensitization of districts on IDSR

Distribution of IDSR materials such as Fact Sheets, Reporting forms and Sample
Collection kits

Specimen collection and transportation to the appropriate destination

Feedback and Reports to the districts

Two Press Conferences on H1N1 and Guinea Worm

Regional Technical Committee Meeting involving KNUST, KATH and MRS.

Timeliness and Completeness reporting (CD1)


Year

%Timely (> 80)

% Complete (>90)

2008

94.4

100

2009

93

98.7

2010

89.3 (Half Year)

100

Timeliness and Completeness reporting (CD2)


Year

Reports

No.

Timely No.

Lately %

Timely

Expected

Received

Received

Received

2008

324

138

186

42.6

2009

324

228

96

70.3

2010

324

109

53

33.6 (Half Year)

21

FIGURE 2.3

Specimen Results
Disease

Specimen
2008

2009

No. Positive
2010

2008

2009

2010

Measles

219

103

76

11

Meningitis

92

21

137

83

YF

28

46

47

AFP

28

48

29

Cholera

11

22

Positive Cases
Case

District Detected

Measles

Ahafo Ano North

Meningitis

Atwima Nwabiagya (type c)


Kumasi KATH (type w135)
Sekyere East (type c)

GUINEA WORM PROGRAMME


About 1000 health and non-health staff(CBS)
through training
Communities sensitized through durbars,
community meeting, etc
Case search in two districts, Sekyere Central and
Sekyere Afram Plains
Distribution of GW materials such as registers,
reporting forms, posters, etc to districts

Districts reporting Guinea Worm Cases


District

No. of cases

Amansie West

Asante Akim South

Atwima Nwabiagya

Ejura Sekyedumase

Sekyere Afram Plains

Total

23

Diseases Earmarked for Eradication and Elimination


BURULI ULCER;
Cases of ulcer have reduced from over 350 in 2008 to below 200 in 2009.Seee figure 2.4
below
FIGURE 2.4
Trend of Buruli Ulcer cases, 2008 - 2010
Year

New

Recurrent

Clinical Forms
Nodules

Ulcer

Others

2008

235

24

36

164

2009

177

15

22

129

46

2010 Half Year

251

72

180

47

Trend of BU cases in Ashanti region, 2008-2010


300

250

251

238

200

177

new
recurrent

150

100

50

24

15

0
2008

2009

2010

24

Onchocerciasis
About 400,000 people at risk. Two hyperendemic districts, Offinso North and Asante Akim
South carried out CDTI activity with coverage of 81% and 79.3% respectively

TRENDS ON ONCHO(CDTI), 2008-2010


YEAR

COVERAGE(%)

2008

74.4

2009

74.5

2010

N/A

REMARKS

Two Hyper endemic


districts were dosed in
January. All endemic
districts will be dosed
in December 2010

Leprosy Cases:
The region registered some few new cases in the year. See figure 2.5 below:
Trends on Leprosy cases 2008 - 2010
Year

No. of cases

2008

44

2009

50

2010(HY)

26

25

H1N1 VACCINATION BY DISTRICTS


No
District
1 ADANSI NORTH
2 ADANSI SOUTH
3 AFIGYA KWABRE
4 AHAFO ANO NORTH
5 AHAFO ANO SOUTH
6 AMANSIE CENTRAL
7 AMANSIE WEST
8 ASANTE AKIM NORTH
9 ASANTE AKIM SOUTH
10 MAMPONG MUNICIPAL
11 ATWIMA MPONUA
12 ATWIMA NWABIAGYA
13 ATWIMA KWANWOMA
14 BEKWAI MUNICIPAL
15 BOSOME FREHO

COVERAGE
67.4
66.6
56.4
65.5
49.9
70.3
56.3
50.9
22.3
42.7
46.1
68.2
52.9
56.5
69.3

WASTAGE
2.5
1.8
18.4
5.1
15.0
1.3
5.3
7.5
9.7
5.6
2.6
1.3
32.3
0.2
1.4

AEFI
0
7
0
6
0
0
2
2
0
2
0
0
0
5
0

H1N1 VACCINATION BY DISTRICTS


No
District
17 EJISU JUABEN
18 EJURA SEKYEREDUMASI
19 MANHYIA SOUTH
20 ASOKWA
21 BANTAMA
22 MANHYIA NORTH
23 SUBIN
24 KWABRE
25 OBUASI MUNICIPAL
26 OFFINSO MUNICIPAL
27 OFFINSO NORTH
28 SEKYERE AFRAM PLAINS
29 SEKYERE CENTRAL
30 SEKYERE EAST
31 SEKYERE SOUTH
TOTAL

COVERAGE
36.4
25.3
32.8
16.3
61.0
64.9
279.2
59.5
61.8
61.1
36.7
51.3
53.2
66.2
65.5
58.5

WASTAGE
0.7
9.2
0.3
0.9
0.3
0.5
0.3
0.9
6.2
6.7
8.5
0.5
21.4
5.4
0.5
4.4

AEFI
0
0
0
2
2
0
0
0
0
0
0
0
3
0
0
31

26

YAWS FIGURE 2.6

27

OTHER ENDEMIC DISEASES:


TUBERCULOSIS

TB Case Detection
Indicator

2007

2008

2009

2010 Half

Regional Population

4,565,683

Expected # of Cases

12,830

9,583

9,910

10,219

2,011

2,101

2,106

1,101

16

22

21

11

1,181

1,269

1251

626

627

635

629

341

Relapses

71

70

74

42

Other RTR

28

58

37

21

104

69

74

43

41

28

Total Cases Detected


Case Detection Rate
New Smear Positives
New Smear Negatives

Extra Pulmonary
Others

4,720,916 4,881,738

Tuberculosis Surveillance Unit

5,033,938

28

TB TREATMENT OUTCOME
Indicator

2006

2007

2008

2009 HY1

Smear Positives

1,283

1,181

1269

650

1,033 (81%) 965 (82%) 1033 (81%)

504(78%)

Cured
Completed
Treatment Success Rate
Died
Failed
Default
Transferred Out

69

99

113

78

86%

90%

90%

90%

86 (7%)

83 (7%)

80 (6%)

42(6.5%)

49 (4%)

14 (1%)

24 (2%)

10(1.5%)

38

14

10

12

Tuberculosis Surveillance Unit

TB/HIV (2008-2010 HY)


Indicator

2008

2009

2010HY1

New Patients Diagnosed

2101

2106

1101

# Counseled

1493

1616

900

# Patients Tested for HIV

1305

1437

775

# of Patients HIV Positive

293

314

159

# Starting CPT

159

128

99

# Registered at HIV Clinic

112

171

77

# on ART

52

37

70

Tuberculosis Surveillance Unit

29

HIV/AIDS:
The table 2.10 below shows CT trend analysis of HIV/AIDS activities carried out in the Haly
Year 2010. See table below:

CT Trend Analysis,2008-2010HY
Indicators

2008

2009

2010HY

# Pretest
Counseled

16949

24794

8706

# Tested

16530

23631

8278

# Receiving
Positive Test
Results

2485

3718

2182

# Receiving
Posttest
Counselling

16530

23631

8278

PMTCT-Trend Analysis(2008-2010)
Indicators

Jan - Dec 08

Jan - Dec 09

Jan - Jun 10

# of ANC Registrants

78782

69919

42801

# Tested

62996

54031

33308

% Tested

80%

77%

90%

# Positive

1275

1141

850

# Given ARVs

1037

845

222

% Given ARVs

81%

74%

26%

30

MALARIA CASES:
Malaria control activities carried out in the year under review included training of health
staff on management of uncomplicated and complicated malaria as well as Malaria in
Pregnancy (MIP).
The policy on malaria is now on definitive diagnosis especially in persons above 5 years. As
a result Rapid Diagnostic Test (RDT) kits were provided to aid in diagnosis especially in
health facilities without microscopy.
Chemical sellers were also trained on home based care which included recognising
symptoms of malaria and knowing when to refer. There were also radio discussions on the
use of ITNs and recognising symptoms of malaria throughout the region.
With the support of Ghana Sustainable Change Project (GSCP), CBSVs, some districts were
able to train community leaders and religious leaders in communication skills to educate
community members on malaria, breastfeeding and on complementary feeding. The Figure
2.7 below shows 3-year trend of malaria cases recorded at Outpatient departments
throughout the region.

31

Total Malaria(2008-2010HY)
1000000
900000

858822

923521

800000
700000
600000

2008
2009
2010

500000
400000

301019

300000
200000
100000
0
CASES

Total Malaria admissions(2008-2010HY)


35000

33649

33706

30000
25000
20000
15000

12143

10000

2008
2009
2010

5000
0

ADMISSIONS

32

Total Malaria deaths(2008-2010HY)


179

180
160
140
120
100
80
60
40

66

2008
2009
2010

28

20
0

DEATHS

<5yrs Malaria Admissions(2008-2010HY)


14000
12000

13348
12114

10000
8000
6000

4778

4000

2008
2009
2010

2000
0

ADMISSIONS

33

<5yrs Malaria CFR(2008-2010HY)


0.058

0.06
0.05

0.042

0.045

0.04
2008
2009
2010

0.03
0.02
0.01
0

%CFR

IPT Trend(2008-2010HY)
90000
80000
70000
60000
50000
40000
30000

2008
2009
2010

20000
10000
0

IPT1

IPT2

IPT3

34

2.1.5 Strengthen disease surveillance, emergency preparedness and response


Surveillance activities were carried out at the various levels throughout the region.
Community Health Officers and community based surveillance volunteers played an active
role in disease surveillance activities in the districts
All CBSVs and health personnel were sensitized on the preparedness, such as CSM, HINI
and Measles and others. Clinician sensitization and records review were conducted on a
regular basis at the various health facilities. See table 2.11 below.
All suspected measles, tuberculosis and acute-flaccid paralysis cases were investigated.
Some blood samples and stool samples were sent to the Public Health Reference
Laboratory and Noguchi Memorial Laboratory for investigations respectively.
All Districts have been sensitized on the preparation of Epidemic Preparedness and
Response plans and the formation of District Epidemic Management Committees and
Response teams.
H1N1 Situation
Cases of H1N1 are being reported in the Region since the first cases in August 2009. By
28th July, there had been 110 suspected cases with 47 being confirmed positive. The main
reporting facilities are KATH, Kumasi South Hospital, MRS, St Michaels and KNUST
Hospital. Kumasi South Hospital and MRS are the regional designated Influenza Sentinel
Sites.
Two outbeaks have been reported in Asante Akim South and Bosome Freho districts and
these were in schools.
The region has substantial stocks of Tamiflu, but the challenge is the limited supply of Viral
Transport Media for collecting specimen.
Currently the region is free of sporadic cases though there is intensive surveillance on all
Influenza Like Illnesses.

35

LABORATORY SURVEILLANCE

CSM Surveillance
2006

2007

2008

2009

2010 HY1

# Tested

13

33

21

37

N. meningitidis A

S. pneumoniae

10

H. influenzae b

N. meningitidis C

Zonal Public Health Laboratory, Kumasi

Cholera Surveillance

# Tested
V/c Ogawa
V/c Inaba

2006

2007

2008

2009

2010 HY1

176

20

20

11

54

Zonal Public Health Laboratory, Kumasi

2.16. IMPROVE EARLY DETECTION, REPORTING AND MANAGEMENT OF NONCOMMUNICABLE DISEASES


Non-communicable diseases such as diabetes, hypertension, stroke, cancer that were
earlier attributed to developed countries are now becoming major causes of mortality,
morbidity and disability in Ghana.
36

THE UNDERLINING DETERMINANTS INCLUDE

High consumption of alcohol and nutritionally deficient food that are also high in fat,
sugar, and salt

Reduced levels of physical activity at home, at school and at work

Obesity and

Lack of rest and recreation

During the year under review diet related diseases clinic were set up in selected health
facilities to manage reported cases and to give counseling, Health and Nutrition talk to
clients visiting these facilities. In all 6,244 clients were seen and of these 3651 were
hypertensive, 1649 were diabetic, 682 had both conditions and 262 were obesed. After
analyzing their body mass index (BMI) 4140 females and 2004 males were seen.

Diet Related Diseases


DIET RELATED DISEASES - 2008- 2010

70

64.7

58.86

% No. of Cases

60

58.49

50

Diabetes

40

Hypertension

30

28.4

Diab-Hypertension

26.47

25.58

Obesity

20

10

10.34

4.1

0
2008

2.8

5.22

2009

10.92
4.2

1st Half 2010

YEAR

37

Year
Type of Disease

2007

2010 1ST
Half Yr

2008

No.

No.

No.

Diabetes

3357

28.40

3051

25.58

1649

26.47

Hypertension

7646

64.70

7022

58.86

3651

58.49

Diabetes-hypertension

486

4.10

1233

10.34

682

10.92

Obesity

316

2.80

623

5.22

262

4.20

Total

11805

11929

6244

2.1.7 Improve access to Quality Maternal, Newborn and Reproductive Health


Service
The vision of the reproductive and child health unit is to improve the health and quality of
life of persons in the reproductive age and beyond as well as children by providing high
quality reproductive and child health service.
Improving access to quality maternal, newborn and reproductive health service requires the
provision of focused Ante Natal Care (ANC), Supervised Delivery, Post Natal Care, Family
Planning Services, promotion of Exclusive Breastfeeding and Prevention of Mother to Child
Transmission (PMTCT) of HIV.
Antenatal Care
During ANC visits the Weight, Height, HB, Urine and Blood Pressure were checked by public
health unit of all facilities to detect any risks or complications associated with the
pregnancy.
The target set for ANC Registrants during the year was 90% while 83% representing a
decrease of 3.1% over the previous year. Operational research will be conducted in 2010 to
assess the reason for the downward trend. The table 2.14 below shows a three year
(2007-2009) trend of the coverage and registrants.

38

ANC Coverage, 2008 2010 Half Year


Trend of ANC Coverage, 2008-2010 half year

86.1

83

% COVERAGE

90
80
70
60
50
40
30
20
10
0

39.7

YEAR
2009

2008

2010

TREND IN LOW BIRTH WEIGHT


13.4

14
12

10.3

10

9.1

8
6
4
2
0
2008

2009

2010

39

% Caesarean section rate


12
10

9.6

10.6
8

8
6
4
2

0
2008

2009

2010

Trend in TT2+ coverage 2007-2010

90
80

81.8

71.5

70
60
50
40

33

30

20
10
0

2008

2009

2010

40

Clients with 4+ visits


23
22.8

26.3

27.5

2009

2010

22.8

22.6
22.4
22.2
22
2008

% COVERAGE

SKILLED DELIVERY, 2008-2010HY

50
45
40
35
30
25
20
15
10
5
0

49.4

47.5

20.5

2008

2009
YEAR

2010

41

Low Birth Weight and Still Birth


Year

LBW

Still Birth
Macerated

Fresh

Total

2008

9200

1080

777

1857

2009

11143

1341

631

1972

2010

3291

488

242

730

TREND IN STILL BIRTH


2.1

2.1

2.1

2.05

2
1.95

1.9
1.85

1.8

1.8
1.75
1.7

1.65
2008

2009

2010

FIGURE2.9
Supervised Delivery
This is done by skilled staff to ensure safe delivery of babies to reduce infant and maternal
mortality. However TBAs also conduct deliveries because there are not enough midwives.
Activities carried out include:

Midwives encouraged to use partograph to monitor progress of labour


42

Trained midwifery staff on resuscitation of the newborn.

Mothers were encouraged to practice exclusive breastfeeding after delivery for six
months and they were also given Vitamin A after delivery.

During the year a target of 60% was set .The region however achieved 49.4% which again
indicated a decrease of 5.9 % over the previous year. See the figure 2.10.
The low skilled delivery could be attributed to the low numbers of trained Midwives in the
facilities and in some cases the absence of Midwives in most of the rural clinics as a result
of diploma Midwives refusing posting to the rural areas.

Figure 2.10
Skilled Delivery, 2008 - 2010

% COVERAGE

SKILLED DELIVERY, 2008-2010HY

50
45
40
35
30
25
20
15
10
5
0

49.4

47.5

20.5

2008

2009
YEAR

2010

43

TREND IN STILL BIRTH


2.1

2.1

2.1

2.05

2
1.95

1.9
1.85

1.8

1.8
1.75
1.7

1.65
2008

2009

2010

Assisted delivery/EOC 2010


8

7
6
5
4
3
2

0.6

1
0
caesarian

vacuum

0
forceps

44

Post natal coverage 2008-2010


60

51.6

50

47.8

40
30
18.6

20
10
0
2008

2009

2010

Trend in FP acceptor rate


20
18
16
14
12
10
8
6
4
2
0

15.7

2008

17.5

7.4

2009

2010

45

Post Natal Care


This service has to do with a follow up care of both mother and baby to assess the mother
and babys health in order to detect any complications early and manage them promptly.
Mothers were sensitized to report within the 1st 48hrs. The coverage for the half year is
very low compared to 2008 and 2009. Efforts would be made to address this shortage. The
RHD as part of the LDP project assessed Pregnant womens perefection of Maternal Health
Services in the region and the findings and recommendations would be implemented for
improvement in health care quality.

Post natal coverage 2008-2010


60
50

51.6

47.8

40
30
18.6

20
10
0
2008

2009

2010

46

% Caesarean section rate


12
10

9.6

10.6
8

8
6
4
2

0
2008

2009

2010

FAMILY PLANNING
Family planning services are carried out to prevent unwanted pregnancies and help in the
reduction of maternal deaths. The acceptor rate for the previous year was quite low and as
part of measures to improve the rate, durbars were held in a number of districts e.g.
Kumasi Metro, Ahafo Ano South, Atwima Kwanwoma and Bosomtwe.
In Kumasi Metro, satisfied trained with support from Engender Health were used to give
testimonies about various methods.
To scale up the use of Jadelle, some districts namely Bosomtwe, Ahafo Ano South, Amansie
West and Atwima Kwanwoma in collaboration with the Metro Director of Health Services
trained a number of service providers in Jadelle insertion.
collaboration with Marie Stoppes International.

There was also close

There is an increasing demand for the

Jadelle. However the acceptor rate apperas to be low at 7.4% compared with 2009 figure
of 17.5%.
However there has being a steady increase in the number of males accompanying their
spouses to access reproductive and child health services.

47

MATERNAL DEATHS
Maternal deaths recorded for the half year is 67 which compare favourably with 177 and
222 in 2009 and 2008 respectively.This represents a significant reduction of maternal
deaths in the region. The regional maternal committee was re activated though it met only
once for the half year. A region wide sensitization of Safe Motherhood protocol has been
undertaken and this would enable practitioners handle emergency situations.
Reported Maternal Mortality 2008 2010
Institution

Death

G H S Institutions

18

KATH

49

Total

67

Maternal Deaths 1st Half Year


Institution

Death

G H S Institutions

18

KATH

49

Total

67

No. Audited

56

Not Audited

11

% Audited

83.6

48

CHILD HEALTH
Child Welfare Average Visits

CWC PARAMETERS
Children 0- 23 months
Year
Total Registrants
W/A <80%
Target Population
% Coverage
% Malnourished

2008

2009

1st Half Year


2010

299693

319642

205914

7837

5432

3716

372952

384606

398065

80.4

83.1

51.7

2.6

1.7

1.8

CWC PARAMETERS
Children 24- 59months
Year
Total Registrants
W/A <80%
Total Population
% Coverage
% Malnourished

2008

2009

1st Half Year


2010

96607

108810

75969

2540

2111

1642

405999

418683

433336

23.8

26.0

17.5

2.6

1.9

2.2

49

BFP PARAMETERS
2008

2009

1st Half Year


2010

Expected
delivery

188837

194736

201552

B.F < 1hr

41332

62386

31237

% Initiation

40

67.94

74.96

% M. Vitamin A

43

45.80

41.1

Year

50

BREASTFEEDING PROMOTION
Year
Total facilities
Designated
% BF

2008

2009

1st Half Year


2010

313 ( mat)

313 ( mat )

313 ( mat )

Nil

Nil

28

Twenty-eight (28) facilities awaiting assessment since


2004 have now been designated.

51

52

Iodated Salt Programme


Market & Household Survey
Year

2008

1st Half Year


2010

2009

May

Nov.

May

Nov.

May

% Availability

72.1

66.4

62.3

76.8

77.2

% Use

66.8

70.5

59.9

75.1

77.6

Target

90%

90%

90%

90%

90%

Nov.

90%

Promote the survival growth and development of all children


To ensure the survival and growth of children in the region, many activities including
exclusive breastfeeding for the first six months of life, complementary feeding, Vitamin A
supplementation, child welfare services, nutrition, and integrated management of child
hood illness were some of the key activities undertaken during the year.

53

Growth Monitoring & Promotion 0 - 23months


Year
Total Registrants
W/A <80%
Total Population
% Coverage
% Malnourished

2008
299693
7837
372952
80.4
2.6

2009
319642
5432
384606
83.1
1.7

2010 1ST Half Yr


205914
3716
398065
51.7
1.8

Growth Monitoring & Promotion 24 - 59months

96607

2009
108810

2010 1ST Half Yr


75969

2540

2111

1642

405999

418683

433336

% Coverage

23.8

26.0

17.5

% Malnourished

2.6

1.9

2.2

Year

2008

Total Registrants
W/A <80%
Total Population

Growth Monitoring & Promotion 0 - 59months


Year
Total Registrants

2008
396300

2009
428452

2010 1ST Half Yr


281883

W/A <80%

11282

7543

5358

Total Population

778951

803289

831401

% Coverage

50.9

53.3

33.9

% Malnourished

2.8

1.8

1.9

CWC % Malnourished & % Coverage for


children 0-59months

% Mal. & % Cov.

60

53.3

50.9

50
40

33.9

30

% Malnourished

% Coverage

20
10

2.8

1.8

1.9

2008

2009

1st Half 2010

Year

54

Mother Support Groups were established in communities to support breastfeeding activities


as well complementary feeding.
No.

District

1.
2.

No. of Mother
Support Groups
2
3

Offinso North
Amansie West

Communities where groups


are established
Nkenkaaso & Akomadan
Manso Kwanta, Antoakrom &
Agroyesum

Sale and promotion of the use of iodated salt was also carried out in majority of the
communities in the districts, in addition to surveys carried out in market areas, households,
institutions, restaurants and chop bars to assertain the status of the districts.
Iodated Salt Survey (Market & Household)
Year

2008

2010 1ST Half Yr

2009

Months

May

Nov.

May

Nov.

May

% Availability

72.1

66.4

62.3

76.8

77.2

% Usage

66.8

70.5

59.9

75.1

77.6

Target

90%

90%

90%

90%

90%

Nov.

90%

Iodated Salt Survey-May & Nov/Dec (Food Vendors, Chop Bars & Rest. &
Institution)
Year
No. collected,
Tested & %
Passed

Months

2008

No. Tested

Food Vendors

M
104
8

N
123
5

Institutions
Chop Bars &
Restaurants

86
111
5

158
129
2

% Passed

M
74.
5
81.
4
73.
5

2010 1ST Half Yr

2009

N
63.9
81.6
71.6

No.
Tested

M
N
13
32 1621
26
2
174
16
59 1574

% Passed

M
72.
5
80.
9
69.
6

N
76.3
83.9
69.3

No.
Tested

M
160
0
249
172
6

% Passed

M
72.
8
81.
9
79.
1

55

Lactation Management workshops were also organized in some district at selected facilities
for all staff to make the facilities baby friendly.

District

No.

Facility Trained

Trained

Offinso
North

Amansie
West

Category of

Resource

Staff & No.

Person

trained

Reg. & Dist.

Nkenkaasu Government

Nut. Off,

Hospital

All the Staff in


the facility
totaling 86

Midwife I/C

people

Reg. & Dist.

All the Staff in

St. Martin Hospital Agroyesum

Nut. Off,

the facility

& Antoa Health Centre

DCO, Midwife

totaling 76

I/C

people

All trained facilities were assessed by the National assessors for designation. On the 27TH of
July 2010, twenty-eight trained facilities in lactation management in Ashanti Region were
designated as Baby Friendly at Prempeh Hall in Kumasi.
Maternal Vitamin A Supplementation was carried out in all delivery facilities to boost the
Vitamin A levels in breast milk especially for postnatal mothers within eight (8) weeks of
postpartum. This would cater for the vitamin A needs of children 0-5 months of age who
are being exclusively breastfed.
Maternal Vitamin A
2008

2009

2010 1ST Half Yr

Expected Delivery

188837

194736

201552

BF<1HR

41332

62386

31237

% Initiation

40

67.94

74.96

% Mat. Vit. A

43

45.80

41.1

Year

56

Two rounds of Vitamin A supplementation was carried out for children 6-59 months of age
during the National Immunization days to boost the vitamin A levels in their bodies and also
to fight against infection. Children under 2 years of age were also given dewormers as a
measure to prevent anaemia.
Vitamin A supplementation (6-59mths)
Year

2008

Month

May

Target

Nov.

May

822183

Children Dosed

% Coverage

2010 1ST Half Yr

2009

Nov.

Apr

May

(NID)

(CHPW)

843726

865269

175655

833968

68628

759353

832389

10339

21.4

101.4

8.1

90

96.2

1.19

PROMOTE THE REDUCTION OF MALNUTRITION


A PUBLIC HEALTH AND DEVELOPMENTAL PROBLEM
During the year under review existing Rehabilitation centres in the Region were strengthen
to carry out their activities. Those that were dormant were reactivated to rehabilitate
malnourished cases seen in the community, With support from UNICEF, a workshop
organized for front line providers on the use of ready to use therapeutic foods, equipped
health officers with the technical know how on the preparation of the feed using locally
available ingredients.

57

Year

2008

2010 1ST Half

2009

Yr
Total No. of Cases seen

7651

4347

2135

Kwashiorkor

642

484

273

Marasmus

4780

2598

1308

Kwash-Marasmus

354

396

235

Anemia

1875

869

319

Rehabilitation Rate

34.0

62.7

74.9

Case Fatality Rate

0.41

0.60

0.80

Nutrition surveillance was also carried out in selected day care centres to determine the
nutritional status of the children. Nutrition and health talks on Breastfeeding, importance
of good weaning practices among others were given to mothers and caregivers so they
could take good care of these children in terms of their Nutritional needs.

% Underweight, Stunting & Wasting

NUTRITION SURVEILLANCE
14

13.1
11.5

12
10
9.7

8.1

9.5

% Underweight
% Stunting

% Wasting

5.2

2
0

11.8
2008

11
2009

1st Half 2010

YEAR

The Regional Health Directorate in collaboration with the District Health Management
Teams supported the school feeding programme at all levels. Several workshops were
organized for caterers and other stakeholders in charge of the feeding programme on menu
preparation, basic Nutrition etc.
58

The National Commission on children organized several seminars and workshops on early
childhood Development for all stakeholders of which the Ghana Health Service and the
Department of social welfare were part. The programme sought to improve upon the skills
and performance of day care attendance at day care centres. Food demonstrations were
organized in Kumasi, Sekyere East, Ejura Sekyereduamse and Asante Akim North with the
support of world vision International to show case the various balanced diets that can be
fed to children to improve upon their nutritional status. Resource persons included District
Nutrition officer and DHMT members. Topics treated included the three food groups, how
to combine them and the need to give fruits and vegetables.
IMMUNIZATION COVERAGE:
Routine immunization and NIDS were intensified in the half year of 2010 in all Districts
with supervision from the Regional Health Directorate. Some of the activities included
House to house immunization, defaulter tracing and mop-up.
EPI Activities Half Year 2010

Routine Immunization

Two (2) Rounds of NID

H1N1 Vaccination

There has been appreciable increase in EPI coverage in all the antigens. The main
improvement was from Kumasi Metro where various strategies were implemented to boost
the coverage.
On other hand the BCG/Measles drop out is way above the accepted value of 10%.
However the NIDs carried out throughout the year were successful and this goes on to
ensure the regions fruitful fight towards Polio eradication.

59

BCG PERFORMANCE BY DISTRICTS

BCG PERFORMANCE BY DISTRICTS

60

Penta 3 Performance by Districts

Penta 3 Performance by Districts

61

Measles Performance by District

Measles Performance by District

62

NIDS
NIDS

Target
Population

Total
Vaccinated

Coverage

ROUND 1

950,190

1,000,927

105.3%

ROUND 2

950190

977,507

102.9

Children missed between March and April NIDS - 23,420

2.2.0 Improve access and quality of oral health services


Improving access and quality of oral health services is one of the major key activities of the
clinical care services. However, except KATH, Kumasi South and Suntreso Hospital there is
no such facility in most of the District Hospitals.
During the year under review Kumasi South and Suntreso Hospitals treated 2034 and over
9,140 dental patients respectfully. The type of cases recorded was: Periodontal diseases,
Apical trauma, Impacted teeth, Oral tumours and Gingival and tongue ties
2.2.1 Improve access and quality of eye care services
Reduction of blindness and low vision is generally the main objective of the eye service .
During the year under review the eye care centre of the Regional Hospital screened and
treated various types of eye conditions. See table 2.20 below.

63

CHAPTER THREE
3.0 Strategic Objective 3- General Health System Strengthening

3.1.1 Develop and use information technology to improve information


management and service delivery
The Region has an ICT Unit. The key role was to supervise and prompt repair of ICT
equipment as and when they broke down. During the year Unit installed and configured 10
new ICT equipments brought to the Regional Health Directorate including the installation of
anti virus software for the districts who had procured some computers.
The use of the District Health Information Management System (DHIMS) software to
process and analyze health service data has improved access to timely and accurate
information. It has enhanced planning, management and evidence-based decision making
at all levels of health service delivery. All the 27 districts were trained and are currently
using the DHIMS in managing their data. The data submission rate as at the time of
collating this report had increased.
The National Health Insurance Authority has also provided health facilities within the
Region with a computerized networked clients registration system.
Most ofl the districts are currently connected to the World Wide Web internet system and
have greatly enhanced information management and accessibility.
3.1.2 Improve human resource recruitment, deployment and retention and
management
As part of measures put in place by the health sector, quota systems of staff distribution
were given to Regions for the engagement of clinicians and other Technical Staff based on
the needs of Regions and the availability of the professionals.
Based on that directive the region conducted formal placement interviews together with
CHAG officials for the recruitment some key staffs.
In the case of the Doctors those who completed the placement forms wanted to work in
CHAG facilities even though there were vacancies in the GHS quota whereas the CHAG
quota had been exceeded. The Region formally expressed concern about this situation to
the national level.

64

A posting committee was set up to review and submit recommendations to the Regional
Director, all request for study leave.
HUMAN RESOURCE SITUATION
The total regional staff strength in 2009 was 4952 as against 4192 in 2008. See Table 3.1
below.

Manpower Situation

Total staff
Retired
Death

June 2009

June 2010

4, 386

4,748

23

21

Resignation

Vacation of Post

65

Retirement 1st Half Year 2010


Staff Category

No

District

Nurse

Kumasi , Mampong

Midwives

Ejisu, Bekwai (2), Kumasi, Mampong

Accountant

RHD, Ahafo Ano North

Dispensing Assistant

Asante Akim South

Orderly

Amansie West

Security

Kumasi, Atwima Nwabiagya (2)

Medical Assistant

Atwima Mponua. Amanise West

Technical Officer

Ahafo Ano North, Ejura Sekyedumase

Storekeeper

Adansi South

Health Assistant

Offinso Municipal

Driver

Kumasi

Total

21

Appointment and Placement of Newly Qualified Health


Professionals Ashanti Region 2010
Category

Regional
Quota
150

Total No of
Applicants
486

No Selected

Staff Nurse
Staff Nurses ( Mental)

90
9

188
21

92
9

Staff Midwives
Technical Officer (HI)

20
3

62
13

22
5

Technical Officer (CH)

13

29

13

9
160

12
530

6
178

Community Health Nurses


Diploma Community Health
Nurse
Medical Assistant

Field Technician
Medical Officer
Health Assistant Clinical

159

CHALLENGES
The constraints the Region faced in the management of Human Resource included the
following:
1. Inadequate clinicians (Doctors, Medical Assistants and Midwives)
2. Large number of staff applying for study leave
66

3. Large number of Casual appointees in facilities.


4. Ageing work force (Midwives especially)
5. Increasing numbers of staff with intention to pursue higher education

3.1.3 Expand infrastructure to support effective and efficient service delivery at


all levels
In spite of being the Region with the largest population in the Country, Ashanti has not had
a befitting Regional Hospital. The Kumasi South Urban Health Centre has for some time
being referred to as the Regional Hospital for Ghana Health Service in the Region. The
status of this facility which is below that of a District Hospital does not come anywhere near
that of a Regional Hospital.
Again only two of the facilities referred to as District Hospitals in the Region were put up
purposely as District Hospitals.
The Region has continued to carry out advocacy for the construction of a Regional Hospital
and District Hospitals especially in the newly created Districts which do not have Hospitals.
A priority list for the construction of District Hospitals in the Region was developed. The
priority list for the construction of District Hospitals in Ashanti outside the areas mentioned
earlier is as follows:
1. Adansi North
2. Bosome Freho
3. Sekyere Afram Plains
4. Sekyere Central
5. Atwima Kwanwoma
6. Afigya Kwabre
7. Amansie Central

67

On-going projects
Project

Location

Contractor

Consult

Works
done

Upgrading of Old Tafo


Polyclinic to
District Hospital

Tafo

Konneh Ent

BIC

68%

Upgrading of Manhyia
Hospital - Construction
of OPD Block

Manhyia

Consar Ltd

ACP

68%

Construction of
Coldchain Room

Abrepo
Junction

Al-Raxmak

Ocads

40%

Staff Accommodation
The availability of residential and office accommodation in both the Regional and District
level is a factor that helps to attract qualified critical personnel to enhance improvement in
Service delivery. We did not make much progress in this area. An eight (8) flat residential
accommodation block at Bantama in Kumasi has not seen any additional works within the
last three (3) years due to lack of funding. The situation is similar in the Districts. There are
quite a number of abandoned projects in the region and it is hoped that capital investments
would be made available to complete them.

68

Suspended Projects
Project

Location

Contractor

Consult

Works
done

Rehab/Expansion (Const of
Wards)

Kumasi
South

Konneh Ent

BIC

68%

Const of 3 B/room staff quarters

Kumasi
South

Rafcofe Ent

BRRI

85%

Const of 4 storey 3 B/room staff


qters

Abrepo
Junction

Duocon
Services

Ocads
Consult

60%

Const of DHMT Office

Ejura

Gyaba Const

AESL

60%

Const of 2 storey
Adm/Pharm/Lab Blk

Ejura

Gyaba Const

AESL

75%

Construction of Cold Chain Room, Abrepo

69

Planned Projects
Projects

Location

Remarks

Regional Hospital

Sewua

Procurement in
Process

District Hospitals

Bekwai
Konongo
Tepa

Stakeholders levels

DHMT Blocks

All newly created


districts

3.1.4 TO IMPROVE SUPPLY AND EQUIPMENT MANAGEMENT


Most of the equipment in the facilities were old and therefore part failure and ageing
constituted major causes of equipment breakdown. However with the Planned Preventive
Maintenance Program that was in place and an active response to service calls from the
Clinical Engineering Unit, our facilities were able to use the equipment to render fairly
uninterrupted medical care to the people.
The Region had also in previous years submitted a request to the National Level for basic
equipment requirements to support our vision of no tolerance for maternal deaths. Follow
ups revealed that the new equipment could be available in 2010.
The introduction of job card system and Medical Equipment tracking system by the Clinical
Engineering Unit in the course of the year are good practices that enhanced better
management of the equipment. Again, the offices in the Unit were able to come up with
local modifications to keep some of the equipment working. The Unit was also able to
design and construct basic medical equipment like Phototherapy Unit for some Hospitals.

70

EQUIPMENT INSTALLATION
NO

INSTITUTION

EQUIPMENT

LOCATION

QUANTITY

ASONOMASO

UNIVERSAL OPERATING
LAMP
DELIVERY BED

THEATRE
MATERNITY

1
1

TABLE TOP AUTOCLAVE


CEILING THEATRE LAMP

THEATRE
THEATRE

1
1

ANGLE POISED LAMP


FLOOR MOUNTED OP LAMP

THEATRE
THEATRE

1
1

SURGEON STOOL
MAYO TABLE

THEATRE
THEATRE

2
1

PATIENT TROLLEY
SUCTION MACHINE

THEATRE
THEATRE

1
1

AUTOCLAVE
THEATRE LAMP

THEATRE
THEATRE

1
1

NKAWIE

CYCLINDRICAL AUTOCLAVE

THEATRE

TAFO

NEBULIZER

WARD

3.1.5 Improve supply of essential medicines and essential commodities


The regional health directorate through prudent procurement planning has been able to put
structures in place to procure essential medicines, pharmaceutical raw materials, non
medicine consumables to ensure the availability of quality health commodities at affordable
cost.
Procurement activities are carried out through the National Competitive Tendering Method
of procurement.
The process is carried out twice a year. Advert is placed in the news papers to invite
potential suppliers to tender in their bids for consideration.
CHALLENGES
Money has been a problem as health facilities are not able to pay the RMS when they
collect the medicines and non-medcines commodities. This is because of delays in the
payment of medical bills by the National Health Insurance Schemes.
The regional medical store has to cut down what to buy, and this really affects the supply
of essential medicines and commodities to the health facilities.

71

3.1.6 Improve transport availability and management


In the beginning of 2009 the Region disposed of 113 motorbikes and 43 vehicles which
were mostly over aged, very expensive to maintain when some were off road and just
increased the numbers on the Regions inventory of vehicles. The Region had in previous
years gone through the process for the disposal of the vehicles and motorbikes. While 200
new motorbikes were assembled and distributed to facilities in the Region as part of the
motorbike revamping project, only 4 new pick ups were received in the Region in the
course of the year. See TABLE.3.2 below

Fleet Inventory by type


Vehicles
Saloon
Station Wagon
Ambulances
Pick - ups
Water Tank
Haulage Trucks
Bus
Total
Motorbikes
Boat

2009
1
3
16
58
0
1
2
81
331
1

2010
0
3
20
89
0
1
2
115
531
1

72

Fleet Situation
Ages
Vehicles

2009

2010

1-5 yrs

26

32

63

55

Green

6-9 yrs

47

58

37

32

Yellow

10 yrs +

10

15

13

Red

81

100

115

100

1- 3 yrs

221

67

392

74

Green

4 6 yrs

91

27

110

21

Yellow

6 yrs+

19

29

25

Red

Total

331

100

531

100

Total

Zone

M/Bikes

Ambulances
Five (5) of the Twelve (12) facility based ambulance in the Region were in good condition
while five (5) of the rest could be said to be in fair condition. The other two (2) were off
road. Ten (10) facilities are in urgent need of ambulances in the region.
Boat Service
The only natural lake in the Country is in the Ashanti Region. The only boat that is utilized
in support of service delivery is nine (9) years old. This boat like some of the vehicles in the
Region is in red zone and needs to be replaced with a fibre glass boat. There is also only
one coxswain on the boat. There is the need for the organisation of regular survival training
for staff in the area to cover new staff in the District.
Drivers
About 48% of the drivers in the service were between 50 and 60 years old. Only 14% of
the drivers were below 40 years old.

73

FIGURE.3.4

Drivers Situation
2009

2010

39 & below
yrs

11

14

11

Green

40- 49 yrs

30

38

29

36

Yellow

50 60 yrs

39

48

42

53

Red

Total

80

100

80

100

Age Range

ZONES

Year

2009

2010

Driver Vehicle Ratio

1:1.0

1: 1.5

74

Promote Research and Development


The Regional Health Directorate undertook a baseline survey to assess the CHPS situation
in the region. The key findings were that CHPS is much active in the rural districts as
compared to the urban and preiurban districts.

Current CHPS Status


INDICATOR

NUMBER

No of sub districts

133

DHMTs trained

No of Demarcated Zones

341

No of CHPS Zones

171

No of functional CHPS
compounds

36

Roll Out Plan(2010-2015)

75

Social Amenities at CHPS Compounds

Capacity of CHPS

76

Way Forward
Appointment of District CHPS Focal Persons
Formation of Community Health Management
Committees(CHMC)
Training of CHMC
CBRDP districts- ASS, OFM, AAS, AAN, AMC,
ATN, ATM
GHS/MOH financing of 2 CHPS compounds
per district
108

Community Health Management


Committee
Community Health
Officers (CHO)
Chief(Rep of Traditional
Authority)
Sub District Leader
Queen mother
Herbalist
Teacher

TBA
Volunteer (s)
Chemical Seller
Agric Extension Officer
Environmental Health
Assistant
Assembly Member
Womens group Leader
Other opinion leaders

109

77

Health Promotion
Mabel Kissiwah Asafo appointed as new
Regional Health Promotion Officer
Review a draft strategic document on Health
Promotion on the 1st and 2nd March, 2010

Activities 1
Celebration of World No Tobacco Day
May, 24th is World no tobacco day
Radio talk show on Nhyira FM on tobacco use
and its effect on the users. Time was allowed
for phone -in where people raised various
concerns about tobacco and were addressed
accordingly

78

Activities 2
Production of Materials on Pandemic Influenza
H1N1
Jingles produced and aired on Nhyira FM &
Garden City FM.
Jingles aired for two months
Audio CDs produced for distribution to all the
districts for continuous education at the OPDs
and communities.

Activities 3
Tuberculosis Training
The unit in collaboration with Metro TB
coordinator trained information services
department staff on TB.
All district representatives of the service were
present.
They were also given recorded messages on
TB to aid their public education.

79

CHAPTER FOUR
4.0 Strategic Objective 4- Governance, Partnership and Sustainable Financing

4.1.1 Strengthen management systems


The Regional Health Directorate organized Monthly Health Management meetings through
out the year. During the meeting, issues bordering on the management of health services
at the various levels were discussed and amicable solutions arrived at. Weekly core
management meetings were also held to plan health programmes and activities.
The same process was replicated at various District and facility levels. Core management
and various committee meetings were held to ensure the effective running of facilities.
Quarterly staff durbars were also organized in the various facilities to identify staff needs
and promote the involvement of staff in the decision-making process.
As part of strengthening management and leadership skills, Regional health management
team members as well as their counterparts from the Districts participated in a six-month
training program on Leadership Development Program organised by the Ghana Health
Service in partnership with Management sciences for Health (MSH). The training treated
topics like:
1. The tools of effective management (Scanning, focusing, aligning etc.)
2. The mission and vision
3. Improving work group climate.
4. The challenge and how to address the challenge
5. Changing complaints into request
6. Coaching
7. Breakdowns and other topics

80

4.1.3 Establish performance monitoring framework and reporting system for


organizational accountability
During the year under review the Region could not undertake any integrated monitoring to
the districts and health facilities. However some Regional BMCS such as the clinical care
and the public health units carried out some form of facilitative supervision to DHMTS ,
Sub-districts and all the facilities during the year.
Half yearly Performance reviews were organized during the year in collaboration with key
stakeholders. Performance indicators of the various districts and regional programmes were
critically examined to identify weak areas and also to outline strategies needed to improve
service delivery.
Teams from National level visited the Region to monitor and supervise the performance of
both clinical and public health activities.
Monthly reports were submitted regularly to National Health Directorate and feedback
received especially from the public health directorate.

4.1.4 Mainstream gender and ensure equity in health programmes


In all our activities in the region, gender issues were critically taken into consideration.
During the year under review staffs from the regional training unit of the regional health
directorate undertook some training in gender mainstreaming. It is hoped that orientation
would be given to key staff in the period ahead so that gender issues would be inculcated
into health service planning and provision in the municipal.
4.1.5 Develop mechanism to achieve effective intersectoral collaboration
In all our health service delivery systems collaboration with stakeholders was pursued to
improve access and quality of care.
Advocacy meetings were held with stakeholders such as Ghana Education Service,
Traditional rulers and Ministry of Food and Agriculture and NGOS
Private sector collaboration was also enhanced by inviting staff in some facilities to
workshops organized by the Regional health Directorate. Regular feedback on regional
activities was also communicated in the form of reports to them.
Metro, Municipal and District Assembly meetings were regularly attended which provided a
forum to raise issues of health concern. They are also briefed regularly on health events.
81

Priorities /WAYFORWARD FOR 2010


The under-listed items of priorities would constitute the regional plan of action for 2010.
The priorities are:

Addressing the issue of delay in data capture and submission

Addressing high number of still birth

Investigating all maternal deaths and instituting measures to limit avoidable


causes

Promoting healthy lifestyle to reduce high incidence of hypertension and


diabetes mellitus.

Promote good linkage with NHIS to reduce delays in the payment of medical
bills to the health facilities

NEXT STEPS
1. Schedule for RHMT/SMC Meetings for 2010
2. Regional staff awards
3. Schedule for Regional Staff appraisal
4. Schedule for monitoring and support visit to facilities
5. Workshop on ATF rules
6. Orientation and induction for newly recruited staff
7. Submission of hard/soft copy of Annual Reports to National by the end of March
10. Refresher training on DHIMS for data managers
11. Refresher training course for motorbike riders
12. Ensuring that all facilities have Quality Assurance (QA) and Drug and Therapeutic
Committee (DTCs) in place

82

APPENDIX 1- Trend in Performance Indicators 2008 - 2010 HALF


Objective

Indicators

Healthy
lifestyle

2008

2009

2009

2010

Actual

Target

Actual

Half
Actual

and

healthy
environment
Availability

of

communication

80

100

100

80

60

100

80

60

NA

NA

10

2660

2660

180

180

NA

strategy and materials at health


facilities
% of facilities providing screening
and counselling services
# of inter-sectoral meeting on
RHN
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
#

of

schools

with

health

2550

programmes
# of health workers oriented in

50

ALL

RHN
#

H/Workers
of

community

volunteers

NA

% of facilities with functional

NA

oriented on RHN
10

occupational health services

Objective

Indicators

2008

2009

2009

2010

Actual

Target

Actual

Half
Actual

83

Health,

Institutional maternal mortality

222 (253)

180

177 (189)

67

% of maternal deaths audited

86.9

90

162 (91.5)

56

Reproduction
and

Nutrition

Services

(83.6)
% of facilities with functional customer

NA

100

50

50

60

100

75

# of facilities with functional Q.A system

10

25

15

15

% of facilities with adverse incident

NA

100

85

90

Non-polio AFP rate

0.79

1.2

1.4 (48)

0.7 (29)

% increase in completeness of reporting

95

100

80

90

95

100

100

90

18.5

81

80

6/27

4/27

8/27

TB case detection rate

2101(22)

2106(21)

1101(11)

TB treatment success rate

90

90

COHORT

90

# of lymphatic filariasis cases

Hiv + clients receiving ARV therapy

1290

1182

1286

# of cases of guinea worm

% of district with functional facility based

30

19

29.6

care services
% of client satisfied with health care
services

monitoring register/guidelines in places

increase

in

timeliness

and

completeness of reporting
% of hospital with functional public health
units
Proportion of districts with functional
facility-based ambulance

ambulance
% district with functional EPR teams

100

80

%ANC coverage

90

83

83

39.5

# of health facilities that are youth

28

40.8

60

60

20.5

% PNC coverage

51.6

55

41.3

18.6

% of pregnant women attending at least

22.8

60

26.8

friendly
% of deliveries attended by trained health
workers

4 prenatal visits

84

% WIFA accepting FP

15.7

17

17.5

7.5

% of children receiving Penta 3

77

100

83.7

41.6

N/A

of

children

0-6months

exclusively

N/A

breastfed
% of facilities offering basic EOC

100

100

74

74

% of facilities offering Comprehensive

100

100

74

74

EOC
% of children 6-59months receiving VAC

101.4

90

97.3

Number of specialist outreach services

NA

NA

NA

# of dentist

#of oral health nurse

# of surgeries performed

17399

24361

14902

conducted

85

Objective

Indicators

2008

2009

2009

2010

Actual

Target

Actual

Half
Actual

General Health

# of facilities network through

NA

NA

NA

NA

System

hospital computerisation

Doctor population ratio

46281/1

42450/1

31157/1

39153/1

Nurse population ratio

3523/1

3315/1

3414/1

7215/1

OPD per capita

0.7

0.8

0.8

0.4

Equipment performance index

100

100

88

% of population living within 8km

60

100

80

80

# of functional CHPS zone

36

36

Tracer drugs availability

98

100

86.8

Fleet performance index

NA

NA

NA

NA

in

NA

57

57

71

% of functional district health

NA

100

40

40

% of functional hospital board

NA

NA

NA

NA

NA

100

80

Strengthening

of health infrastructure

Governance,

of

managers

trained

Partnership

leadership programme

and
Sustainable
Financing

committees hospital board

sub-district

that

have

autonomy to manage their funds


% of staff appraised
%

BMCs

with

performance

NA

NA

NA

contracts
# of staff trained in gender
mainstreaming
Per capita expenditure on health
Proportion of NHIS claims settled

4.55

4.55

52

64

62

within 4 weeks
%non

wage

GOG

budgets

allocated to district level

86

% of annual budget allocation to

52

76

39

% IGF generated from NHIS

78

87

86

% of IGF to total budget

80

90

89

# of audit queries

NA

NA

NA

NA

NA

NA

10

items 2 and 3 (GOG and HF/


SBS) disbursed

allocated

budget

utilized

according to approved plan


% GHS budget contributed to by
NGOs/CBOs/FBOs/HPs

APPENDIX 1- Trend in Performance Indicators 2007- 2009


Objective

Indicators

Healthy
lifestyle

2007

2008

2009

2009

Actual

Actual

Target

Actual

and

healthy
environment

87

Availability

of

communication

80

80

100

100

50

60

100

80

NA

NA

NA

NA

10

1979

2550

strategy and materials at health


facilities
% of facilities providing screening
and counselling services
# of inter-sectoral meeting on
RHN
# of CSOs and other stakeholders
oriented and collaborated with to
provide RHN interventions
#

of

schools

with

health

2660

programmes
# of health workers oriented in

50

ALL

RHN
#

180

H/Workers
of

community

volunteers

NA

NA

of facilities with functional NA

NA

NA

oriented on RHN
%

10

occupational health services

Objective

Indicators

2007

2008

2009

2009

Actual

Actual

Targe

Actual

t
Health,

Institutional maternal mortality

179 (246)

222 (253)

180

177 (189)

% of maternal deaths audited

84.4

86.9

90

162 (91.5)

NA

NA

100

50

Reproduction
and

Nutrition

Services

% of facilities with functional customer

88

care services
% of client satisfied with health care

NA

60

100

75

# of facilities with functional Q.A system

25

10

25

15

NA

NA

100

85

Non-polio AFP rate

0.79

0.79

1.2

1.4 (48)

% increase in completeness of reporting

95

95

100

80

% increase in timeliness and completeness

95

95

100

100

18.5

18.5

81

11/21

6/27

4/27

TB case detection rate

2011(16)

2101(22)

2106(21)

TB treatment success rate

86

90

90

COHORT

# of lymphatic filariasis cases

Hiv + clients receiving ARV therapy

695

1290

# of cases of guinea worm

18

% of district with functional facility based

62

30

% district with functional EPR teams

100

80

%ANC coverage

76

86

90

83

17

28

40.8

47.5

50

49.4

% PNC coverage

50.6

51.6

55

41.3

% of pregnant women attending at least 4

22.7

22.8

60

26.8

% WIFA accepting FP

15.1

15.7

17

17.5

% of children receiving Penta 3

74.3

77

100

83.7

N/A

N/A

% of facilities offering basic EOC

100

100

100

74

% of facilities offering Comprehensive EOC

100

100

100

74

% of children 6-9months receiving VAC

99.7

101.4

90

Number of specialist outreach services

NA

NA

NA

services

of

facilities

with

adverse

incident

monitoring register/guidelines in places

of reporting
% of hospital with functional public health
units
Proportion

of

districts

with

functional

facility-based ambulance

1182
0

2
19

ambulance

# of health facilities that are youth friendly


% of deliveries attended by trained health
workers

prenatal visits

of

children

0-6months

exclusively

N/A

breastfed

89

conducted
# of dentist

#of oral health nurse

# of surgeries performed

11005

17399

24361

90

Objective

Indicators

2007

2008

2009

2009

Actual

Actual

Target

Actual

NA

NA

NA

NA

Doctor population ratio

46589/1

46281/1

42450/1

48334/1

Nurse population ratio

3349/1

3523/1

3315/1

2271/1

OPD per capita

0.5

0.7

0.8

0.8

Equipment performance index

100

100

100

88

% of population living within 8km

60

60

100

80

# of functional CHPS zone

31

Tracer drugs availability

97

98

100

86.8

Fleet performance index

66

60

100

86

in

NA

NA

57

57

% of functional district health

NA

NA

100

40

% of functional hospital board

100

100

100

100

% sub-district that have autonomy

NA

NA

100

80

NA

NA

NA

Per capita expenditure on health

482P

2.46

4.55

Proportion of NHIS claims settled

50

52

64

General

# of facilities network through

Health

hospital computerisation

System
Strengthening

of health infrastructure

Governance,

of

managers

trained

Partnership

leadership programme

and
Sustainable
Financing

committees hospital board

to manage their funds


% of staff appraised
%

BMCs

with

performance

contracts
#

of

staff

trained

in

gender

mainstreaming

within 4 weeks
%non

wage

GOG

budgets

allocated to district level

91

% of annual budget allocation to

52

76

items 2 and 3 (GOG and HF/ SBS)


disbursed
% IGF generated from NHIS

61

78

87

% of IGF to total budget

84

80

90

# of audit queries

26

NA

utilized

NA

NA

NA

% GHS budget contributed to by

NA

NA

allocated

budget

according to approved plan

NGOs/CBOs/FBOs/HPs

SECTOR WIDE INDICATORS 2007-2010 HALF

2007
Indicators
Actual
Number of Infants deaths
Institutional
2,602
Number of Infants admissions
Institutional
6,285
Number of under five deaths
Institutional
3,018
Number of under five admissions
Institutional
24,941
Maternal Mortality ratio
Institutional (per 100,000 LBs)
246/100,000
Number of Under five years who
are under weight presenting
under facility & Outreach
% Under five years who are
underweight Institutional
13.5

2008

2009

2009

2010 Half

Actual

Target

Actual

Actual

2,280

2,000

2,460

331

6,133

6,000

8,647

5012

3,202

3,000

2,700

908

19,656

19,000

25,160

18947

253/100,000

200/100,000

189/100,000

167/100,000

16,872

16,000

14,005

8930

11.8

11.7

7.0

11.0

Number of outpatient visits

2,809,681

3,140,880

3,900,000

3,500,286

2,041,603

Outpatient visits per capita

0.5

0.7

0.8

0.8

0.4

117,326

138,484

140,000

140,557

85669

26

29

30

32

16.9

82
90

COHORT
COHORT

82
90

81
90

78
90

Number of admissions
Hospital Admission rate
Specialist Outreach
Number of specialist visits
received from the national level
Number of patients seen by
national team
Number of operations performed
by national team
Disease Surveillance
TB cure rate
TB Treatment Success Rate

92

HIV prevalence (among


pregnant women)

3.2

2.9

2.55

No. of guinea worm cases seen

18

No. of AFP cases seen

17

27

30

48

29

797,748

964,545

950,000

900,000

773,389

160,478
15.1

171,988
15.7

180,000
17

166,131
16

72,706
7.5

139,082
76
25.9
92,397
50.6

162,607
86
41
97,351
51.6

175,742
90
41
102,305
55

150,461
83
67,158
89,070
40.4

78,792
39.5
37,592
37,130
18.6

74,507

89,753

98,999

17,961

40,786

40.8

60

60

60

20.5

100,241

113,453

120,666

83,924

40,923

40.8

60

60

60

20.5

10

36

36

77
72
72
78

81
77
77
79

85
80
80
82

84
83.6
83.7
87.1

44.4
41.6
41.6
43.5

10,914

13,348

14,000

21,160

16,194

151

193

180

162

56

Total number of maternal deaths

179

222

200

177

67

% maternal death audits


Total number of Under five
deaths due to malaria
Under five malaria case fatality
rate
% Tracer Drugs available out of
the tracer drug list at the
Regional Medical Store

84.4

86.9

90

91.5

83.6

139

121

100

146

35

0.05

0.06

0.06

0.04

0.05

97

98

100

98

Total Number of TB Cases Cured

965

COHORT

AFP Non-Polio AFP rate


(/100,000 population under 15

0.79

1.2

Total number of malaria cases


Diseases targeted for
Elimination
Lymphatic filariasis treatment
coverage
Reproductive & Child Health
Safe Motherhood
Number of Family Planning
Acceptors
% of WIFA accepting FP
Number of ANC registrants
% ANC coverage
% ANC registrants given IPT2
Number of PNC registrants
% PNC coverage
Number of Supervised Deliveries
(includes deliveries by trained
TBAs)
% of Supervised Deliveries
Number of deliveries by skilled
attendants
% of Deliveries by Skilled
Personnel
CHPS
No. of functional CHPS zones
Child Survival
EPI coverage Penta 1 (%)
EPI coverage Penta 3 (%)
EPI coverage OPV3 (%)
EPI coverage Measles (%)
Total number of Under five
malaria cases Admissions
Number of maternal deaths
audited

361

504

2.05

0.7

93

years
Revenue Mobilization
IGF (bn)
Cash & Carry
NHIS
GOG Subsidy ((bn))
Health Fund ((bn))
MOH Programmes (Earmark
Funds) (bn)
District Assembly Common
Fund(bn)
Other Sources e.g. Financial
Credits, HIPC (bn)
Expenditure by Item
Item 1: Personal Emoluments
(bn )
Item 2: Administration Expenses
(bn )
Item 3: Service Expenses (bn )
Item 4: Investment Expenses
(bn )
Number of doctors
Population to doctor ratio
Number of nurses
Population to nurse ratio

11,407,149

162,446
105,446

21,177,134
4,636,084
16,250,601
620,497
0

24,353,704
5,331,497
19,022,207
713,572
0

3,288,926
12,212,000
183,487

12,890,204.98
1,760,368.11
11,129,836.87
220,990.61
144,925.92

1,941,027

1,701,703

1,936,958

1,184,749

1,423,131.50

10,000

41,500

15,000

115,869

4,052,101

0
0

0
0

15,000
15,000

178,790
295,468

106,256,.94
70,314.80

0
98

32,344
102

37,196
115

143

0
129

46,589/1

46,286/1

42,450/1

31,157/1

39153/1

1,529

1,711

1,911

1,305

700

3,349/1

3,523/1

3,315/1

3,414/1

7215/1

94