GRAND CAPE MOUNT COUNTY

HEALTH PLAN2011/2021

Draft Plan as of May 2011

MINISTRY OF HEALTH & SOCIAL WELFAREREPUBLIC OF LIBERIA

Executive Summary - Grand Cape Mount County Health Plan (2011-2021)

Grand Cape Mount has a population of 133,000 inhabitants. Its 32 health facilities include one hospital, two health centers and 29 clinics. 66% of the population lives within 5km (one hour walk) of a health facility, yet only 21% of deliveries occur with skilled assistance in health facilities. OPV3/Penta3 vaccination coverage for children under one year is very good at 84%. The county ten year health plan will improve access to the EPHS by adding seven Service Delivery Points (see map). The plan will also reinforce systemic components to support services. Specific objectives, baselines (2010) and targets (2021) will include the following1:

Increase the population living within 5 km of a health facility from 66% to 90%; Increase facility-based deliveries with a skilled birth attendant from 21% to 80%; Increase pregnant women provided with 2nd dose of IPT for malaria from 41% to 80%; Increase children under 1 year who received OPV3/Penta3 from 84% to 95%; Increase public facilities with a two star accreditation from 0% to 90%; Increase timely, accurate and complete HIS reporting from 78% to 90%; and Increase facilities with no stock-out of tracer drugs to 95%.

1 Baselines and targets will be refined and adjusted as more reliable data become available.

Our Vision: A population with improved, equitable access to quality and sustainable health and social

welfare services in Grand Cape Mount County.

Our Mission: The mission of the GCCHT is to strategically reform its health system for the provision of equitable access to quality and

sustainable health and social welfare services

Grand Cape Mount County Plan 2011

1. Introduction and Context

1.1 County population, geography and administrative structure

Grand Cape Mount County is one of the leading counties in Liberia. Established in 1924, the county is situated in the southwestern most corner of Liberia. It is bounded on the East by Bomi County, on the West by the Republic of Sierra Leone, on the North and Northeast by Gbarpolu County and on the South by the Atlantic Ocean. Cape Mount County has five major ethnic groups, namely: – Vai, Mende, Gola, Kpelleh and Mandingo.

The county is sub-divided into five functional health districts: 1. Gola Konneh, 2) Garwula, 3) Porkpa, 4) Tewor ; and 5) Commonwealth. The estimated population of Cape Mount County is 127,076, with a 2.1 percent population growth, according to the 2008 National Housing and Population Census. Robertsport city, the capital of Cape Mount County, houses the administrative seat of the county within the county administrative building and City Corporation.

The major economic activities in Grand Cape Mount are fishing, mining and subsistence farming. Capemount county has a very promising investment with great market potential that has the prospect of sustaining itself even when that ‘Free Health Care’ provision come to a close. Grand Capemount county is endowed with some of the world’s most needed natural resources. These resources when used for the good of the citizenry, will record one the fastest economic emancipation ever in the history of Liberia’s GDP.

Grand Cape Mount County’s population density is 65 persons per square mile in the county. Grand Capemount county is fortunately one of the very few counties that is blessed with more than 75% accessible –road to service delivery points. This implies that when the county reaches its economic zenith, there would obviously exist an absolute access to service delivery points and better and improved service for all.

Approx. Population by District and SexDistrict Male Female Total

Commonwealth 3,418 3,466 6,884Garwula 14,911 14,460 29,371Gola Konneh 13,280 10,650 23,930Porkpa 21,270 19,651 40,921Tewor 14,043 13,906 27,949

Demography Health Indicator

Indicator PerCentEstimated

Target Population

Total pop 100% 135,251Under 1 pop 4% 5410Under 5 pop 17% 22,993WCBA 23% 31,108Pregnant women 5% 6,763Non-Pregnant Women 18% 24,345Expected Delivery 4.5% 6,086

The Grand Capemount county health plan was done in consultation with all relevant stick-holder within the county. All line ministries and agencies, district commissioners, the office of the superintendent, key supervisors, and our health partners. References were made to the old plan as well as the national health plan with strategy look at BPHS and EPHS common indicators.

The process was closely guided by three consultants from central MOH/SW along with the CHO and the M&E OFFICER who also served as a local facilitators.

1.2 Administrative Structure of Grand Cape Mount County in organization Chart

The county Superintendent is appointed by the President of Liberia and he/she heads the administration of the county and as well represents the President in the county. He/she has oversight responsibility of the county and is assisted by a core of officials including an assistant superintendent for development, who is responsible for the coordination of development activities, including the formulation of a county development agenda, a multi-year county plan. A superintendent’s council, headed by the superintendent, serves as an advisory council in the county.

Please find below the administrative organization configuration Grand Cape Mount County;

Please see below the organigram of the Grand Cape Mount CHSWT.

2. Summary of previous plan and its implementationInfrastructure

Grand Cape Mount county recorded some successes in the area of infrastructure development from 2007 to present (2011), through joint coordinating efforts of CHT and health partners. Currently the county still maintains 32- functional health facilities (1-hospital; 2-health centers; & 29-clinics) in the five health districts (Commonwealth, Garwula, Tewor, Porkpa, & Gola-konneh).

Achievements / Strengths:

Water supplies: During 2009 August and up to present (April 2011), the CHT in collaboration with its health partners installed or renovated water supply sources (hand pumps) at 8-facilities (2-health centers & 6-clinics).

Facility Renovations: From 2007 to present CHT & partners successfully did some renovations at all 32-HFs. Below table describes renovations & construction activities:

Types of health facilities

Minor Renovation

MajorRenovation

New construction

Hospital 0 1 0Health Centers 0 2 0Clinics 26 4 2Drug depot o 1 0

Light system: Currently all of the health facilities now have light system (electricity & solar supplies). These efforts were jointly achieved by the CHT & its health partners. Table below describes light system sources per facilities.

Types of health facilities

Electricity (generator)

SolarPower

Both Electricity & Solar

Hospital 0 0 1Health Centers 0 0 2Clinics 10 0 19

Supply of medical & non-medical equipment to health facilities: From 2007 to present, tremendous efforts from CHT & partners have been made to ensure that all 32-functional facilities received some equipment for provision of quality service delivery.

Wastes Management: The CHT & partners have worked hard over the years (2007 – present) to put in place standard wastes disposure sites in majority of the health facilities in the county. Up to present about 80% of the facilities have incinerators and pits for proper wastes management.

Weakness / Gaps:

During the years (2007-2011), CHT and its partners have worked to curtail some of the problems, but the below still remains major challenge to the health service delivery system in Cape Mount;

Roads inaccessibility remains a major problem to some the health facilities during the rainy season, especially the county only hospital.

For physical structure, few of the health facilities remain in fair conditions, very limited capacity, and lack of extension. Moreover, most of the facilities water supplies (hand pump) during the dry season run into problems – that is water runs dry or become unsafe for drinking.

A few of the health facilities (about 20%) currently do not have wastes management sites.

Planned and Achieved Component of the Strategy Plan and Policy.

Obtained copy of the HR policy and plan. Recruited and assigned outstanding staff in all BPHS facilities. 40 new GCHVs recruited and trained. 100% of staffs are supervised at least every three month to continue delivery of

quality service. 100% of existing CHWS received in-service training to implement multi-purpose

BPHS programs

BASIC PACKAGE OF HEALTH SERVICESService delivery Area Status Comments

Communication Education for BPHs- Printing of health promotional materials

Not achieved MOH/SW was also printing the same health promotion materials and sending same in counties, so Grand Cape Mount County Health Team did not want to duplicate.

Distribution of health promotion materials Achieved Received health promotional materials from MOH/SW and distributed to clinics.

Town meetings with communities, health workers and CHWs around 16 health facilities AchievedRadio talk show AchievedPlan with OICs on the implementation of BPHSOICs to develop detailed plan to implement BPHS in their facilities in conjunction with CHT

Achieved

Coordinate with MOH/SW on the implementation of BPHSCHT develops quarterly report on BPHS implementation

Achieved

To increase access to BPHS-Maternal & Newborn CareInstitute routine de-worming at all ANC clinics Achieved

Procure drugs and medical supplies for ANC clinics.

Achieved

Service delivery Area Status CommentsDistribute ITNs to all pregnant women and children under-five

Partially achieved

All pregnant & children under five did not received but some benefited from net distribution through the clinics.

Labor and Delivery CareTraining of midwives in BLSS AchievedConduct in-service training for 65 TTMs and TBAs

Achieved

Train all midwives, 2 doctors and 5 counselors in PMTCT services

Achieved There is only one doctor in county instead.

Increase collaboration with CHT to support the BPHS

Achieved

Maternal and New born Care- EmergencyMaintain all services under EOC. AchievedIncrease access to BHPS: Child Health-EPIConduct training for all health workers providing EPI services and maintain EPI services with 90% administrative coverage

Achieved

Install vaccine storage facilities at Kongo and Zaway.

Achieved Solar fridge installed at Kongo Clinic while Zaway is outstanding. Negotiation with MOH/SW to get one to Zaway.

Increase access to BPHS- Child Health- IMCIProvide training to clinical IMCI to all screeners at the various health facilities.

Achieved

To increase access to BPHS: Child Health- Infant & Young Child feedingConduct growth monitoring activities in BPHS facilities

Not achieved

Increase access to BPHS: RH- Family PlanningMaintain services for family planning AchievedProcure IUDs and Norplants at health centers and hospitals

Not achieved Just completed the training for IUD insertion and removal just a week ago. So procurement is ongoing

Conduct training for 2 doctors and 10 midwives on IUD insertion and removal

Achieved 15 midwives trained in IUD insertion and removal with training for 10 doctors pending

Increase Access to BPHS- HIV TestingIncrease testing centers to five AchievedMaintain HIV services AchievedEquip existing and additional testing centers AchievedRecruit additional counselors for testing centers. AchievedTo Expand DOTs for TB patientsMaintain services at three existing sites for TB AchievedTraining of Lab. & CHWs Technicians in TB diagnosis and prevention

Achieved

Increase diagnostic and treatment centers to 5 AchievedProcure TB drugs AchievedTo increase access to BPHS-Disease Control-MalariaMaintain services for Malaria control at all health facilities

Achieved

To increase access to BPHS- Disease Control and SurveillanceConduct IDSI training for 100 screeners in Malaria case management

Achieved

Conduct in-service training in Malaria case Management

Achieved

To increase access to BPHS-Mental HealthEstablish a mental health program in all BPHS facilities

Not achieved

Review MOH/SW Mental Health Assessment Achieved

Service delivery Area Status CommentsTo improve essential emergency treatmentProcure drugs and medical equipment for hospital and health centers

Achieved

Develop county EPR Plan AchievedEstablish and train EPR Team Not achieved MOH/SW EPR Division not available at

the timeSecure contingency stocking at county level. Achieved

The Grand cape Mount county Health And Social Welfare Team as part of its 2008-2010 human resource plan, targeted to recruit a list of professional and support staff to enhance its human resource gap.

There has been challenges in respect recruiting professionals as, nurse-midwife, OR tech, CMs, and Physiotherapist. The County Health and Social Welfare has however made some gains in respect to its targets. Below is a list of achieved activities as enshrined in the strategy plan the Grand Cape Mount county health and social welfare policy and plan.

Human ResourcesCategory Health

Workers Targets Achievements Gaps Comment

Medical Doctors 2 2 0Pharmacist 2 1 1P.A.s 12 15 0 Not all of these PAs are facility base

some are supervisorsNurses 24 39 0 Target achievedCMs 38 29 9Lab. Tech 5 2 3LPN 5 5 0Social worker 1 1 0Nurse Anesthetist 2 1 1Community health Volunteers 132 134 0

More than 100% achieved owing to partners support

Nurse Midwife 2 0 2 No one with this specific disciplineX-RAY TECH 1 O 1 No X-RAY machinePhysiotherapist 1 0 1OR tech 6 1 5

County PartnersPublic Sector (line ministries) Private Sector: Local NGOMOFMPEAMOAMOEMPWMOLMIAMOJMOGMOLM

MTI—capacity building of CHT and delivery of BPHSRBHS—capacity building of CHTPSI—Social marketingFBOsLNCRS (public & private agency)

SLPP—community servicesADEN—community servicesNWDA

# Indicator Base-line

County Target

Annual Target Definition Source of

Data

Maternal & Newborn

1

[# and] % of deliveries that are facility-based with a skilled birth attendant  19%

Target for

10yrs. = 54%

80% Numerator: Total deliveries by in facility by skilled personnel, Denominator: expected deliveries HMIS

2

[# and] % of pregnant women provided with 2nd dose of IPT for malaria 49%

Target 80%

Nat. Target

80%

Numerator: Total pregnant women provided with 2nd IPT, denominator: expected pregnancies; (also report with ANC1 as denominator, but not PBC) HMIS

Child Health

3

[# and] % of children under 1 year who received DPT3/pentavalent-3 vaccination

 84% 90% 90%

Numerator: total children under 1 year who received DPT3/pentavalent-3 vaccination; Denominator:population of children under one HMIS

4

Number and percentage of children under 5 receiving artemisinin-based combination treatment (ACT) for malaria

 124% 90% >80%

Numerator: total children under 5 receiving ACT ; Denominator: malaria cases in U5 (clinical, RDT & microscopy) HMIS

F.Planning 5

Couple year of contraceptive protection provided by facilities and CHVs (disaggregated by method)

 40% 60% 50% HMIS and distribution outlets

Communicable Disease

6

# and % of people who received HIV counseling and testing and received their test results (HCT and PMTCT)

Ref. NACP

HMIS7 Ref. NTLCP

Community

8

Average number of CHDC meetings held per facility in the last quarter

Same as MOHS

W target

At least 1 per

facility/quarter

CHDC records

9

Average number of CHC meetings held per facility in the last quarter

Same as MoHS

W target

At least 1 per

facility/month

CHC records

10

[# and] % of gCHVs who received at least 1 supervision visit in last quarter

80%

gCHV records and EHT supervisory report

SupportSystems

11

[# and] % of facilities reaching two-stars level in accreditation survey including clinical standard (once a year?)

90% >90%

Numerator: number of facilities reaching one-star level in accreditation survey; Denominator: total number of facilities surveyed

Accreditation report

12 [# and] % of facilities TBD 95% 95% Numerator: number of Supervision

# Indicator Base-line

County Target

Annual Target Definition Source of

Datawith no stock-out of tracer drugs during the quarter (amoxicillin, cotrimoxazole, paracetamol, ORS, iron folate, ACT)

facilities with no stockout of tracer drugs; Denominator: Total facilities supervised report

13

[# and] % of timely, accurate and complete HIS reports submitted to the MOH during the quarter

TBD 95% >90%

Numerator: number of timely, accurate and complete HIS reports submitted; Denominator: Total HIS reports submitted for the quarter

Central HMIS Reporting Checklist

14

[# and] % of facilities that received at least 1joint supportive supervision visit in last quarter

90% 80%Numerator: number of facilities jointly supervised; Denominator: total functional facilities

Supervision report

15

[# and] % of facilities that received at least 3 supportive clinical supervision visits in last quarter (this is CHT responsibility)

90% 80% Numerator: number of facilities supervised; Denominator: total functional facilities

Supervision report

16

[# and] % of CHT/NGO submitting timely and complete quarterly report to MOHSW (this is CHT and NGO responsibility)

N/A 100% Report reaching MOH on or before reporting deadline (30th of month following end of quarter)

External Aid Reporting Checklist