Ashanti Region Report Half Year 2010

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1

FORWARD

This report highlights some of the major health service activities and programmes carriedout in the Ashanti Region during the year under review.

The activities were largely determined by the priorities and action plans of the region in line

with the Ghana Health Service Strategic Objectives and New Paradigm of the Ministry of

Health. It also highlights the broad policy and operational direction of the Ashanti Regional

Health Directorate in 2010.

A detailed description of the key activities in the region has been expressed, though other

areas of service delivery have not been highlighted. It is hoped that the final report at the

end of 2010 would bring all into focus. Certain information has been added and other parts

have been documented in more detailed to make sure the report serves as a valuable

reference material.

We acknowledge with many thanks the contributions from all the Institutions,

Headquarters, Regional Coordinating Council, Health Partners, NGOs, DHMTs and units of

the Regional Health Directorate towards the overall service delivery in the region.



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EXECUTIVE SUMMARY

The Regional Half Year Report 2010 reflects the major activities undertaken by the Regional

Health Directorate under the four health sector strategic objectives and its results as

measured by the key sector indicators. The Regional Health Directorate viewed the first six

months of the year 2010 as successful though challenging. The region appears to be oncourse in achieving most of the set targets particularly in the areas of key priorities.

There was a conscious effort to sensitize the populace on healthy lifestyles and

environmental management and these were achieved through Radio shows, health

talks and durbars.

The District Health Information Management System (DHMIS) has been implemented

throughout the region though there are challenges with timelines and completeness

of reporting from the districts.

Though maternal deaths have reduced over the period, other indicators like postnatal,

TT2+, ANC coverage and Caesarean rate have reduced. Maximum effort would be put in

the second half of the year to ensure improvement in the maternal and child health

indicators as we push to achieve the MDGs 4 and 5.

There have been substantial improvements in the indicators of malaria leading to a

significant reduction in deaths in U-5. IPT coverage however deceased due to the erratic

supply of SP. The OPD per capita of 0.4 appears to be on course in line with that of 2009.

It is hoped that with increasing coverage of NHIS, OPD utilization would increase further.

However Hypertension is the third most reported disease at OPD and this call for more

efforts to address non communicable diseases in the region.

Routine EPI coverage has been impressive.The two NIDs during the half year also

recoreded coverage of more than 100% in both rounds. However the H1N1 vaccination has

received a lot of negative reports from the media with rumours of severe adverse reactions.

The region has officially recored 31 AEFIs and there are no reports of any severe reaction.

The region reported one outbreak of H1N1 in a secondary school and was well managed by

the District Epidemic Response Team with support from the Regional level.



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The Leadership Development Programme has trained several key managers in the region

and it is hoped that the acquired leadership skills would impact greatly in the second half of

the year as the rest of the untrained manpower in the region are brought on board the

programme.

Financial support from central Government has continued to be below par and is greatly

affecting planned activities. Delayed payments to health facilities from the NHIA are alsoimpeding health service delivery at the hospitals and health centres. It is hoped that

financial inputs to health service would improve in the second half of the year to enhance

total health delivery.



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INTRODUCTION

1.0 REGIONAL PROFILE

Ashanti Region lies approximately between longitude 0.15’ to 2.25’ west and latitude 5.50’

to 7.40’ north. It has common boundary with Brong Ahafo Region in the north, Central

Region in the south, Eastern Region in the east and Western Region in the west. The

Region has a land size of 24,390sq km representing about 10.2% of the land area ofGhana.

Ashanti is the most heavily populated region in Ghana, with a population of 4,881,738 for

2009 (Projection from the 2000 Housing and Population Census, Ghana Statistical Service).

It has a population density of 169.3 per sq. km. The region has 27 districts and 132 sub-

districts. Kumasi has the highest population of 1,559,807 (32.4%) of the regional total.

About 47% of the population are in the rural areas. The region has a large proportion of

hard to reach areas especially in the Afram Plains sections of Sekyere Afram Plains, Ejura

Sekyedumase, Sekyere Central and Asante Akim North districts.

There are five hundred and twenty-seven (527) health facilities in the region. The Ghana

Health Service operates about 33% of all health facilities in the region. Kumasi has the

highest number of facilities (29%) with Ejura-Sekyedumase having the least (2%). The

population hospital ratio is 48,276.

TABLE 1. 1–HEALTH FACILITIES

TYPE NUMBER

Government Hospitals and Health Centres 170

Mission Health Institutions 71

Private Maternity Homes and Clinics 278

Quasi – Government 8

Total 527



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PRIORITIES FOR 2010:

The regional priorities included the following:

• Improvement of Staff and Management capacity through leadership and regular in-

service training

• Improve staff motivation

•

Ensure staff performance measurement• Strengthen health information system

• Improvement of customer care

The activities carried out in respect of the above are well articulated in the respective

strategic objectives.

The Key Priorities for the year are:

!

Maternal Mortality

! Low TB case detection

! Stillbirth

! Low AFP detection

! Malaria

! HIV

! NTDs

!

Low EPI Coverage

! School Health

! Adolescent Health

! Poor Data Management

! Malnutrition in Children U-5



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CHAPTER ONE

1.1.1 Strategic Objective

Healthy Lifestyle and Healthy Environment

1.1.2 Increase awareness on health promotion and protection

Various strategies were used by the region to increase awareness on health related issues.In the hospitals, health education talks are being held on regularly basis at the Out Patient

Departments on selected diseases like malaria, H1N1, TB and HIV/AIDS and also

Regenerative Health. For the period a lot of sensitization was also on the H1N1

vaccination. The RHD is collaborating with local FM stations particularly Angel FM and Hello

FM to promote health.

During the year under review, Health talks were given on the local FM stations i.e. Hello

Fm, Nhyira Fm, Angel Fm etc, churches, mosques, outreach points, facilities and other

social organizations to increase awareness on the new paradigm shift of Regenerative

Health and Nutrition, importance of optimal exclusive breastfeeding and benefits of iodated

salt and fortified products usage.

The general populace were educated on the importance to eat healthy meals, drink a lot of

water, exercise three times a week, as well as make time for recreation and to rest for at

least 8 hours a day. Discussions were centered on eating plant based diet and to limit the

intake of animal based food products which are high in fat, salt and sugar. Environmental

and personal hygiene were also stressed so that people would maintain a hygienic and

sanitary environment as well as live sensible lifestyles. Babies are to be breastfed

exclusively for six months, continued along side the introduction of appropriate

complementary feeding.



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No. Organization Location Topic Treated ResourcePersons

Date

1. Methodist men’sGroup

Effiduase Iron FortificationProgramme & essence

of exclusivelybreastfeeding babies

Reg. &Dist. Nut.

off

April2010

2. Aboabo Mosque Aboabo 1-Kumasi

Regenerative Health &Nutrition & importance

of iodated salt usage

Reg. &Metro Nut.

Off

March2010

3. Hairdressers Association

KumasiCulturalCentre

Iodated Salt, Balancediet and it importance& Personal hygiene

Reg. &Metro Nut.

Off

June2010

4. Boss, Ashh & Angel Fm

Boss-Adum, Ashh-Stadium

& Angel- Abrepo junction

Importance ofExclusive

Breastfeeding forchildren 0-6mths,

appropriatecomplementary

feeding etc

Reg. &Metro Nut.

Off

May 2010

The Health directorate through the Health Learning Material unit (HLM) has also

organized health educational programmes on radio, in churches, communities and

schools. The topics treated in the schools focused mainly on personal and

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

the churches included; predisposing factors to lifestyle diseases such as

Hypertension, Diabetes, Malaria, Hepatitis, HIV/AIDS, TB and prevention of homeaccidents among others.

As part of the efforts to prevent the spread of HIV, ‘know your status’ campaign was

organized by the region in the course of the year under review. The target groups

included; students, beauticians, women and men groups in churches and

communities. The total number of people screened was 77,394. One thousand and

eighty three (1083) representing 1.4% out of the total number screened were

positive.



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See Table 1.2

Indicators SEX Jan- Dec

2009

20222221222

Jan- June

2010

422200

# Tested M 33327 31,345

F 41879 46,049

# Positive M 310 326

F 792 757

# Posttest

counselled

M 33327 31,345

F 41879 46,049

Total 75,206 77,394

KNOW YOUR STATUS CAMPAIGN, 2009KNOW YOUR STATUS CAMPAIGN, 2009--20102010

1.1.3 Work with other stakeholders and communities to help members maintain

healthy lifestyle behaviours

Ghana Health Service in collaboration with other stake holders like Ministry of Agriculture,

Department of Social Welfare, Ghana Tourist Board, Food and Drugs Board, District

Assembles, Ghana Standard Board, Ghana Education Service, Women’s Groups, Religious

Bodies etc., organized workshops, seminars, community durbars in March and May 2010

with the Regional Nutrition Officer, Regional Health Education Officer and Regional Tourist

Board as resource persons to educate food vendors, hoteliers, market women, school

children, health workers, teachers on the need to make the right choice of food, demand

for healthy environment, adopt healthy life styles to reduce the disease burden, be friendlyto water bodies that have become a major source of water borne and water related

diseases. Participants were made to understand the need not to take nutrition for granted

by eating all the wrong foods at the wrong times, at the wrong places, constipate heavily

and generate toxic waste in their bodies which also become the cause of many non-

communicable diseases.

Participants were informed to always make time for rest and recreation to refresh them for

the next production week and not to crowd their week ends with all kinds of unnecessary



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activities. The three food groups were also discussed as well as their uses in the body,

food hygiene, food microbiology, oral hygiene were amongst the topics treated.

WORK WITH OTHER STAKEHOLDERS

Date Programme Resource Persons Target Audience

No. ofParticipants

March 10 Essence ofiodated saltusage &RegenerativeHealth &Nutrition

Tourist Board, Reg. Nut.Off & Reg. HealthEducation Off

Food Vendors 102Market Women 40

May 10 IronFortificationProgramme

National Coordinators(3) & Reg. Nut. Off

TraditionalCaterers

25

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

and Nutrition (RGN)

As part of measures to carry out the above, a five member team made up of, the regional

nutrition officer, the regional training coordinator, the regional DDNS, the regional Health

Educator and a representative from the sports council were invited to a trainer of trainers’

workshops at cape-coast. Afterwards, the training was replicate at the Regional level for all

the 27 districts and five (5) sub-metros. Participants were put into four (4) major groups

being maternal and child health, healthy lifestyle, nutrition and practicals.

TOPICS TREATED AND DISCUSSED WERE CENTERED ON

1. Water and Nutrition

a) The health benefits of water

b) Nutrients

c) Food groups in Ghana

d) How to combine your food and plan your meals

e) Feeding the family

The practical sessions took participants through the preparation of regenerative health

diets. Questions posed by participants were answered to their satisfaction. A period within

the programme was allocated for exercise. In all about one hundred and eighty (180)people participated in the category of nutrition, public health nurses, community health



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nurses, disease control and health promotion officers. It was well attended, patronized and

successful.

1.1.5 Promote food safety

The regional health directorate in collaboration with School Health Education Programme

(SHEP) Coordinators, Nutrition Officers and the Environmental Health department organizedworkshops for heads of schools and food vendors. The objective was to promote food

safety in schools. Some of the topics treated include; food hygiene, personal and

environmental hygiene, cooking practices and food storage among others. A certificate of

participation was given to all the food vendors who attended the workshop.

1.1.6 Promote occupational health and safety

The goal of occupational health services is to establish and maintain a safe and healthy

working environment which will facilitate optimal physical and mental health in relation to

work. It is therefore imperative that workers are periodically given training on occupational

health and safety and also should be provided with protective equipment in order to control

risk and departures from health.

The RHD also ensured the regular supply of personal protective equipment to staff. These

included; wellington boots, goggles, gloves and gowns. The health facilities also have fire

extinguishers and smoke detectors.

1.1.7 Advocate for improved access to water and sanitation infrastructure

The Regional Health Directorate has always been advocating for safe water for drinking.

This is to reduce the number of water related diseases in the region especially in children

U-5.

Equally the Regional Health Directorate in collaboration with the Environmental Health unit

have been working to improve the health status of the people of the region through the

provision of quality environmental sanitation services that are accessible and affordable.



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CHAPTER TWO

2.0 Strategic Objective 2- Health, Reproduction and Nutrition Services

2.1.1 Improve quality of clinical care

In order to improve staff capacity to provide quality care, a series of in-service training

sessions were organized for health workers during the year. Notable among these were;prevention of injection abscess, management of post partum haemorrhage, hypertensive

states in pregnancy, neonatal resuscitation and management of diarrhoea.

2.2 Quality Assurance (QA)

Surveys were conducted in most health facilities on the rational use of medicines. Plans are

underway to meet all prescribers and dispensers in the region with the aim of improving

the indicators for rational use of medicines. See table 2.1 below for the results of the

survey.

TABLE 2.1 Rational Use of medicines indicators

PRESCRIBINGINDICATORS

REGIONAL AVERAGE

WHOSTANDARDS

Average number of medicines per encounter 4.2 2

% of medicines prescribed generic name 95.0 100

% of encounter with antibiotics 35.0 20

% of encounter with injection prescribed 35.0 20% of medicine prescribed from EDL 100 100

PATIENTS INDICATOR

% of patient who understood drug instruction 91.0 100

FACILITY INDICATORS

% availability of tracer drugs 100 100

Facilitative supervision undertaken during year revealed that most of the facilities hadquality assurance teams in place. In 2009, client satisfaction survey was conducted by

most hospitals. About 96% of clients indicated their satisfaction with services provided.

There is a need to revamp the quality assurance systems in all health facilities in the period

ahead.



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Ownership of Health Facilities

Quasi-Govt, 8

Govt, 170

Mission, 71

Private, 278

OPD/CAPITA:

OPD Attendance Per Capita

0.8

0.4

0.6

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

2008 2009 2010 Half-Year

Year

P e r C a p i t a



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OPD ATTENDANCE

Generally, OPD attendance has increased over the years. Districts with mission institutions

in the region contributed almost 60% of total OPD attendance See table 2.2 below.

FIGURE 2.1 OPD Attendance, 2008 – 2010 Half Year

OPD AttendanceOPD Attendance

Year Out-Patients Visits

2010 Half-Year 2,046,993

2009 3,962,986

2008 3,140,880

MORBIDITY PATTERN

Table 2.3 shows the regional top 10 leading causes of OPD attendance for the past three

years. Malaria continues to be the leading cause of OPD attendance. Malaria alone

accounted for almost half (50%) of the total OPD attendance. Hypertension, URTI and



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Rheumatism have also featured prominently over the years.

Top Ten OPD Morbidity, 2008 - 2010

No.

2008 2009 2010 Half Year

DISEASE

CASES

DISEASE

CASES

DISEASE

CASES

1 Malaria 814,998 Malaria 1,449,260 Malaria 797,629

2 Cough (IMCI) 119,490 Acute Respiratory

Inf. 259,701 Acute Respiratory Inf. 148,366

3 Hypertension 80,429 Hypertension 125,453 Hypertension 66,098

4 Skin Disease 70,694 Diarrhoeal Disease 123,107 Diarrhoeal Disease 65,858

5 Diarrhoeal

Disease 57,252 Skin Disease 115,212 Skin Disease 62,839

6 Rheumatic

Conditions 42,617 Rheumatic Conditions 94,531 Rheumatic Conditions 51,229

7 Urinary Tract Inf. 33,900 Urinary Tract Infection 58,324 Intestinal Worms 34,102

8 Intestinal Worms 28,258 Intestinal Worms 54,719 Urinary Tract Infection 32,300

9 Home/Occup

Injuries 26,363 Acute Eye Infection 49,509 Acute Eye Infection 26,619

10 Chicken Pox 22,552 Home/Occup Injuries 43,820 Anaemia 21,574

Hypertension & Diabetes Mellitus cases Reported by District

2008 – 2010 Half Year (a)

District2008 2009 2010 Half Year

Hyp’sion Diabetes Hyp’sion Diabetes Hyp’sion Diabetes

Kumasi 38,388 6,118 36,605 8,200 15,721 3,677

Asante Akim North 2,092 559 2,855 899 7,581 4,101

Obuasi 20,614 5,310 26,750 6,087 7,121 1,691

Atwima Nwabiagya 3,363 930 7,555 2,217 4,564 448

Ejisu Juaben 3,588 581 5,304 1,247 4,101 1,144

Sekyere South 2,940 661 5,025 1,152 3,988 1,156

Mampong Municipal 588 688 1,073 130 3,475 887

Sekyere East 3,672 960 4,389 920 2,734 465

Sekyere Afram Plains 2,339 467 4,728 587 2,221 227



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Hypertension & Diabetes Mellitus cases Reported by District

2008 – 2010 Half Year (b)



Adansi South2,241 237 3,000 292 2,042 277

Afigya Kwabre 3,343 836 3,005 592 1,945 330

Mampong Municipal 2,003 688 2,210 899 1,540 571

Ejura Sekyedumase 1,320 234 1,181 65 951 46

Bekwai Municipal 3,315 600 2,759 422 903 216

Adansi North 1,380 189 1,818 152 898 86

Sekyere Central 0 0 1,678 111 801 60

Ahafo Ano South 1,257 326 1,081 258 752 177

Kwabre 1,159 60 1,711 99 671 62

Hypertension & Diabetes Mellitus cases Reported by District 2008 –

2010 Half Year (c)



Atwima Kwanwoma 1,431 62 1,794 40 618 11

Asante Akim South 2,348 660 5,015 1,214 594 62

Offinso Municipal 1,490 123 1,402 126 548 32

Amansie central 765 135 768 182 479 58

Bosome Freho 265 1 572 38 459 0

Amansie West 237 40 550 98 383 53

Offinso North799 49 582 66 376 64

Ahafo Ano North 1,116 452 1,420 418 361 96

Atwima Mponua 261 21 216 62 136 23



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Hypertension & Diabetes Mellitus cases Reported 2008 – 2010 Half Year

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Year

% o

f O P D M o r b i d i t y

Hy'sion 3.21 3.91 4.1

Diabe 0.64 0.83 0.99

2008 2009 2010 Half Year

15

Hospital Admissions

• Total Admissions 2008 2009 2010 Half Year

107,743 162,591 86,173

• Hospital Admission Rate is 1.71 per 100 populationas against 3.33 per 100 in 2009

• Bed Occupancy (Target = 80%)2010 = 56.7%

2009 = 59.4%

2008 = 37.4%



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Inpatients:

Hospital Admissions have been increasing over the years, but the half year apperas to be

just marginally high. The Average bed occupancy rate also appears to be marginally similar

to the figure in 2009.

TABLE 2.4 Hospital Admission Causes of Admission

Malaria, Diarrhoea, Hypertension, Aneamia, Gastritis, Asthma, Pneumonia, Abortion, Hernia

and Enteric fever were the ten top causes of admissions in the year under review. Malaria

was the highest among the ten leading causes of admissions accounting for over

30.1%.See table 2.5 below.

TABLE 2.5

Top 10 Causes of Admissions, 2008 – 2010 Half Year

16

Top 10 Causes of Admissions, 2008 - 2010

2008 2009 2010 Half Year

No. DISEASE CASES DISEASE CASES DISEASE CASES

1 Malaria 8,914 Malaria 29,486 Malaria 16,362

2 Diarrhoea 815 Diarrhoea 3,203 Diarrhoea 1,6353 Anaemia 663 Anaemia 2,148 Anaemia 1,075

4 Hypertension 503 Hypertension 1,535 Hypertension 831

5 Pneumonia 308 Enteric

Fev./Typhoid 994 Enteric

Fev./Typhoid 576

6 Hernia Inguinal303

HerniaInguinal

911HerniaInguinal

564

7 Asthma 277 Pneumonia 709 Gastritis 373

8 Gastritis 272 Gastritis 691 Asthma 345

9 Enteric

Fev./Typhoid 244 Abortion

683 Pneumonia 33310 Single Spont Del. 183 Asthma 643 Abortion 325



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Causes of Death

The mortality profile shows Malaria, Anaemia, Hypertension, Pneumonia, Septicaemia,

Diarrhoea, HIV/AIDS, Diabetes, Bronchopneumonia and CVA as the ten leading causes of

deaths with Malaria accounting for over 30% cases. See table 2.6 below.

TABLE2.6

Top 10 Causes of Death, 2008 – 2010 Half Year

17

Top Ten Causes of Death, 2008-2010

No. Diseases 2008 Diseases 2009 Diseases2010

Half

Year

1 Malaria 67 Malaria 226 Malaria 126

2 Anaemia 22 Anaemia 83 Anaemia 36

3 Hypertension 21 Hypertension 50 Diarrhoea Dis. 25

4 Diarrhoea 16 Septicemia 35 HIV/AIDS 22

5 Pneumonia 13 Pneumonia 34 Hypertension 20

6 HIV/AIDS 12 HIV/AIDS 34 Pneumonia 17

7 Diabetes Mellitus 9 Diarrhoea Dis. 33 C V A 16

8 Bronchopneumonia 7 Diabetes Mellitus 26 Diabetes Mellitus 12

9 C V A 5 Bronchopneumonia 25 Septicemia 8

10 Typhoid Fever 4 C V A 20 Cardiac Failure 6



19

National Health Insurance Scheme

TABLE 2.7 NHIS – Utilization

NHIS - Utilization

0

10

20

30

40

50

60

70

80

Out-Pat 61.34 38.66 69.58 30.42 75.92 24.08

In-pat 57.2 42.8 68.46 31.54 70.78 29.22

% Insured % Non-Insured % Insured % Non-Insured % Insured % Non-Insured

2008 2008 2009 2009 2010 Half Year 2010 Half Year

Rational Use of Medicine

Indicator 2008 2009 2010 Ashanti WHO

Av No. of Medicine Pres 4.2 4.2 3.8 4.0 2.0

% Generic 88.0 67.8 77.3 95.0 100.0

% Antibiotic 41.8 43.0 46.0 35.0 26.0

% Injection 36.0 18.9 22.0 35.0 20.0

% EDL 100.0 87.5 85.0 100.0 100.0

% Diagnosis 100.0 100.0 100.0 100.0 100.0



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Drug Availability

2.1.2 Promote and facilitate physiotherapy services

Currently only KATH and Mampong hospital provide physiotherapy services in the region.

Mampong Municipal Hospital in the course of the year received and treated the following

types and number of case: Arthritis, CVA , Painful shoulder, Injection neuritis/paralysis and

Low back pain.

2.1.3 Promote and facilitate Prosthetics and Orthotics ServicesClients are referred to KATH for such services.

2.1.4 Improve early detection, reporting and management of communicable

diseases

The Region organized various health talks on TB/HIV at the local FM station, which aimed

at educating the public on signs and symptoms of the diseases, as well as their preventive

measures, Know your status campaign was also highlighted. 270 newly qualified Health

staff and laboratory technicians were trained on TB management care and control. Durbar

on awareness creation to increase case detection was also organized during the World TB

Day celebration. There were health talks at the local information centres to create

awareness on TB disease and the need for early reporting .Over 2000 cases were detected

over the period. See figure 2.3



21

Case search on some selected communicable diseases like AFP, Buruli Ulcer, Guinea worm,

Leprosy and Yaws was conducted by CBSVs in all the communities in the district to enable

them detect early and report suspected conditions to health facilities for management.

The key activities carried out included:

•

Sensitization of districts on IDSR• Distribution of IDSR materials such as Fact Sheets, Reporting forms and Sample

Collection kits

• Specimen collection and transportation to the appropriate destination

• Feedback and Reports to the districts

• Two Press Conferences on H1N1 and Guinea Worm

• Regional Technical Committee Meeting involving KNUST, KATH and MRS.

Timeliness and Completeness reporting (CD1)

Year %Timely (> 80) % Complete (>90)

2008 94.4 100

2009 93 98.7

2010 89.3 (Half Year) 100

Timeliness and Completeness reporting (CD2)

Year Reports

Expected

No. Timely

Received

No. Lately

Received

% Timely

Received

2008 324 138 186 42.6

2009 324 228 96 70.3

2010 324 109 53 33.6 (Half Year)



22

FIGURE 2.3

Specimen Results

DiseaseSpecimen No. Positive

2008 2009 2010 2008 2009 2010

Measles 219 103 76 11 4 1

Meningitis 92 21 137 83 0 3

YF 28 46 47 0 0 0

AFP 28 48 29 0 0 0

Cholera 0 11 4 0 0 0



23

Positive Cases

Case District Detected

Measles Ahafo Ano North

Meningitis Atwima Nwabiagya (type c)

Kumasi – KATH (type w135)

Sekyere East (type c)

!"#$%& ()*+ ,*)!*&++%

– &-./0 1222 345603 578 7.79345603 :05;;<=>?@

03A./B3 0A5C7C7B

– =.DD/7C0C4: :47:C0CE48 03A./B3 8/A-5A:F

G.DD/7C0H D440C7BF 40G

– =5:4 :45AG3 C7 0I. 8C:0ACG0:F ?4JH4A4 =470A56 578

?4JH4A4 &;A5D ,65C7:

–

KC:0AC-/0C.7 .; !( D504AC56: :/G3 5: A4BC:04A:F

A4L.A0C7B ;.AD:F L.:04A:F 40G 0. 8C:0ACG0:

Districts reporting Guinea Worm Cases

District No. of cases

Amansie West 5 Asante Akim South 1

Atwima Nwabiagya 1

Ejura Sekyedumase 1

Sekyere Afram Plains 1

Total 9



24

Diseases Earmarked for Eradication and Elimination

BURULI ULCER;

Cases of ulcer have reduced from over 350 in 2008 to below 200 in 2009.Seee figure 2.4

below

FIGURE 2.4

Trend of Buruli Ulcer cases, 2008 - 2010

Year New Recurrent Clinical Forms

Nodules Ulcer Others

2008 235 24 36 164 0

2009 177 15 22 129 46

2010 Half Year 251 5 72 180 47

!"#$% '( )* +,-#- .$ /-0,$1. "#2.'$3 455674585

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25

Onchocerciasis

About 400,000 people at risk. Two hyperendemic districts, Offinso North and Asante Akim

South carried out CDTI activity with coverage of 81% and 79.3% respectively

!"#$%& ($ ($)*(+)%!,-. /0012/030

!"#$ %&'"$#(")*+ $",#$-.

/001 4565

/007 4568

/030 $9: !;< *=>?@ ?AB?CDE

BDFG@DEGF ;?@? B<F?B DAHIAJI@=6 :KK ?AB?CDE

BDFG@DEGF ;DKK L? B<F?B

DA %?E?CL?@ /030

Leprosy Cases:The region registered some few new cases in the year. See figure 2.5 below:

Trends on Leprosy cases 2008 - 2010

Year No. of cases

2008 44

2009 50

2010(HY) 26



26

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"3+><=&( @7#('(B&A 5025 624 5

"5+*.*@> :/>!* 0?29 "23 6

!"#" %&''(#&)(*# +, -(.)/(').

!" #$%&'$(& )*+,-./, 0.12./, .,34

"012(.3 23&+1# 4567 860 8

"9123/& .1:,1/1-3;&.( <=64 >6< 8

">;&#!,(& .*3)! 4<69 864 8

<8&.*:?& "564 86> <

<"+&#)&;& 5"68 864 <

<<;&#!,(& #*/)! 576> 86= 8

<4.3+(# <0>6< 864 8

<7:?&+/1 =>6= 86> 8

<=*+3&.( ;3#('(@&A 5"69 56< 8

<5*BB(#.* ;3#('(@&A 5"6" 560 8

<0*BB(#.* #*/)! 4560 96= 8

<9.1:,1/1 &B/&; @A&(#. ="64 86= 8

<>.1:,1/1 '1#)/&A =46< <"67 4

48.1:,1/1 1&.) 556< =67 8

4".1:,1/1 .*3)! 5=6= 86= 8

2*2.5 6786 989 :;



27

YAWS FIGURE 2.6



28

OTHER ENDEMIC DISEASES:

TUBERCULOSIS

!" $%&' (')'*)+,-

!"#$%&'() *++, *++- *++. *+0+ 1&23

.'/+,-%0 1,230%)+,- 456765789 45:;<5=>7 4588>5:98 65<995=98

?@2'*)'A B ,C $%&'& >;589< =5689 =5=>< ><5;>=

!,)%0 $%&'& (')'*)'A ;5<>> ;5><> ;5><7 >5><>

$%&' (')'*)+,- .%)' >7 ;; ;> >>

D'E FG'%H 1,&+)+I'& >5>8> >5;7= >;6> 7;7

D'E FG'%H D'/%)+I'& 7;: 796 7;= 94>

.'0%2&'& :> :< :4 4;

J)K'H .!. ;8 68 9: ;>

?@)H% 130G,-%HL ><4 7= :4 49

J)K'H& < < 4> ;8!3M'H*30,&+& F3HI'+00%-*' N-+)



29

TB TREATMENT OUTCOME

Indicator 2006 2007 2008 2009 HY1

Smear Positives 1,283 1,181 1269 650

Cured 1,033 (81%) 965 (82%) 1033 (81%) 504(78%)

Completed 69 99 113 78

Treatment Success Rate 86% 90% 90% 90%

Died 86 (7%) 83 (7%) 80 (6%) 42(6.5%)

Failed 8 6 9 4

Default 49 (4%) 14 (1%) 24 (2%) 10(1.5%)

Transferred Out 38 14 10 12!"#$%&"'()*) ,"%-$*''./&$ 0/*1

!"#$%& ()**+,)*-* $./

!"#$%&'() *++, *++- *+.+/0.

)-*- )-*0 --*-

-123 -0-0 2**

-3*4 -135 554

)23 3-1 -42

-42 -)+ 22

--) -5- 55

4) 35 5*

!6789:6;<=>= ?69@8>;;AB:8 CB>D



30

HIV/AIDS:

The table 2.10 below shows CT trend analysis of HIV/AIDS activities carried out in the Haly

Year 2010. See table below:

CT Trend Analysis,2008-2010HY

Indicators 2008 2009 2010HY

# Pretest

Counseled16949 24794 8706

# Tested 16530 23631 8278

# ReceivingPositive Test

Results

2485 3718 2182

# Receiving

Posttest

Counselling

16530 23631 8278

PMTCT-Trend Analysis(2008-2010)

Indicators Jan - Dec 08 Jan - Dec 09 Jan - Jun 10

# of ANC Registrants 78782 69919 42801

# Tested 62996 54031 33308

% Tested 80% 77% 90%

# Positive 1275 1141 850

# Given ARVs 1037 845 222

% Given ARVs 81% 74% 26%



31

MALARIA CASES:

Malaria control activities carried out in the year under review included training of health

staff on management of uncomplicated and complicated malaria as well as Malaria in

Pregnancy (MIP).

The policy on malaria is now on definitive diagnosis especially in persons above 5 years. As

a result Rapid Diagnostic Test (RDT) kits were provided to aid in diagnosis especially in

health facilities without microscopy.

Chemical sellers were also trained on home based care which included recognising

symptoms of malaria and knowing when to refer. There were also radio discussions on the

use of ITNs and recognising symptoms of malaria throughout the region.

With the support of Ghana Sustainable Change Project (GSCP), CBSVs, some districts were

able to train community leaders and religious leaders in communication skills to educate

community members on malaria, breastfeeding and on complementary feeding. The Figure

2.7 below shows 3-year trend of malaria cases recorded at Outpatient departments

throughout the region.



32

!"#$% '$%$()$*+,,-.+,/,012

858822

923521

301019

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

1000000

CASES

2008

2009

2010

!"#$% '$%$()$ $*+),,)"-,./0012/030456

33649 33706

12143

0

5000

10000

15000

20000

25000

30000

35000

ADMISSIONS

2008

2009

2010



33

!"#$% '$%$()$ *+$#,-./0012/030456

28

179

66

0

20

40

60

80

100

120

140160

180

DEATHS

2008

2009

2010

!"#$% '()($*( +,-*%%*./%0122341252678

13348

12114

4778

0

2000

4000

6000

8000

10000

12000

14000

ADMISSIONS

2008

2009

2010



34

!"#$% '()($*( +,-./0012/030456

0.058

0.042 0.045

0

0.01

0.02

0.03

0.04

0.05

0.06

%CFR

2008

2009

2010

!"# #%&'()*++,-*+.+/01

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

IPT1 IPT2 IPT3

2008

2009

2010



35

2.1.5 Strengthen disease surveillance, emergency preparedness and response

Surveillance activities were carried out at the various levels throughout the region.

Community Health Officers and community based surveillance volunteers played an active

role in disease surveillance activities in the districts

All CBSVs and health personnel were sensitized on the preparedness, such as CSM, HINIand Measles and others. Clinician sensitization and records review were conducted on a

regular basis at the various health facilities. See table 2.11 below.

All suspected measles, tuberculosis and acute-flaccid paralysis cases were investigated.

Some blood samples and stool samples were sent to the Public Health Reference

Laboratory and Noguchi Memorial Laboratory for investigations respectively.

All Districts have been sensitized on the preparation of Epidemic Preparedness and

Response plans and the formation of District Epidemic Management Committees and

Response teams.

H1N1 Situation

Cases of H1N1 are being reported in the Region since the first cases in August 2009. By

28th July, there had been 110 suspected cases with 47 being confirmed positive. The main

reporting facilities are KATH, Kumasi South Hospital, MRS, St Michael’s and KNUST

Hospital. Kumasi South Hospital and MRS are the regional designated Influenza Sentinel

Sites.

Two outbeaks have been reported in Asante Akim South and Bosome Freho districts and

these were in schools.

The region has substantial stocks of Tamiflu, but the challenge is the limited supply of Viral

Transport Media for collecting specimen.

Currently the region is free of sporadic cases though there is intensive surveillance on all

Influenza Like Illnesses.



36

LABORATORY SURVEILLANCE

!"# "%&'()**+,-(

2006 2007 2008 2009 2010 HY1

# Tested 8 13 33 21 37

N. meningitidis A 2 1 7 0 0

S. pneumoniae 3 5 10 0 2

H. influenzae b 0 0 0 0 0

N. meningitidis C 0 0 0 0 1

./,+* 0%1*)- 2(+*34 5+1/&+3/&67 8%9+:)

!"#$%&' )*&+%,$$'-.%

2006 2007 2008 2009 2010 HY1

# Tested 176 20 6 20 11

V/c Ogawa 54 0 0 0 0

V/c Inaba 0 0 0 0 0

/#-'$ 0*1$,. 2%'$3" 4'1#&'3#&56 7*8'9,

2.16. IMPROVE EARLY DETECTION, REPORTING AND MANAGEMENT OF NON-

COMMUNICABLE DISEASES

Non-communicable diseases such as diabetes, hypertension, stroke, cancer that were

earlier attributed to developed countries are now becoming major causes of mortality,morbidity and disability in Ghana.



37

THE UNDERLINING DETERMINANTS INCLUDE

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

sugar, and salt

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

• Obesity and

•

Lack of rest and recreationDuring the year under review diet related diseases clinic were set up in selected health

facilities to manage reported cases and to give counseling, Health and Nutrition talk to

clients visiting these facilities. In all 6,244 clients were seen and of these 3651 were

hypertensive, 1649 were diabetic, 682 had both conditions and 262 were obesed. After

analyzing their body mass index (BMI) 4140 females and 2004 males were seen.

Diet Related Diseases

28.425.58 26.47

64.7

58.86 58.49

4.1

10.34 10.92

2.8 5.22 4.20

10

20

30

40

50

60

70

2008 2009 1st Half 2010

%

N o .

o f C a s e s

YEAR

DIET RELATED DISEASES - 2008- 2010

Diabetes

Hypertension

Diab-Hypertension

Obesity



38

Year 2007 20082010 1ST Half Yr

Type of Disease No. % No. % No. %

Diabetes 3357 28.40 3051 25.58 1649 26.47

Hypertension 7646 64.70 7022 58.86 3651 58.49

Diabetes-hypertension 486 4.10 1233 10.34 682 10.92Obesity 316 2.80 623 5.22 262 4.20

Total 11805 11929 6244

2.1.7 Improve access to Quality Maternal, Newborn and Reproductive Health

Service

The vision of the reproductive and child health unit is to improve the health and quality of

life of persons in the reproductive age and beyond as well as children by providing high

quality reproductive and child health service.

Improving access to quality maternal, newborn and reproductive health service requires the

provision of focused Ante Natal Care (ANC), Supervised Delivery, Post Natal Care, Family

Planning Services, promotion of Exclusive Breastfeeding and Prevention of Mother to Child

Transmission (PMTCT) of HIV.

Antenatal Care

During ANC visits the Weight, Height, HB, Urine and Blood Pressure were checked by public

health unit of all facilities to detect any risks or complications associated with the

pregnancy.

The target set for ANC Registrants during the year was 90% while 83% representing a

decrease of 3.1% over the previous year. Operational research will be conducted in 2010 toassess the reason for the downward trend. The table 2.14 below shows a three – year

(2007-2009) trend of the coverage and registrants.



39

ANC Coverage, 2008 – 2010 Half Year

!"#$% '( )*+ +',#"-.#/ 011230141 5-6( 7#-"

0

10

20

30

40

50

60

70

80

90

2008 2009 2010

86.183

39.7 % C

O V E R A G E

YEAR

!"#$% '$ ()* +'"!, *#'-,!

0

2

4

6

8

10

12

14

2008 2009 2010

10.3

13.4

9.1



40

! #$%&$'%$( &%)*+,( '$*%

0

2

4

6

8

10

12

2008 2009 2010

9.6

10.6

8

!"#$% '$ !!() *+,#"-.# (//01(/2/

0

10

20

30

40

50

60

70

80

90

2008 2009 2010

81.8

71.5

33



41

!"#$%&' )#&* +, -#'#&'

22

22.2

22.4

22.6

22.8

23

2008 2009 2010

22.8

26.3 27.5

!"#$$%& &%$#(%)*+ ,--./,-0-1*

0

5

10

15

20

25

3035

40

45

50

2008 2009 2010

47.5 49.4

20.5 % C

O V E R A G

E

YEAR



42

Low Birth Weight and Still Birth

Year LBW Still Birth

Macerated Fresh Total

2008 9200 1080 777 1857

2009 11143 1341 631 1972

2010 3291 488 242 730

!"#$% '$ (!')) *'"!+

1.65

1.7

1.75

1.8

1.85

1.9

1.95

2

2.05

2.1

2008 2009 2010

2.1 2.1

1.8

FIGURE2.9

Supervised Delivery

This is done by skilled staff to ensure safe delivery of babies to reduce infant and maternal

mortality. However TBAs also conduct deliveries because there are not enough midwives.

Activities carried out include:

• Midwives encouraged to use partograph to monitor progress of labour



43

• Trained midwifery staff on resuscitation of the newborn.

• Mothers were encouraged to practice exclusive breastfeeding after delivery for six

months and they were also given Vitamin A after delivery.

During the year a target of 60% was set .The region however achieved 49.4% which again

indicated a decrease of 5.9 % over the previous year. See the figure 2.10.

The low skilled delivery could be attributed to the low numbers of trained Midwives in the

facilities and in some cases the absence of Midwives in most of the rural clinics as a result

of diploma Midwives refusing posting to the rural areas.

Figure 2.10

Skilled Delivery, 2008 - 2010

!"#$$%& &%$#(%)*+ ,--./,-0-1*

0

5

10

15

20

25

30

35

40

4550

2008 2009 2010

47.5 49.4

20.5 % C

O V E R A G E

YEAR



44

!"#$% '$ (!')) *'"!+

1.65

1.7

1.75

1.8

1.85

1.9

1.95

2

2.05

2.1

2008 2009 2010

2.1 2.1

1.8

!""#"$%& &%(#)%*+,-./ 0121

0

1

2

3

4

5

6

7

8

caesarian vacuum forceps

8

0.60



45

!"#$ &'$'( )"*+,'-+ .//01./2/

0

10

20

30

40

50

60

2008 2009 2010

51.647.8

18.6

!"#$% '$ () *++#,-." "*-#

15.7

17.5

7.4

0

2

4

6

8

10

12

14

16

18

20

2008 2009 2010



46

Post Natal Care

This service has to do with a follow up care of both mother and baby to assess the mother

and baby’s health in order to detect any complications early and manage them promptly.

Mothers were sensitized to report within the 1st 48hrs. The coverage for the half year is

very low compared to 2008 and 2009. Efforts would be made to address this shortage. The

RHD as part of the LDP project assessed “Pregnant women’s perefection of Maternal Health

Services” in the region and the findings and recommendations would be implemented for

improvement in health care quality.

!"#$ &'$'( )"*+,'-+ .//01./2/

0

10

20

30

40

50

60

2008 2009 2010

51.647.8

18.6



47

! #$%&$'%$( &%)*+,( '$*%

0

2

4

6

8

10

12

2008 2009 2010

9.6

10.6

8

FAMILY PLANNING

Family planning services are carried out to prevent unwanted pregnancies and help in the

reduction of maternal deaths. The acceptor rate for the previous year was quite low and as

part of measures to improve the rate, durbars were held in a number of districts e.g.

Kumasi Metro, Ahafo Ano South, Atwima Kwanwoma and Bosomtwe.

In Kumasi Metro, satisfied trained with support from Engender Health were used to give

testimonies about various methods.

To scale up the use of Jadelle, some districts namely Bosomtwe, Ahafo Ano South, Amansie

West and Atwima Kwanwoma in collaboration with the Metro Director of Health Services

trained a number of service providers in Jadelle insertion. There was also close

collaboration with Marie Stoppes International. There is an increasing demand for the

Jadelle. However the acceptor rate apperas to be low at 7.4% compared with 2009 figure

of 17.5%.

However there has being a steady increase in the number of males accompanying their

spouses to access reproductive and child health services.



48

MATERNAL DEATHS

Maternal deaths recorded for the half year is 67 which compare favourably with 177 and

222 in 2009 and 2008 respectively.This represents a significant reduction of maternal

deaths in the region. The regional maternal committee was re activated though it met onlyonce for the half year. A region wide sensitization of Safe Motherhood protocol has been

undertaken and this would enable practitioners handle emergency situations.

Reported Maternal Mortality 2008 – 2010

Institution Death

G H S Institutions 18

KATH 49

Total 67

Maternal Deaths – 1st Half Year

Institution Death

G H S Institutions 18

KATH 49

Total 67

No. Audited 56

Not Audited 11

% Audited 83.6



49

CHILD HEALTH

Child Welfare Average Visits

CWC PARAMETERS

Children 0- 23 months

Year 2008 2009 1st Half Year

2010

Total Registrants 299693 319642 205914

W/A <80% 7837 5432 3716

Target Population 372952 384606 398065

% Coverage 80.4 83.1 51.7

% Malnourished 2.6 1.7 1.8

CWC PARAMETERS

Children 24- 59months

Year 2008 2009 1st Half Year

2010


W/A <80% 2540 2111 1642

Total Population 405999 418683 433336

% Coverage 23.8 26.0 17.5




50

BFP PARAMETERS

Year 2008 2009 1st

Half Year2010

Expected

delivery 188837 194736 201552

B.F < 1hr 41332 62386 31237

% Initiation 40 67.94 74.96

% M. Vitamin A 43 45.80 41.1



51

BREASTFEEDING PROMOTION

Year 2008 20091st Half Year

2010

Total facilities 313 ( mat) 313 ( mat ) 313 ( mat )

Designated Nil Nil 28

% BF 0 0 0

• Twenty-eight (28) facilities awaiting assessment since

2004 have now been designated .



52



53

Iodated Salt Programme

Market & Household Survey

Year 2008 20091st Half Year

2010

May Nov. May Nov. May Nov.

% Availability 72.1 66.4 62.3 !"#$ !!#%

% Use 66.8 70.5 59.9 !&#' !!#"

Target 90% 90% 90% 90% 90% 90%

Promote the survival growth and development of all children

To ensure the survival and growth of children in the region, many activities including

exclusive breastfeeding for the first six months of life, complementary feeding, Vitamin A

supplementation, child welfare services, nutrition, and integrated management of child

hood illness were some of the key activities undertaken during the year.



54

Growth Monitoring & Promotion 0 - 23months

Year 2008 2009 2010 1ST Half Yr


W/A <80% 7837 5432 3716


% Coverage 80.4 83.1 51.7



Year 2008 2009 2010 1ST Half Yr


W/A <80% 2540 2111 1642


% Coverage 23.8 26.0 17.5



Year 2008 2009 2010 1ST Half Yr


W/A <80% 11282 7543 5358


% Coverage 50.9 53.3 33.9


2.8 1.8 1.9

50.953.3

33.9

0

10

20

30

40

50

60

2008 2009 1st Half 2010

% M

a l . & % C

o v .

Year

CWC % Malnourished & % Coverage forchildren 0-59months

% Malnourished

% Coverage



55

Mother Support Groups were established in communities to support breastfeeding activities

as well complementary feeding.

No. District No. of MotherSupport Groups

Communities where groupsare established

1. Offinso North 2 Nkenkaaso & Akomadan

2. Amansie West 3 Manso Kwanta, Antoakrom & Agroyesum

Sale and promotion of the use of iodated salt was also carried out in majority of the

communities in the districts, in addition to surveys carried out in market areas, households,

institutions, restaurants and chop bars to assertain the status of the districts.

Iodated Salt Survey (Market & Household)

Year 2008 2009 2010 1

ST

Half YrMonths May Nov. May Nov. May Nov.

% Availability 72.1 66.4 62.3 76.8 77.2

% Usage 66.8 70.5 59.9 75.1 77.6

Target 90% 90% 90% 90% 90% 90%

Iodated Salt Survey-May & Nov/Dec (Food Vendors, Chop Bars & Rest. &

Institution)

Year 2008 2009 2010 1ST Half Yr

No. collected,

Tested & %Passed No. Tested % Passed No.Tested % Passed No.Tested % Passed

Months M N M N M N M N M N M N

Food Vendors1048

1235

74.5 63.9

1332 1621

72.5 76.3

1600

72.8

Institutions 86 15881.4 81.6

262 174

80.9 83.9 249

81.9

Chop Bars &

Restaurants

111

5

129

2

73.

5 71.6

16

59 1574

69.

6 69.3

172

6

79.

1



56

Lactation Management workshops were also organized in some district at selected facilities

for all staff to make the facilities baby friendly.

DistrictNo.

TrainedFacility Trained

Resource

Person

Category of

Staff & No.

trained

Offinso

North1

Nkenkaasu Government

Hospital

Reg. & Dist.

Nut. Off,

Midwife I/C

All the Staff in

the facility

totaling 86

people

Amansie

West

2St. Martin Hospital Agroyesum

& Antoa Health Centre

Reg. & Dist.

Nut. Off,

DCO, Midwife

I/C

All the Staff in

the facility

totaling 76

people

All trained facilities were assessed by the National assessors for designation. On the 27TH of

July 2010, twenty-eight trained facilities in lactation management in Ashanti Region were

designated as Baby Friendly at Prempeh Hall in Kumasi.

Maternal Vitamin A Supplementation was carried out in all delivery facilities to boost the

Vitamin A levels in breast milk especially for postnatal mothers within eight (8) weeks of

postpartum. This would cater for the vitamin A needs of children 0-5 months of age who

are being exclusively breastfed.

Maternal Vitamin A

Year 2008 2009 2010 1ST Half Yr

Expected Delivery 188837 194736 201552

BF<1HR 41332 62386 31237

% Initiation 40 67.94 74.96

% Mat. Vit. A 43 45.80 41.1



57

Two rounds of Vitamin A supplementation was carried out for children 6-59 months of age

during the National Immunization days to boost the vitamin A levels in their bodies and also

to fight against infection. Children under 2 years of age were also given dewormers as a

measure to prevent anaemia.

Vitamin A supplementation (6-59mths) Year 2008 2009 2010 1ST Half Yr

MonthMay Nov. May Nov.

Apr

(NID)

May

(CHPW)

Target 822183 843726 865269

Children Dosed 175655 833968 68628 759353 832389 10339

% Coverage 21.4 101.4 8.1 90 96.2 1.19

PROMOTE THE REDUCTION OF MALNUTRITION A PUBLIC HEALTH AND DEVELOPMENTAL PROBLEM

During the year under review existing Rehabilitation centres in the Region were strengthen

to carry out their activities. Those that were dormant were reactivated to rehabilitate

malnourished cases seen in the community, With support from UNICEF, a workshop

organized for front line providers on the use of ready to use therapeutic foods, equipped

health officers with the technical know how on the preparation of the feed using locally

available ingredients.



58

Year 2008 2009 2010 1ST Half

Yr

Total No. of Cases seen 7651 4347 2135

Kwashiorkor 642 484 273

Marasmus 4780 2598 1308

Kwash-Marasmus 354 396 235

Anemia 1875 869 319

Rehabilitation Rate 34.0 62.7 74.9

Case Fatality Rate 0.41 0.60 0.80

Nutrition surveillance was also carried out in selected day care centres to determine the

nutritional status of the children. Nutrition and health talks on Breastfeeding, importanceof good weaning practices among others were given to mothers and caregivers so they

could take good care of these children in terms of their Nutritional needs.

11.8 7 11

13.1

8.1

11.5

9.7

5.2

9.5

0

2

4

6

8

10

12

14

2008 2009 1st Half 2010 %

U n d e r w e i g h t , S t u n t i n g & W a s t i n g

YEAR

NUTRITION SURVEILLANCE

% Underweight

% Stunting

% Wasting

The Regional Health Directorate in collaboration with the District Health Management

Teams supported the school feeding programme at all levels. Several workshops were

organized for caterers and other stakeholders in charge of the feeding programme on menu

preparation, basic Nutrition etc.



59

The National Commission on children organized several seminars and workshops on early

childhood Development for all stakeholders of which the Ghana Health Service and the

Department of social welfare were part. The programme sought to improve upon the skills

and performance of day care attendance at day care centres. Food demonstrations were

organized in Kumasi, Sekyere East, Ejura Sekyereduamse and Asante Akim North with the

support of world vision International to show case the various balanced diets that can befed to children to improve upon their nutritional status. Resource persons included District

Nutrition officer and DHMT members. Topics treated included the three food groups, how

to combine them and the need to give fruits and vegetables.

IMMUNIZATION COVERAGE:

Routine immunization and NID’S were intensified in the half year of 2010 in all Districts

with supervision from the Regional Health Directorate. Some of the activities included

House to house immunization, defaulter tracing and mop-up.

EPI Activities Half Year 2010

! Routine Immunization

! Two (2) Rounds of NID

! H1N1 Vaccination

There has been appreciable increase in EPI coverage in all the antigens. The main

improvement was from Kumasi Metro where various strategies were implemented to boost

the coverage.

On other hand the BCG/Measles drop out is way above the accepted value of 10%.

However the NIDs carried out throughout the year were successful and this goes on to

ensure the region’s fruitful fight towards Polio eradication.



60

!"# %&'()'*+,"& !- ./01'/"10

!"# %&'()'*+,"& !- ./01'/"10



61

!"#$% ' !"()*(+%#," -. /01$(0,$1

!"#$% ' !"()*(+%#," -. /01$(0,$1



62

!"#$%"$ '"()*(+#,-" ./ 01$2(1-2

!"#$%"$ '"()*(+#,-" ./ 01$2(1-2



63

!"#$

!"#$ %&'()*

,-./0&*1-2

%-*&0

3&4412&*)5

6-7)'&()

%&'!# ) *+,-)*, )-,,,-*./ ),+012

%&'!# . *+,)*, *//-+,/ ),.0*

Children missed between March and April NIDS - 23,420

2.2.0 Improve access and quality of oral health services

Improving access and quality of oral health services is one of the major key activities of the

clinical care services. However, except KATH, Kumasi South and Suntreso Hospital there is

no such facility in most of the District Hospitals.

During the year under review Kumasi South and Suntreso Hospitals treated 2034 and over

9,140 dental patient’s respectfully. The type of cases recorded was: Periodontal diseases,

Apical trauma, Impacted teeth, Oral tumours and Gingival and tongue ties

2.2.1 Improve access and quality of eye care services

Reduction of blindness and low vision is generally the main objective of the eye service .

During the year under review the eye care centre of the Regional Hospital screened and

treated various types of eye conditions. See table 2.20 below.



64

CHAPTER THREE

3.0 Strategic Objective 3- General Health System Strengthening

3.1.1 Develop and use information technology to improve information

management and service delivery

The Region has an ICT Unit. The key role was to supervise and prompt repair of ICTequipment as and when they broke down. During the year Unit installed and configured 10

new ICT equipments brought to the Regional Health Directorate including the installation of

anti virus software for the districts who had procured some computers.

The use of the District Health Information Management System (DHIMS) software to

process and analyze health service data has improved access to timely and accurate

information. It has enhanced planning, management and evidence-based decision making

at all levels of health service delivery. All the 27 districts were trained and are currently

using the DHIMS in managing their data. The data submission rate as at the time of

collating this report had increased.

The National Health Insurance Authority has also provided health facilities within the

Region with a computerized networked clients’ registration system.

Most ofl the districts are currently connected to the World Wide Web internet system and

have greatly enhanced information management and accessibility.

3.1.2 Improve human resource recruitment, deployment and retention andmanagement

As part of measures put in place by the health sector, quota systems of staff distribution

were given to Regions for the engagement of clinicians and other Technical Staff based on

the needs of Regions and the availability of the professionals.

Based on that directive the region conducted formal placement interviews together with

CHAG officials for the recruitment some key staffs.

In the case of the Doctors those who completed the placement forms wanted to work in

CHAG facilities even though there were vacancies in the GHS quota whereas the CHAG

quota had been exceeded. The Region formally expressed concern about this situation to

the national level.



65

A posting committee was set up to review and submit recommendations to the Regional

Director, all request for study leave.

HUMAN RESOURCE SITUATION

The total regional staff strength in 2009 was 4952 as against 4192 in 2008. See Table 3.1

below.

!"#$%&'( *+,-",+%#

!"#$ &''( !"#$ &')'

.%,"/ 0,"11 23 456 23725

8',+('9 :4 :;

<'",= > ?

8'0+@#",+%# 4

A"B",+%# %1 C%0, 4



66

!"#$%"&"'# )*# +,-. /",% 01)1

Staff Category No District

Nurse 2 Kumasi , Mampong

Midwives 5 Ejisu, Bekwai (2), Kumasi, Mampong

Accountant 2 RHD, Ahafo Ano North

Dispensing Assistant 1 Asante Akim South

Orderly 1 Amansie West

Security 3 Kumasi, Atwima Nwabiagya (2)

Medical Assistant 2 Atwima Mponua. Amanise West

Technical Officer 2 Ahafo Ano North, Ejura Sekyedumase

Storekeeper 1 Adansi South

Health Assistant 1 Offinso Municipal

Driver 1 Kumasi

Total 21

!""#$%&'(%& *%+ ,-*.('(%& #/ 0(1-2 34*-$/$(+ 5(*-&6

,7#/(88$#%*-8 9 !86*%&$ :(;$#% <=>=

Category Regional

Quota

Total No of

Applicants

No Selected

Community Health Nurses 150 486 159

Diploma Community Health

Nurse

6 5 4

Medical Assistant 5 7 5

Staff Nurse 90 188 92

Staff Nurses ( Mental) 9 21 9

Staff Midwives 20 62 22

Technical Officer (HI) 3 13 5

Technical Officer (CH) 5 6 5

Field Technician 13 29 13

Medical Officer 9 12 6Health Assistant Clinical 160 530 178

CHALLENGES

The constraints the Region faced in the management of Human Resource included thefollowing:

1. Inadequate clinicians (Doctors, Medical Assistants and Midwives)

2. Large number of staff applying for study leave



67

3. Large number of “Casual” appointees in facilities.

4. Ageing work force (Midwives especially)

5. Increasing numbers of staff with intention to pursue higher education

3.1.3 Expand infrastructure to support effective and efficient service delivery at

all levels

In spite of being the Region with the largest population in the Country, Ashanti has not had

a befitting Regional Hospital. The Kumasi South Urban Health Centre has for some time

being referred to as the Regional Hospital for Ghana Health Service in the Region. The

status of this facility which is below that of a District Hospital does not come anywhere near

that of a Regional Hospital.

Again only two of the facilities referred to as District Hospitals in the Region were put uppurposely as District Hospitals.

The Region has continued to carry out advocacy for the construction of a Regional Hospital

and District Hospitals especially in the newly created Districts which do not have Hospitals.

A priority list for the construction of District Hospitals in the Region was developed. The

priority list for the construction of District Hospitals in Ashanti outside the areas mentioned

earlier is as follows:

1.

Adansi North

2. Bosome Freho

3. Sekyere Afram Plains

4. Sekyere Central

5. Atwima Kwanwoma

6. Afigya Kwabre

7. Amansie Central



68

!"#$%&"$ ()%*+,-.

Project Location Contractor Consult Works

done

Upgrading of Old Tafo

Polyclinic toDistrict Hospital

Tafo Konneh Ent BIC 68%

Upgrading of Manhyia

Hospital - Construction

of OPD Block

Manhyia Consar Ltd ACP 68%

Construction of

Coldchain Room

Abrepo

Junction

Al-Raxmak Ocads 40%

Staff Accommodation

The availability of residential and office accommodation in both the Regional and District

level is a factor that helps to attract qualified critical personnel to enhance improvement in

Service delivery. We did not make much progress in this area. An eight (8) flat residential

accommodation block at Bantama in Kumasi has not seen any additional works within the

last three (3) years due to lack of funding. The situation is similar in the Districts. There are

quite a number of abandoned projects in the region and it is hoped that capital investmentswould be made available to complete them.



69

!"#$%&'%' )*+,%-.#

Project Location Contractor Consult Works

done

Rehab/Expansion (Const of

Wards)

Kumasi

South

Konneh Ent BIC 68%

Const of 3 B/room staff quarters KumasiSouth

Rafcofe Ent BRRI 85%

Const of 4 storey 3 B/room staff

q’ters

Abrepo

Junction

Duocon

Services

Ocads

Consult

60%

Const of DHMT Office Ejura Gyaba Const AESL 60%

Const of 2 storey

Adm/Pharm/Lab Blk

Ejura Gyaba Const AESL 75%

!"#$%&'(%)"# "+ !",- !./)# 0""12 34&56"



70

!"#$$%& !()*%+,-Projects Location Remarks

Regional Hospital Sewua Procurement in

Process

District Hospitals Bekwai

Konongo

Tepa

Stakeholders levels

DHMT Blocks All newly created

districts

3.1.4 TO IMPROVE SUPPLY AND EQUIPMENT MANAGEMENT

Most of the equipment in the facilities were old and therefore part failure and ageing

constituted major causes of equipment breakdown. However with the Planned Preventive

Maintenance Program that was in place and an active response to service calls from the

Clinical Engineering Unit, our facilities were able to use the equipment to render fairly

uninterrupted medical care to the people.

The Region had also in previous years submitted a request to the National Level for basicequipment requirements to support our vision of no tolerance for maternal deaths. Follow

ups revealed that the new equipment could be available in 2010.

The introduction of job card system and Medical Equipment tracking system by the Clinical

Engineering Unit in the course of the year are good practices that enhanced better

management of the equipment. Again, the offices in the Unit were able to come up with

local modifications to keep some of the equipment working. The Unit was also able to

design and construct basic medical equipment like Phototherapy Unit for some Hospitals.



71

!"#$%&!'( $'*(+,,+($-''- $'*($(#($-' !"#$%&!'( ,-.+($-' "#+'($(/

0 +*-'-&+*- #'$1!2*+, -%!2+($'3

,+&%

4!,$1!2/ 5!4

(6!+(2!

&+(!2'$(/

0

0

(+5,! (-% +#(-.,+1!

.!$,$'3 (6!+(2! ,+&%

(6!+(2!

(6!+(2!

0

0

+'3,! %-$*!4 ,+&%

7,--2 &-#'(!4 -% ,+&%

(6!+(2!

(6!+(2!

0

0

*#23!-' *(--,

&+/- (+5,!

(6!+(2!

(6!+(2!

8

0

%+($!'( (2-,,!/

*#.($-' &+.6$'!

(6!+(2!

(6!+(2!

0

0

+#(-.,+1!

(6!+(2! ,+&%

(6!+(2!

(6!+(2!

0

0

8 '9+:$! ./.,$'42$.+, +#(-.,+1! (6!+(2! 0

; (+7- '!5#,$<!2 :+24 0

3.1.5 Improve supply of essential medicines and essential commodities

The regional health directorate through prudent procurement planning has been able to put

structures in place to procure essential medicines, pharmaceutical raw materials, non

medicine consumables to ensure the availability of quality health commodities at affordable

cost.

Procurement activities are carried out through the National Competitive Tendering Method

of procurement.

The process is carried out twice a year. Advert is placed in the news papers to invite

potential suppliers to tender in their bids for consideration.

CHALLENGESMoney has been a problem as health facilities are not able to pay the RMS when they

collect the medicines and non-medcines commodities. This is because of delays in the

payment of medical bills by the National Health Insurance Schemes.

The regional medical store has to cut down what to buy, and this really affects the supply

of essential medicines and commodities to the health facilities.



72

3.1.6 Improve transport availability and management

In the beginning of 2009 the Region disposed of 113 motorbikes and 43 vehicles which

were mostly over aged, very expensive to maintain when some were off road and just

increased the numbers on the Regions inventory of vehicles. The Region had in previous

years gone through the process for the disposal of the vehicles and motorbikes. While 200

new motorbikes were assembled and distributed to facilities in the Region as part of themotorbike revamping project, only 4 new pick ups were received in the Region in the

course of the year. See TABLE.3.2 below

!"##$ &'(#'$)*+ ,+ $+-#

Vehicles .//0 ./1/

Saloon 1 0Station Wagon 3 3

Ambulances 16 20

Pick - ups 58 89

Water Tank 0 0

Haulage Trucks 1 1

Bus 2 2

Total 81 115

Motorbikes 331 531

Boat 1 1



73

!"##$ &'$()$'*+

Ages

Zone%2010%2009Vehicles

Green556332261-5 yrs

Yellow323758476-9 yrs

Red131510810 yrs +

10011510081Total

M/Bikes

Green74392672211- 3 yrs

Yellow2111027914 – 6 yrs

Red25296196 yrs+

100531100331Total

Ambulances

Five (5) of the Twelve (12) facility based ambulance in the Region were in good condition

while five (5) of the rest could be said to be in fair condition. The other two (2) were off

road. Ten (10) facilities are in urgent need of ambulances in the region.

Boat ServiceThe only natural lake in the Country is in the Ashanti Region. The only boat that is utilized

in support of service delivery is nine (9) years old. This boat like some of the vehicles in the

Region is in red zone and needs to be replaced with a fibre glass boat. There is also only

one coxswain on the boat. There is the need for the organisation of regular survival training

for staff in the area to cover new staff in the District.

Drivers

About 48% of the drivers in the service were between 50 and 60 years old. Only 14% of

the drivers were below 40 years old.



74

FIGURE.3.4

!"#$%"& (#)*+)#,-Age Range 2009 % 2010 % ZONES

39 & below

yrs

11 14 9 11 Green

40- 49 yrs 30 38 29 36 Yellow

50 – 60 yrs 39 48 42 53 Red

Total 80 100 80 100

Year 2009 2010

Driver Vehicle Ratio !"!#$ !" !#&



75

Promote Research and Development

The Regional Health Directorate undertook a baseline survey to assess the CHPS situation

in the region. The key findings were that CHPS is much active in the rural districts as

compared to the urban and preiurban districts.

!"##$%& !()* *&+&",

-./-!0123 .45673

!" "$ %&' ()%*+),*% -..

/012% *+3)45( .

!" "$ /563+,3*5( 7"45% .8-

!" "$ 90:; 7"45% -<-

!" "$ $&4,*)"43= 90:;

,"6>"&4(%

.?

!"## %&' (#)*+,-.-/,-.01



76

!"#$%& ()*+$,$*- %, ./0! .")1"2+3-

!"#"$%&' )* !+,-



77

!"# %&'("')

• *++&,-./0-. &1 2,3.',4. 5678 %&4"9 70'3&-3

• %&'/".,&- &1 5&//:-,.# 60"9.; <"-"=0/0-.5&//,..003>56<5?

• @'",-,-= &1 56<5

• 5AB27 ),3.',4.3C *88D E%<D **8D **FD *<5D

*@FD *@<

• G68H<E6 1,-"-4,-= &1 I 5678 4&/+&:-)3

+0' ),3.',4.

108

!"##$%&'( *+,-'. /,%,0+#+%'

!"##&''++

• !"##$%&'( *+,-'.

/00&1+23 4!*/5

• !.&+046+7 "0 82,9&'&"%,-

:$'."2&'(5

• ;$< =&3'2&1' >+,9+2

• ?$++% #"'.+2

• *+2<,-&3'

• 8+,1.+2

• 8@:

•

A"-$%'++2 435• !.+#&1,- ;+--+2

• :B2&1 CD'+%3&"% /00&1+2

• C%E&2"%#+%',- *+,-'.

:33&3',%'

• :33+#<-( F+#<+2

• G"#+%H3 B2"$7 >+,9+2

• /'.+2 "7&%&"% -+,9+23

109



78

!"#$%& ()*+*%,*-

• .#/"$ 0,11,2#& 31#4* #55*,-%"6 #1 -"2

7"8,*-#$ !"#$%& ()*+*%,*- 944,:")

• 7";,"2 # 6)#4% 1%)#%"8,: 6*:<+"-% *- !"#$%&

()*+*%,*- *- %&" =1% #-6 >-6 .#):&? >@=@

!"#$%$#$&' )

!"#"$%&'()* ), -)%#. /) 0)$&11) 2&3

• *+,- ./#0 $' 12345 62 #27+""2 5+,

• 8+5$2 #+49 '02: 26 ;0,$3+ <* 26 #27+""2 ='&

+65 $#' &>>&"# 26 #0& ='&3'? @$A& :+' +442:&5

>23 B026& C$6 :0&3& B&2B4& 3+$'&5 %+3$2='"26"&36' +72=# #27+""2 +65 :&3& +553&''&5

+""235$6D4,



79

!"#$%$#$&' )

!"#$%&'(#) #+ ,-'."(-/0 #) !-)$.1(& 2)+/%.)3-

4565

• *$+,-&' ./012"&1 3+1 3$/&1 0+ 456$/3 78 9:3/1&+ ;$#6 78<

• *$+,-&' 3$/&1 =0/ #>0 ?0+#5'

• !21$0 ;@' ./012"&1 =0/ 1$'#/$A2#$0+ #0 3-- #5&

1$'#/$"#' =0/ "0+#$+202' &12"3#$0+ 3# #5& BC@'

3+1 "0??2+$#$&'<

!"#$%$#$&' )

!"#$%&"'()*) !%,*-*-.

• *+& ,-$# $- ".//01.20#$.- 3$#+ 4&#2. *5

"..26$-0#.2 #20$-&6 $-7.280#$.- '&2%$"&'

6&902#8&-# '#077 .- *5:

• !// 6$'#2$"# 2&92&'&-#0#$%&' .7 #+& '&2%$"& 3&2&

92&'&-#:

• *+&; 3&2& 0/'. <$%&- 2&".26&6 8&''0<&' .-

*5 #. 0$6 #+&$2 9,1/$" &6,"0#$.-:



80

CHAPTER FOUR

4.0 Strategic Objective 4- Governance, Partnership and Sustainable Financing

4.1.1 Strengthen management systems

The Regional Health Directorate organized Monthly Health Management meetings through

out the year. During the meeting, issues bordering on the management of health services

at the various levels were discussed and amicable solutions arrived at. Weekly core

management meetings were also held to plan health programmes and activities.

The same process was replicated at various District and facility levels. Core management

and various committee meetings were held to ensure the effective running of facilities.

Quarterly staff durbars were also organized in the various facilities to identify staff needs

and promote the involvement of staff in the decision-making process.

As part of strengthening management and leadership skills, Regional health management

team members as well as their counterparts from the Districts participated in a six-month

training program on Leadership Development Program organised by the Ghana Health

Service in partnership with Management sciences for Health (MSH). The training treated

topics like:

1. The tools of effective management (Scanning, focusing, aligning etc.)

2. The mission and vision

3. Improving work group climate.

4. The challenge and how to address the challenge

5.

Changing complaints into request

6. Coaching

7. Breakdowns and other topics



81

4.1.3 Establish performance monitoring framework and reporting system fororganizational accountability

During the year under review the Region could not undertake any integrated monitoring to

the districts and health facilities. However some Regional BMC’S such as the clinical care

and the public health units carried out some form of facilitative supervision to DHMT’S ,

Sub-districts and all the facilities during the year.Half yearly Performance reviews were organized during the year in collaboration with key

stakeholders. Performance indicators of the various districts and regional programmes were

critically examined to identify weak areas and also to outline strategies needed to improve

service delivery.

Teams from National level visited the Region to monitor and supervise the performance of

both clinical and public health activities.

Monthly reports were submitted regularly to National Health Directorate and feedback

received especially from the public health directorate.

4.1.4 Mainstream gender and ensure equity in health programmes

In all our activities in the region, gender issues were critically taken into consideration.

During the year under review staffs from the regional training unit of the regional healthdirectorate undertook some training in gender mainstreaming. It is hoped that orientation

would be given to key staff in the period ahead so that gender issues would be inculcated

into health service planning and provision in the municipal.

4.1.5 Develop mechanism to achieve effective intersectoral collaboration

In all our health service delivery systems collaboration with stakeholders was pursued to

improve access and quality of care.

Advocacy meetings were held with stakeholders such as Ghana Education Service,

Traditional rulers and Ministry of Food and Agriculture and NGO’S

Private sector collaboration was also enhanced by inviting staff in some facilities to

workshops organized by the Regional health Directorate. Regular feedback on regional

activities was also communicated in the form of reports to them.

Metro, Municipal and District Assembly meetings were regularly attended which provided a

forum to raise issues of health concern. They are also briefed regularly on health events.



82

Priorities /WAYFORWARD FOR 2010

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

The priorities are:

• Addressing the issue of delay in data capture and submission

•

Addressing high number of still birth• Investigating all maternal deaths and instituting measures to limit avoidable

causes

• Promoting healthy lifestyle to reduce high incidence of hypertension and

diabetes mellitus.

• Promote good linkage with NHIS to reduce delays in the payment of medical

bills to the health facilities

NEXT STEPS

1. Schedule for RHMT/SMC Meetings for 2010

2. Regional staff awards

3. Schedule for Regional Staff appraisal

4. Schedule for monitoring and support visit to facilities

5.

Workshop on ATF rules

6. Orientation and induction for newly recruited staff

7. Submission of hard/soft copy of Annual Reports to National by the end of March

10. Refresher training on DHIMS for data managers

11. Refresher training course for motorbike riders

12. Ensuring that all facilities have Quality Assurance (QA) and Drug and Therapeutic

Committee (DTCs) in place



83

APPENDIX 1- Trend in Performance Indicators 2008 - 2010 HALF

Objective Indicators 2008

Actual

2009

Target

2009

Actual

2010

Half

Actual

Healthy

lifestyle and

healthy

environment

Availability of communication

strategy and materials at health

facilities

80 100 100 80

% of facilities providing screening

and counselling services

60 100 80 60

# of inter-sectoral meeting on

RHN

NA 4 1 0

# of CSOs and other stakeholders

oriented and collaborated with to

provide RHN interventions

NA 10 1 0

# of schools with health

programmes

2550 2660 2660

# of health workers oriented in

RHN

50 ALL

H/Workers

180 180

# of community volunteers

oriented on RHN

NA NA 0

% of facilities with functional

occupational health services

NA 10 0 0

bjective Indicators 2008

Actual

2009

Target

2009

Actual

2010

Half

Actual



84

ealth,

eproduction

nd Nutrition

ervices

Institutional maternal mortality 222 (253) 180 177 (189) 67

% of maternal deaths audited 86.9 90 162 (91.5) 56

(83.6)

% of facilities with functional customer

care services

NA 100 50 50

% of client satisfied with health care

services

60 100 75 0

# of facilities with functional Q.A system 10 25 15 15

% of facilities with adverse incident

monitoring register/guidelines in places

NA 100 85 90

Non-polio AFP rate 0.79 1.2 1.4 (48) 0.7 (29)

% increase in completeness of reporting 95 100 80 90

% increase in timeliness and

completeness of reporting

95 100 100 90

% of hospital with functional public health

units

18.5 81 80

Proportion of districts with functional

facility-based ambulance

6/27 4/27 8/27

TB case detection rate 2101(22) 2106(21) 1101(11)

TB treatment success rate 90 90 COHORT 90

# of lymphatic filariasis cases 0 0 0 0

Hiv + clients receiving ARV therapy 1290 1182 1286

# of cases of guinea worm 5 0 2 0

% of district with functional facility based

ambulance

30 19 29.6

% district with functional EPR teams 100 80 0

%ANC coverage 90 83 83 39.5

# of health facilities that are youth

friendly

28 3 3 8

% of deliveries attended by trained health

workers

40.8 60 60 20.5

% PNC coverage 51.6 55 41.3 18.6

% of pregnant women attending at least

4 prenatal visits

22.8 60 26.8



85

% WIFA accepting FP 15.7 17 17.5 7.5

% of children receiving Penta 3 77 100 83.7 41.6

% of children 0-6months exclusively

breastfed

N/A N/A 0

% of facilities offering basic EOC 100 100 74 74

% of facilities offering Comprehensive

EOC

100 100 74 74

% of children 6-59months receiving VAC 101.4 90 97.3

Number of specialist outreach services

conducted

NA NA NA

# of dentist 3 3 3

#of oral health nurse 3 4 4

# of surgeries performed 17399 24361 14902



86


Actual

2009

Target

2009

Actual

2010

Half

Actual

General Health

System

Strengthening

# of facilities network through

hospital computerisation

NA NA NA NA

Doctor population ratio 46281/1 42450/1 31157/1 39153/1

Nurse population ratio 3523/1 3315/1 3414/1 7215/1

OPD per capita 0.7 0.8 0.8 0.4

Equipment performance index 100 100 88

% of population living within 8km

of health infrastructure

60 100 80 80

# of functional CHPS zone 8 8 36 36

Tracer drugs availability 98 100 86.8

Fleet performance index NA NA NA NA

Governance,

Partnership

and

SustainableFinancing

# of managers trained in

leadership programme

NA 57 57 71

% of functional district health

committees hospital board

NA 100 40 40

% of functional hospital board NA NA NA NA

% sub-district that have

autonomy to manage their funds

0 0 0 0

% of staff appraised NA 100 80

% BMCs with performance

contracts

NA NA NA

# of staff trained in gender

mainstreaming

1 1 0

Per capita expenditure on health 4.55 4.55

Proportion of NHIS claims settled

within 4 weeks

0 0 0

%non wage GOG budgets

allocated to district level

52 64 62



87

% of annual budget allocation to

items 2 and 3 (GOG and HF/

SBS) disbursed

52 76 39

% IGF generated from NHIS 78 87 86

% of IGF to total budget 80 90 89

# of audit queries 8 NA NA

% allocated budget utilized

according to approved plan

NA NA NA

% GHS budget contributed to by

NGOs/CBOs/FBOs/HPs

NA 8 10

APPENDIX 1- Trend in Performance Indicators 2007- 2009


Actual

2008

Actual

2009

Target

2009

ActualHealthy

lifestyle and

healthy

environment



88

Availability of communication

strategy and materials at health

facilities

80 80 100 100

% of facilities providing screening

and counselling services

50 60 100 80

# of inter-sectoral meeting on

RHN

NA NA 4 1

# of CSOs and other stakeholders

oriented and collaborated with to

provide RHN interventions

NA NA 10 1

# of schools with health

programmes

1979 2550 2660

# of health workers oriented in

RHN

50 ALL

H/Workers

180

# of community volunteers

oriented on RHN

NA NA NA

% of facilities with functional

occupational health services

NA NA 10 0

jective Indicators 2007

Actual

2008

Actual

2009

Targe

t

2009

Actual

alth,

production

d Nutrition

rvices

Institutional maternal mortality 179 (246) 222 (253) 180 177 (189)

% of maternal deaths audited 84.4 86.9 90 162 (91.5)

% of facilities with functional customer NA NA 100 50



89

care services

% of client satisfied with health care

services

NA 60 100 75

# of facilities with functional Q.A system 25 10 25 15

% of facilities with adverse incident

monitoring register/guidelines in places

NA NA 100 85

Non-polio AFP rate 0.79 0.79 1.2 1.4 (48)

% increase in completeness of reporting 95 95 100 80

% increase in timeliness and completeness

of reporting

95 95 100 100

% of hospital with functional public health

units

18.5 18.5 81

Proportion of districts with functional

facility-based ambulance

11/21 6/27 4/27

TB case detection rate 2011(16) 2101(22) 2106(21)

TB treatment success rate 86 90 90 COHORT

# of lymphatic filariasis cases 0 0 0 0

Hiv + clients receiving ARV therapy 695 1290 1182

# of cases of guinea worm 18 5 0 2

% of district with functional facility based

ambulance

62 30 19

% district with functional EPR teams 0 0 100 80

%ANC coverage 76 86 90 83

# of health facilities that are youth friendly 17 28 3

% of deliveries attended by trained health

workers

40.8 47.5 50 49.4

% PNC coverage 50.6 51.6 55 41.3

% of pregnant women attending at least 4

prenatal visits

22.7 22.8 60 26.8

% WIFA accepting FP 15.1 15.7 17 17.5

% of children receiving Penta 3 74.3 77 100 83.7

% of children 0-6months exclusively

breastfed

N/A N/A N/A

% of facilities offering basic EOC 100 100 100 74

% of facilities offering Comprehensive EOC 100 100 100 74

% of children 6-9months receiving VAC 99.7 101.4 90

Number of specialist outreach services NA NA NA



90

conducted

# of dentist 3 3 3

#of oral health nurse 3 3 4

# of surgeries performed 11005 17399 24361



91


Actual

2008

Actual

2009

Target

2009

Actual

General

Health

System

Strengthening

# of facilities network through

hospital computerisation

NA NA NA NA

Doctor population ratio 46589/1 46281/1 42450/1 48334/1

Nurse population ratio 3349/1 3523/1 3315/1 2271/1

OPD per capita 0.5 0.7 0.8 0.8

Equipment performance index 100 100 100 88

% of population living within 8km

of health infrastructure

60 60 100 80

# of functional CHPS zone 5 8 8 31

Tracer drugs availability 97 98 100 86.8

Fleet performance index 66 60 100 86

Governance,

Partnership

and

SustainableFinancing

# of managers trained in

leadership programme

NA NA 57 57

% of functional district health

committees hospital board

NA NA 100 40

% of functional hospital board 100 100 100 100

% sub-district that have autonomy

to manage their funds

0 0 0 0

% of staff appraised NA NA 100 80

% BMCs with performance

contracts

NA NA NA

# of staff trained in gender

mainstreaming

0 1 1

Per capita expenditure on health 482P !!2.46 4.55

Proportion of NHIS claims settled

within 4 weeks

0 0 0

%non wage GOG budgets

allocated to district level

50 52 64



92

% of annual budget allocation to

items 2 and 3 (GOG and HF/ SBS)

disbursed

52 76

% IGF generated from NHIS 61 78 87

% of IGF to total budget 84 80 90

# of audit queries 26 8 NA

% allocated budget utilized

according to approved plan

NA NA NA

% GHS budget contributed to by

NGOs/CBOs/FBOs/HPs

NA NA 8

SECTOR WIDE INDICATORS 2007-2010 HALF

Indicators

2007 2008 2009 2009 2010 Half

Actual Actual Target Actual Actual

Number of Infants deaths –

Institutional 2,602 2,280 2,000 2,460 331

Number of Infants admissions –

Institutional 6,285 6,133 6,000 8,647 5012

Number of under five deaths –

Institutional 3,018 3,202 3,000 2,700 908

Number of under five admissions

– Institutional 24,941 19,656 19,000 25,160 18947

Maternal Mortality ratio –

Institutional (per 100,000 LBs) 246/100,000 253/100,000 200/100,000 189/100,000 167/100,000

Number of Under five years who

are under weight presenting

under facility & Outreach 16,872 16,000 14,005 8930

% Under five years who are

underweight – Institutional 13.5 11.8 11.7 7.0 11.0

Number of outpatient visits 2,809,681 3,140,880 3,900,000 3,500,286 2,041,603

Outpatient visits per capita 0.5 0.7 0.8 0.8 0.4

Number of admissions 117,326 138,484 140,000 140,557 85669

Hospital Admission rate 26 29 30 32 16.9

Specialist Outreach

Number of specialist visits

received from the national level

Number of patients seen by

national team

Number of operations performed

by national team

Disease Surveillance

TB cure rate 82 COHORT 82 81 78

TB Treatment Success Rate 90 COHORT 90 90 90



93

HIV prevalence (among

pregnant women) 3.2 3 2 2.9 2.55

No. of guinea worm cases seen 18 5 3 2 0

No. of AFP cases seen 17 27 30 48 29

Total number of malaria cases 797,748 964,545 950,000 900,000 773,389

Diseases targeted for

Elimination

Lymphatic filariasis treatment

coverage

Reproductive & Child Health

Safe Motherhood

Number of Family Planning

Acceptors 160,478 171,988 180,000 166,131 72,706

% of WIFA accepting FP 15.1 15.7 17 16 7.5

Number of ANC registrants 139,082 162,607 175,742 150,461 78,792

% ANC coverage 76 86 90 83 39.5

% ANC registrants given IPT2 25.9 41 41 67,158 37,592

Number of PNC registrants 92,397 97,351 102,305 89,070 37,130

% PNC coverage 50.6 51.6 55 40.4 18.6Number of Supervised Deliveries

(includes deliveries by trained

TBAs) 74,507 89,753 98,999 17,961 40,786

% of Supervised Deliveries 40.8 60 60 60 20.5

Number of deliveries by skilled

attendants 100,241 113,453 120,666 83,924 40,923

% of Deliveries by Skilled

Personnel 40.8 60 60 60 20.5

CHPS

No. of functional CHPS zones 5 8 10 36 36Child Survival

EPI coverage Penta 1 (%) 77 81 85 84 44.4

EPI coverage Penta 3 (%) 72 77 80 83.6 41.6

EPI coverage OPV3 (%) 72 77 80 83.7 41.6

EPI coverage Measles (%) 78 79 82 87.1 43.5

Total number of Under five

malaria cases – Admissions 10,914 13,348 14,000 21,160 16,194

Number of maternal deaths

audited 151 193 180 162 56

Total number of maternal deaths 179 222 200 177 67

% maternal death audits 84.4 86.9 90 91.5 83.6

Total number of Under five

deaths due to malaria 139 121 100 146 35

Under five malaria case fatality

rate 0.05 0.06 0.06 0.04 0.05

% Tracer Drugs available out of

the tracer drug list at the

Regional Medical Store 97 98 100 98

Total Number of TB Cases Cured 965 COHORT 361 504

AFP Non-Polio AFP rate

(/100,000 population under 15 0.79 1.2 2 2.05 0.7



years

Revenue Mobilization

IGF (bn¢) 11,407,149 21,177,134 24,353,704 12,890,204.98

Cash & Carry 4,636,084 5,331,497 3,288,926 1,760,368.11

NHIS 16,250,601 19,022,207 12,212,000 11,129,836.87

GOG Subsidy ((bn¢)) 162,446 620,497 713,572 183,487 220,990.61

Health Fund ((bn¢)) 105,446 0 0 144,925.92MOH Programmes (Earmark

Funds) (bn¢) 1,941,027 1,701,703 1,936,958 1,184,749 1,423,131.50

District Assembly Common

Fund(bn¢) 0 0 10,000 41,500 0

Other Sources e.g. Financial

Credits, HIPC (bn¢) 0 0 15,000 115,869 0

Expenditure by Item

Item 1: Personal Emoluments

(bn ¢) 0 0 0 4,052,101 0

Item 2: Administration Expenses

(bn ¢) 0 0 15,000 178,790 106,256,.94Item 3: Service Expenses (bn ¢) 0 0 15,000 295,468 70,314.80

Item 4: Investment Expenses

(bn ¢) 0 32,344 37,196 0

Number of doctors 98 102 115 143 129

Population to doctor ratio 46,589/1 46,286/1 42,450/1 31,157/1 39153/1

Number of nurses 1,529 1,711 1,911 1,305 700

Population to nurse ratio 3,349/1 3,523/1 3,315/1 3,414/1 7215/1

Documents

Ashanti Region Report Half Year 2010