Embed Size (px)
Citation preview
Offinso
Ejura Sekyedumasi
Kwabre
Sekyere West Sekyere Eest
Asante-Akim North
Amansie West Amansie Eest
Obuasi
Adansi South
1
1.0 INTRODUCTION
1.1 REGIONAL PROFILE 1.1.1 Location
Ashanti Region has a land size of 24,390sq km, which is about 10.2% of the land
area of Ghana. The region in its nodal structure share common boundaries, to
the north with Brong Ahafo; to the south with Central Region, to the east with
Eastern Region and to the west with Western Region. It lies approximately
between longitude 0.15’ to 2.25’ west and latitude 5.50’ to 7.40’ north.
1.1.2 Demography
Ashanti is the most heavily populated region in Ghana, with a population of
4,415,554 for 2006 (Projection from the 2000 Housing and Population Census,
Ghana Statistical Service). Kumasi has the highest population of 1,430,241
(32.4%) of the regional total. About 47% of the populations are in the rural
areas. The region has a population density of 163.8 per sq. km. The region has a
large proportion of hard to reach areas especially in the Afram Plains sections of
Sekyere East, Ejura Sekyedumase, Sekyere West and Asante Akim North
districts. Three new districts namely Adansi North, Atwima Mponua and Amansie
Central were created in 2005. This has raised the number of districts to twenty-
one (21) districts with 114 sub-districts.
1.1.3 Vegetation
The vegetation is broadly classified into two: Semi deciduous forest and Guinea
Savanna woodland. The average annual rainfall is about 166.7cm (66 inches)
and the temperature is generally high, averaging over 27°C in the forest zone
and 29°C on the northern fringes of the forest zone. The humidity is relatively
high, averaging about 85% in the forest area and 65% for the Savannah belt.
2
1.1.4 Culture
Ashanti Region has 33 traditional councils and each is headed by a
Paramount Chief. All these Paramount Chiefs in turn owe allegiance to
Otumfuo, the Asantehene. The region is often referred to as the seat of
the country’s culture due to the fact that several items that portray the
Ghanaian culture like pottery, kente weaving, wood carving, traditional
sandals, beads, smithing and a lot more can be found in the Region.
The main economic activity in the region is agriculture. Major crops grown
include cocoa, oil palm, plantain, maize, yam, cassava, vegetables and citrus.
1.1.5 Road Network
Road network to major towns and villages is comparatively good. Kumasi, the
regional capital, is centrally placed and easily accessible by road from almost all
parts of the country. Parts of Sekyere East, Sekyere West, Asante Akim North
and Ejura Sekyedumase districts are however inaccessible most of the time,
especially during the rainy season.
1.1.6 Health Facilities
There are five hundred and thirty (530) health facilities in the region. The Ghana
Health Service operates about 32% of all health facilities in the region. Kumasi
has the highest number of facilities of 38%. (Source: Service Availability Mapping
Survey).
Health Facilities by Ownership Government : 170 Mission : 71 Private : 281 Quasi Government : 08
Total 530
3
1.1 Key Priorities of the region at the beginning of the year
To intensify child survival, Safe-motherhood and IDSR/DC intervention
To improve the quality of health care through training
To reduce maternal and neonatal deaths
To improve outreach services especially in specialized services
Dental, Eye and Obstetric Gynaecology.
To develop capacity of sub district staff in financial management and
improve audit response by BMCs.
To improve data management
Key Challenges
Incomplete and late submission of reports.
Delay in payment of claims by NHIS
Long waiting time in the hospitals
Inadequate Human resource
High attrition of health staff
Poor Staff attitude towards work
Low motivation of staff
Inadequate budgetary provision
Irregular flow of funds
Non compliance to ATF rules and other government Regulations
Transport: Inadequate, Old fleet, lack of ambulance for accident prone areas
Infrastructure: Inadequate accommodation for office & staff
Inadequate infrastructure to cope with government policy
Increasing maternal deaths in the region
4
High still birth rate
Stagnation in some of the service indicators (EPI)
High Malaria disease burden especially in under 5 yr old
Strategies to address challenges
Quarterly data validation exercise and Feedbacks.
Regular meetings with Providers & Scheme managers
Instituted Financial Management Control Systems
Provided transport support occasionally to districts without vehicles
Intensify activities in specific interventions to improve coverage
5
FOLLOW UP ON ISSUES ARISING FROM IN-HOUSE REVIEW FOR 2006
ISSUE PERSON RESPONSIBLE 1. Investigation into high TB defaulter
rate at Atwima Nwabiagya
Regional TB coordinator
2. Strategies to strengthen community
based surveillance on Guinea worm
Guinea worm coordinator
3. Training in the diagnosis and
management of yaws
DDPH and DDCC
4. Follow up on the assessment of 31
facilities trained in Baby friendly
Initiative
Regional Nutrition Officer
5. Measures to ensure availability of
approved designs for building projects
to District Health Directorates
Estate Manager
6. Mechanisms to ensure that all drugs
are kept at the pharmacy at all levels
DDPS
7. Establishment of a Regional
Monitoring unit
SMC
8. Awareness creation on cervical
cancer screening.
DDNS (PH)
9. Circular to headquarters on the
effects of shortages of TB drugs.
SMC/Regional TB Coordinator
10. Circular to headquarters on the
high cost of drugs at CMS as compared
to the open market.
SMC
11. Ensure functioning of all
committees
SMC
6
2006 REGIONAL PERFORMANCE REVIEW ISSUES FOR DISCUSSION
• Human Resource
• Transport
• Service Delivery
Still Birth
Maternal Death
TBAs
• NHIS
• Data Management
• Infrastructure
Human Resource • Trainees to serve in Ashanti for 3 years
• Sensitise trainees to accept posting to rural areas
• Liaise with MoF for concession to employ staff
• Train CHNs in midwifery to man CHPS
• Keep Diploma midwives under supervision for at least a year
• Liaise with District Assembly for Incentive package for staff in deprived areas
• Dialogue with DAs to sponsor training of staff
• Policy to make transfer/movement mandatory
• Expansion of our training institutions
• Provide decent accommodation for staff when posted
7
Transport • Collaborate with GPRTU
• Send concerns on jailing motor bikes to the RHD
• Take advantage of tax waive to acquire personal vehicles capacity 1.8 litre
Service Delivery Still Birth - Need to develop guidelines on neonatal management
Maternal Death - Training in Life Saving Skills
- Intensify FP campaigns TBAs
– Give percentage of delivery fees to TBAs to encourage them to send cases
to hospital
– Encourage ward assistants/orderly trained on job to practise midwifery
– Specialist O&G visit to facilities
Format for presentation • Quality Assurance issues to be added
• Presentation skewed towards PH
NHIS • Policy on private participation in NHIS
• Procedure for payment terms – 50% upfront before services are provided
• Unified costing
• Poor negotiation skills – Build up capacity to negotiate with scheme
• Imposition of tariffs by scheme
• Slow pace of renewals
• Comprehensive Drug list needed (e.g.Quinine not on list)
8
Data Management - Sensitise staff to be interested in data management at all levels
- Build up capacity in data management
- Need to discuss and use data at the all levels
- Scaling Up of DHIMS
- Non Involvement of Health Info Officers in data management at district level
- Institute regular Data Validation Exercise
- Managers should use data to take decision
Infrastructure & Equipment • Package of Infrastructure and equipment
• Use of IGF to replace basic equipment
• Adhere to Policy on donation
9
2.0 PUBLIC HEALTH SERVICES 2.1 DISEASE CONTROL The main focus of activities was prevention and control of communicable diseases, especially those of National and International Public Health importance. The objective of the reportable diseases were to:
• Eradicate poliomyelitis and Guinea Worm • Eliminate Neonatal Tetanus • Control Yellow Fever, Tuberculosis, Yaws and Onchocerciasis • Accelerate control of measles
The primary objective of the EPI programme was to reduce morbidity and mortality of diseases that are vaccine preventable by immunization (. e.g.: Polio, Measles, NNT, TB, DPT-Hep B/Hib) and secondly, to improve immunization coverage for all antigens. Activities:
1. Quarterly review meetings on TB, HIV-AIDS/STI, Buruli Ulcer, Leprosy, Yaws, Onchocerciasis, Guinea Worm, Malaria, Surveillance and Expanded Programme on Immunization.
2. Training on diseases of public health importance.
3. Conducted NID (mass immunization on measles, polio) distribution of ITN for under 2 years population.
4. Weekly/Monthly/Quarterly feedback on performance in surveillance and other
diseases to Metro/Municipal and Districts.
5. Transportation of Acute placid Paralysis stool to Noguchi Lab, Legon, Yellow fever and Measles blood samples to PHRL, Korle-Bu for confirmation
6. Sensitization of health workers and traditional healers and spiritual centres to
improve on disease surveillance system.
7. Distribution of Benzathine Peniciline for Yaws treatment, Tabs Mectizan (Ivermectin) for oncho treatment. ART for HIV/AIDS patients
8. Monitoring/Supervisions, Technical support visits to Metro/districts.
9. Monthly consultative meeting in Accra.
11
Achievement: 1. Documentation of EPI cold chain inventory. 2. Additional refrigerators were supplied to boost the performance of the EPI
programme. 3. 100% completeness of submission of returns to National level in both Weekly
Notifiable and Monthly Communicable Diseases. 4. Timely on Monthly Communicable Disease was 79% whilst Weekly was 70%.. 5. TB control programme saw remarkable improvement. Constraints:
• Cash flow for programmes not the best. • Weak response from, Metro, Municipal and Districts for all forms of
meetings. • Poor quality of data submission • Poor timely submission of reports • Incomplete submission of reports
Surveillance:
• Continuously monitoring and analysis Metro, Municipal and Districts reports submission rate.
• Collecting/receiving and collating all data on disease reporting from 396 Health Institutions (both private and public) analyzing disseminating information of the various institutions/ Units for appropriate action to be taken.
TIMELINESS AND COMPLETENESS, WEEKLY NOTIFIABLE DISEASE (DISTRICTS SUBMISSION) The Regional average coverage (% score) on Timeliness of reporting from Metro/Municipal and Districts for the year under review was 95%. The Completeness was 100%. Even though six districts including KATH, Sekyere East, Amansie East, Amansie Central, Amansie West, Adansi South scored below 90% all Metro/Municipal and districts performed above the target of ≥80%. The same number of districts (6) failed to achieve the target of ≥80% in 2005. Whilst in 2005 the least performed district scored 33%, in 2006 the least performed district (Adansi South) scored 83%, an indication of 50% increase.
12
Weekly Notifiable Diseases, District Submission, % Score Timeliness. Jan-Dec 2006 Ashanti Region
100 100 100 100 100 100 100 100 98.198.198.196.296.294.294.290.488.587.386.5 85 83 83
95
0
20
40
60
80
100
120
ADNAAN
ATMATN
EJJKUM
OBMSEW
AASASS
EJS AFSKW
ABAK
OFFATM
SEEAME
AMCAMW
ADSKATH
REG
Districts
% S
core
% Score
Weekly Notifiable Diseases Timeliness and Completeness, Regional Reporting Ashanti 2002-2006
Year
Timeliness ≥ 80%
Completeness
≥ 90%
2003
89.2
89.2
2004
89.2
83.5
2005
94
79.8
2006
95
100
13
% Score Timeliness of Monthly Reporting in Ashanti by Districts for Year 2006
100 100
91 9183 83
7975 75 7580
100
66
41
25
0
20
120
ATMKW
AAAN
EJS AASOBM
REGAMC
ATNSEE
ADNASS
EJJKUM
OFFSEW
AMEAFS
ADSAMW
BAKASN
Districts
58 58 58 58 5854
50
41 4140
60%
Monthly communicable Disease Surveillance Reporting –Ashanti 2006 There has been much improvement in coverage in monthly CD surveillance reporting over the years from region to the national level in both Timeliness and Completeness. The regional average coverage for Timeliness was 79%. Six (6) districts Atwima Mponua, Kwabre, Ahafo Ano North, Ejura Sekodumasi, Ahafo Ano South, Obuasi Municipality achieved the target of ≥80% whilst Adansi South, Amansie West, BAK and Asante Akim North could not even reach 50%. Asante Akim North achievement of 25% was the most disastrous in recent years. Monthly communicable disease surveillance reporting from Municipal, Metro and Districts recorded a decreased in coverage (2% decreased). In 2006 the regional average coverage was 79% timely as against 81% in 2005. However, the region maintained the 100% Completeness recorded in 2005.
14
Timeliness Completeness
ACCUTE FLACID PARALYSIS (AFP) Twenty-five (25) stool specimens were detected and sent to Noguchi Memorial Lab, Legon for confirmation. 24 out of the 25 stool specimen were collected within < 14 days of onset of paralysis (96% Timely). Afigya Sekyere, Amansie West, Asante Akim North, Atwima Nwabiagya, Ejura Sekodumasi, Ejisu Juaben districts failed to detect a case.
Monthly Communicable Disease Surveillance
2006 Ashanti.
92.5
7581 79
100 100 100 100
0
20
40
60
80
100
120
2003 2004 2005 2006
Year
% c
over
age
Submission, % Score Timeliness and Completeness, 2003-
15
AFP STOOL COLLECTION BY DISTRICT - ASHANTI, 2006
1 10
21 1
2
0 01
2
0
3
0 0
23
1 12
10
24
0 0 0 0 01
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01
0
5
10
15
20
25
30
AD N
AD S
AFS
AA N
AA S
AMC
AME
AMW
ASN
ASS
ATM
ATN
BAK
EJJ
EJS
KUM
KWA
OBM OFF
SEE
SEW
KATH
TOTA
L
D I S T R I C T
NO
. OF
CA
SES
<14 >14
The minimum expected case to be detected was 37 at the Regional level whilst Metro, Municipal and Districts were expected to detect at least 2 cases. The Region detected 44 cases in 2005 as against 25 in 2006, (43 % reduction).
16
AFP STOOL COLLECTION BY D
Obuasi2
1
17
ISTRI 0CT ASHANTI 2 06
2
Ejura Sekyedumasi
1
Offinso Sekyere West
1
0
Sekyere Ea
2
st
2
1
Adansi North
1
02
Amansie West
10
Adans 1
0 0
kim Northnte-A
0
Asa
i South
Kwabre2
3
3
NIL
1 CASE
Annualized non-polio rate in 2006 was 1.24 of the Regional target of 2.0.
OUTBREAK RESPONSE: Nine (9) major outbreaks were recorded in 2006: Six on Cholera from Asante Akim South, BAK, Ahafo Ano South, Kumasi, Afigya Sekyere and Adansi North districts, One chemical food poisoning (from Amansie West) and two whooping cough (from Amasie Central and Ejurs Sekojumasi). Report on Chemical Food Poisoning in Amansie West shown that a total of 17 cases were
eated and discharged after the people had taken banku. There were 4 males and 13 males.
MENINGOCOCAL MENINGITIS EPIDEMICS (MME)
trfe
Detection of meningitis by lumber puncture for lab examination to determine the bacteria for management of patients and prevention of close contacts (immunization) has not being the best. Cases were usually clinically diagnosed by the clinicians (except KATH), which resulted in 12 cases not classified.
Meningococcal Meningitis Epidemics (MME), 2006 Ashanti.
N. Meningitides
H.
Influenzae
Strep.
Pneumonae
High Neutrophiles
Count
Others
4
0
40
106
12
19
Cerebro Spinal Meningitis 1997-2006, Ash.281
133
29 2514 17
34
9278
162
55
203 4 2 2 7 12 15
20
50
100
150
200
Dea
ths
250
300
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
No.
of C
ases
/
Cases Deaths
CHOLERA The Region recorded a total of 211 cases with 16 deaths (CFR=6%) with Afigya Sekyere registering the highest number of cases (57 representing 23% with 8 deaths (CFR=14%). Most reported districts were Afigya Sekyere, Ahafo Ano South, Adansi North, Kumasi and Asante Akim South.
he Region recorded 1966 cases with 11 deaths in 2005 as against 211 in 2006 with 16 eaths given a case reduction of 89%.
Td
20
Trend of Cholera Cases and Deaths, 1997-2006 Ashanti.2500
4
823
1270
4
1065
16 0 0
1966
211
0 19 40 0 16 1 0 0 33 160
500
1000
2000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
No.
of C
1500
ases
/Dea
ths
Cases Deaths
INTERGRATED DISEASE SURVEILLANCE AND RESPONSE – IDSR. ACCELERATED MEASLES CONTROL A total of 65 suspected measles cases as against 96 in 2005 (32% reduction) were detected with blood samples (sera) sent to PHRL Korle-Bu for confirmation.19 Metro/Districts detected the 65 cases as against 13 districts in 2005. Asante Akim South and Sekyere East did not detect a case with Kwabre and Ejisu-Juaben detecting the highest cases of 7 each.
21
Trend of Suspected Measles Cases, Ashanti 1992-2006.
14000
7000 7100
479 403 86 650
14000
16000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
9000
10900
8000
10000
. of C
ases
650060006000N
o
4000 4000
27003600
2000
4000
Susp Measles
Imp act o n measles accelerat io n p ro g ramme,C A SE- 12000B A SED
1992 1993 1994 1995 1996
Out of the 65 cases detected, five (5) samples proved positive, same number of positive cases in 2005.
Measles IgM Positive by Districts, Jan-Dec 2006, Ashanti Districts No. of Cases
Ahafo Ano South 1
Ejisu Juaben 1
Kumasi 2
Kwabre 1
Total 5
22
Trend of Measles IgM+ve Cases in Ashanti 2003-2006
13
5 5
0
5
10
25
2003 2004 2005 2006Year
No.
of C
ase
YELLOW FEVER The region detected 114 suspected Yellow Fever cases with blood samples sent to PHRL Korle-Bu for confirmation against 97 in 2005 (15% increase).
22
15
20
s
Suspected Yellow Fever Cases by District, 2006 Ashanti
11
2
6 52 3
5
1 03 4
34
3
10
6 53 3
0
8
0
5
10
15
20
25
30
35
40
ADNADS
AFSAAN
AASAMC
AMEAMW
ASNASS
ATMATN
EJJ EJSKUM
KWA
OBMOFF
SEESEW
Districts
No.
of C
ases
23
Two (2) districts (Asante Akim North and Sekyere East) failed to achieve the minimum target of 1 case.
TREND OF YELLOW FEVER CASES, 2004-2006 Year No. of Cases +ve
2004 61 0
2005 97 1
2006 114 0
YAWS CASES Out of the total 2,435 yaws cases treated in 2006, 1,139 were infectious of which 870 were < 14 years and 269 >15 years with 802 males and 337 females.
Yaws Cases (under 14years) by Districts, Ashanti 2006.
1 1900 61
9143
4 12
292
30 490 0
651 4
14
400 9
870
1
2
3
4
5
6
7
8
9
1000
AMCAME
AMWASN
ASSATM
ATNBAK
EJSKW
AKUM
OBMOF SEE
SEW
Reg.Tota
l
Districts
No.
of C
ases
2 00
700
00
00
00
00
00
00
00
AD AD AASN SAFS
AANEJJ F
Yaws Cases under 14yrs
24
NON-INFECTIOUS YAWS: 795 >15 years with 1,183 males and 413 females were treated as non-
fectious. 501 <14 years and in
Yaws Cases (15years and above) by Districts, Ashanti 2006.
300
0 11
200 7 4 2 0
40 41
1833
0 0
25
2 6
48
3 09
269
0
50
100
250
ADN SAAS
AMCAME
AMWASN
ASSATM
ATNBAK
EJJ EJSKW
AKUM
OBMOFF
SEESEW
Reg.Tota
l
Districts
No.
of C
ases
200
150
AD AFSAAN
Yaws Cases 15yrs and above
CTIC TREATMENT were given prophylactic tre t. 3,256 were were
ith 3,127 males and 2,109 fem
icts are Adansi South, Ahafo Ano North, Asante Akim South, Atwima Juaben, Obuasi Municipality and Offinso.
PROPLYLA5,236 contacts atmen <14 years whilst 1990> 15 years w ales. Most affected DistrNwabiagya, Ejisu
25
Trend of Yaws Cases, 2000-2006 Ashanti Region.
1424
2113
3073
3500
1962 4
10171139
0
00
2500
3000
2001 2005 2006
Year
of C
ases
ONTROL PROGRAMME
200
500
10
1500
No.
2000
2000 2002 2003 2004
NCHOCERCIASIS CO
pply of the drugs, first line communities were tackled,
d
onal % coverage was 37%.
Tabs mectizan (Ivermectin) were used to treat (dose) the affected communities by district. Training was conducted at the Regional and District levels after which tabs mectizan were released for the treatment. Due to irregular/inadequate suCommunity Direct Treatment with Ivermectin was used. 13 out of the 21 Metro/Municipal and Districts did the dosing. Kumasi, Kwabre anBAK are non-endemic whist Ejura, Ahafo Ano North, Amansie East, Asante AkimNorth, and Atwima Nwabiagya districts did not dose.
he RegiT
26
% Coverage by District. Oncho Control Programme AshanJan-Dec 2006
98100
120
ti,
32 33.5
86.5
2722
63.3 60
6.4
3740
80
SEW
REGION
District
% C
over
age
60
36
13.2 1520
0 0 0 3.2 0 0 0 0 00
ADNADS
AFSAAN
AASAMC
AMEAMW
ASNASS
ATMATN
BAKEJJ EJS
KWAKUM
OBMOFF
SEE
% Coverage Onchocerciasis 2004-2006, Ashanti.
13.2
4.3
37
0
5
10
15
20
30
35
2004 2005 2006
Year
% C
over
ag
40
25e
27
GUINEA W ORM ERADICATION
t of 21 distric rded 52 cases ommunities in 2006 as against 50 in 2005.
Thirty-one (31) out of the cases recorded were indigenous and twenty-one (21) imported from Brong Ahafo Region (1), Northern Region (1) and MALI (19). Cases were captured by OBUASI
ITY. All case orded were contained.
Seven (7) ou
ts reco in 15 c
MUNICIPAL
s rec
Guinae Worm Cases Reported by D ricts in 2006
4 5
31
1
52
40
50
60
EJSKUM
KW OBMO SE
SEWREG
ist
30
20
810
0 0 0 0 0 0 0 0 1 0 0 0 0 0 02
0
ADNADS
AFSAAN
AASAMC
AMEAMW
ASNASS
ATMATN
BAKEJJ A FF E
GWEP - Monitoring Chart by Month, Ashanti 2006.
02
5
0 0 0 1 03 4
0
35
Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec
Month
N M
rin
2930
25gs
15
20
onito
8
5
10o. o
f
28
Reported G1600
uinea Worm Cases, Ashanti.
50 52
600
12
3 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
No.
of C
INEA ORM ERAD E SEARCH RESULTS
1521
1400
00
9821000
ases
800
671
450 460400
149 12849
11664
11257 50 39 48 85
0
200
1989 1990 1991 1992 199
GU W ICATION CAS
o. District No. of case search Cases
N1 Adansi North 0 0 2 Adansi South 0 0 3 Afigya Sekyere 0 0 4 Ahafo Ano N thor 0 0 5 Ahafo Ano South 1 0 6 Asante A orkim N th 0 0 7 Asante A oukim S th 0 0 8 Amansie Central 0 0 9 Amansie East 0 0 10 0 Amansie West 0 11 Atw 0 ima Mponua 0 12 Atwima Nwabiagya 0 0 13 0 Bosomtwe-Atwima-Kwanwoma (BAK) 014 0 0 Ejisu-Juaben 15 1 Ejura-Sekyedumase 2 16 Ku 0 masi Metro 0 17 Kw e 0 abr 0 18 Obu i 0 as Municipality 0 19 Offinso 2 4 20 Sekyere East 2 0 21 Sekyere West 2 0 -+
29
WATER SUPPLY
uth - 1 twima Mponua - 4
4
Densareso
The District Assemblies are doing well by providing boreholes to endemic communities in Offinso - 4 Atwima - 1 The underlisted districts with eleven (11) communities are yet to benefit from this package. Asante Akim South - 2 Adansi SoASekyere East - Districts/ communities without safe drinking water are.
1. Asante Akim South •• Asampana
2. Atwima Mponua
• Boakye Krom • Hiawoanwu • S.K. Nyame • Kekako
3. Sekyere East
• Densi • Sabrewa • Kofui Dawu • Besore
WATER FILTER DISTRIBUTION District No. Issued Comments Offinso 200 Sekyere East 400 Sekyere West 300 Ejura-Seko 300
Water filters were given to endemic communities
Kumasi 100 Asante Akim South 100 Ahafo Ano South 100 Atwima Mponua 300
Disease without potable water. reporting Guinea Worm
30
Buruli Ulcer There ha Buruli Ulce cases detec n 2006 from in 2005 to 505 in the year under review. Out of this number 140 were nodular and 296 were Ulcerati illustrated in the t low:
uruli Ulcer Cases from 2004 to 2006
YEAR
s been a reduction of r new ted i 673
ve cases. This is able be
B
INDICATORS 2004 2005 2006
Nodules 150 171 140
Ulcers 323 345 296
Others 134 121 69
GRAND TOTAL 607 637 505
The reduction of ulcerative cases means we had a lot of health education conducted in
ost of the endemic areas.
he districts that had cases on Buruli Ulcers were Amansie West -107, Atwima wabiagya -99, Asante Akim North-82, Amansie Central-75, Ahafo Ano North-73, Ejisu
uaben-33, Atwima Mponua-14, Ahafo Ano South-11, Amansie East-3, Afigya Sekyere-, and Obuasi Municipality-1.
Agogo Presbyterian Hospital is now an international training centre for Buruli Ulcer Surgical Management. The inaugural ceremony was done by the sector minister Major (Rtd) Courage Quarshiegah in the first quarter of 2006 at Agogo. Surgical experts from France, Australia, Germany and Britain with local experts from KATH & Korle-Bu were present. Sponsorship Training The American Leporsy Mission sponsored Buruli Ulcer Training for health professionals in Kwabre at Kaase Methodist Faith Healing Hospital, Mankranso Hospital and Apromase Hospital. Facilitators were drawn from KATH led by Consultant Dr. Pius Agbenorku.
m TNJ2 International Training Centre
31
Support Visit The National Programme Manager, Dr. Ampadu visited some treatment centres like Nkawie, Agroyesum, Agogo, Nyinahin, Konongo and St. Peter’s Hospitals to strengthen support for excellence in these facilities. There was free supply of dressings and other consumables from the National Buruli Ulcer Secretariat to the above institutions/Districts. Challenges
• Patients travel long distances for treatment • Free supplied dressing and other consumables are not separated from exemptions.
Way forward
• To train health professionals to remove Nodules within their catchment’s areas • To visit treatment centres periodically to ensure that free supplied dressings /
consumables to patients are separated from the facility stock. • Improvement of training of wound dressing among patients in their villages.
Leprosy
eprosy control in the region has been on elimination target of 1 per 10,000 populations ince the last 8 years. All what we need to do is to sustain this and this means intensifying ase search activities, adequate supply of chemotherapy to patients and good case holding
tion of children under 15 years old among ewly detected cases was 7%. Case detection rate was 7.05% and Prevalence rate was .5/100,000pop. Patients released from treatment were 99. Out of the 99 patients released
illary cases and 27 were paucibacillary
Lscpractices. 72 new patients were registered and proporn0from treatment 72 were multibac Trend in reported cases of Leprosy 2004 – 2006 Year 2003 2004 2005 2006 Cases 85 84 116 72
32
Three year trend of Leprosy cases, 2004-2006
Indicator 2004 2005 2006
Prevalence 80 107 52
New Cases 84 116 72
Discharged 70 83 99
Case Search • The entire districts embarked on case search activities. This time, more concentration
was centered on training of community based health volunteers (CBS). It is important to note that with the knowledge imparted to the CBS, they helped
greatly to register 72 new cases (Passive approach). It is interesting to note that Asante Akim North District which recorded most of the
patients had consistently embarked on good case holding and this has resulted in total reduction of patients load from 43 in 2005 to 14 in 2006.
hallenges Recycling of patients Nerve assessment as component of case holding. Low awareness among population under 15 years
ay forward Periodic visit to update patient register and review to ensure that patients who
complete the stipulated chemotherapy are released from treatment. on nerve assessment, so that patients who report with disability
e after treatment. Health education in schools and communities to create awareness am school children.
•
•
C••• W•
• Training of prescribersG1 would remain sam
• ong
33
Malaria Co ol Progr Objectives of the Progra
ntr amme
mme 1. Implement new AMDP
• Train relevant staff on AMDP (Artesunate Amodiaquine) • Monitor side effects of AMDP
. Provide IPT to pregnant women
mation, education &communication on home-based care
2
• Train health staff on IPT • Carry out information, education &communication on IPT
3. Increase proportion of caretakers who are able to identify early signs and
symptoms of uncomplicated malaria and severe malaria and seek prompt treatment • Undertake infor
4. Monitoring and Evaluation ITN ALLOCATION TO ASHANTI REGION Quantity Received - 103,600PCS
ULPHADOXINE PYRIMETHAMINE ALLOCATION
uantity received - 640,000 uantity issued - 92907 tock balance - 547,093
alaria Cases Total Number of Malaria Cases = 873,911 (46.3%)
Malaria in Pregnancy = 16,330 (2%)
missions = 34,568 Malaria admissions
<5 malaria admissions - 82 <5 m - <5 - 1.8%
Quantity Issued - 99,200PCS Stock Balance - 4,400PCS S QQS M
Total number of Malaria ad
12,3229 alaria deaths
malaria CFR
34
TUBERCUL IS C TR PRO RAMOS ON OL G I DUC N T bercu is co ol p ram ntin s to i ent DOTS in the management of cases. This h ade t reg to ieve ry good successes in c m gem t in the year under review. The Global Fund support received also injected a great deal of vigor in program management activities like supervision and monitoring, which is a major component for program success. If this momentum and commitment is maintained, the burden of TB in the region will be minimal. A DA F TH AIn 2006, the region set itself to support all district to or ize resh trai s to i rporate new trends of Tuberculos ana en ith munity involveme bei il by omtwe A Kw m tr A ITIETraining: There were refresher trainings four districts ffins Asa Ak o , Eji uaben a umas he nin over 11 hea care ract ners nd mun based t t s rte
eview Meetings: There were quarterly regional and district review meetings. The meetings were sed to discuss case detection rate, inadequate microscopy services and the intermittent drug hortages. The new reporting forms (TB 07 and TB 08) were reviewed and institutionalized for use reporting from the fourth quarter. The major comment on the TB07 was the column for defaulters at were placed under smear positives, since some defaulters return and are smear negative and
et must be re-registered. Data was also reconciled with the districts. nablers Package: Districts disbursed the fund to care providers, which includes health workers, nd community based surveillance volunteers. This was given to support their transportation for ome verification before treatment commenced and lunch packs. Some districts also gave out T-hirts for propagation of TB messages and motivation. Most providers of care were greatly ncouraged by the support and token given. Patients in the region received the package in the rm of feeding supplementation (cooked food, provisions like Milo and mackerel), travel and ansport allowance to health facilities for treatment and payment for other medications. echnical Support: Regional and District TB teams paid technical support visits to all districts and cilities treating cases to know at first hand the problems on the ground and institute remedial easures. uality Assurance: External Quality Assurance (EQA) was carried out to review the performance f the laboratory in support if diagnosis. Details are covered in the diagnostic services report.
Case Finding:municipal consistently does ll d ctin 8% e d A d leascase detection rate of 3.9%. See chart 1. B is a le sh ng category of cases.
NTRO TIOhe Tu los ntr rog co ue mplemas m he ion ach ve ase ana en
GEN OR E YE R s gan ref er ning and nco
is m gem t w com nt ng p oted Bostwima anwo a dis ict.
CTIV S ; O o, nte im S uth su-J
nd K i. T trai g c ed 3 lth p itio a 237 com ity reatmen uppo rs.
RusinthyEahsefotrTfamQo ACHIEVEMENTS
The region detected 1931 (15.6%) out of its expected 12408 cases. Obuasxpecte
i t we ete g 48. of its cases. dansi North ha the
elow tab owi
35
Table showing trend of total cases detected 004 200 202 5 06 New ositive 2 122 1283 Smear P 1 56 9 New gativ 527 48Smear Ne e 448 9 Relaps 100 96 es 110 Extra 46 55 63 PulmonaryTotal 860 191 191 1 31
Chart 1: Case Detection Rate by Districts, 2006
49
30
10
15
25
30
35
40
45
50
212020
1917
16 16 1
1211
9
7 7 65
4
165 15 15 1413
5
0OBS ASN AFS ASS ATN AD.S KWA AME EJJ KUM AAN SEW BAK OFF ATM AAS EJS AMC SEE AMW AD.
N REG
cases, maintains a zero defaulter rate. See charts 2 and 3.
Treatment Outcomes: For the first time all cases detected in 2005 were accounted for. Regional treatment success rate was 80% and adverse outcome rate was 20%. The adverse outcome ismade up of 7% Default, 9% Death, 1% Treatment failure and 3% others. Kumasi, which sees alarge number of the
36
Chart 2: Treatment Outcome by Districts, 2006 (Cases detected in 2005)
98
2
93
7
90
10
90
10
72 69 69
82
18
80
20
78
22
77
23
75
25
74
26 28 31 31
68
32
66
34
66
34
64
36
56
44
100
20
80
90
70
50
60
80
0
10
20
30
40
AFS KUM EJS AD.S EJJ BAK OBS AMW ASN OFF SEE ASS AAS SEW AME KWA AAN ATN REG
AdverseSuccess
f Regional s and Adverse Rates - 2005
Chart 3: Trend o Succes , 2002
63
75
25
78 80
70
80
90
100
2022
37
10
20
50
60
AdverseSuccess
40
30
02002 2003 2004 2005
37
DIAGNOSTIC SERVICES aboratory service continues to improve over the years. The Central Tuberculosis unit supported e region with ten new Olympus microscopes to improve the microscope situation. Both public and
rivate diagnostic facilities benefited. uality assurance visits were made to selected public and private laboratories and 292 slides were icked for re-checking during the second and third quarters. Results gave an overall agreement of 2% and sensitivity of 100%. See chart 4 and table 2 below. aboratories are not observing internal quality control measures may be accounting for the high lse positive rate. hart 4: Smear Preparation Assessments
LthpQp9LfaC
38
Table 2: Correlation Table Result of Periphery Laboratory
Neg 1-9AFB/100
1+ 2+ 3+ Total
Neg 181 6LFP 6HFP 5HFP 6HFP 204
1-9AFB/100 0LFN 1 3 1 0 5
1+ 0HFN 2 2 6 6 16
2+ 0HFN 0 2 13 11 26
3+ 0HFN 0 2 9 30 41
Result of
ssessor
Total 181 9 15 34 53 292
A
Assessment of Reading ability:
and Negative agreement) rate: 92%Overall agreement (Positive [(269 / 292) x 100] – 23
sitivity: Number of Positive agreement / Number of assessor’s total Positive x 100 = 100%
D agreement: False PositiveisenS
[(88 / 88) x 100]
HALLENGES ajor challenges faced in our bid to improvement program management has been the low morale mongst microscopists who feel all the job is left for him yet does not receive any motivation and e intermittent short supply of logistics and medicines. Late reporting and poor data quality was lso encountered.
EXT STEPS istricts will be supported to re-train the staff to catch for the human resource gap caused by staff ttrition and be abreast with new trends in Tuberculosis control featuring high will be TB / HIV llaborative activities to improve case detection.
CMatha NDaco
39
Reported TB Cases by districts 2006
Pulmonary Tuberculosis Extra-pulm
TB
Smear-Positives Smear-negative
New cases Relapses New cases New cases TOTAL DIST M F TOT M F M F M F M F T AD.N 9 2 11 2 0 2 0 0 0 13 2 15 AD.S 36 9 45 4 1 12 3 0 0 52 13 65 AFS 36 15 51 0 1 14 18 1 0 51 34 85 AAN 17 6 23 6 2 5 0 0 0 28 8 36 AAS 25 16 41 0 0 0 2 0 0 25 18 43 AMC 7 4 11 0 0 0 2 0 2 7 8 15 AME 44 26 70 7 1 5 1 1 1 57 29 86 AMW 7 3 10 0 0 6 2 0 0 13 5 18 ASN 40 28 68 3 2 35 12 7 1 85 43 128 ASS 29 11 40 2 2 10 10 1 1 42 24 66 ATM 14 3 17 0 1 9 6 0 0 23 10 33 ATN 44 28 72 1 1 9 1 5 4 59 34 93 BAK 28 11 39 0 0 16 8 0 0 44 19 63 EJJ 36 20 56 2 0 4 0 2 0 44 20 64 EJS 11 3 14 1 0 4 0 0 0 16 3 19 KUM 262 129 391 26 5 101 57 15 9 404 200 604 KWA 37 28 65 3 0 18 6 1 0 59 34 93 OBS 109 36 145 16 1 44 30 6 3 175 70 245 OFF 28 13 41 2 0 9 5 0 0 39 18 57 SEE 15 9 24 3 1 2 0 1 1 21 11 32 SEW 35 14 49 0 0 14 7 1 0 50 21 71 TOTAL 869 414 1283 78 18 319 170 41 22 1307 624 1931
40
Quarterly Report on Treatment Outcomes
r Category M F Total Cured Comp Died Failure Default Trans Out Total Quarte
Sm. Pos 195 94 289 199 21 29 2 26 12 289
Sm. Neg 89 55 144 118 17 0 2 7 144
Relapses 18 4 22 17 3 2 0 0 0 22 1ST 2005
Other RTR 3 3 1 2 0 0 0 0 3
Sm. Pos 184 90 274 220 10 24 2 14 4 274
Sm. Neg 79 55 134 101 22 0 4 7 134
Relapses 18 4 22 8 8 3 0 2 1 22 2ND 2005
Other RTR 2 2 0 2 0 0 0 0 2
Sm. Pos 217 115 332 250 15 31 3 19 14 332
Sm. Neg 75 39 114 92 16 2 3 1 114
Relapses 13 7 20 16 1 1 2 0 0 20 3RD 2005
Other RTR 7 7 1 3 0 0 1 2 7
Sm. Pos 217 117 334 249 15 21 5 33 11 334
Sm. Neg 88 54 142 123 11 0 5 3 142
Relapses 23 6 29 18 5 6 0 0 0 29 4TH 2005
Other RTR 0 0 0 0 0 0 0 0 0
Sm. Pos 813 416 1229 918 61 105 12 92 41 1229
Sm. Neg 331 203 534 434 66 2 14 18 534 ANNUAL
Relapses 72 21 93 59 17 12 2 2 1 93 EPI 2 6 th a lot of challenges. Among them were r t
p to the districts and training of staff were held during
uR ly or monthly in all distr ith some amount o uLog
00 EPI undertook series of activities but wi and mops ups. Mass campaigns, support visits ou ine static, out reach programmes
up ly of logistics monthly feedbacksthe year under review . Ro tine Static/Out reach
outine static and out reach programme were carried out daily, weekicts at the institutional levels. Earlier on the Region was provided w
f f el coupons to support the programme. istics support
41
The programme was successful due to logistics support which was regularly received om headquarters. The items supplied included cold chain equipment, vaccines, needles
upport Visit ts by the various officers including Deputy
irector (PH) the programme coordinator and the cold chain managers. The visit was
MaCo s, Awas organized from b 06. Even gh the c ges comparedthe previous years were low, it was quite successful Mop-up Mop-ups were carried out in all the districts following the fuel coupons provided by programme manage ncrease cove at the late of the y Logistics support was adequately supplied from hea ters. Th clude cold ch
u ment, vaccineraining of staff even though was not adequate it was done concurrently along side with
Challengers encountered.
- Inadequate funds to support the programme. - Proposed mid level training could not be carried out because of funds.
- Inadequate support visit at various levels. - Strike action of the staff. EPI Performance 2006 Target 176281 Antigen/Year 2004 2005 2006
frand syringes, etc. SSupport visits were made to the districDdone together with the WHO Stop team member, Dr. Messeret. Records in the Districtand Metro Hospitals were reviewed for missed AFP, suspected yellow fever and measles cases. On EPI the teams were in the districts to assist in performance indicators, monitoring graphs drop out rates, missed opportunities, etc.
ss campaign mbined measle Polio, Vitamin
st 5 supplementation and bed net distribution campaign
1 to th Novem er 20 thou.
overa to
r to i rage r part ear.
dquar ese in ain eq ip s, needles and syringes etc. Tother programmes
No % No % No % BCG 118795 72 148870 87 151852 86 Penta 3 117854 66 126799 74.2 125321 71 OPV 3 109193 66 133812 78.3 124948 71 Measles 112371 72.3 128832 75.4 126756 73 YF 55580 34 128472 75.2 127965 72
42
Chart 1 EPI trend 2004 to 2006
EPI Performance by Antigen 2004-2006 Ashanti 90%target for all antigens
72 71
6668
34
57
87
74.278.3
75.4 75.2
64.8
86
71 7173 72
68
0
10
20
30
40
50
60
70
80
90
100
BCG PENTA 3 OPV 3 MEASLES Y F TT2+
Antigens
Perf
orm
ance
2004 2005 2006 Besides the TT2+ all the antigens coverage fell below those of the previous year.
43
Chart 2 BCG by districts
91 91 90
100
10
80
9087
83 83 83 8381
79
75 74 74 74 72 72 72 71 70
6563
59
50
60
70
20
30
40
0AFS ATM AD.N AMW ADS AAS AMC OFF EJS EJJ OBS ASS KWA ATN AAN BAK SEE REG ASN SEW AME KUM
The best three performing districts are Offinso, Adansi North and Adansi South while Kwabre,Kumasi and Ahafo Ano North are the low performing districts Chart 3: Penta 3 by districts
92 91 9087
84 84 83 82 81 80 7976
74 73 72 72 72 72 7169
63
59
0
10
20
30
50
60
90
0
40
70
80
10
AFS ATM AD.N AMW OFF OBS AAS ADS EJS AMC EJJ ASS ATN KWA AAN SEW BAK SEE REG ASN AME KUM
44
Afigya Sekyere Atwima, Mponua and Adansi North are the best three performing while Kumasi, Amansie East andAsante Akim North are lowest. Chart 4: OPV 3 by district
91 91 9087
83 83 83 8381
79
75 74 74 74 72 72 72 71 70
6563
59
0
10
20
30
40
50
60
70
80
90
100
AFS ATM AD.N AMW ADS AAS AMC OFF EJS EJJ OBS ASS KWA ATN AAN BAK SEE REG ASN SEW AME KUM
45
Chart 6: YF by district
100
120
101
93 92 92
8784
8179 78 78 78
74 73 73 72 71 70 6967 67 65
20
40
80
63
60
0AD.N ATM AFS ADS AAS AMW EJJ ASS AMC SEE BAK ATN OFF REG EJS OBS AME KWA AAN ASN SEW KUM
Chart 7: TT2+ by district
105
85 8481 79 78 77
75 73 72 72 70 7068
6563
61 6057 56
5047
0
20
40
60
80
100
120
AD.N ATN SEW ASN AFS KWA EJS SEE ATM O AAS REG AM UM AME ADS AAN
BS EJJ BAK W ASS K OFF AMC
46
Campa n suig Re lts
86.6358,020413,400Bed-net
85.3784,229919,126Vitamin A
80.2les
85.48725941,021,251OPV
696,310868,063Meas
%AchievedTargetItem
ecommendations
-Permanent labourer to be stationed at the regional cold room. -The regional cold room must be provided with a desk top computer.
are required in the cold room
utlook 2007 nthly feedback
gular support visits ata quality audit to be carried out in all the districts
- Quarterly review meeting - Coverage survey to be car d out in Kum si
R
BCG & PENTA 3 drop out rate by districts- 2006
10.4
7.0
13.6
-1.8
8.2
4.1
23.0
2.010.0
23.5
12.2
26.0
18.0 17.8
AD AS
AANAAS
AMCAME
AM ASSATM
ATNB EJS
KUMKWA F
SE
2
21.2 22.120.1
16.617.8
9.911.5 1
0.6
.N DSAF W N*
AS AK EJJOBS
OF ESEW*
REG
dr ra
teop
out
- Additional writing desk and shelf O - Mo - Re
- D rie a
47
HIV/AIDS/STIs Control MAJOR HIV/AIDS /STIs ACTIVITIES
• HIV Sentinel Surveillance.
ill• Behavioural Surveillance Survey • Screening of d for transfusion• PMTCT/VCT Services
nagement IDS – ART/OI • Training
oural C ge Co unicat• Inter-Sectoral Collaboration
OBJECTIVES
• AIDS Surve ance.
Bloo
• Ma of A
• Behavi han mm ion
• To reduce further spre of HIV Infection in the Region. adequately manage S and STD Cases in the Reg n.
• To reduce the impact of HIV Positive status on the Individual, Family anCommunity.
SURVEILLANCE
ad
• To AID iod
Three Surveillance Surveys were conducted (as National/Regional activities by NACP) during the year: - (a) HIV Sentinel Surveillance Since 1990 HIV Sentinel Surveillance Survey has systematically looked at the trend of the infection in pregnant women between 15-49 years and has systematically seen a rise each year until 2004. The Prevalence results of the 4 sentinel sites, including the rural site at the St. Martins Hospital at Agroyesum in the Amansie West District are shown below in %
48
Suntreso STI - (200 maximum Samples collected) 15.0% HIV Positive * Preliminary Results
TREND OF HIV SENTINNEL SURVEY IN ASHNTI REGION, 2002 - 2006
4.2
5
6.6
5.4
5.86
6.2
2.8
5
4.2
5
5.9
2.4
2.72.8
33
3
0
1
2
3
4
5
6
7
2003 2004 2005Y E A R
2.4
3.2
3.7 3.43.4
2002 2006
SUNTRESO
MAMPONG
OBUASI
AGROYESUMREGIONAL
The 2006 HIV/Syphilis Sentinel survey officially stated on the 25th September and ended on 006; the official authenticated results are yet to be released by the NACP. Each of the 4 sites was able to collect and screen the maximum regnant women for HIV and Syphilis. The main STIs linic at Suntreso - Kumasi was also able to collect and screen the required 200 amples of STD Patients for HIV.
YEAR NATIONAL KUMASI - MAMPONG OBUASI AGROYESUM REGIONAL MEDIAN SUNTRESO
2000 2.3 3.8 1.6 - - 2.7 Average 2001 verage 2.9 3.4 4.8 - - 4.1 A2002 verage 3.4 4.2 2.4 6.0 - 4.2 A2003 3.6 5.0 5.4 3.7 - 5.0 Average 2004 .0 Average 3.1 2.4 3.2 3.4 2.8 32005 0 Average 2.7 3.4 2.7 2.8 3.0 3.2006* 6.6 5.8 6.2 5.0 5.9 Average * SYPHILIS verage * * 8.8 2.2 11.4 13.0 8.9 A
the 12th of Dec. 2
number of 500 pCs
49
(b) AIDS Surveillance In line with the strategy of implementing Second Generation Surveillance in Ghana, the National AIDS/STI Control Programme (NACP) and the Regional
ealth Directorates (RHD) in the country under took Sentinel AIDS Surveillance the country.
The AIDS Surveillance Survey was conducted alongside the annual HIV Sentinel
Sekyere i in the Obuasi Municipality and Agroyesum in the Amansie
W t forms inistered by Clinicians. Clinicians were supposed to tick the Cl c orms that a client might present and an HIV Test. AI e VCT (Diagnostic) though the old Qu tQuest VCT Table). (c) Behavioural Surveillance Survey
HReporting Survey in the forty (40) sentinel sites in
Surveillance Survey (HSSS) throughout the country; however the AIDS Surveillance was extended to early 2007. In Ashanti the four (4) sites are Suntreso in Kumasi Metro, Mampong inWest District, Obuas
es District. Each site was given 100 AIDS Sentinel Surveillance Reporting to be adm
ini al Syndromes on the fDS Cases were still captured under thes ionnaire forms were sometimes used alongside with that of the VCT
ionnaire from NACP (Refer
fter a 4-day National training for Regional Coordinators, Field Supervisors and ata Collectors from Monday 24th February to Thursday 2nd March 2006 imultaneously in Kumasi for the Northern sector and Koforidua for the Southern ector, Behavioural Surveys started through out the country in March up to May
ADss2006. The General objective of this survey was: To obtain national baseline indicators related to HIV behaviour and prevention for developing a national database onHIV/AIDS in Ghana. In Ashanti, the survey covered the 4 Sentinel Districts and targeted at: - the general public, the JSS, SS, Polytechnic and one University - KNUST. HIV AND BLOOD TRANSFUSION To avoid HIV infection through blood and blood products Transfusion, blood for
ansfusion was screened in all Health Institutions before transfusion
BLOO
trThere are 27 sites for screening blood for transfusion. Table below shows incidence of HIV positive among blood donors in the Region between 2000 and 2006.
D 2000 2001 2002 2003 2004 2005 2006
50
Dono
Screened
1 7,430 8,715 8715 7935 rs 12476 1357
Donors
Positive
337 308 193 189 310 310
2.5% 1.4% 2.5% 3.6% 3.9% 5.3% 4.3%
TREND OF BLOOD DONAR POSITIVE IN ASHANTI REGION, 1995-2006
2.5
4.2
5.3
3.6
0
2
3
4
6 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
1.9
1.4
1
3.7
3.9
2.6 2.5
22.1
5
6
Y E A R1995 199
51
PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV SERVICES Prevention of Mother To Child Transmission (PMTCT) of HIV services wereprovided in most of the 34 Health Institu
tions. Summary result for 2005 and
6 2006 is shown below.
2005 200
No. Of ANC Registrants 21,547 45670 No. Receiving Pretest Counselling 6,533 13337 Number Tested 3,335 9117 Number Positive 125 304 No. Receiving Positive Test Results
125 302
No. R .ec Post Test Counselling 3,332 8877 No. Of Pregnant Women Rec. Nevir i
55 111 ap ne At ANC
No. Of Pregnant Women Taking Nevir i
41 60 ap ne In Labour
No. Oevirapine
38 62 f Babies Receiving NNo. Of Mother/Took Nevirapine
Baby Pairs That 38 58
In the course of the year, 14 Private Maternity Homes were accredited to provide both VCT and PMTCT Services in the Region after going through the training conducted by NACP in Accra. VOLUNTARY COUNSELLING AND TESTING (VCT) SERVICES Voluntary Counselling and Testing (VCT) is the process by which an individual
elling enabling him or her to make an informed choice about eing tested for HIV. VCT is also one of the methods to limit the spread of the
alth mmary report is shown below.
undergoes counsbinfection in the Region. VCT services were provided in almost all the 34 HeInstitutions that provided PMTCT services. Su
52
VOLUNTARY COUNSELLING AND TESTING RESULTS
2005 2006
Male 751 2042 No. Rec. Pretest Counselling Female 959 2704
Male 732 1850 Number Tested Female 911 2470 Male 732 1,844 No. Receiving Results
Female 911 2468 Male 277 594 No. Receiving Positive Test
Results Female 429
1007
Male 732 1,844 No. Receiving Post Test Counselling Fe
male 911 2468
TYPES OF CLIENTS: Walk Inn: - 1848 Diagnostic - 2781 Other Specify (Visa) - 49 Referral from NGOs - 68
ESULTS OF HIV/AIDS FROM COUNSELLING AND TESTING AND OPD CASES (a) HIV/A
R
IDS CASES
Counselling and Testing sites
OPD cases
Gender
2005 2006 2005 2006
227
594
992
728 Male
Fem
429
1007
1266
1016 ale
Total
706
1601
2258 1744
53
(b) HIV/AIDS CASES (Morbidity)
YEAR Admission Deaths
Male 132 34
2005
372
Female 240
58
92
Male
128
29
2006
Female 312 51
440
80
PROVISION OF ART SERVICES
n had 6 en sBy the end of the year the Regio C tre in 4 of the 21 Districts providing
ART Services to PLWHA. Below are the ART Centres in the Region
NO OF REGISTRANTS
NO ON
ADHERANCE
NO ON ARVs
NO OF DEATHS WHILE ON
s COUNSELLING ARVI
F
NSTITUTION
M F M F M F M
OFF 0 INSO
17
39
8
17
6
6
1
ANGLOGOL 67 75 18 21 17 17 4
0 D
OBUASI 2
4
2
4
1
2
0
0
BOMSO 4
3
37
49
1
1
14
26
PRAMS 0
0 O
12
24
3
4
7
8
KSH 31 85 5 21 18
32
0
1
TO166 276 37 68
63
91
9
4
TAL
54
SEX DISTRIBUTION OF CLIENTS RECEIVING ARVs IN ASHANTI, 2006
35MA
6
1
14
7
18
2
8
32
0
5
10
15
30
26
25
20
17 17
6
OFFINSO ANGLOGOLD OBUASI BOMSO PRAMSO KUMASI SOUTH
LE
FEMALE
ne of the factors that easily facilitate the transmission of HIV is the acquisition
e the spread of the HIV in the Region, STI
linic at Suntreso in Kumasi als conducted HIV Sentinel Survey along side with
the HSSS. The purpose was to estimate HIV Prevalence among STI Clients.
Clients with STDs are managed in both private and Public Health Institutions
both the E ical and drom roach owever, re are thre
STDs Clinics in the Region from where the bulk of the STD tients repo
gement. They are KATH, Suntreso, and O i Hospital dditional S
Clinic was opened early in the year at the M ternal pital
(MCHH) in Kumasi- Kejetia under the WAPCAS/SHARP PROJECT.
STIs /STDs O
of STIs. As part of the effort to reduc
C o
using tiolog Syn ic App es. H the e
main s Pa rt
for mana buas s. A TI
a and Child Health Hos
55
STI S mic M agemen CIDA Pro Sites SYNDROMES
2005
2006
yndro an t at ject
965 Vagina Discharge 1617
Urethra Discharge 926
467
PID
551
0 39
Genital Warts
15
34
Genital Herpes
11
272
Genital Ulcers
716
239
ONITORING AND SUPERVISION M
wo special Regional monitoring teams undertook monitoring and support visits to VCT, PMTCT, ART, HSSS, BSS and AIDS Surveillance sites in the second and third quarters of the year. Special visits were also paid to these sites by various Na onit I na . BEHAVIOURAL CHANGE COMMUNICATION
T
tional M oring and nternatio l Teams
eminars, symposia and other activities were organised in the Region by e resource persons were from the
e. For example the Regional Coordinator was involved /AIDS/STIs Programmes during the period. Some of the
rogrammes were: • Organisation of workshops/facilitation in the Region and Outside the
Regions. sentati
ng of Keynote Addresses. of th V/AIDS C mittee he KNU by the Ho
r of Health i pril for rs and Vice-Principals of Training
the cou y.
SStakeholders during the year. Some of thRegional Health Directoratin several HIVP
• Radio Pre ons. • Deliveri• Inauguration e HI om for t ST n.
Ministe• HIV/AIDS/STI Presentations
n A Tuto
Colleges in ntr
56
CARE AND SUPPORT FOR PLWHA IN THE REGION Care and Support for People Living with HIV/AIDS (PLWHA) has been identified as p rea ve M me IV inf the Region. The PLWHA Associations formed in 2003 grew to 70 by the end of 2006. A work of t ssociati as form (with 2 PLWHA and advisor from each
twork met once a month (the 2nd Thursday of each
f the infection etc. Some people invited to talk at the meetings were the Regional n current issues); the Pharmacist at the ART Centre at KATH (on
rug Compliance) etc
ssociat hav v um porS INITIAT through NACP for their monthly meetings and
tivities to support members. The Associations have a total 2,000 as at e end of 2 6, with more Associations still
registering.
COLLABORATION
riority a in the Pre ntion and anage nt of the H ection in
net he A ons w edof the Associations). The nemonth) at the Regional Health Directorate Conference room to discuss matters concerning the Associations, prevention of the spread oof the special
nator (oCoordid Out of the 70 A ions 42 e received arious s s of sup t from the GLOBAL FUNDIncome Generating Ac
IVE the
number over th 00
The RHD worked in close collaboration with various HIV/AIDS/STDs Stakeholders like:
ting Council (RCC).
The Ashanti Network of NGOS (ASAN).
Ashanti Network of PLWHA Associations and Service Organisations.
Community Based Organisations (CBOs).
Educational Institutions e.g. KNUST, Workers College (Distance
Education)
Ministries and Departments.
The Regional Coordina
District Assemblies.
Faith Based Organisations.
The Press etc.
MEETINGS
(a) There was a two-day Advocacy Meeting on VCT / PMTCT for Health rsday 27th and Friday 28th July 2006 at the Crystal
Rose Hotel in Kumasi Managers in the Region on Thu
57
The Objectives were: - ief Managers with detail information on PMTCT/VCT Services in
the Region - To sensitize Health Managers to play advocacy role in the provision and
scaling up of PMTCT/VCT - To Ma w cu IV/AIDS/STI situat- To discuss and plan the way forward.
vide he W an
one meeting for PMTCT Counsellors was held on 12th Decem2006 at the RHD Conference room. One representative each from 49 counselling
i ding centres o he Pr e Homes) attended. The meeting was to afford assessment of performance and collaboration in the arof VCT/PMTC vices in egion
- To br
update nagers kno ledge on rrent H ion and
Funds were pro
d by t HO-Gh a
(b) A -day VCT/ ber
centres ( nclu f t ivate Mat rnityea
T Ser the R .
TRAINING
(a) Regional There were three training workshops on Manageme portunistic Infections in S a i r:-- 23 Medical Officers and 2 M/As from the 21 Districts of the Region from Monday 7th – Friday 11th Au 006.- 25 Medical Assistants from Monday 23rd – Friday 27th October and
25 Nurse–Prescribers from Monday 13th – Friday 17th November 2006 in
unds were provided by Global Funds through the NACP (b) National
nt of OpHIV/AID nd other D seases fo
gust 2
- Kumasi. F
There were series of trainings organise he NACP for various st the Region e.g.
- ART for Pramso, St. Michael, Offinso St. Patrick’s and Obuasi Government Hospitals
- Care and Support for HIV/AIDS and Families - HIV Testing for Counsellors - Refresher training for Regional Trainers.
cers (2) etc.
SPECIAL V
d by t aff in
- ART Data entry offi
ISITS A team from ESTHER from France visited the Region in June and December 2006 to discuss HIV/AIDS activities and how they could support the Region.
58
WORLD AIDS DAY 2006
he Region joined the rest of the world in celebrating this year’s world AIDS Day, 1st December 2006, as declared by the UN with the Theme: -“ Stop AIDS; Keep the promise; with the sub theme the Time i However, for genuine reason, the Regional celebration had to take place on the 8th of December 2006 at Fomena in the Adansi South District.
HALLENGES
T
s now”.
C
of awareness to the desired behavior change Inadequate human resources at all levels
crimination of PLWHA about the epidemic
False claims of cure IS
HIV PR
Translation of high levels
Stigmatization and DisMisconceptions
nadequate financial resources. etting up a high quality comprehensive care package programme for /AIDS in the region
IORITY AREAS FOR INTERVENTION IN 2007
BM
Infection control unselling and Testing (CT) skills
ivities (CT, PMTCT, ART, OIS)
uilding staff capacity (Training) anagement of sexually transmitted diseases
Blood safety
Improving CoRegular meeting with Counsellors Prevention of Mother to Child Transmission (PMTCT) of HIV. Management of Opportunistic Infections in HIV and AIDS Scaling up of ART sites in the Region Counseling and Home Based care Support for PLWHA and OVC Reducing Stigma and Discrimination against PLWHA Behaviour Change Communication Quarterly monitoring of HIV/AIDS ActStrengthening intersectoral collaboration
59
COMMUNITY PSYCHIATRIC SERVI A TI ON RY – EM 200
CES – SHAN REGIANNUAL REPORT, JANUA CDE BER 6
hiatric Unit provided out–Patient care, C ling, iciliary
he Four Community Based Mental Health community Mental services.
The Old Tafo Psyc ounse Domand Health Promotion activities while tUnits in the Region provided mainly
ACTIVITIES
(a) MEETINGS
The staff of the Tafo unit met twice a month for report readings (alternate Fridays). Discussions were held on home visits, client concerns, and problems; measures were formulated to improve the services in the region. Emergency meetings were held when the need arose to discuss issues concerning the
gion. There were also staff personal development meetings, where discussion nd presentation on various topics pertaining to psychiatry were held on hursday afternoons.
b) CLINIC DAYS
reaT
ekwai and Mampong were Wednesdays (A staff from the
( Major clinic days for Tafo Hospital were Monday and Thursday, while Tuesday and Wednesday were maintained as minor clinic and home visit days. Major clinical days for BTafo Psychiatric Unit assisted the Mampong Unit every Wednesday). (C) MENTAL HEALTH PROMOTION In all 158 Health Promotion Talks were organized by the Tafo Psychiatric Unit. Some of the institutions that benefited were:
, Ash Town and Gyenyinase 3. urch
H y ic l p Abu n
lne
) ILLA
1. SDA Church 2. Assemblies of God Church – Tafo Ahenbronum
Buokrom Estat Old Tafo e of the top
e Presbyterian Ch 4. Som
ospital – dails treated inc
uded Epile sy, Drug se and Me tal Health /
Il ss. (d DOMIC RY DT
uri riod nts we ted as t 717 s in 2 the afo staf
ng the pe hospital
, 431 clief
re visi agains client 005 by
60
Some of the clients were visited at least 2 times during the year. Home visits enabled taff to access how clients coped and integrated at home with family members and the ublic in general.
PECIAL VISITS
sp S
As part of the effort by Basic Needs (an NGOs working to support Mental Patients) to improve Mental Health Situation in the Region Mr. Evans Oheneba Mensah visited the Tafo Psychiatric Unit on 27th of July 2006 to have discussions with the staff on how best they could work together to improve the conditions of Mental Patients in the Region.
EETING ON NATIONAL MENTAL HEALTH BILL
M
uring the year, a -3 day Workshop was held in Accra from 4th - 7th April 2006 to view the Mental Health Bill. The Region was represented by One Officer of the afo Psychiatric Unit
OTATION NURSING
ommunity Psychiatric Nursing a heir basi ts in Psychiatry as against 97 nurses in PSYCHIATRIC CONDITIONS I EGION
ental Health conditions seen were ly:
ANXIETY NEUR S EPRESSION
- HYSTERIA RAINE
ANCE AB IZOPHRROSIS
LEPSY
PSYCHIATRIC CASES IDENTIFIED AND REFERRED TO HEALTH ONS BY VO ERS MA EM UN O
FOR MENTAL HEALTH PROJECT (AMANSIE EAST, SEKYERE WEST, OFFINSO AKIM
DreT
R Eighty-Five (85) newly qualified General Nurses went through C
s part of t c training requiremen2005.
N THE R The main M most -
- OSE- D
- MIG- SUBST- SCH
USEENIA
- NEU- EPI
INSTITUTI LUNTE FOR NAG ENT DER THE NATI NS
AND ASANTE N.
61
(a) AMANSIE EAST NEW CASES
5
2002006
CO MALE AL TA MA TOTAL NDITION FEM E TO L LE FEMALE
PSYCH0SES 110 63 37 37 173 74
NEUROSES 19 8 7 3 5 9 14 23
SUBST. ABUSE 28 0 28 16 0 16
TOTAL 113 50 163 62 51 113
EPILEPSY
2005
2006 MALE FEMALE TOTAL MALE FEMALE TOTAL
199 125 324 24 29 53
(b) SEKYERE WEST TICS ES DISTRICT STATIS - NEW CAS
2
2006
005
CONDI MALE FEMALE TION FEMALE TOTAL MALE TOTAL
PSYCH0SES 52 42 94 59 52 111
NEURO 14 6 20 SES 13 11 24
SUBST. 0 1 ABUSE 0 0 1 0
TOTAL 65 53 118 74 58 132 EPILEPSY
5
2006 200
62
MALE FEMALE TOT ALE E TOTAL AL M FEMAL
159 204 36 80 115 193 5
C) OFFINSO DISTRICT STATISTICS
NEW CASES
2005
2006
C MALE ALE TOT MALE ALE TOTAL ONDITION FEM AL FEM
PSYCHOSES 10 8 1 10 1 11 8
NEUROSES 0 0 0 0 2 2
SUBST. ABUSE 6 2 8 0 0 0
TOTAL 16 10 26 10 3 13
EPILEPSY
2006
2005
MALE FEMALE TOTAL MALE FEMALE TOTAL
76 25 101 13 12 25
C) ASANTE AKIM NORTH STATISDISTRICT TICS
NEW CASES
2005
2006 CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCHOSES 16 13 29 11 7 18
NEUROSES 2 5 1 0 1 7
SUBST. ABUSE 0 0 0 0 0 0
T 18 18 11 7 18 OTAL 26
63
EPILEPSY 2005
2006
MALE FEMALE TOTAL M MALE TOTAL ALE FE
37 32 69 1 3 16 3
Y REPORTS OF STATISTIC TAFO COMMUNITY PSY.SUMMAR S FROM H AND ROTATION NUROME VISITS SES YEAR 2005 2006
NO OF CLIENTS VISITED 717 415
NO OF ROTATION NURSES 97 85
NEW CASES
2006
2005
CONDITION MALE FEMALE TOTAL MALE FEMALE TOTAL
PSYCH98
OSES 176 206 382 188 210 3
NEUROSES 60 133 193 66 122 188
SUBST.
ABUSE 16 1 17 29 1 30
TOTAL 6 252 340 592 283 333 61
EPILEPSY
2005
2006
MALE FEMALE TOTAL MALE FEMALE TOTAL
257 210 467 225 179 404
64
OLD CASES (REVIEWS)
5 2006
200
MALE FEMALE TOTAL MALE FEMALE TOTAL
6954 7803 147 6428 7123 13551 57
PATIENTS REFERRED IN
2005
2006
71
79
PATIENTS REFERRED OUT
2005
2006
26
15
(Mostly Referred to KATH Psychiatric Dept., Ankaful, Accra Psychiatric Hospital and
antang Psychiatric Hospital)
THE WAY FORWARD
P
ity Based M ealth Project t ablished in a D
tal Health R eeting with Pr s in the manag mental conditions and record keeping.
- Mental Health Promotion activities to be intensified. - To effectively monitor mental health activities in the Districts especially where the GHS/WHO’s Community Mental Health projects are in place.
- One Commun ental H o be est istrict - To hold Men eview m escriber ement of simple
65
ADOLESCENT AND REPRODUCTIVE HEALTH SERVICES School Health
School health activities provide opportunity to give messages about health disease
prevention to children that can be spread to their families and communities in which they
live. Supervision of school health activities in the region still remains a problem. There
were training and retraining of school health coordinators in the course of the year since
most people already trained have either left their schools or gone on transfer outside the
region and this was affecting the service. School Health week was also organised and a
number of durbars were held together with teachers to create awareness. This yielded a
good result. 4350 schools were visited and
able: 12 School Health Activities (2004-2006) T 2004 2005 2006 Total School Enrolled 438,004 428,852 442,340 No of Children Examined 127,801 192,717 389,791 % of Children Examined 29.2 45.0 88.0 Schools with current Environmental Health Certificate. 4.4 4.6 9.0 No. of schools 5,943 5,948 11,835 No. of schools Visited 1,162 2,910 4,350 88% of the target group was covered. Adolescent health
ctivities carried out included facility assessment, sensitisation and orientationA of staff.
ent of
d.
in 2005
1%).
Peer educator’s training is still on going in the region. There has been refurbishm
some adolescent health corners. Adolescent health services are provided in 13 facilities
with 17 youth corners well established. The region has 44 abstinence clubs forme
Adolescent Pregnancy in 2006 was 16219 (12.4%) as against 17553 (13.4%)
with adolescent maternal deaths of 19 (1
66
SAFE MOTHERHOOD
lly to reduce maternal morbidity and mortality and to contribute to reducing infant
orbidity and mortality.
s has seen a drastic decrease in coverage from in
2003 to 74% in 2006. T al number of antenatal registrants for 2006 was
or supervis ry in 2006 was 54.3%, skilled deliveries were
) and postnatal ca age was 51.5% a ated in the table b
able 14c: Reproductive Health Outcomes, 2003-2006
Ante Natal Care Supervised Deliveries Post Natal Care
The goal of the safe motherhood programme is to improve women’s health in general and
especia
m
Antenatal care over the past three year
83.6% he tot
130698. Coverage f ed delive
72,062 (40.8% re cover s illustr elow.
T
YEAR
Target
Coverage Registrants Coveragepopulation Registrants Coverage Number
2003 30 58.1 159766 133575 83.6 89829 56.2 928
2004 55.7 165196 131778 79.8 92484 56.0 91947
2005 170814 130980 76.7 92829 54.3 87927 51.5
200 51.9 6 176,622 130,698 74.0 94210 53.3 91,596
67
Table Reproductive and Child Health Performance by District, 2006
ANC
PNC
Supervised Deliveries
DISTRICT Population
Registrants
% Registrants
%
Number
%
Target
Adansi North 5,492 3268 59.5 4713 85.8 2,655 48
Adansi South 5,343 3248 60.8 2525 47.3 3,015 56
Afig 57 ya Sekyere 5,822 3943 67.7 3673 63.1 3,341
Aha 78.5 1645 46.8 2,016 57 fo Ano North 3,517 2761
Aha fo Ano South 6,533 4093 62.7 2406 36.8 2,486 38
Am 50 ansie Central 3,187 835 26.2 249 7.8 1,590
Am ansie East 7,827 4495 57.4 3793 48.5 3,587 46
Amansie West 5,315 4623 87.0 3403 64.0 3,014 57
Asa 59 nte Akim North 6,183 4509 72.9 2972 48.1 3,638
Asa 4135 87.3 3072 64.9 2,166 46 nte Akim South 4,735
Atw 56 68.7 1,726 ima Mponua 4,4 3060 2109 47.3 39
Atw ya 7,160 01 86.6 55.3 3,741 2 ima Nwabiag 62 3959 5
B.A.K 7,139 5624 78.8 3531 49.5 4,422 62
Ejis u-Juaben 6,070 4831 79.6 3774 62.2 4,011 66
Eju 71 ra Seko 3,965 3829 96.6 2200 55.5 2,825
Kumasi 57,210 41,913 73.3 27629 57.6 30,262 53
Kwabre 8,050 7139 88.7 4634 55.8 4,849 60
Obu asi Municipality 7,142 6332 88.7 3983 54.6 3,726 52
Offi nso 6,779 6279 92.6 3701 37.6 5,510 81
Sekyere East 7,694 3863 50.2 2891 67.6 3,084 40
Sekyere West 7,001 5717 81.7 4734 57.6 4,621 66
Regional 91596
51.9
94,210
53.3
176,622 130,698 74.0
68
FAMILY PLANNING
rginal rise in FP acceptor rate from 14.15 to 15.3% in 200
istrict performance ranged from 6.1% in Sekyere East to 39.4% in the Kwabre district. Planning Acceptor Rate in Ashanti
ate
There was a ma in 2005 6.
D
Table 14a: Trend of FamilyYEAR Target Population Number of
Acceptors Acceptor R
2004 991,187 126,810 12.8% 2005 1,024,887 139,692 14.1% 2006 1,035,831 158,757 15.3% Family Planning Performance by District 2006
Target Population Number of Acceptors Acceptor Rate
Districts
ADANSI NORTH 441 13.9 31,854 4
ADANSI SOUTH 408 13.2 30,991 9
AFIGYA SEKYERE 33,767 7146 21.2
AHAFO ANO NORTH 20,401 2845 13.9
AHAFO ANO SOUTH 37,890 10034 26.5
AMANSIE CENTRAL 18,485 1206 6.5
AMANSIE EAST 45,399 6741 14.8
AMANSIE 30,828 4399 14.3
WEST
ASANTE AKIM NORTH 35,861 5431 15.1
AS T27,466 3771 13.7
AN E AKIM SOUTH
AT M25,846 2126 8.2
WI A MPONUA
ATWIMA NWABIAGYA 41,525 5900 14.2
B.A.K 41,405 7362 17.8
EJISU-JUABEN 35,209 13333 37.9
EJ AUR SEKO 22,999 2029 8.8
69
KU10.8 343,258 37211
MASI
KWABRE 46,690 18406 39.4
OB SUA I MUNICIPALITY 41,425 8570 20.7
OFFINSO 39,320 7148 18.2
SE E6.1 44,628 2718
KY RE EAST
SEK E04 3878 9.6
RE WEST 40,6
Y
TOTAL 1,035,851 158757 15.3
Couple Years Protection
ral Pills remained the most preferred method within the short term method range. method used by 59.3% of acceptors
f long term contraceptive method.
tion by Method 2006
OFemale sterilization also remained the most preferredo Couple Year Protec
Contraceptive 2006 Oral Pills 17,185.93
Condoms 16,028.45
Spermicides 390.29
Norigynon 3,716.53
LAM 1,279.64
Depo Provera 25,830.34
Total 64,431.18
IUD 17,225.50
Female Sterilisation 58,853.52
Norplant 21,187.40
Natural 1,516.00
Vasectomy 417.80
Total 99,200.22
GrandTotal 163,631.40
70
INTEGRATED MANAGEMENT OF CHILHOOD ILLNESS (IMCI) ACTIVITIES Growth Monitoring & Promotion Data on the above is collected from child welfare clinics and the indicator of malnutrition
ased on weight for age, i.e. underweight.
24-59months.
ver the past three years incidence of malnutrition in children under 5yrs of age has seen marginal decrease from 3.40% in 2004 to 3.10% in 2006. However CWC coverage for nder five increased by 10% (34.80% in 2004 to 44.50% in 2006). Amansie central corded the highest incidence of malnutrition (7.3%) with Adansi North and Obuasi
incidence of 10.80% of malnutrition whiles Amansie East recorded the lowest of 0.15% for children 24-59 months of age. CWC PARAMETERS Children 0- 23 months Year 2004 2005 2006
b The target for the year was 100%. For children 0-23 months there was a decrease in coverage from 66.50% in 2005 to 61.12% in 2006 and an increase in coverage from 13.81% in 2005 to 16.93% in 2006 for children Oaurerecording the lowest of 0.55% and 0.69% respectively. For children 0-23 months, Atwima Mponua recorded the highest
Total Registrants 206144 221676 245287 W 6762 6722 5591 /A <80% Total population 326265 337359 348849 % coverage 63.20 65.71 61.12 % ourished 3.30 3.03 2.89 maln Children 24- 59months Year 2004 2005 2006 Total Registrants 29770 50704 66091 W/a <80% 1878 1653 1880 Total population 355175 367251 379737 % coverage 8.40 13.81 16.93 % malnourished 6.30 3.26 3.34
71
CW rage for children to 59months in 20
1
2
C cove aged 0 06
3
4
5
6
7
0
2004 2005 2006
24-59 0-23
CWC PARAMETERS Malnourished Cases of Children 0- 59 months
ear 2004 2005 2006 YTotal Registrants 237407 275203 324354 W/a <80% 8096 9163 9947 Total population 681440 704610 728576 % coverage 34.80 39.10 44.50 % malnourished 3.40 3.30 3.10
Prevelence of malnutrition in children aged 0-59months attending CW C in 2006.
2
4
6
8
02004 2005 2006
24-59mos 0-23mos
72
BA IATIVE PROGRAMME Data on the above is compiled from all delivery facilities. However data on breastfeeding init iofriendly facilities has not increased over
vi anagement. Thirty - one (31) thirteen (313) maternity facilities in the region are baby friendly.
or assessment since 2005.
d
unity level should be from TBAs.
BY FRIENDLY HOSPITAL INIT
iat n is limited to only baby friendly facilities. The number of designated baby the past 12 months. During the year under
re ew none of the district undertook training in lactation mout of three hundred and Additional 31 facilities were trained in 12 districts and ready fThere is an urgent need to assess the back log of 31 facilities trained since 2005 to scale up the number of facilities designated as baby friendly in the region. An upward trend in the initiation of breastfeeding which started in 2003 reached its highest level in 2004 an gradual fall was registered in 2005 and 2006 thus making it a call for concern. a
KATH which delivers a substantial proportion of women in the region is not baby friendly and does not submit reports on maternal supplementation of vitamin A and other baby friendly activities
istricts that have no breastfeeding facilities have to take steps to address this anomaly Dby the end of 2nd quarter 2007.
hannels for vitamin a distribution and reporting at commCstrengthen to capture data Mother support groups at local levels should be strengthened and improved. BREASTFEEDING PROMOTION Year 2004 2005 2006 Total Facilities 313 313 313 ( mat ) Designated as BF 31 Nil Nil % BF 9.9 0 0 An additional 31 facilities have been trained in 12 districts and ready for assessment since 2005. BABY FRIENDLY PARAMETERS Year 2004 2005 2006 Expected delivery 165195 170815 176622 B.F < 1hr 45979 37431 32672 % Initiation 49.6 40.3 38.80 % M. Vitamin 49.6 38.10 66.10
73
Community Based Growth Promotion (CBGP) Data on the above is compiled from 55 sites (communities) in the region where community growth promoters have been trained with PPTAP and BASICS II support. BASICS II supported 15 out of the 55 communities while PPTAP supported 40. The programme which first started in Atwima district was extended to all the 21 districts
munities with support from PPTAP (promoting e. ok
saw a highly unacceptable defaulter rate in all communities. dequate weight gain did not meet the minimum target of 80% set for the year. Monthly
ow side; however Sekyere west did not submit a single report for
wards.
P)
in Ashanti region and scaled up to 40 compartnership with traditional authorities’ project) under the auspices of the AsantehenDistricts were tasked to train additional communities each but none of them undertothe training. The year under reviewAreporting was on the lthe period under review. There is the need for districts to organize and conduct refresher training in the use of counselling cards for growth promoters and also promote quarterly community meetings as well as strengthening reporting system and institute re Community Based Growth Promotion (CBGYear 2004 2005 2006 District trained 1 21 Nil Community trained 22 40 Nil Districts were asked to train an additional site each for year 2006 but none did. (Target: 21 communities; one community per district) Micro Nutrient Supplementation
eactivation of the committee in Kumasi- metropolis also contributed significantly to the rise b asi being the capital of Ashanti region is stra i and all commercial activity in the region and the Diaspora are carried out here and so reactivating the metropolis iodated salt committee has adversely affe d usage in the region. There is the need to intensify education at static points, outreach points, local fm stations and other social gatherings as well as reactivate iodated salt committee that are dormant or estab ittees in districts that do not have. The following districts did not submit report for the November; market and household iodated salt survey. They were; Adansi north, Adansi south, Ahafo Ano north, Amansie
Iodated Salt Programme An upward trend in both the availability and usage of iodated salt was recorded during the year under review this is being attributed to the gradual increase in the number of functional iodated salt communities which are responsible at the local level to oversee the programme. R
in oth availability and usage. Kumteg cally located
cte availability and
lish comm
74
wes ma Mponua, Offinso, Atwima Nwabiagya and Sekyere WeThree sub metros Asokwa, Bantama and Tafo passed whilst two; Manhyia and Subin failed. Seven (7) districts and two sub metros out of the eleven- (11) districts, which carried out the survey, failed. Iod dYea 04 2005 2006
t, Asante Akim north, Atwist.
ate Salt Programme 20r
Ava 26.50 35.50 82.8 ilability Use 38.40 43.12 79.3 Test kits for iodated salt monitoring for the year under review was not received. What is
xpired in November 2005; this has been communicated to Accra currently available enutrition unit but no feedback has been received.
itamin A Supplementation VVitamin A supplementation for children 0-59 months has over the years been scheduled to coincide with national immunization days and child health week. Coverage of 85.32% was recorded for the region in November 2006 indicating a decrease of 38.10% over the previous year's coverage. The downward trend of maternal supplementation of vitamin a (within eight (8) week of post partum) that started in 2005 reversed in 2006 showing a significant increase (28%) in maternal vitamin A supplementation, the figure however did not meet the target (70%) set for the year under review. Vitamin A programme, Children aged 6-59 months Year 2004 2005 2006 Target 598840 619200 919127 Dosed 822154 865826 784229 % D. T. Card 137.29 139.83 85.32 Nutrition Rehabilitation The region recorded a marginal increase in the rate of rehabilitation of children with
protein energy malnutrition. There was a drastic decrease in case fatalities by over 30% from the previous year's figures. Thus meeting the target set for the year. Rehabilitation centres in the region are facing dire problems with regard to funding. The issue has been raised twice at two meetings during the year under review (first at the national public health review at Wadoma hotel and second at RHMT meetings)
here is the need to support rehabilitation financially to enable them run efficiently. T
75
Nutriti 2006 Year 2005 2006
on Rehabilitation, 2004 - 2004
Cases 1836 3239 4774 RR 46 44.9 48.40 % CF 2.90 2.59 1.17 Target: To reduce case fatality by 30% in rehabs. Anaemia Control No major activities in terms of training/durbars were carried out during the year.
owever, nutrition and health education in majority of facilities and outreach were entered on prevention of anaemia and the eating of fruits and green leafy vegetable to
tus of pregnant women and children <5 years of age.
d utilisation of results appear to be a major istricts
ional iodated salt committee in most districts.
ional assessment team for BFHI programme to assess the backlog s trained in 2005.
h iodated salt committees in districts. uled monitoring of iodated salt programme. number of facilities per current designated number of baby
rganize the distribution of vitamin A supplements for newly delivered mothers
hildren 6-59months. hnical officers.
Hcimprove the nutritional staAnaemia cases formed about 56.80% of the total admissions of nutrition rehabilitation cases for the year under review but contributed to about 32.50% of the total case fatalities. Challenges
• Lack of technical staff • Financial constraints • Lack of log istics
analysis an• Data compilation, enge in most dchall
• Non funct Way forward
nat• Liase withof 31 institution
s• Revive/establihed• Conduct sc
• Train marchingfriendly institutions.
• Organize and conduct training session on rehabilitation for centre staff. • Organize and conduct two durbars per Subdistrict on GMP and conduct one on
iodated salt/vitamin A. • See to the holistic management of diet related diseases. • O
within 8 weeks post partum. • Distributive two rounds of vitamin A capsules for c• Capacity building in data management for tec
76
PUBLIC HEALTH LABORATORY - KUMASI
INTRODUCTION
The public health laboratory, Kumasi is situated on the premises of the Kumasi South
hospital. It serves as the zonal laboratory for Ashanti and Brong-Ahafo regions in the
investigation of diseases of public health importance. It has staff strength of five (5); two
A
Tra in ve
visi w spitals on infection prevention practices.
Technical Support / Monitoring: All HIV testing facilities were visited in the year
The opportunity was used to
(2) Biomedical scientists, two (2) laboratory assistants and one (1) hospital orderly.
The year under review has been challenging but routine activities were carried out with
some success.
C VTI ITIES
in g: There was no structured refresher training in the year but on-site correcti
ts ere paid to two (2) sub-district ho
under review twice to monitor test-kit usage and availability.
ascertain the preparedness of the facilities to transport samples for investigation of
diseases of public health importance. The facility also actively monitored the four (4)
HIV sentinel survey sites and ensured adherence to protocols.
Quality Assurance: Quality Assurance was carried out in the 2nd and 3rd quarter of the
year under review for Tuberculosis Sputum smear microscopy. The report revealed a
sensitivity of 100% and overall agreement of 92.1%. Smear preparation abilities
improved but 23 out of the 292 slides re-examined turned out to be false positives.
Routine Microbiological Services: The Public health Laboratory provides routine
culture and sensitivity services to the Kumasi South hospital and other hospitals in the
umasi metropolis and surrounding districts. K
77
Table 1: Summary of samples and most common isolates, 2006
Sample Cultured Isolates #
Urine 185 E. coli - 16, Klebsiella spp. - 10, Coliforms - 2 HVS 156 Candida - 18 Blood 16 Sputum 6 CSF 2 Wound 37 Pseudomonas- 10, Proteus spp.- 7, Klebsiella spp- 3 Stool 57 Pus 10 Klebsiella spp. - 2, Serratia - 1 Urethral S 6 N. gonorrhoea - 4 Ear 3 Pseudomonas - 1, Klebsiella spp. - 1 SF 1 Total 479
re were reports of suspected outbreaks of cholera and Disease Surveillance Support: The
other diarrheal diseases, which were all investigated.
2005 2006
Table 2: Three-Year trend of some serological tests:
Test 2004 # Pos # Pos # Pos HIV 393 170 375 154CSM 25 1 21 2 8 2HBsAg 43 13 100 12 129 20VDRL 4 0 13 1 62 5Widal 1869 1624 1216 Cholera 5 0 142 49 Ogawa 176 54 Ogawa
Challenges/Constraints
78
Major challenges in the year included slow pace of maintenance of faults at the facility
and the poor rate of report submission from the district hospitals. Lack of dedicated
Mission of H• To su in al institution with the capacity to design, produce,
itate the organization and maintenance of well organized regional and health
• To cr mong the people of Kumasi on attitudes,
percep n at will positively influence them towards improved health.
s Production • Resource Centre Management
ell Disease Education and Counseling
d Activities
i) I In-Service Policy Document ls and In-service Training
with QHP. The manuals ave been made camera-ready and submitted to QHP for printing.
cuments
transport for frequent support visits is a big constraint.
Health L rea ning Material
N LMC sta a permanent nation
distribute and evaluate the impact of HLM targeted at health service tutors, staff in service and trainees (students)
• To facil
training institutions-based resource centres
eate and increase awareness atio s and behaviours th
Major Activities for the Year As part of the responsibilities towards the improvement of overall health status of people living in Ghana, the National Health Learning Materials Centre (NHLMC) continued with activities entrusted to the Centre. In pursuit of the responsibilities, the Centre worked on the following programme areas within the period under review.
• Health Learning Material
• Sickle C• Health Education • Coordination of IE & C of TB Global Fun• Administration and Support
HLM PRODUCTION nduction and Orientation/
The Unit completed works on Induction and Orientation manuaPolicy which were being developed by HRD in collaborationh ii) Policy Do
79
Four policy documents namely: postings, appointment, promotion, counseling underwent t level editing, formatting, layout and submitted to HRDD forfirs technical review. The
)
ental Health Manual itiative of the Centre that was started some years back. This manual
has go t w stage. In May th y ospitals, Training Institut ssuitability nual. During t e that a major aspect of Mental Health was not
In this regard two members were e chapter has been received and is
nt he manual. The next step for the manual is the sti l production, i.e, and printing. Currently, a
has br head office in Accra, wh
sponsorship.. Research Manual The Research manual is also initiative of the Centre that was started in 2005. The scripts have been collated to form an acceptable manuscript. Currently the contents are being modified to suite the curriculum of nurse trainees who have been targeted as the primary audience. iv) New Materials These are materials that are at the writing stage. The materials are on Radiography, Occupational Health and Laboratory Services. These manuals were developed based on a curriculum from the HRDD. Based on the curriculum a book plans were developed out of which the various chapters were allocated to writers. The writing started in 2004 and
ment in
feedback was received and final editing and desktop works had commenced on them.
iii Mental Health and Research Manuals . MThis manual is an in
ne hrough the various stages of production, up to the technical revieis ear, a technical review team drawn from the Psychiatric hion , HRDD and other stakeholders were put together to assess the content and the
of the ma
h review, the team realizedincluded in the document, which is stress management.asked to write a chapter on the stress management. Tht
curre ly being edited for inclusion into trete ng stage, proofreading and finap
proposal een sent to Basic Needs International, a Non-Governmental Organization with thei ich has expressed interest in the manual for printing
most writers have not completed their scripts in spite of persistent calls to complete the scripts. Currently contacts are being made heads of the respective groups to move these manuals forward. v) Materials Needs Assessment Survey A proposal to identify materials needs within the health sector was developcollaboration with the National Training Coordinator. The purpose was to identify priority materials for production based on needs. The proposal has been finalized and submitted to HRDD. vi) Ashanti Journal
80
The Unit continued with the collection of articles and pictures for inclusion intoAshanti journal. The journal has been made ready for final editing
the by the editorial board.
a related development a National Service Person with journalism background was ith the work of the journal.
ipments were pu ed to enhan work of the e. Notables ngst ystems, T DVD p ese have ropriate d
ks.
bought quantities Directorate to help with the writing of
ooks. Rout maintenance of almost all the equipment was carried out the air-conditioners, generator, mower and
airs uternd the photocopies. these eq are functioning except one 2 laptops and 2
ters.
s as a model for the regional resourc tres and t stitution based The libr as a wide e of books ealth and d topics.
gain we took stock of all the materials in the library. In view of this an up-to-date data ase was updated to ensure proper monitory of the materials in the library. Reading aterials that received the highest patronage were:
Planning • Pharmacology • HIV/AIDS • SCD Reports • Journals • Health Education • Medicine • Administration And Quality Assurance • Maternal and Child Health • Primary Health Care • Environmental Health • Other Health Reports
In all 2, 874Books were used and 14 Videocassettes were borrowed within the year.
Inposted to the Unit to assist w Resource Centre and Library Management New equ rchas ce the offic amothem are; PA s V set and layer. Th been app ly recordein the inventory boo Also items were in bulk t ke entry into the stores books easier. A o mastorekeeper was engaged from the Metro Healththe numerous b ine within the period. Significant among these are anti-virus upgrading. There were frequent rep of the comp s including the laptops a All uipment compu The library serve e cen he inresource centres. ary h rang on h relateAbm
• Research reports • HIV/AIDS • TB • DRUG ABUSE • Malaria • Health System Management • Nursing • Family
81
Health EducatThe health education component continued to reach out to the people of Kumasi
lis on ng t ealth. T ati ramme at in rene e p asi p ons
voiur tively influence them towards improved health.
d on this res d gram la and d. edu rog re responsive, however, few
proactive programmes were u To ceive ten ere S, S culo opa al h nvi ntal
ation, Nu atin The invita hes, schools, NGO’s and Communities. The team w bark prog s at
The educational component to h f Ed and sp ship World niza HO) an educational awareness
e on Drug Abuse dubbed Youth Enter-Educate on Drug Abuse targeting titutions in som ed dis the Metro To
assess the impact of the education, mpetition was organized for the schools in ticipatin ts on the ecember
Coordination of IEC Activities of TB Global Fund The Centre also engaged in activities aimed at creating awareness on tuberculosis The activities carried out on awareness creation were mainly done in communities. Places visited included Adiebeba, Anwomaso, Domeabra, Apromase, Bantama, South Suntreso,
manfrom, Ohwim, etc. Church group and school education rogrammes were also undertaken. Radio and Jingle broadcast were also done to promote
The following facilities were monitored for progress work as well as challenges confronting them.
Tafo Hospital Suntreso Hospital Kumasi South Hospital Maternal and Child Health Hospital Central Prisons Technology Hospital 4 miles.
Some of the constraints that came up from the facilities were lack of PA system for Education and inadequate finance for T&T. The Unit engaged in TB educational campaign in JSS within the Bantama Submetro. This was the first phase of programme lined up to cover all JSS within the Kumasi Metro.
ion
Metropo matters relati o their h he health educ on prog s aimedcreating and creasing awa ss among th eople of Kum on attitudes, erceptiand beha that will posi
Base , proactive, ponsive an reactive pro me were p nned implemente Most of the cational p
ndertaken. rammes wepics that re d most at tion w
HIV/AID TI’s, Tuber sis, Men use, Person ygiene, E ronmeSanit trition and E g Habits. sources of
as able to emtion included on radio
churcramme
Nhyira FM.
gether with t e Ministry o ucation onsorfrom Health Orga tion (W carried outprogrammsecond cycle ins e select tricts outside Kumasi polis.
a quiz co12the par g distric th D 2006.
North Suntreso, Adoato, Apthe awareness creation. The FM stations contracted were Nhyira and GCR FM.
82
Drug Abuse Campaign Within the period, there was a drug aschools dubbed, “Youth Enter Educate
buse educational campaign in all second cycle Programme” in the under listed districts in two
e e
he first phase covered these districts;
oma
Ahafo Ano North
at KNAT hall Kumasi. The participating schools
ekyere East - T.I Ahamadiya Sec. Effiduase Sec Com. and Dadease Agric Sec.
, Christ thAt onua – Mpasatia ch Amansie East – Oppong Memorial Sec, Wesley High Sec, SDA Sec
Dignitaries present included the following: Mr. J.O. Adje e Guidance and Counseling Unit of the Ghana Education Service, Ashanti Regional Office. Mr. Andrews Adjei Druye, head of the National H earnin rial rs. Sophia -Barima, a representative from the WHO. Mr. Dan Briama, A onal Phar At the end of the three rounds Amansie East came first with 56 points, Obuasi Municipal was second with 40 points, with 37 points the third position went to Sekyere East. Ahafo Ano out h 35 points, Atwima Mponua was fifth with 32 points and the sixth position went to Ahafo Ano No th 23 p Awards m were give e vario ool ed the ts and the contestants received books and certificates as w t three districts received a shield each.
phases. The campaign was a follow up to a research conducted by the Centre to ascertainthe prevalence of substance use and abuse among the youth in Ghana in 2003. Thprogramme was supported by the World Health Organisation (WHO) Reports on thesprogrammes have already been submitted to WHO. T
Sekyere West Bosomtwe Atwima KwanwAtwima Nywabyiaga Kwabre Ejisu-Juaben
The second phase covered the following districts;
Atwima Mponua Sekyere East
Ahafo Ano South Amansie East Obuasi Municipal
As a follow up to the educational activities carried out in Second Cycle Schools on DrugAbuse, a quiz competition was organized among the schools that benefited from theprogramme on 12th December 2006were grouped on district bases. The district and corresponding schools are enumeratedbelow:
• S• Ahafo Ano South – Mankranso Secondary School
h orth – Tepa Sec Schoo• A• Obuasi Municipal – Obuasi S
afo Ano N ondaryec Tech
l e King Sec
• wima Mp Sec Te•
i, Head of th
ealth L g Mate s Centre. M Twumshanti Regi macist
S h came fourth witrth wi oints.
ade up of books n to th us sch s that represent districell. The firs
83
Sic Ce and Counsel
T llowing were specific objectives set for th le C ject; Educate and counsel parents and patients at the sickle cell clinic
asi metropolis
i. PEducation and Counseling of parents and patiesuccessfully for both first attendants and continuous education. At the end of the year
e clinic was 201. Among ent of pain
v ations ll crisis, Septicem ns of inf nici ylaxis and Folic Acid, Managing fe nd home, Nutrition, lari dr at for data
llect t clinic s n as intro in 006
Aw Public education in churches was done together with the Sickle Cell Association based on request. Some of the churches visited were, Methodist m ves meeting at
ofraturo Girls School Kumasi odist C ch , Kwadaso te Methodist Church, Ahwia Methodist Church, Oforikrom Church of Christ, Corpus Christi Catholic Church, New Tafo, St. Theresa Parish, Asawase etc. In addition, radio
ucat the dio . P was d in the following organizations: Kum ytechnic and KNUST.
Int al StudentsDuring the year under review, only one student arrived from the USA to undertake a
arc ntry. S rri latter part of June and stayed for six weeks. The title of her study was “Willingness of sickle cell parents to pay for National
ealth Insurance”. The Component supported her in the data collection. She was still at e analysis stage when she left for the US
n he Component provided support to the Sickle Cell Association of Ghana both locally
the
ent
The component has helped the association to open a branch at Koforidua, Eastern Region.
kle ll Education ling
he fo e Sick ell Disease pro•• Continue create awareness about Sickle Cell Disease in the Kum• Support international students • Support Sickle Cell Association
arents and Patient Education at the Sickle Cell Clinic nts at the Sickle Cell clinic continued
under review the total number of first attendants registered at thp ed were is ng for SC dthe to
d aics discuss
itu; what th i
SCD, carihe
D chil , home manageman oiding s at w trigger t ia and sig
t e s,ction
PeMa
llin Propha, acute ch
ver a pain aest syn
ion at the firsome etc. The component has developed a new
ew format w form
November 2co . Thi duced
ii. areness Creation
inisters wiMm , Wesley Meth hur , Amakom Esta
ed ion was given on stu s of Nhyira and Luv Fasi Pol
Ms ublic education one
iii. ernation
rese h in the cou he a ved in the
Hthiv. Support to Sickle Cell AssociatioTand nationally. The Component provides Administrative and Educational Support toAssociation. Monthly meetings were held on first Thursday of every month at KATH. The Compontook the opportunity to give them talk on various issues and also invited resource persons to talk to the members on other relevant topics
84
iv. Celebration of FALDA – 10TH MAThe celebration of Africa Day of Sick
Y le Cell Disease took place at the Eastern Regional
apital, Koforidua under the Theme: “Sickle Cell Disease – A Need for More Regional ssociations”. The programme was attended by all the existing branch members namely:
as chaired b asebre Nana ti Boateng, the Omanhene of the New al area and er dignitaries ttendance, we he Regional ister,
aw Barimah, the Regional Director of Health Servi r. Ebenezer piah r. Fleischer-Djoloto, NPO- Fam
Deputy Director nical Care, tern Region hers were ical SSCD Project, Dr. Osei Ya the Med tor of t al
r. Obeng Apori, and heads of departments within the GHS, National xecutive of Sickle Cell Association of Ghana (SCAG) and members of the SCAG.
The and coun staff have going to very Wed to counseling nee f the people
unseling T ing the component attended a raining for two (2)
n Nigeria. The tra g was organ from 2th august 20 t the Idi-Ara Surulere, Ni a. For pants drawn from
The objective o p ts with the requi knowledge a skills t counseli since unseling is viewed as a cost effective mean kle cell problems
isory Committee eting ittee meeting for th on the 17th October 2006. The
al investigator Dr. ku Ohene ponent were presented and each component gave a report on their various activities covering the
eriod January – June 2006
hip aster’s
he Centre received funds from the Government of Ghana for the following activities
• Service • TB Global
CAAccra, Tema, Kumasi and Sunyani. The occasion wJuaben tradition
y D oth
Dr Oin a re, t Min
Hon. Y ce, D ApDenkyira, DTaylor,
ily Health and Popula Eas
tion of WHO and Dr. . Ot, Cli Clin
Coordinator, N w Akoto, ical Direc he RegionHospital, DE v. Genetic Counseling
education seling been the SCFG e nesdayaddress the
ds o .
vi. Genetic Co rainOne staff fromweeks i
Genetic and Counseling Tizedinin 30th July to 1 06a
Sickle Cell Centre ba geri ty-one (41) particiGhana, Sierra Leone and Nigeria attended. participan
f the course was to equio conduct effectivesite nd ng
genetic coamong the populace.
s of addressing sic
vii. AdvThe 2
Mend advisory comm e year was held
princip Kwa Frimpong was around. All the comrep viii. Change in CordinatorsDuring the year under review the coordinator Mrs. Stella Appiah left to pursue a mdegree in philosophy at the University of Ghana, Legon. Her position is replaced by Mr.Andrew Adjei Druye Finance and Administration T
• Administrative Expenses
• Donor Pooled Fund
85
Some IGF were also raised through the use hiring of equipment and use of the conference d there wa tanding bill
ort fficial vehicle and thes rovers
Hilux Pick up o One Nissan Petrol
ll the vehicles were repaired and serviced regularly. However, one of the Land Rovers
ost of maintaining the vehicles were very ded budget set by the Centre.
ajor repairs and the details were as follows, Land Rover (GV led. The Toyota Hilux (GV7290C) Complete Home used engine was
ought to replace the old one. New tyres and a battery were bought to replace the old new tyres bought and the tape Monthly
bmitted to the Regional transport manager for assessment during the period under review. A• and Instructional Guide have been
irect . • un on the foll icy docume pointment, Promotion,
ling. • hanti Hea l has been completed and given to the
editorial board for editing. • tion p s responded• hased to enhan ntre’s work C
procurement of HLM for the institu Several calls to Director of supply Division did not yield any result.
The old nature of some of the vehicles put serious financial burden on the Centre’s s of maintenance.
s to initiate health education programmes from the centre. R
for funds to initiate health education programmes e new vehicle to replace the old Land rovers
uters and Printers and other accessories need to be bought for the Centre
The need to procure new HLM for the Reso ntres and the training institutions in the country.
hall. All bills have been settled an
s a not outs
TranspThe centre has four (4) o
o Two lande are;
o One Toyota
A(GV 982C) has been packed since 2005. The chigh and as such always excee The vehicles underwent m956C) was overhaubones. the Nissan Patrol, new battery was bought, vehicle reports were also su
chievements Employees Handbook, Manual for Inducting Staff,
completed and delivered to D or HRDD DTP work has beg
Posting and Counseowing pol nts; Ap
DTP work on the As lth Journa
All request for health educa rogramme to New computer purc ce the Ce .
hallenges The health training tions is long over due.
budget in term Lack of fund
ecommendation • Need to solicit• Need to acquir• New comp
• urce Ce
86
3.0 CLINICAL/INSTITUTIONAL CARE
Utilization of Hospital Services
F TREND IN NCE ASH
3.1
IG. 4: OPD ATTENDA PER CAPITA ( ANTI, 2002 – 2006)
0.480.48O
PD P
0.50 0.50 0.50
0.48
0.49
50
0.51
E
0.500.50
0.ITA
0.472002 2003 2004 2005 2006
Y E A R
0.49
R C
AP
Out of this, the
South Hospital reported 71846 (80911 in 2005) representing
4%. This is an indic iet low and therefore there is
the need to increase accessibi
OPD attendance per capita rem
spite the implementation of National Health
years.
Asante Akim North had the highest per capMu i west of 0.09. 3.1.1 Summary Statistics Tab 1
Indicato 2005 2006
The total OPD attendance stood at 2,219,881 as against 2,129,973 in 2005.
regional hospital, Kumasi
ation that patronage at the hospital is qu
lity and use of health services in the region.
ains at 0.5 meaning only about half of the population is
consulting at our institutions per year de
Insurance Schem been relatively stable for the past four e in the region. The trend has
ita attendance of 1.3 followed by Obuasi nic pality – 1.0 while Amansie Central had the lo
le 6a: Clinical Care Performance Indicators 2003- 2006 r 2003 2004
OPD Att 29973 2,219,881 endance 1,987,184 2087720 21Atte an 0.5 0.5 0.5 nd ce Per Capita 0.50 Adm i 104,326 118,252 115,891 iss ons 107,029 % B Occ 46.9 43.6 26.2 ed upancy 40.5 Turn eov r per Bed 37 53.3 43 42.9
87
Table 16b: Hospital Utilisation by Ownership QUASI GOV’T PRIVATE GHS MISSION
OPD% 65% 20 9 6
ADMISSION/1000 42.6% 50.3% 6.5% 0.6%
BED OCCUPANCY 20.8% 26.2% 5.7% 0.3%
BED TURN OVER 22.5 28.5 4.1 0.2%
3.1.2 Causes of OPD Attendance
shows that Malaria (47.3%), ARI (7.4%), Diarrhoeal
, it is important to
op ten lists for the past four years,
conditions that ely treated or prevented through non-hospital
interventions.
Ta 17: Diseases Diseases 2006
Analysis on morbidity pattern
Diseases (5.0%) were the leading causes of OPD Attendance. However
note that hypertension has been appearing in the t
where as HIV/AIDS is still not included. Most of the leading causes of morbidity are
can be most cost effectiv
ble Top Ten Causes of OPD Attendance (Morbidity 2004-2006) 2004 Diseases 2005
1 9.1%) Malaria 873911 Malaria 682213(45.5%) Malaria 817,028 (4
2 136610 ARI 105827 (7.1%) Cough (IMCI) 101,980 (6.1%) Cough (IMCI)
3 Diarrhoea arrhoeal Dx 92323 69897 (4.7%) Diarrhoeal Dx 75,058 (4.5%) Di
4 63,003 (3.8%) Skin Diseases 76752 Skin 54534 (3.6%) Skin Diseases
5 Hypertension 44,622 (2.7%) Hypertension 57218 Hypertension 41588 (2.8%)
6 Home/Occp. Home/Occp. Accidents 35128 (2.3%) Injuries 43,302 (2.6%) Injuries 50118
7 UTI 31358 (2.1%) Acute Eye Infection 29,851 (1.8%) Rheumatic/Joint
conditions 38312
8 30932 (2.1%) Rheumatic/Joint conditions 29,557 (1.8%) Acute Urinary
Tract Infections 29879 Rheum
9 Intst. Worm 30587 (2.0%) Acute Urinary Tract Infections 22,892 (1.4%) Intestinal
Worms 26752
10 25258 (1.7%) Intestinal Worms 20,984 (1.3%) Acute Eye
Infection 25126 Eye
All other
s
391944 (26.1%) All other 414,903 (24.9) All other diseases 441714 disease diseases
)
Total 1499266 Total 1663180 (100%) Total 1848715 (100%
88
3.2 Fig ATION (ASHANTI, 2002-2006)
ADMISSIONS
5: TREND IN HOSPITAL ADMISSIONS PER 1000 POPUL
24
25
24
25
26
NU
MB
ER
26
28
26.2
22
28
2002 2003 200 2005 2006
27
PER
100
0
29
23
4
Y E A R
health facilities in the region showed a slight decrease from 27.7 per
6.2 per 1000 in 2
The Admission rate is highest in Asante Akim North District (74.9 per 1000), but lowest
Districts (9.7 00). A o Sou rict has consistently
f low admissions for the past five years.
cy Rate
ional bed occupan obser the dist nd regional hospitals
43.6 in 2005 to 2006 her decr om 47.8% in 2004.
Health facilities in the region are operating efficiently at a level far below the national
occupancy ccup te in the region reflects inefficient
sources.
s of Hospital Admiacy in term of causes of admis
34568 of the total causes of admissions in the hospitals. It is worth mentioning that
to be among the top ten causes of adm for so many years is
past three yea
Admission rate in
1000 in 2005 to 2 006.
in Ahafo Ano South per 10 hafo An th dist
being reporting o
3.2.1 Bed Occupan
The average reg cy rate ved in ricts a
has dropped from 41.6 in , a furt ease fr
target of 80-90 percent . Low o ancy ra
use of hospital re
3.2.2 Cause ssions Malaria has retained its suprem sion and accounted for
Accidents, which used ission
not included for the rs.
89
The Table below gives the ten lea ses s for the period under
Table 18: Ten Top Causes of Admission (Ashanti, 2004-2006) ses 5 sease 2006
ding cau of hospital admission
review.
No. Disea 2004 200 Di
1 Malaria 4 1 Malaria 34568 2139 25112
naemia 4351 1 Pregnancy Related Diseases
6538 A 539
3 Hernia 2204 4 A ia 5408 182 naem4 Diarrhoea 2 3 Diarrhoea 4986 312 2925 Pregnancy Related
ses 4929 5472 Gynaecological Disorders 3168 Disea
6 Gynaecological Disorders 2007 1776 Hernia 2342
7 Typhoid Fever 1970 1944 Hypertension 2222 8 Hypertension 1817 1844 Pneumonia 2170 9 onia 1876 2365 Typhoid 1934 Pneum10 36 1444 Cough/Cold 1370 Cough/Cold 16
3.2.3 Causes of Institutional Deaths
Malaria and Anaemia are still the leading causes of hospital deaths in the region.
still shuttles between the 4th, 5th and 6th Positions in the three-year trend.
was not registered in the
previous ye eaths are shown in the table
Tab 1O. Disease 2004 Disease 2005 Disease 2006
HIV/AIDS
Strangely, Septicaemia has taken the 4th position as though it
ars. The Top ten causes of institutional d
below;
le 9: Top Ten Causes of Death (Ashanti, 2004 – 2006) N1 Malaria 309 Malaria 248 Anaemia 276 2 Anaemia 214 Anaemia 134 Malaria 254 3 Pneumonia 106 Pneumonia 120 Pneumonia 112 4 CVA 94 HIV/AIDS 92 Septicaemia 106 5 HIV/AIDS 88 Hypertension 76 HIV/AIDS
Related conditions
80
6 Hypertension 79 Malnutrition 72 Cerebro Vascular Accident
78
90
7 Diarrhoeal Dis. 73 Cerebro Vas. Accd
64 Hypertension 74
8 Typhoid Fever 62 Typhoid Fever 46 Cardiac Dx 72 9 Cardiac
Diseases 60 Cardiac
Diseases 46 Malnutrition 58
10 Meningitis 54 Diabetes Mellitus
38 Diabetes Mellitus
42
3.3 MATERNAL DEATHS
otal Maternal Deaths recorded from health facilities in the region was 178 with 115
eaths reporting from KATH. From the table below 77.5% of the deaths were audited.
owever KATH audited all their maternal deaths. The main causes of maternal death
ere attributed to Postpartum Haemorrhage, Sepsis, Eclampsia and Ruptured Uterus. The
nderlying contributory factors were delays at home, community and facility level. The
gion calls for improvement of road networks and improvement of transfusion services
s a step to dealing with the problem.
able 20a: Maternal Mortality (Ashanti, 2003-2006) ACILITIES 2003 2004 2005 2006
T
d
H
w
u
re
a
TF
GHS Facilities 72 52 63 81
KATH 101 109 115 94
TOT 173 AL 161 178 175
% AUDITED 100 76 (122) 76 (138) 71 (124)
Table20b: Summary of Major Causes of Matern
CAUSES 2004 2005 al Deaths, 2004 - 2006
CAUSES 2006
Eclampsia 21 20 Haemorrhage 36
Haemorrhage 12 25 Eclampsia 26
Sepsis 20 21 Septicaemia 20
Obstructed labour 5 3 Unsafe Abortion 16
Abortion 16 6 Ruptured Uterus 3
Anaemia 6 14 Ruptured Ectopic 1
91
Ruptured Uterus 35 5 Others 73
Others 34 77 - -
Total 161 178 Total 175
3.4 Quality of Care
.4.1 Description of Quality of Care Activities Undertaking
o upgrade the knowledge and skills of staff in order to provide quality service to clients
e following programmes/workshops were organized for various categories of staff.
able 22: No. of Trainings Organized - 2006
OPIC STAFF CATEGORY NO. TRAINED
3
T
th
T
T
Management of Opportunistic Infection
HIV/AIDS and Other Diseases
Staff Mix 75
in
Reduction of Maternal Mortality Staff Mix 42
COPE Staff Mix 25
Neonatal Resuscitation Nurses and Midwives 60
Health Information System Health Information
Officers
35
3.4.2 Specialist Services
uch was not done on outreach services because of breakdown of the Vehicle. It is still
r l Case ery
M
at the fitting shop.
Eye Care Services (Static)
Institution Gene a s Surg
Agogo Hosp. 9278 40 5
St. Michael’s Hospital Pramso 8463 231
Westphalean, Oyoko 7746 114
Kumasi South Hospital. 5050 N/A
92
St. Patricks Hospital, Offinso 2386 141
Jachie Anglican Unit 43 2021
Maternal & Child Health Hosp 6 56 N/A
Total 35,510 1034
Dental (Static)
n No. of Cases
Institutio
Suntreso Hospital 7707
Kumasi South Hospital 2442
Mampong Hospital 40
Total 10,189
ental Care (Outreach Services)
DISTRICT No. of days No. of cases % with satisfactory
dental condition.
D
Amamsie East 3 232 66
BAK 3 196 62
Amansie Central 3 160 40
Obuasi Municipality 3 247 54
Dental care outreach services were carried out only in 4 districts. In all 835 cases were
1. Sweets sold on school compound must be stopped.
on in school should be intensified
3. Mobile Dental Equipment needed by the team
seen with 56% having satisfactory dental condidtion.
Recommendations were:
2. Oral health educati
93
4.4.3 Major Challenges in overall service delivery includes:
- Long waiting time for clients
- Ineffective Twenty four (24) hour service
- Inadequate release of funds for exemptions
- Polypharmacy and generic prescription (is not the best)
- Frequent power outage at the Regional Medical Store
and non-drugs consumables
ed is 281 with only 19 zones functioning
h inadequate staff and motorbikes.
Un
NT and Dermatology.
acilities to meet NHIC accreditation status.
and blood banks in all
facilities especially emphasis on Kumasi Hospitals.
- Poor Emergency Response at facilities
- The use of antibiotics is still high (40% as against WHO 20%)
- Poor waste disposal system
- Inadequate staff and staff mix
- Inadequate equipment/logistics for service delivery and/ or for storage of drugs
3.4.4 CHPS Implementation
All the 21 districts in the region have well demarcated zones for the implementation of
CHPS. The number of CPHS zones demarcat
well. Ahafo Ano South is doing excellence work on CHPS.
e major setback on CHPS implementation isT
3.4.5 Improving Access
der this programme the under-listed activities shall be undertaking:
1. Strengthening the CHPS concept
2. Strengthening and improve outreach services in Eye, Dental, Obstetrics,
E
3. Upgrade f
4. Upgrade New Edubiase, Juaso, Nyinahin, Obuasi and Nkenkasu Health
facilities to meet emergency obstetric care.
5. Encourage domiciliary midwifery.
6. Ensure the availability of protocol, drugs
94
3.5 IMPLEMENTATION OF NHIS
Insurance Act,
fut re.
.5.2 Scheme Establishment and Implementation
hemes in full operatio ge % registered ients with ID cards is 38%. Payment of claims to
roviders were not regular and full payments were never made. Some of the
riate”) MGT staff
ent by informal secto
tariff
- Delays in refund of exempted fees
All 36 hospitals and 158 health centers in the region have signed contracts with all the services. Facilities have not
undergone much change in terms of quality service delivery in context of the NHIS. Facility utilization by insured and non-insured are shown in the table below:
Facility
Insured
Non-insured
% insured
3.5.1 Introduction The establishment and implementation of the National Health Insurance Scheme (NHIS)
n the Ashanti Region has taken off as prescribed by the National Healthi
Act 650.
There are high indications that the expected objectives would be achieved in the nearer
u
324 District Wide Health Insurance Sclients was 65% and average % of cl
n. The averacpChallenges and Concerns of Scheme Managers were as follows:
- Inadequate (“inapprop
- Payment of premium by installm r clients
- Vetting for payment not easy - no uniform
- Inadequate logistics
- No uniform tariff
3.5.4 Providers readiness
schemes to provide services and are providing
Bekwai Hospital 14,470 18,676 43.7
Obuasi Hospital 5,721 23,291 19.7
New Ed’bease Hos. 7559 18,353 29.2
Dominase SDA 8250 15,825 34.3
95
St. Martin’s 4,42 40.4 Ag’sum 9 6,545
Tep 7885 234 48.9 a Hospital 8
Ma a 8901 744 50.4 nkr so Hosp. 8
Pre . 30012 630 39.1 sby Hosp. Agogo 46
Kon g 15524 575 59.5 on o Hosp. 10
Jua 12036 208 51.8 so Hosp. 11
Nyi 5211 653 29.1 nahin Hosp 12
Nkawie-Toase Hosp 10540 16637 38.8
St. cMi haels Hosp 16151 48405 25.0
Ma omp ng Hosp. 13455 23976 35.9
St. Patricks Offinso 16670 18799 46.9
Manhyia hosp 10348 65153 13.7
Su 77403 10.1 ntreso hosp 8687
Tafo hosp 9818 49994 16.4
Kum i South hosp as 6687 52112 11.4
Mat h. C ild Hosp 4235 27188 13.5
Eff a 86 62.7 idu se hosp 21017 124
Challenges
• No uniform tariff for provider • Regular submission of claims to schemes but irregular delayed payment by
uality service delivery
• Continuous education on HI for health care workers t payments by schemes
schemes • Upgrading of facility to improve q• Strengthen HR base of facility
• Unclear vetting and shor
96
Way fo• ew management capacity of schemes to:
ID cards promptly romptly
ntext (inputs, process etc.)
rward Assess and revi
o register and produce o vet claims accurately and pay p
• Strife to operate with a standard tariff • Improve quality delivery services in all co
97
4.0 SUPPORT SERVICES 4.1 General Administration Main Priorities for 2006 - pening of files for all categories of staff O
DRA
-
ey Challenges l of letters
• • •
- econgestion of the filing cabinets - educing misfiling to the barest minimum
- utomation of the registry Re-arranging of Personal and General Files
K• Difficulty in storage and retrieva
Misfiling of Letters Lack of funds Working with old computers at the Typing Pool
• Frequent breakdown of photocopier machine in the registry Correspondence
LETTERS RECIEVED AND DESPATCHED
2004 -2006
10000
0
2000
4000
6000
8000
No
OF
LETT
ERS
2004 2006
YEAR2005
Letters Received Letters Despatch
98
Files • Total No of General Files = 729
rso les 6 No o ff reg 3 tage ta pe al file
l No o f w ut p nal f • Percentage of staff without personal files = 8%
ted or e de ath r Sa son Dwomoh, S r Exe O ade retrieval na s f era rses diffic
as the ed fice r sev ears Meetings
Type
Planned
Held
• Total No of Pe nal Fi = 2,89• Total f Sta in the ion = 3,15• Percen of s ff with rson s = 92%• Tota f staf itho erso iles = 257
Unexpec Perf manc• The sud
of person del file
of Mor gen
mpl nu
enioult
cutive fficer m very
• He w sch ule of r fo eral y
RHMT 12 12
Staff Durbar 4 4
RSS Core 4 4
Reg Health Council Meeting
4 2
Wednesday Monthly Update
12 12
99
Wednesday Update by Regional Support Service
follo• Leave
h Sector Salary • Retirement Planning Way Forward • Organise training on Administrative Practice and the use of computer for staff • Automation of the Registry • Provision of new computer for the typing pool Estate Management Key Priorities for 2006 To implement Preventive Maintenance at the Regional Health Directorate offices and
Official accommodation unit and also offer support in Preventive Maintenance of Health Institutions in the Region.
To provide routine minor and major repair works on official accommodation unit,
equipment and offices (RHS). To carry out facility survey in the remaining 45 Health Facilities.
To Rehabilitate at least four (4) dilapidated buildings
Completing the Accommodation unit at Abrepo Junction
Completing the O.P.D unit at Manhyia Gov. Hospital
Completing theatre and ward block at Kumasi South Hospital.
Completing the Pilot Accommodation unit at Kumasi South Hospital Key Challenges
Topics handled were as ws
• New Healt Structure
Late release of funds for capital investment. Late release of approved Capital Investment for the year. National Level Allocating funds for specific projects which are not the priority of the
Region. Non provision of Funds for maintenance Districts not informing region about works that have been going on and the haphazard
way development projects are carried out
100
Work that were carried out in the year under review The Maintenance team completed a renovation work on Bungalow No.88 Danyame
and this has been allocated to the Human Resource ManagerConstruction of Fence wall at Abrepo Junction-Cold room
Work that were carried out in the year under review The unit worked on removal of old wooden Shelves to pave the way for installation of
new metal shelves in the RMS.The unit also did internal painting in the affected areas in the RMS.
Property Acquisition The unit started with the processes of securing the Indenture on the Apampetia land. We requested for a new site layout this is because the Ring road designed by the
Urban roads passes through the land The corrected one was sent to B.A.K for plotting onto the master layout. After which it
will be send to Manhyia for the King’s Approval. Training Programme In the year under review, Training Workshop on contract Management and Administration was organised for (75) participants. They included District Directors of Health Services, Health Services Administrators and Estate Managers. Capital Investment The year under review, the Region had authority to procure the following works but did not have commencement certificate and so the works could not take off.
Description
Allocation Upgrading Kumasi South Hospital
¢1,3 billion
Const.of 4 Storey Block 3bedroom Semi-detached at Abrepo
¢600,000,000
Completion of DHMT Block at Tepa
¢750,000,000
Completion of DHMT Block at Ejura ¢750,000,000
Construction of 10no.Chps Compound ¢2billion
Const. of Health Centre at Pankrono ¢1,4billion
Upgrading of Manhyia Health Centre ¢1billion
101
Projects in Districts without RHD knowledge
District
1. Afigya-Sekyere 2. Adansi South 3. Asante Akim South 4. Amansie East 5. Ahafo-Ano South 6. Kwabre 7. Atwima Mponua 8. Offinso 9. Sekyere West 10. Sekyere East 11. Ejura/Seko
Total
No. of Project 7 1 2 6 2 6 4 3 3 4 1 39
• Project developments were generally at a standstill in the year under review. • Funds were not released for 2006 approved project. • Certificates on project completed and submitted in the year 2005 were paid at the
end of 2006 Way forward Carrying out advocacy for the District to allot funds for maintenance. Carrying out advocacy for the release of project funds in bulk for the region to
apportion along its own priority lines. Carrying out advocacy for the National level to publish approved projects on time.
4.3. Equipment
Main Priorities • To improve equipment performance index. • Carry out equipment need assessment • To decommission all obsolete equipment. • To implement equipment revolving fund
Key challenges
• Logistics support e.g. irregular supply of fuel. • Lack of spare parts • Lack of tools and test equipment • Poor communication between the unit and the districts/institutions
102
Unexpected performance • Training of safe use of medical gases for anesthetist in the region. This has been a
planned programme since 2004, but due to lack of sponsorship from sponsors, it was not possible until 2006, when we secured funding from various organizations and the RHD .
Critical Equipment Needing Replacement The following were identified as critical equipment needing replacement.
• Infection control equipment (autoclaves) • Surgical instruments (all types) • Laboratory equipment (microscopes, analysers etc) • Solar equipment • Monitoring equipment (vital signs monitors) • Maternity and delivery equipment (instruments and delivery tables) • Life support equipment (anaesthesia machines) • Theatre equipment (lamps, suction units, electro surgical units, operation
tables) • Dental chairs and accessories
Table 26a: Repairs of Broken Down Equipment 2004 2005 2006 No that Broke down 220 78 186 No repaired 207 47 161 Repair Rate (%) 94 80.3 86.6 Equipment Achievement of the Unit
• Attended all service calls • Benefited from various training programmes i.e. solar energy workshop at deng
solar systems, cold chain equipment training at B.E.U, ophthalmic equipment training at eye center korle bu
• All new equipment that were dumped in the district from medical stores, Accra were identified and installed
• One gen set was installed at the regional cold room backup by an automatic change over switch.
Way forward 2007
• PPM for all hospital and health centre • Update regional inventory • Implementation of revolving fund • Carry out need assessment of equipment • Organized training for equipment users • Decommissioning of obsolete equipment
103
TRANSPORT INTRODUCTION Transport is essential for the delivery of effective health services. Lack of transport, unreliable vehicles, and inability to pay for vehicle running costs have all been given as reasons to explain failure in service delivery. MAIN PRIORITIES FOR 2006 • Acquisition of Land as Regional responsibility in the establishment of Regional
Mechanical Workshop • Aid District motorbikes riders to acquire riding license in the region • Defensive Driving Training for all Drivers • Vehicular Support for newly created districts
• Refresher Boat Confidence and Survival Training for BAK District • Disposal of old vehicles
KEY CHALENGES FOR 2006 • Ageing Fleet and broken down (Vehicles and Motorbikes) • No GHS mechanical workshop to enhance regular adherence to PPM • Inadequate drivers that give pressure to the few • Lack of funds to pay mechanics for work done and others
ACTIVITIES UNDERTAKEN • Site for Regional Mechanical discussed and proposed by management and effort
being made to acquire • Newly created districts gained majority of new motorbikes allocated to the region • Support of vehicle extended to newly created districts at the Regional level in the
carriage of consignments, outreaches activities and EPI activities TRAINING OF STAFF DEV. No. Type of Training Group Number Period
1 Defensive Driving and Basic Life Support Skills
Drivers 85 5 days
2 4 Stroke Maintenance Motorbike Technician
23 3 days
3 Ambulance Operations and Emergency Care Mgt
DDCC, RTM,Med Supts. Nurses & Drivers
40 3 days
104
FLEET SITUATION Vehicles
Age 2004 % 2005 % 2006 % Zone
1-5 yrs 34 33.3 27 28 37 34 Green
6-9 yrs 38 37.3 48 49 20 19 Yellow
10 yrs + 30 29.4 23 23 51 47 Red
Total 102 100 97 100 108 100
Motor Bikes
1- 3 yrs 18 13.3 57 13.3 86 35.6 Green
4 – 6 yrs 21 15.6 68 15.6 47 19.5 Yellow
6 yrs+ 96 71.1 67 71.1 108 44.8 Red
Total 135 100 192 100 241 100
New Vehicles TYPE NUMBER
Saloon 1
Pick- ups 2
Motorbikes 44
Tricycles 5
Ambulance 8
105
NEW AMBULANCES ALLOCATION REGISTRATION NO. INST. ALLOCATED
GV. 701 W K’si Metro (Tafo Hospital)
GV 665 W K’si Metro ( Reg. Hospital)
GV 670 W Obuasi Mun. (Dist. Hosp.)
GV 624 W BAK (St. Michael Hospital)
GV 693W Asante A. South (Dist. Hospital)
GV 660 W Sekyere East (Dist. Hospital)
GV 690 W Offinso(Nkekansu Hospital)
GV 684 W Ahafo Ano North (Dist. Hospital)
ACCIDENT SITUATION • Two vehicles were involved in an accident. They are allocated to : • RHD- GV 174R • Amansie West District- GV 461U • No casualty recorded DRIVER SITUATION Age Range TOTAL % of Total ZONES
50- 60 yrs 17 19 Red
40- 49 yrs 52 59 Yellow
39 and below yrs 19 21 Green
Total 88 100
• Driver Vehicle Ratio 1.4 • No. of casual drivers 9
106
CRITICAL NEED FOR VEHICLES • Districts and hospitals including Mankranso Hospital, Juaben Hospital, MCHH
Hospital, Agona and Kokofu, Hospital are in critical need. • Atwima Mponua, one of the newly created districts is still not equipped with
vehicle(s). • Accident prone areas that require urgent ambulance to aid referrals include Bekwai,
New Edubiase, Nkawie, Nyinahin and Mankranso, Manpong, Ejura KEY ACHIEVEMENT • Successful Defensive Driving and Life Support Skills for all drivers • Some DHMT taken keen interest in transport issues • The region being graded the best Transport Management Unit among the ten
regions • Successful vehicular mobilisation of vehicles for EPI/ MEASLES activities • Participating in Developing of National Transport Policy for the country OUTLOOK FOR THE YEAR 2007 • Piloting of Regional Mechanical Workshop/Acquisition of Land for regional mech.
shop • Aid district motorbike riders to acquire riding license in the region • Expect new vehicles to replace old ones • Auctioning of disposable vehicles • Expect engagement of additional drivers • Provide refresher training for drivers on Basic Life support skills and HIV/AIDS • Provide Training for District Transport Officers on Transport Mgt. • Refresher training for Motorbike Riders • Undertake monitoring and supervisory visits • Refresher Boat Confidence and Survival Training for BAK District
107
PROCUREMENT OBJECTIVES The Procurement Unit set for itself the following targets to be achieved by the end of the year 2006.
Procure goods, works and services in accordance with the Public Procurement Act 663.
Ensure the availability of goods works and services at the right time, right quantity, quality and at the right cost.
Build up the capacity of the Procurement Unit.
Monitor procurement activities in the districts.
Sensitize supplier, Medical superintendents and district directors on the Public Procurement Act.
CHALLENGES
The functioning and in some cases the non –existence of Procurement Committees at the districts
The persistent procurement, storage as well as issues of drugs being handled by the same person in the person of the Pharmacist in charge which contradicts the procurement and supply guidelines of the Ghana Health Service.
The massive indebtedness of the district hospitals to the Regional Medical Store in the area of Non Drugs Consumables present a major challenge to the Unit.
Procurement of non-drugs consumable items by the district facilities without prior ascertainment of stocks at the Regional Medical Stores has also been the major concern of the Directorate.
REGISTRATION The Directorate updated its supplier’s database during the first quarter of the year under review. A total of 75 (seventy-five) potential suppliers registered with the Directorate for its 2006/7 procurement activities. The distribution is as follows:
1. Drugs - 39 2. Non- Drug Consumables - 20 3. Others, etc - 16 75
108
THE PUBLIC PROCUREMENT ACT 663 As part of efforts to comply with the provisions of the Public Procurement Act 663, especially with regards to the use of procurement methods and evaluation of tenders, the Directorate used National Competitive Bidding to procure its Essential Drugs and Non-Drugs Consumables requirements whiles shopping method was used for other items procured in the year under review. Evaluation panels were on a number of occasions set up to assist in the detailed evaluation of bids on all tenders. WORKSHOP The acting Regional Procurement Manager was part of a team led by the Deputy Director Administration to participate in a 3day workshop on Procurement Planning organized by the office of the Stores, Supply and Drug Management Division of the Ghana Health Service from 1st –3rd October 2006 at the Marina Hotel (Dodowa) EDUCATION The substantive Regional Procurement Manager in the person of Mr. Desmond A. Antwi has returned and assumed duty from a years study abroad PROCUREMENT AT YEAR 2006 Procurement for the period under consideration started in the month of January 2006.Total Procurement made in the year amounted to ¢19,110,073,033 as against 21,052,992,193.08 in 2005 a decrease of 2% due to the near completion of renovation work at the Central Medical Store. Drugs continue to form the bulk of the procurement from the open market amounting to 14,596,208,658 followed by Eunice Ansah Asamoah Production Unit with 2,009,627,675 Non-Drugs consumables came third with 1,956,366,100 with the Regional Health Directorate (equipment, stationary and other items) taking the last position with 547,870,600 expenditure on procurement. TABLE REPRESENTATION ITEM VALUE % OF TOTALDrugs 14,596,208,658 76Prod. Unit 2,009,627,675 11Non Drug Cons. 1,956,366,100 10RHD 547,870,600 3
TOTAL 19,110,073,033 100
109
PROCUREMENT OF DRUGS & NON DRUGS CONSUMABLES FROM CMS BY YEAR 2005 & 2006
ITEM 2005 % Of TOTAL 2006
% Of TOTAL
Drugs (op.mkt) 14,170,249,900 72%
12,444,812,660 75
Drugs (cms) 3,052,203,427 16% 2,151,395,998 13
NDC (op.mkt) 1,414,463,400 7% 1,645,417,500 10
NDC (cms) 900,208,000.08 5% 310,948,600 2
TOTAL 19,537,124,727 100 16,552,574,758 100
AUDITING 1.The books of the Procurement Unit were audited by auditors from Ernst & Young who were commissioned by the Ghana Health Service Among the facilities included in the auditing exercise were New Edubiase, Kumasi South Hospital, Midwifery Training School and Obuasi Municipal Hospital 2. There was also Year 2005 Ex-Post Procurement Audit conducted Messrs Benning, Anang & Partners, a private auditing firm contracted by the Ghana Health Service/MOH as part of the requirements of the Development Credit Agreement signed by the Government of Ghana and the International Development Association and agreed by the MOH and its Health Partners at the 2002 review of the programme of work under the Ghana Health Sector Support Programme. BMCs included in the audit exercise were Kumasi South Hospital, Mankranso District Hospital and Kumasi Metro Health Administration. WAY FORWARD
Organize sensitization workshop for suppliers, Medical Superintendents and District Directors on the provisions of the Public Procurement Act.
Strengthen supervision and monitoring of procurement activities of district facilities to ensure that they comply with the Procurement Act especially the institution of Procurement Committees and appointment of Procurement Officers at the facility level particularly the Regional and Mampong hospitals.
Strengthen working relations with other units to ensure easy access to information
110
Human Resource Development
Introduction This report highlights on human resource activities within the Regional Health Service, Ashanti for the year 2006. Staff Distribution The region’s total staff strength stood at 3453. A summarised detail of staff strength is provided in Table shown. The breakdown of staff distribution by staff category and district is set out in Annex 1. Table Overview of Staff Distribution by category 2006
Staff Category In Service No on Study Leave
No on Leave without pay
Total
Directors 14 1 15 Doctors/Dentist Medical Assistants Nurses/Midwives Pharmacist 29 2 1 32 Administrator 12 12 Anaesthetist Technical Officer Biomedical Scientist 10 10 Others Total 45 3 2 50 New Entrants Pharmacist` – 3 Accountants – 3 Medical Laboratory Technologist – 3 Administrators – 2 Health Aides -110 3. Wastage Seventy-Four staff (2005:91) separated from the service. The main mode of leaving was through retirement, which accounted for 70.3% as against 47.3% in 2005. This was followed by deaths 20.3% (2005:39.6%). We present a 3-year trend on wastage is provided in Table below: Table Mode of Leaving 2004 - 2006 Mode 2004 2005 2006 Retirement 30 43 52 Vacation of Post 23 9 4 Death 12 36 15 Resignation 5 3 2 Dismissal 0 0 1 Total 70 91 74
111
It appears that staff that left through vacation of post have reduced significantly and accounted for 5.4% of wastage as against 9.9% in 2005. We have however noted the problem of under reporting by BMCs. We would encourage BMCs to early reporting of staff vacation.
Staff DeathAs can be seen from Table 4 above, staff deaths reduced from an all-high figure of 36 in 2005 to 15. Sixty percent of deaths were female and the remaining 40% were male. Nurses/midwives category formed 33.3% (5) followed by Field Technician 20% (3) of the total deaths.
Staff death for a 4-year period is provided in Figure below.
Staff Death 2002 - 2006
16
912
36
15
05
10152025303540
2002 2003 2004 2005 2006Year
No
of S
taff
A plausible explanation for the reduction in deaths can be attributed to the mandatory medical examination for staff. The medical examination revealed hidden ailments of staff which lead to its management and treatment.
The Nurses/Midwives category formed 34.2% of the total staff that separated from the service in 2006 (2005: Orderly – 27.4%), followed by the watchman and Technical officers categories each with 17.8%. See Annex 4
Appointment to Key Positions The following appointments were in the course of the year to fill the headship of the three regional BMCs Deputy Directors:
Clinic Care – Dr Joe Bonney;
Public Health – Dr Kyei Faried;
Administration - Kofi Poku
112
Other Appointment DDHS – Francis Osei Medical Superintendent – Dr Kesse
Movement of Key Officers Mr. B.W. Quarshie the Regional Accountant was transferred to the Ministry of Local Government, Rural Development and Environment in April 2006.
Mr. Kwabena Ennin who took over as the Regional Accountant also moved over to Central Region Regional Health Directorate in August 2006.
Mr. Yaw Okyireh has taken over as the Regional Accountant
Dr S. Kyei Faried the Deputy Director, Public Health was transferred to the Northern Region
Ms. Abena Akuamoah Boateng, the Regional Nutrition Officer proceeded on leave without pay with effect from 1st October 2006.
Health Sector Salary Exercise The Unit collated data on health staff in the region for the Health sector Salary exercise. The exercise was however plagued with a lot of problems. List of Problems encountered are
Inaccurate data - Wrong Staff ID - Wrong Grade
Refusal of some staff to report when grades they were placed on favoured them Conflicting Date of Birth Non capture of some staff in the exercise Non receipt of salaries of some staff for some period Payment of salaries to wrong banks Discrepancies on payslip Distortion in calculations
Staff Durbars The Unit coordinated staff durbars, all 4 staff durbars as planned for the year were came off successfully. The durbars were used to discuss pertinent issues related to the service
Staff Development Sixty-six staff indicated their intention to purse further various courses in the course of the year.
113
Responded to intention to go to school – provide table NO PROFESSION NUMBER
DECLARED INTENTION
NUMBER FURTHER EDUCATION
1 Accountant 1 3 2 Community Health Nurses 10 17 3 Field Technician 7 6 4 Health Aides 5 4 5 Health Service Admin 1 0 6 Medical Asst 1 1 7 Medical Officer 5 8 8 Orderly 1 1 9 Pharmacy Technician 1 5 10 Principal Storekeeper 1 0 11 General Nurses 17 31 12 Nutrition Officer 1 2 13 Stenographer 1 2 14 Technical Officer 4 4 15 Ward Assistant 1 0 16 Total 57 89
Post graduate Seventeen staff left to purse various postgraduate courses as against 10 in 2005. A little of over a third (31.3%) of participants were female. The 4 staff in the residency programme are pursing course in Public Health, Child health and Obstetrics and Gynaecology respectively.
The breakdown of staff undertaking postgraduate course is in given below.
Table Postgraduate Training by Course Course Award No of Staff Place Course Type Epidemiology MSc 1 Overseas Long Residency 4 Nursing Mphil 1 Health Service Planning and Management
MSc 1
Health Education MSc 2 Health Education Postgraduate
Diploma 1
Population and Reproduction Health
MSc 7
Total 17
114
This table shows staff pursing postgraduate staff pursuing postgraduate course are doctors
Table 5b Postgraduate Staff Ca
MePharmNurCliEnTotal 17
ADB Special initiative – Focus BekwUnder the auspices of thtraining schem Medical ExaminationThe ClinicaDirectorate to undergo medical exam The Regional Health Directowas involved in a m Staff Land OwThis schemacquires large plot of land at
115
course by staff category. Half (50%) of the
training by Staff Category 2006 tegory
No % dical Officers 9 52.94
acists 3 17.64 ses 3 17.64
nical 1 5.88 vironment Technologist 1 5.88
99.98
ai e Africa Development Bank, the region is benefiting from a
e as part of rehabilitation of the District Hospital.
/Treatment l Care Unit played the key role in arranging for staff of the Regional Health
ination
rate footed the cost of plastic surgery carried on a staff, who otor accident in the course of National Immunisation Day activities.
ning Scheme e was started in 2004, under this scheme the Regional Health Directorate
various locations within the region and which are in turn sold to interested staff on a flexible payment system. This is to enable staff put up their personal residence (buildings) as it is one main concern on retirement. Since its inception in 2004, 453 plots of land have been acquired at various locations within the region for sale to staff. ( Atwima Agogo – 129; Mamponteng 121; Afrancho-5 3 and Saaman- 100), Asenua (50) The staff have continued to show keen interest in the scheme. The Regional Personnel Officer plays pivotal role in the scheme as a member of The Staff Land Acquisition Committee
Award Total of 17 staff were awarded during the year under review’s annual party. 12 of the awarded staff were recognised for good performance, whilst two staff received the Regional Director’s Special Award. 3 retired staffs wer also awarded.
Pilot ProSelect as oncom Constraints
Way Forw
116
ject e of the region to pilot the decentralization of salary management in the
ing year 2007
• Three of the unit’ staffs were in school and this affected the output of the unit. • The only functioning computer of the unit was working for sometimes as results
of virus infection. • The unit could not organized retirement planning workshop for the retired staff as
planned due to financial constraints. • Embargo on promotion put much pressure on the unit. • One of the unit’s computers is not functioning. • Difficult to recruit, category D&E staff
ard
• Develop Regional HR. Plan • 2 .Produce 2008 Retirement Schedule • Organize Retirement Planning Workshop • .Improve Upon HR information system • Recruitment HR officers for the districts
In Service Training (IST) A total number of 68 Training Sessions
The total nu
2005 to 34% in 2006. Majority of the staff tr
Most of the topics treated cen
Health services.
No. of In-Service Training
117
were organized during the period under review. mber of staff who received in-service training has increased from 30% in
ained were nurses and technical officers.
tered on Public health, Clinical care and Management of
2004 2005 2006
Sessions Organized 61 75 68
No. of staff trained 765 (21%) 1101(30%) 1080(34%)
Total cost of training 373,361,370 1,009,371,287 696,222,944
Course Areas
Clinical 22%Public Health 56%Management 22%
118
Post Graduate Training Eleven staffs are currently pursing various postgraduate courses. Three of the courses are
being pursued outside the country.
Course
No of Staff
Place of Study
Public Health
2
School of Public Health, Legon – Ghana Harvard University, USA
Health Service Management
ersity of chnology (KNUST),
4
Kwame Nkrumah UnivScience and TeKumasi – Ghana
Procurement and Strategica
gham, UK lly Management
1
University of Birmin
Health Educat niversity, UK ion
1
Leeds Metropolitan U
Reproductive He
ersity of chnology
alth
3 Kwame Nkrumah UnivScience and Te
Total
11
COLLABORATION F
Private Sector Involvement Involvem
im
package. Infor
119
OR HEALTH
ent of the private sector in public health service delivery was of utmost
portance. Privately managed Maternity Homes were covered by the exemptions
mation sharing sessions and training programmes organised during the
year also included participants from the private sector. It is hoped that in the ensuing
years greater attempts would be made to contract out services and provide logistics
support to the sector
Available information gathered indicates that students from the University of Ghana and
Kwame Nkrumah University of Science & Technology undertook various studies in
Kumasi Metropolis with the aim of improving service delivery.
Key Innovations and Best Practices the Region had unde 1.
2. Construction of four (4) sem
3. Installation of com
Regional Health Directorate.
4. In the course of the
high number of deaths am
exam
4. new Generator.
120
rtaken
The region facilitated in the formation and development of the district wide mutual
health insurance scheme.
idetached units at Atwima Nwabiagya, Afigya
Sekyere, Amansie Central and Adansi North through the initiative of the Director
General of Ghana Health Service.
puter network to provide Internet access for all officers at the
year under review, the region was concerned with the unusual
ong staff and instituted compulsory medical
ination for all staff.
Renovation of Regional Vaccine storage depot (Cold Room) and installation of
General Ou
Acquisition of Land fo
121
tlook for 2007
Scaling Up of District Health Information Management System (DHIMS) to all districts Programmes to reduce maternal and neonatal
deaths – Training of Midwives - Improving All Safe motherhood Indicators
eg. FP Piloting decentralization in payroll management Budgetary Control will be instituted at the various
BMC level in the region Data management training for staff at various
levels in the system Piloting of Regional Mechanical Workshop/
r regional mechanical shop. Advocate for the replacement of old vehicles Ensure the establishment of at least two completed CHPS compounds in every district Revamp Community Based Surveillance Intensification of monitoring and supervision at all levels Operationalise 80% quota for Ashanti in regional health training institutions
2006 PERFORMANCE REVIEW REGION: Ashanti Name of Regional Director: Dr. Kofi Asare Tel. Number:05123651 / 05122089 Postal Address of RHMT: P. O. Box 1908, Kumasi PERFORMANCE
AREA INDICATORS 2004 Actuals 2005 Actuals 2006 Target 2006 Actual Comments
Number of Infants deaths - Institutional (0-11 months) 315 362 289 Number of Infants admissions - Institutional (0-11 months) 7590 8626 6704
Number of under five deaths - Institutional (0-4 years) 670 740 649 Maternal Mortality ratio - Institutional
180/100,000 200/100,000 150/100,000 208/100,000
Number of Under five years who are under weight presenting under facility & Outreach 8096 9163 9947
HEALTH STATUS
% Under five years who are underweight - Institutional 3.4 3.3 3.1
ACCESS Clinical Care
123
Utilization
Number of outpatient visits 2,087,720 2,129,973 2,219,881
Outpatient visits per capita 0.5 0.5 0.6 0.5 Number of cases seen and treated by the CHOs. - - - - Not Available
Number of admissions 104,326 118,252 - 115,891
Hospital Admission rate 25.2 27.7 40 26.2
Specialist Outreach
Number of specialist visits received from the national level to region
- - - -
Number of patients seen by national team - - - -
Number of operations performed by national team - - - -
Number of specialist visits made by regional team to district
- - - -
No reporting format to collect data
Number of patients seen on specialist visits to the districts - - - -
ACCESS
Number of operations performed by regional team by specialty at the district
- - - -
124
DISEASE SURVEILLANCE
No. of TB patients Detected 1860 1911 1931 No. of HIV positive cases diagnosed 1840 2258 1957
No. of AFP cases seen 43 31 25
Total number of malaria cases 682694 817028 873911 Diseases targeted for Elimination
Number of guinea worm cases seen 85 50 - 52 Lymphatic filariasis treatment coverage - - - - Not Applicable
Reproductive & Child Health
Safe Motherhood
Number of Family Planning Acceptors
126810 138692 158757
%Family planning acceptors 12.8 14.1 25 15.3
% of WIFA accepting FP - - - - Same as % FP Acceptors
Number of ANC registrants 131778 130980 130698
% ANC coverage 79.8 76.7 90 74
Proportion of ANC registrants given IPT2
- - - 1776 Started in 2006
125
126
Number of PNC registrants 91947 87927 91596
ACCESS
% PNC coverage 55.7 51.5 80 51.9
Total number of deliveries (including trained & untrained TBA)
92484 92829 94210
Number of Supervised Deliveries (including trained TBA)
92484 92829 94210
No delivery from Untrained TBA in
the region
% of Supervised Deliveries (including TBA) 56 54.8 53.3
Number of deliveries by skilled attendants (excluding TBA)
65770 70728 72062
% of Deliveries by Skilled Attendance (excluding TBA) 71.1 76.2 76.5
Proportion of fresh still births to total still births 1275/1951 661/1736
Fresh still births were not captured in 2004
No. of pregnant women given ITN Vouchers - - - No reporting format
to collect data
CHPS
No. of CHPS zones demarcated 187 187 281
No. of functional CHPS zones 0 2 19
Child Survival
127
EPI coverage Penta 1 66.4 76 90 74.1
QUA
EPI coverage Penta 3 71.3 74.2 90 71.3
OPV3 66 78.3 90 71.1
EPI coverage Measles 68 75.4 90 73.5
Total number of Under five malaria cases - Outpatients 167452 201842 219225
Total number of Under five malaria cases - Admissions 7717 14255 14340
Exemptions Granted (No. of Patients by category)
Children Under 5yrs
Ante-natal
Deliveries
Elderly (>70yrs)
Poor (Paupers)
All other Diseases
Information Not Available
number of maternal death audits 122 138 124 LITY
Total number of maternal deaths 161 178 175
128
% maternal death audits 75.5 77.5 100 70.9
Total number of Under five deaths due to malaria 725 272 - 179
Under five malaria case fatality rate 0.74 1.61 <1 1.42 Number of drugs available out of the tracer drug list at the Regional Medical Stores
56 57 61 56
Number of drugs available out of tracer drug list at the regional hospital
58 58 61 57
Total Number of TB Cases Cured 886 918 - - Not due AFP non polio rate per 100,000 population under 15 years
2.05 1.33 1 1.24
HIV seroprevalence among
15 – 19 years - 1 2.6 Not due
20 – 24 years - 1.5 2.6 Not due
Clinical Care
Total number of beds 2334 2464 - 2578
Total number of discharges 98534 103013 - 108165
EFFICIENCY
Total number of deaths 2608 2603 - 2405
129
Number of patient days 401330 39226 - 391232
% Bed Occupancy 46.9 43.6 80 41.6
Bed Turnover Rate 53.3 42.9 - 42.9
Doctor Ratio 1:23724 1:20679 - 1:23616
Nurse Ratio 1:1814 1:1443 - 1:1539
Resource Allocation
% total regional recurrent budget allocated to:
Private sector providers - - - -
Missions - - - -
NGOs and CSOs - - - -
PARTNERSHIP
Other government sectors - - - -
Not Applicable
Revenue Mobilization
IGF - - - 71,157,594,443
Cash & Carry - - - -
NHIS - - - -
GOG Subsidy - - - 10,358,714,241
FINANCING
Health Fund - - - 9,861,821,586
Could not get data for 2004 & 2005 due a computer that is
crashed
130
MOH Programmes (Earmark Funds) - - - 29,233,877,042
District/Municipal/Metro. Assembly Common Fund - - - -
Other Sources - - - -
Exemptions
Total Exemptions Provided - - - 536,148,303
Total Exemptions Re-imbursed - - - - Not Available
Expenditure by Source
IGF - - - 62,229,835,205
GOG Subsidy/Operating Grant - - - 10,287,142,574
Health Fund - - - 10,954,271,836 MOH Programmes (Earmark Funds) - - - 26,043,470,422 District Assembly Common Fund - - - -
Other Sources - - - -
Expenditure by Item FINANCING
Item 1: Personal Emoluments - - - PVs are sent directory to districts so information is not available at regional level
131
Item 2: Administration Expenses - - - 21,798,367,798
Item 3: Service Expenses - - - 14,532,245,198
Item 4: Investment Expenses - - - 531,688,215,
Number of doctors 88 103 - 94
Population to doctor ratio 46931:1 41460:1 - 46973:1
Number of nurses 1151 1476 - 1442
Population to nurse ratio 3588:1 2893:1 - 3062:1 Number of community resident Nurses (CHOs) - - - -
Proportion of staff appraised - - - -
Proportion of Drs & Midwives Trained in Life Saving Skills - - - -
Total number of IST programmes organized 61 75 68 Total number of staff receiving IST programmes 765 1101 1080
HUMAN RESOURCE
% of clinical staff who received IST 68 65 69
Nunber of vehicles 102 98 108 Equipment, Transport & Procurement Number of vehicles road
worthy 85 81 57
132
Proportion of vehicles road worthy 83.3 82.7 52.8
Number of motorbikes 135 168 241 Number of motorbikes road worthy 81 104 133 Proportion of motorbikes road worthy 60 62 55.2 Proportion of non salary recurrent budget spent on buildings (PPM)
Number of Facility Based Ambulance 8 8 17
133
