Regional Health Directorate Brong Ahafo Performance Review Report 2005

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					Regional Health Directorate
       Brong Ahafo
Performance Review Report
           2005




                 ALHAJ DR. MOHAMMED BIN IBRAHIM
           REGIONAL DIRECTOR OF HEALTH SERVICES
                            BRONG AHAFO REGION
TABLE OF CONTENTS

Background Information about the Region               5

Position, Size and Structure                          5
Population                                            6
Population per District                               7
Key Issues and Priorities                             8
Challenges for 2005                                   9

Public Health Activities and Achievements             10

Expanded Programme on Immunization                    10
Polio NID Coverage                                    14
Integrated Disease Surveillance and Response          15
Report Submission                                     16
AFP Surveillance                                      16
Measles Surveillance                                  18
Meningitis Surveillance                               18
Cholera Surviellance                                  19
Yellow Fever Surveillance                             19
Community Based Surveillance                          20
Buruli Ulcer Control                                  22

Tuberculosis Control                                  25
Guniea Worm Eradication Programme                     29
Surveillance                                          31

Lymphatic Filariasis and Onchocerciasis Control       32
Onchocerciasis Control                                33

Malaria Control                                       35

HIV/AIDS Control                                      37
Community Based Health Planning and Services (CHPS)   42
Health Promotion                                      45
Nutrition                                             48
Iodated Salt Programme                                48
Anaemia Programme                                     48


                                                           2
Community Based Anaemia Education                      50
Maternal Post Partum Vitamin A Supplementation         52
Adolescent and Reproductive Health Services            52
Maternal Health                                        53

Child Health                                           53

School Health Services                                 54
Adolescent Health and Development                      56

Adolescent Friendly Corners                            57

Service Availability for Adolescents                   57
Baby Friendly Initiative                               58
Integrated Management of Childhood Illnesses (IMCI)    59
Community IMCI Activities                              59
Clinical IMCI                                          59
Safe Motherhood Programme                              59
Ante-Natal Care                                        60

Supervised Delivery                                    61
Maternal Mortality Ratio – MMR                         62
Maternal Death Audits                                  64
Post Natal Services                                    64
Family Planning Programme                              65
Clinical/Institutional Care                            70
Outpatient Attendance                                  70
Per Capita OPD Attendance                              71
Admissions                                             71
Bedstate Statistics                                    73
Disease Profile                                        74
Comments on Specialist Outreach Service                81
Urology                                                81
Quality Assurance                                      81
Inservice Training                                     83
Classification of In-Service Training Course (Types)   86
Finance Department                                     88




                                                            3
Inflow of Funds                                                   89
Disbursements                                                     95
Donor Pooled Funds (DFP)                                          95
Exemptions                                                        98

Health Administration and Support Service (HASS)                  100

General Administration                                            100

Estate Management                                                 101
State Of Infrastructure against Building Plan                     101

Transport Position in the Region                                  102
Proportion of Serviceable and Unserviceable Vehicles/Motorbikes   102
Driver Situation                                                  103
Auction                                                           104
Equipment Situation                                               104
Planned Preventive Maintenance (PPM)                              104
New Equipment Input                                               104
JICA Equipment Survey                                             104

Human Resource Development                                        106

Current Human Resource Position                                   106
Human Resource Development Strategies                             107
Health Training Institutions                                      109
Rural Health Training School, Kintampo                            109
Nurses Training College – Sunyani                                 115
Berekum Nursing and Midwifery Training College                    116
Community Health Nurses Training School, Tanoso                   118
National Health Insurance Scheme                                  119
The Policy Thrust For 2006                                        120
Annex                                                             121




                                                                        4
Background information about the region
POSITION, SIZE AND STRUCTURE:



             Regional Map showing districts

                                                                     Volta Lake




The Brong Ahafo Region is one of the ten regions of Ghana. It lies within longitude 0° 15'E to 3°
W and latitude 8° 45"N to 7° 30'S. The Region shares common boundaries with five others -
Northern Region to the North, Ashanti and Western Regions to the South, the Volta Region to
the East and the Eastern Region to the South East. It has an international boundary to the West
which it shares with La Côte d'Ivoire.
It is the second largest Region in Ghana and has an area of 39,557 sq. km. The region is divided
into 19 administrative districts.
The relief is as follows: the southern and eastern parts have rather low elevations not exceeding
152.4m (500ft) above sea level. The land then gradually rises towards the north around
Techiman, where it attains a height of 533.7m (1751ft) in the Buoyem hill. Other higher
elevations occur at Bosumkese 712.6m (2338ft) and Bonsam 643.1m (2110ft). Sunyani has an
average elevation of about 384.8m (1000ft). Along the Côte d'Ivoire border the land rises at


                                                                                               5
certain places, for instance, Asuakwaw 483.7m (1587ft) Sampa 457.5m (1501ft) and Banda
592.2m (1943ft).
Two main drainage systems could be distinguished in the Region. The Black Volta dominates
the Northern parts of the Region, while to the south, rivers like the Tain, Bia Pru and Tano form
the main drainage basins

b         CLIMATE:
i.        Temperature: - Temperature in the region is generally high averaging over 23.9° (75°F)
          throughout the year.
ii.       Humidity:- Relative humidity in the Region is also quite high averaging over 75%
          throughout the year, as expected humidity is high in the wet months and low in the dry
          months.
iii.      Rainfall:- Stretching across the centre of the country the region enjoys a moderate to
          heavy amount of rainfall. In the South the average annual rainfall is well over 1651 mm
          (65f). To the North of Berekum along the Western border of the Region, the average
          annual rainfall is about 1143-1270 mm (45-50 inches). Rainfall in the northern parts of
          the Region is lower than these values.

c         VEGETATION:
The predominant vegetation zones are the moist semi-deciduous forest to the South and South
West and the Guinea Savannah Wood in the eastern half of the northern third of the region.
Reserved forests are virtually confined within the moist semi-deciduous forest zone, especially to
the South West of Sunyani.


d         POPULATION:
       Population 2005 (calculated from Census data): 2,053,988 Proportion in Rural/Urban area:
       62.6% / 37.4% as per census data 2000
       Census calculated annual growth rate: 2.5%




                                                                                                6
Population per district

          DISTRICT        DISTRICT POPULATION
Asunafo North                               113,446
Asunafo South                                83,448
Asutifi                                      95,587
Atebubu Amantin                              93,508
Pru                                          91,285
Berekum                                     105,487
Dormaa                                      170,050
Jaman North                                  79,514
Jaman South                                  88,325
Kintampo North                               94,183
Kintampo South                               71,874
Nkoranza                                    145,906
Sene                                         92,963
Sunyani                                     202,709
Tano North                                   70,298
Tano South                                   69,322
Techiman                                    197,544
Wenchi                                       94,799
Tain                                         93,740
TOTAL                                     2,053,988




                                                      7
INDRODUCTION


This report covers the performance of the Regional Health Services as part of the
overall health delivery services in the Region for the year 2005. It serves as a source of
data for district managers and other stakeholders in the reformulation of strategies
where necessary.
It is also hoped that this report will make available relevant data and information to the
Regional Health Administration for health planning purposes.


Key Issues and Priorities
   The 2005 Programme of Work of the Brong Ahafo Regional Health Directorate is based on
   the following:
          Ghana Health Service Policies and Priorities for 2005
          GHS Proposed Schedule of Meetings, issued by PPMED, GHS
          The 2004 Regional Annual Performance Review of BMCs.
          The outcome of a Regional Strategic Operational Dialogue Workshop.
   The Ghana Health Service Policies and Priorities and the GHS proposed schedule of
   meetings have been attached for study and referenceThree broad areas of performance in
   2004 were reviewed to provide a basis for the 2005 Programme of health.
   The 4 events that could not be done are rolled over to 2005, to be redesigned since it has been
   realized that their achievement is mostly dependent on external factors beyond our control.
   Recommendations and lessons learnt from the 2004 Annual Performance review shall be
   factored into the implementation of activities in this POW.
   Some of the lessons learnt in 2004 include the following.
          Audit hearings organized for BMCs by the Regional Finance & Audit Committee
          facilitated the understanding and appreciation of the need for quick and appropriate
          Audit responses
              Focus demands a lot of sacrifice. It took many people working very hard to
              accomplish some of the targeted events. The establishment of the Nurses Training
              College and the Municipal Hospital in Sunyani in 2004, demanded a lot of efforts.
              The reshuffle of District Directors needs careful management especially in respect
              of the timing, which had to be postponed from January to September 2004.
               Indications are that the reshuffle had proven acceptable and increased efficiency.



                                                                                                 8
              The Regional and District Health Committees if well nurtured could be extremely
              useful for social mobilization, advocacy, land acquisition for health institutions
              and conflict resolution.


CHALLENGES FOR 2005
   The key challenges for us in 2005 are:
          Implementing the unfinished business of 2004
          Strengthening the Internal Audit Unit
          Strengthening Leadership and Management at all levels
          Strengthening Financial Management
          Strengthening the Procurement Procedures in all BMCs.
          Improving Supervision and monitoring.
          Implementing the NHIS
          Scaling up of CHPS
          Strengthening collaboration with District Assemblies
          Implementation of service deliverables with accountability to achieve set targets.
          Establishing the 6 newly created districts.
          Strengthening service delivery in the island communities of Sene and Pru districts.
          Connecting the two new Health Training Institutions (CHNTS, Tanoso & NTC,
          Sunyani) and the two old Institutions (RHTS, Kintampo & NMTC, Berekum)
          Creating a SHARED VISION for the Health Sector in Brong Ahafo Region. The
          Vison is that:

“By the year 2015, no mother dies from child birth in Brong Ahafo Region”

Details are contained in the Regional 2005 Programme of Work




                                                                                                   9
PUBLIC HEALTH ACTIVITIES AND ACHIEVEMENTS
1. Expanded Programme on Immunization
Expanded programme on immunization remains one of the regional priorities for the
year. This was in line with the national policy of reaching every child.
1.1. Target:
•      To achieve coverage of 90% and above for all antigens
•      80% of districts in the region to achieve coverage of 90% and above for each
antigen.
•      To achieve drop out rate of below 10%


1.2 Key activities.
•      Routine EPI services at static and out reach points.
•      The creation of new out reaches clinics.
•      Regular supply of logistics to districts e.g. vaccines, needles and syringes etc.
•      Collection, compilation, analysis and interpretation of EPI data by graphs, tables,
charts by months and districts
•      Submission of monthly returns to national with feedback to districts.
•      Quarterly review meetings.
•      Organization of EPI mop-up immunizations.
•      Technical support visits to all nineteen districts.
•      Surveillance on the EPI target diseases
•      Four rounds of Polio NIDs
•      Training
•      Vaccine wastage monitoring




                                                                                           10
1.3 Achievements
FIG 1: TREND OF EPI COVERAGE 2003-2005

                                    TREND OF EPI COVERAGE IN BRONG AHAFO 2003-2005


              120



              100



               80
 % COVERAGE




                                                                                                   2003
               60                                                                                  2004
                                                                                                   2005


               40



               20



                0
                     BCG            MEASLES        PENTA3              OPV3        YF     TT2+
              2003   96.9              87.7         81.8               80.4     74.5          99
              2004   97.6              86.7         82.5               82.5     81.6          70
              2005   106.6             91.6         94.6               94.5     96.3      81.5
                                                            ANTIGENS




1.4 .1 Coverage by antigen compared with target

                             2004                              Target 2005              Coverage 2005
                             No.                               No.                      No.
Antigen                      Vaccinated %                      Vaccinated %             Vaccinated %

BCG                          78,202           98               76,148         95        87,610       106.6

MEASLES                      69,495           87               72,140         90        75,241       91.6

PENTA3                       66,165           83               72,140         90        77,687       94.6

OPV3                         66,103           82               72,140         90        77,603       94.5
YELLOW
FEVER                        65,386           82               72,140         90        79,109       96.3

TT2+                         56,077           70               72,140         90        66,985       81.5
The coverage of all antigens saw an improvement over 2004. This has been as a result
of use of the data for action. The regular feedback on the monthly EPI performance
served as a motivation to work hard. Low performing sub-districts were identified early



                                                                                                             11
for mop- up activities. Where there are big markets, they were identified for vaccination
services.
With the exception of TT2+, targets for all the antigens were met. Data quality issues
could account for the low coverage of TT2+ especially in Wenchi district.            Wenchi
district had the lowest coverage of TT2+ of 31%.
The region could however not achieve the target of 80 % of all districts achieving
coverage of 90% and above for each antigen.
Fig 1. below is the coverage of measles by district. Six out of the nineteen districts could
not meet the 90% target.
The low coverage of measles compared with yellow fever was as a result of a shortage
of measles vaccine in the year.
Fig. 1.




The overall drop out rate for Penta1 and Penta3 was 4.7%. The dropout rate as shown
in the figure 2 below is highest in the Pru districts. This was as a result of interruption of
services to the islands. The Pru district currently does not have a boat. This has made it
difficult to undertake vaccination regularly on the islands. Asutifi, Berekum, Jaman
North, Kintampo South had negative drop out rate. The reason could be poor data
quality. This problem needs to be addressed. With the increasing EPI coverage
attention should be focused on quality issues in the programme.
Of great concern is the weak surveillance on adverse events following immunization.
This area will be given priority in 2006.




                                                                                           12
Fig 2. Map of drop out rate by district in 2005




                                                  13
The detailed coverage by district is as found in the table 2 below:
 REGIONAL HEALTH DIRECTORATE - BRONG AHAFO
 EPI COVERAGE BY MONTH BY DISTRICT, 2005
  MONTH :JANUARY - DECEMBER           YEAR : 2005
                                          BCG               MEASLES          DPT-Hep B -Hib


                                                                                                2nd
                              TARGET                                         1st dose           dose      3rd dose
                              POP.(0-     No.               No.              No.                No.
 DISTRICTS        POP.        11mnths)    immz      Cov.    immz.    Cov     immz       Cov     immz      Cov
 ASUNAFO NORTH    113,446     4,538       5,051     111.3   4,013    88.4    4,752      104.7   4,595     101.3
 ASUNAFO SOUTH    83,448      3,338       3,386     101.4   3,132    93.8    3,594      107.7   3,100     92.9
 ASUTIFI          95,587      3,823       3,949     103.3   3,110    81.3    3,350      87.6    3,337     87.3
 ATEBUBU          93,508      3,740       4,600     123.0   4,180    111.8   4,544      121.5   4,214     112.7
 BEREKUM          105,487     4,219       5,396     127.9   4,333    102.7   4,028      95.5    3,713     88.0
 DORMAA           170,050     6,802       8,398     123.5   7,255    106.7   7,740      113.8   7,613     111.9
 JAMAN NORTH      79,514      3,181       3,114     97.9    2,688    84.5    2,709      85.2    2,764     86.9
 JAMAN SOUTH      88,325      3,533       3,618     102.4   3,271    92.6    3,125      88.5    3,179     90.0
 KINTAMPO
 NORTH            94,183      3,767       3,712     98.5    3,002    79.7    3,490      92.6    3,148     83.6
 KINTAMPO
 SOUTH            71,874      2,875       2,850     99.1    2,877    100.1   2,828      98.4    2,943     102.4
 NKORANZA         145,906     5,836       5,824     99.8    5,427    93.0    5,724      98.1    5,542     95.0
 PRU              91,285      3,651       3,629     99.4    2,593    71.0    3,597      98.5    3,067     84.0
 SENE             92,963      3,719       3,790     101.9   3,176    85.4    4,028      108.3   3,820     102.7
 SUNYANI          202,709     8,108       8,549     105.4   7,589    93.6    8,122      100.2   7,829     96.6
 TAIN             93,740      3,750       3,125     83.3    3,224    86.0    3,552      94.7    3,243     86.5
 TANO NORTH       70,298      2,812       2,676     95.2    2,380    84.6    2,603      92.6    2,469     87.8
 TANO SOUTH       69,322      2,773       2,866     103.4   2,555    92.1    2,744      99.0    2,533     91.3
 TECHIMAN         197,544     7,902       9,588     121.3   7,176    90.8    7,726      97.8    7,419     93.9
 WENCHI           94,799      3,792       3,489     92.0    3,260    86.0    3,248      85.7    3,184     84.0
 TOTAL            2,053,988   82,160      87,610    106.6   75,241   91.6    81,504     99.2    77,712    94.6



1.4.2 POLIO NID COVERAGE
There were four rounds of Polio NID. Coverage for all the rounds was above 100%. The
success was as a result of the political commitment for the programme in the Region,
hard work of the volunteers and supervisors and effective social mobilisation. The
support from the various NGOs was also a contributory factor.




                                                                                                         14
MONTH FOR NID                Target    Coverage          % Coverage
February                     518,119   537,032           103.7
April                        518,119   537,032           103.7
November                     518,119   537,622           103.8
December                     518,119   556,882           107.5


1.5. Constraints/Challenges
•       Inadequate and weak motorbikes at the sub districts
•       Inadequate 4 WD vehicles
•       Inadequate staff
•       Poor state of the boat in Pru district.
•       Difficult terrain.
•       Hard to reach communities.


2. INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDRS)
The strategy is to enhance early detection, reporting and timely response to epidemic
prone and other priority diseases.
2.2 ACTIVITIES
2.2.1 Technical Support Visits
Facilitative visits were made to all the nineteen (19) districts by the IDSR teams.
Health Workers were sensitized on case identification and the need for early
identification, investigation and reporting. Routine case-based reporting system was
reviewed during the visits.


2.2.2 Training/Seminars
•       Three National Surveillance Performance Review Meetings were held in Accra.
The SMO(PH), Regional Disease Control Officer, Regional Surveillance Officer and
the Regional Laboratory Technologist attended.
•       A Regional EPIINFO TOT was organized for sixteen (16) selected staff within the
region from 24th to 28th February.
•       Training in Integrated Disease Surveillance and Response was organized for 6
District Teams, selected Regional Team members and Tutors of the two Nursing




                                                                                      15
Training Schools in the region. The training was organized by the National Surveillance
Unit and sponsored by PHR Plus.
•      Training in IDSR was organized for Berekum District by School of Public Health
of the university of Ghana
•      All District Disease Control Officers in the region were orientated on active
surveillance in June at Kumasi by the National Surveillance Unit and W.H.O.
•      Weekly Surveillance Data Reviews were carried out but not for all the weeks due
to positive interruptions.
•      District and Regional Teams met in December to review the year’s activities.


2.2.3 Report Submission
The average submission rate of weekly disease reports from the districts is plateauing
around 82%. The regional average of timeliness fell from 87.6% in 2003 to 82.1% and
82.3% respectively for 2004 and 2005. However, the target of 80% had been achieved
over the years as a region. Seven out of the nineteen districts could not achieve the
minimum submission rate of 80% for the year under review.


2.2.4 AFP SURVEILLANCE
Seventeen (17) cases were detected as against a target of eighteen (18) for the year.
The cases were reported from 12 out of the 19 districts of the region. The silent districts
for 2005 were Asunafo South, Atebubu, Pru, Jaman South, Kintampo South, Tano
South and Tain. All the cases were investigated within 14 days of onset of paralysis.
The region achieved a Non-Polio Rate of 1.8 instead of a minimum of 2.0. 60th day
follow-up has been conducted for all of them.




                                                                                        16
DISTRICT DISTRIBUTION OF AFP CASES - 2005




AFP SURVEILLANCE PERFORMANCE (1999 – 2005)
YEAR                  REPORTED AFP          ISOLATED POLIO NON-POLIO     AFP
                                            VIRUS                 RATE
1999                  9                     0                     1.0
2000                  19                    3*                    1.7
2001                  36                    0                     4.0
2002                  17                    0                     2.0
2003                  16                    1**                   1.3
2004                  17                    0                     1.6
2005                  16                    0                     1.8
 *All 3 polio cases of 2000 were from Tano District
**The 2003 polio case of the region came from Kintampo District




                                                                           17
2.2.5 MEASLES SURVEILLANCE
The number of reported cases of measles reduced from 167 in 2004 to 39 in 2005.
There were also only two confirmed cases compared with nine in 2004. The maps
below show the reported and confirmed cases of measles in 2004 and 2005
respectively.


                2004 reported measles                     2004 confirmed measles




                 2005 reported measles                     2005 confirmed measles




2.2.6 MENINGITIS SURVEILLANCE
A total of 79 cases with 28 deaths ( CFR of 35.5 %) were reported through the weekly
communicable reporting system from 13 out of the 19 districts.
In 2004 eleven out of the then thirteen districts reported 198 cases. The CFR for 2004
and 2003 were respectively 32.7% and 21.6 respectively. S pneumoniae has been the
principal isolate.




                                                                                   18
Find below the trend of meningitis from 2002-2005:

                            REPORTED MENINGITIS CASES (2002-2005)


    100


    90


    80


    70


     60
 # OF CASES
                                                                                      2002
                                                                                      2003
    50
                                                                                      2004
                                                                                      2005
    40


    30


    20


    10


     0
          JAN   FEB   MAR   APR   MAY    JUN    JUL   AUG    SEP    OCT   NOV   DEC




2.2.7 CHOLERA SURVIELLANCE
Six (6) cases were reported from Techiman and Asunafo Districts in October 2005. The
outbreak was a follow up of that which occurred in Kumasi. Cholera alert was issued to
all DHMTs, health facilities and media houses for the creation of public awareness.
Treatment protocol was also distributed for use by all facilities. No case of cholera was
reported in 2004. Districts were reminded to use increased number of diarrhoea cases
in age 5years and above as proxy to investigate for cholera.


2.2.8 YELLOW FEVER SURVEILLANCE
Thirty-five (35) suspected yellow fever cases were reported from 9 out the 19 districts
(47.4% of districts) for the year under review. Virological examination revealed that
none was a true case of yellow fever. In 2004 77% of districts in the region reported a
total of 22 suspected cases.
As an indicator in yellow fever surveillance each district is to investigate at least a case
of yellow fever a year.




                                                                                             19
  2.2.9 DISEASE TRENDS
  The table below compares the occurrence of some selected diseases for the period
  2002 to 2004.
DISEASE            2002      2003        2004          2005
PERTUISSIS         55        51          92            35
POLIOMYELITIS      0         1           0             0
TETANUS            38        36          28 / 2        18
                                         (CFR 7.1%)
NEONATAL           7         12          0             2/2
TETANUS                                                (CFR 100%)
VIRAL              1,975     1,311       1,593         986
HEPATITIS
YELLOW FEVER       0         0           0             0
MEASLES            1,975     181         167           34
(reported)
MENINGITIS         198       153         198           79
CSM                14        8           4             0
BURULI ULCER       238       312         307           291
YAWS(Infectious)   2,557     2,052       2,039         783




  2.2.10 COMMUNITY BASED SURVEILLANCE
  The districts' performance in CBS is gradually improving over the years. The
  performances of Berekum and Techiman districts have been commendable. The two
  districts maintained submission rate over the target of 80% for the three consecutives
  years.




                                                                                     20
                                                  CBS REPORTS SUBMISSION


         120




         100




          80

    RATE (%)
                                                                                                                     2003
          60                                                                                                         2004
                                                                                                                     2005


          40




          20




           0
                       AST   ATE   BER   DOR            NKO             PRU   SEN   SUN   TAN   TEC TAIN WEN
      ASU SOUTH
           ASU NORTH                          JAM NORTH KIN SOUTH
                                         JAM SOUTH            KIN NORTH                                   REGIONAL




2.2.11.CONTRAINTS
•         Most of the cases that are detected late are due to the improper functioning of
the Hospital Public Health Units.
•         The awareness of the general public on disease surveillance is low.
•         District teams do not provide adequate supervision to sub-districts, facilities and
communities.
2.2.12 WAYFORWARD
The unit hopes to accomplish the following in order to move the unit forward.
•         Quarterly clinician sensitization on integrated surveillance and response.
•         Use of e-mail services for data transfer from regional level to the national level.
•         Production of timely monthly feedback bulletins.
•         The unit has planned for quarterly review of surveillance activities with the
districts.
•         Weekly surveillance data review at the regional level.
•         Specimens of all AFP and suspected measles and yellow fever cases will be
collected and sent to the requisite laboratories for examination.
•         Districts are to submit weekly activity report on AFP surveillance.



                                                                                                                21
3. BURULI ULCER CONTROL


3.1 INTRODUCTION
The 1998 national case search showed that all the then Thirteen districts were endemic
as cases were detected in all the districts. After the search, cases were reported from
districts with communities within the Tano basin, thus; Asunafo (North and South),
Asutifi, Tano (North and South) and Sunyani. Jaman and Nkoranza Districts also report
cases.
The disease is an important public health problem as it has serious socio-economic
implications.


3.2. ACTIVITIES
The main activities carried out in respect of Buruli ulcer control during the period under
review include:
•        Case finding
•        Treatment of cases and prophylaxis for contacts
•        Surveillance
•        Health education




                                                                                       22
3.3 ACHIEVEMENTS
Case Detection
Over two hundred cases are detected each year since 2001. (see chart below)

                                BURULI ULCER CASES ( 2001-2005)

    350


                                                312
                                                                      307
    300                                                                        291




    250                        238

              220

 # OF CASES
    200




    150




    100




     50




      0
              2001            2002              2003              2004         2005



Out of the 291 cases of year 2005 Asutifi District reported 209 (71.8%) of the cases.
The cases were reported from 6 out of the 19 districts of the region for the year under
review. Females constituted 54.3% of cases whilst 49.1% of cases were children below
15 years of age.
The table below gives the district distribution of 2005 cases.
DISTRICT        1st       2nd           3rd            4th        TOTAL     % Total
                Quarter   Quarter Quarter Quarter
Asutifi         50        68            52             39         209
                                                                                      71.8
Asunafo         3         5             11             7          26
South
                                                                                       8.9
Tano North      3         2             1              9          15
                                                                                       5.2
Tano South      3         3             3              4          13
                                                                                       4.5
Sunyani         0         0             3              0          3
                                                                                       1.0
Nkoranza        4         2             0              19         25
                                                                                       8.6
TOTAL           63        80            70             78         291
                                                                                 100.0



                                                                                             23
Age and sex distribution of cases (2003 – 2005)
         < 15 YRS        15 – 49 YRS     > 49 YRS           TOTAL         GRAND
YEAR     M      F        M       F       M        F         M       F     TOTAL
2003     78     61       62      70      21       20        161     151   312
2004     72     95       37      67      20       16        129     178   307
2005     74     69       42      64      17       25        133     158   291


CLINICAL FORMS
Cases were detected late judging from the clinical presentations of the reported cases.
As much as 267 (91.1%) of the 2005 cases were seen at the ulcer stage. In 2005 4.4%
cases presented with disability as against 1.3% for 2004.




                                                                                    24
3.4 CONSTRAINTS
1. Low case detection: Active case search is not embarked upon by districts and sub-
districts to detect more cases.
2. Inadequate logistical support to Districts and Institutions offering services.
3. Inadequate funds for the payment of exemptions.


3.5 WAY FORWARD
•      Clinician sensitization to improve case detection and management.
•      Active case search at districts and sub-district levels.
•      Training of community based volunteers.
•      Operations research.



4. TUBERCULOSIS CONTROL

4.1 INTRODUCTION
Currently, sixteen (16) out of the nineteen (19) districts have at least a diagnostic
centre. Asunafo South, Kintampo South and Tain Districts are without diagnostic
centres and rely on nearby districts for microscopy support in diagnosing suspect cases.


4.2. PROGRAMME OBJECTIVES
The national Tuberculosis programme has set itself the following objectives.
•      A case detection rate of 70% and above.
•      A cure rate of 85% and above.
•      A defaulter rate of less than 10%
•      The estimated incidence of tuberculosis is 281 cases in a population of 100,000
for all forms; and 123 cases in 100,000 population for the smear positive cases.


4.3 REGIONAL TARGETS
The regional TB Team tasked itself to achieve the following targets by the end of the
year 2005.
•      To increase the case detection rate from 16.4% to 20%
•      To increase the cure rate from 62.8% in 2003 to 70% at the end of 2004




                                                                                     25
•      To reduce or maintain the defaulter rate of 10.1% of 2003 to less than 10% for
2004 cohort.
•      To conduct at least two quarterly quality assurance visits to all the districts and
microscopy centres.
•      To carry out at least two quarterly review meetings.


4.4 MAIN ACTIVITIES

4.4.1 MONITORING & SUPERVISION
The Regional TB Team paid support visits to all the districts. However, the Quality
Assurance Team could visit all the TB Microscopy centers once (in July 2005).


Objectives of supervision
To determine the strengths and/or weaknesses of institutions and plan intervention
strategies for improvement. However, most anomalies were addressed during
supervision/support visits.

4.4.2 IN-SERVICE TRAINING / SEMINAR

A National Annual Review meeting was held in Kumasi, Amasharo Hotel, from 24th to
26th January 2005. Regional Teams and the Headquarters participated.
The Regional and District Teams met in July to review the programme's performance in
the region.
Training in Tuberculosis case management was organized by 4 districts (Jaman North,
Sunyani, Asutifi and Nkoranza) for their staff.

4.4.3 HEALTH EDUCATION

Public education was pursued on local radio stations, both at the district and the
regional levels. The need and importance of un-interrupted treatment was emphasized.
People were also encouraged to seek early treatment when they fall ill.
A regional team attended the National celebration of the World TB Day at Elmina in the
Central Region in March.

4.4.4 PROCUREMENT

The region procured drugs and other logistics for the year from the Central Medical
Stores (CMS) Tema. Districts have since taken delivery of their allocations.


                                                                                       26
4.4 5 ANALYSIS OF CASE FINDING AND TREATMENT RESULTS

Although all the districts submitted report for all the four quarters of the year, the
submissions have been untimely, especially, form Atebubu and Dormaa districts. Find
below a table of the distribution of reported cases for the period under review.
Case detection has been considerably low over the years; ranging from an average of
15% to 20% detection rate as compared to a programme target of 70%.
The table below shows the Case Detection Rates CDR) from 2001 to 2005.
            POPPULATI        #      CASES POSITIVE CASES
 YEAR
            ON               DETECTED        #               #               CDR
                                             EXPECTED        DETECTED
 2001       1,872,273        631             2,303           435             19
 2002       1,907,131        741             2,346           468             20
 2003       1,954,997        662             2,405           449             18.7
 2004       2,003,892        664             2,465           405             16.4
 2005       2,053,967        588             2,526           390             15.4
Treatment Outcome for New Smear Positive
Selected Indicator       2000      2001    2002      2003   2004
Total            positive 457      445     449       454    412
evaluated
Cure rate (%)            52.7      53.7    63.5      62.8   60.7
Treatment       success 66         68.1    70.4      69.1   66.5
(%)
Death rate (%)           15.1      13      12.8      15.1   12.6
Failure rate (%)         3.1       4       3.3       1.8    1.9
Defaulter rate (%)       15.5      16.6    8.7       10.1   14.3
The region achieved defaulter rate of “less than 10% standard” in 1999 and 2002.




                                                                                    27
4.5. SPUTUM MICROSCOPY QUALITY ASSESSMENT
The Regional TB Microscopy Quality Assessment team paid a support visit to all the
microscopy centers in July 2005.




4.5.1 OBJECTIVES OF THE VISITS
•      To assess TB microscopy centers in terms of:
•      Manpower
•      Documentation
•      Working environment (bio-safety measures)
•      Reagents / logistics supply
•      Slides collection for blinded rechecking
•      Technical support


4.5.2 ASSEMENT FINDINGS
•      Each center had at least one personnel trained in TB microscopy and quality
control
•      Proper documentation in 60% to 70% of facilities visited
•      Working environment was satisfactory
•      80% of centers had efficient reagent supply
•      Shortage of slide boxes was observed in almost all the centers visited since the
year 2003.




4.6 CONSTRAINTS / CHALLENGES
1. Low case detection rate
2. Decreasing cure rate with increasing defaulter rate
3. Low capacity building: The new entrants into the programme have not enjoyed any
formal training on Tuberculosis control. The few trained personnel remaining also need
refresher courses to revamp their skills.
4. Defunct District and Institutional TB Control Teams: Almost all District and
Institutional TB Teams have gone into sleep and Tuberculosis control has become the
prerogative of the TB Co-ordinator.
5. High attrition of trained staff.


                                                                                    28
6. Late submission of quarterly reports
7. Poor documentation




4.6. FUTURE PLANS AND (RECOMMENDATIONS)

4.6.1 TO THE DISTRICT AND INSTITUTIONAL MANAGEMENT TEAMS

Active District and Institutional TB Teams is bedrock of successful Tuberculosis Control
Programme in the region. It is therefore advised that the District and Institutional teams
be revitalised. It will be helpful for the teams to meet monthly to review the programme,
which will then strengthen efforts towards defaulter prevention and increased cure rate.
Public awereness creation and clinician sensitization are the surest ways to improve on
our case detection rate.

4.6.2 TO THE REGIONAL HEALTH DIRECTORATE

Training and/or in-service training is eminent. The Global Fund support has to consider
the training of all categories of staff in TB control.
The Regional TB Team has to meet monthly to review programme performance and
restrategise.


5. GUNIEA WORM ERADICATION PROGRAMME
Brong Ahafo Region is among the (3) three top Guinea worm endemic regions in
Ghana.
The Region recorded a total of 287 cases as against 336 in 2004 (a modest reduction of
14.6%).
Atebubu- Amanten, Pru and Kintampo districts are among the top 3 districts in the
region, during the year under review. There was an increase of cases in the Kintampo
district whilst thee was a reduction in Atebubu, Sene and Nkoranza districts.
Case containment was 68% in 2005 compared with 88% in 2004. The containment
rates in Atebubu and Kintampo were 70% and 62% respectively.




                                                                                       29
5.1 GUINEA WORM TREND IN BRONG AHAFO REGION FROM 1996 – 2005




                                                    Cases of GW by district in BAR 2004-2005

         400



         350                                                                                                                                          336



         300                                                                                                                                            287



         250
 cases




                                                                                                                                                              2004
         200                         181                                                                                                                      2005
                                   167

         150
                                                                          117

         100                                                                   87



         50
                                                                                                        23
                                                                                        14
                                                                                                    5        7                    6
               0 2       0 0                  0 0       0 0       1 0                                            3 3       2 0           0   3 2
          0
                         Asutifi




                                                                                                         Sene
                                              Berekum



                                                         Dormaa



                                                                  Jaman




                                                                                             Nkoranza




                                                                                                                 Sunyani




                                                                                                                                             Wenchi



                                                                                                                                                       BAR
               Asunafo




                                                                           Kintampo




                                                                                                                           Tano



                                                                                                                                  Techiman
                                    Atebubu




                                                                                  district




                                                                                                                                                                     30
6.1 SURVEILLANCE


Surveillance was stepped up in the Pru district by:
•        Re-zoning of the Pru district to include the Abrumase in the East Gonja.
•        Re-training of village volunteers, Zonal coordinators and area coordinators.
•        Placing a new technical Assistant at Parembo (the current endemic sub- district
in the region) to ensure supervision at all levels.


Number of villages reporting 1+ cases in 2004-2005
Village status               Number of villages          Total number of cases
Indigenous cases             19                          221
Imported cases only          95                          66
One Case only                33                          33
Total cases 2005                                         287


6.2 WHAT AND WHERE ARE THE CHALLENGES IN BAR:
•        Changeover of staff after 2004-05 transmission seasons in Kintampo &
Atebubu-Amanten and Pru Districts resulted in poor documentation.
•        Discovery of indigenous Guinea worm cases in two villages that previously did
not report cases (Anyingbi & Mempeasem)
•        Lack of CBS volunteers in several communities, resulting in passive
surveillance during 2004-05 transmission season
•        Terrain is difficult to navigate due to poor road system, populations are hard to
reach.
•        Transient farmers, inadequate safe water sources, difficulty in identifying ponds
on farms.
•        Separation of Atebubu-Amantin and Pru Districts
•        On the ground supervision of Abrumase sub-district of East Gonja District due
to proximity to Pru
•        Getting the commitment of all District Directors in the fight to eradicate Guinea
Worm Disease




                                                                                        31
6.3 Way forward
•        To create a surveillance system that can detect and contain every case within 24
hours (in endemic & non-endemic communities), and careful documentation of all
cases.
•        Improved tracking, management, and documentation of imported cases
•        Improved communication between districts and regions (namely Ashanti and
Northern, and Upper West Regions)




7. LYMPHATIC FILARIASIS AND ONCHOCERCIASIS CONTROL
7.1 Lymphatic Filariasis
7.1.1 Introduction
Sunyani and Techiman Municipalities in Brong Ahafo Region are endemic with the
disease. Mass drug administration was thus undertaken using albendazole and
ivemectin under the CDTI. Training was organized for the Regional Health Management
Team and District Health management Teams.
7.1.2 Training
Trainings were later organized for the community distributors.
IEC component involved the following activities: FM discussions, Mobile van
announcements and gong-gong beating in some communities.
7.1 3 Drug distribution
The RHMT and the Municipal Health Management Team paid monitoring visits to the
field.
The coverages for sub municipalities within Sunyani Municipality ranged from 75.6% to
91% and that for Techiman Municipality ranged from 69% to 82.8%. The overall
coverages were 86.6% and 78.6% for Sunyani and Techiman Municipalities
respectively. The prevalence of elephantiasis in Techiman and Sunyani Municipalities
were 4 per every 10,000 (40/112676) and 3 per every 10,000 (51/162635) respectively.
Prevalence of hydrocoele for Techiman and Sunyani were 9 per 10,000 (102/112676)
and 18 per 10,000 (288/ 162635) respectively.       The prevalence was highest in the


                                                                                      32
Odumasi sub-municipality of Sunyani, 60 per 10,000 populations (137/22806).
Interestingly almost equal figures of around 1250 -1300 refused to take the drug in the
two municipalities.
Regional Monitoring revealed 96% treatment among eligible population for Tuobodom
sub-district   in Techiman. Proportion of eligible population treated was 87% for the
Sunyani Municipality which conforms well with their field coverage.
7.1 3 Constraint
The programme was constrained by inadequate sensitization and education before the
take off of the programme.


7.2 ONCHOCERCIASIS CONTROL
Brong Ahafo Region has many fast flowing rivers including the black Volta, Tain, Bia,
Pru, and Tano. The region thus provides vast areas which serve as breeding sites for
the Simulium vectors of Onchocerciasis. Currently, twelve out of the nineteen districts
are endemic of the disease. Nine of the districts occur towards the northern part of the
region and experience the savanna type of the disease. The remaining three located in
the forest zone, Tano South, Tano North and Asutifi endemic with the forest type.


7.2.1 Activities
Two main activities were undertaken
These were:
    Community Directed Treatment with Ivermectin (CDTI) and
    Epidemiological surveillance.
7.2.1.1 Community Directed Treatment with Ivemectin
It must be stated that but for the ivermectin distributed together with albendazole under
mass drug administration     for lymphatic filariasis control in Sunyani and Techiman
Municipalities, there was not any distribution against Onchocerciasis.       In fact the
National and regional headquarters together took a decision to postpone this exercise
which is normally conducted in the fourth quarter to the first quarter to synchronise it
with mass drug administration exercise




                                                                                      33
7.2.1.2 Epidemiological Surveillance
The above activity took place within the Pru Basin in Nkoranza and Atebubu Districts in
conjunction with the national headquarters from 20th to 25th September, 2005. In all, 9
communities were visited. The range of infection ranged between 0 and 25.6%.
Results
          Community Popn          No.        No.        Prevalence
                        registered snipped   Positve    (%)
1         Dumanafo      123       109        13         11.9
2         Tanfiano I    176       135        0          0
3         Tanfiano II   156       77         1          2.0
4         Yusif         62        33         0          0
          Akuraa
5         Tanfim        68        37         3          8.1
6         Nyinase       210       134        5          3.7
7         Fakwasi       439       232        1          0.4
8         Dimango       328       269        69         25.6
9         Jerusalem     196       161        34         21.1
          Total         1758      1187       126        10.6


7.2.1.3 Challenges
    Inadequate support for volunteer motivation
    Vector nuisance


7.2.1.4 Recommendation
Support needed to motivate volunteers to conduct effective CDTI




                                                                                    34
8. MALARIA CONTROL

8.1 INTRODUCTION
The threat of Malaria to the population of Brong Ahafo Region continues to be enormous. For
many years, the proportion of OPD attendance due to Malaria is always above 45% and the
pattern of the disease claiming the life of an under five years every 48 hours in the region seems
to have stabilized.

8.2 OBJECTIVES
In consonance with the overall goal of the Roll Back Malaria in the country to facilitate human
development and contribute to the reduction of poverty by reducing malaria disease burden by
50% by 2010, the following objectives were given consideration during the year:
•Conduct survey to assess the coverage and utilisation of treated bednets in the region
•60% of households in the region will have at least one ITN by the end of 2005
•60% of pregnant women will sleep in ITNs by the end of 2005
•60% of children under five years will sleep under ITNs by the end of 2005
•All districts should have implemented IPT by the end of 2005
•50% of pregnant women will be on IPT by the end of 2005
•80% of caretakers and parents in rural areas and 90% in urban areas will be able to recognize
early symptoms and signs of malaria
•80% of caretakers and parents in rural areas and 80% in urban areas will respond appropriately
to cases of malaria they identify.



8.3 Activities
8.3.1 IPT
•       Regional TOT conducted for all 19 districts
•      All nineteen districts have conducted refresher training in IPT
•      All nineteen districts have started implementation of IPT to pregnant women
•       13 districts conducted refresher training in IPT
•      The region procured Sulfadoxine Pyrimethamine (SP) in the quantities 84,150 and 66,000
in February and July respectively. Further two supplies in quantities 8,550 and 12,150 were



                                                                                               35
made to Techiman Municipal Health Directorate.

8.3.2 ITN
•         Distribution from headquarters as source:      11,000 nets received and distributed to
districts Further 14,000 nets received and distributed
•         ITN retreatment training conducted in Techiman for Community Based Volunteers
•         Eleven retreatment sites established in Techiman Municipality
8.3. 4 Voucher Scheme for ITN distribution
•         Five training sessions organised for the implementation of ITN voucher scheme,
courtesy, USAID/ NetMark
•         USAID supported air programmes and private IEC team on the scheme
•         Commercial partners Transcol West Africa Ltd, Netco Rockville, Agrimat, Reiss & Co
together distributed 34,991 nets.


8.3.5 Global Fund Malaria Scaling up

•         Regional Biologist and two District Directors attended orientation meeting on GF
concepts in Accra.

•         As a follow up to the above, orientation meeting on Global Fund concepts was organised
for 90 participants including RHMT members, DHMT members and NGOs in Sunyani


8.3.6 New anti-malaria Drug and malaria case management Policy Guidelines
•         TOT for DHMTs and hospital staff conducted (in 2 batches)
•         Eighteen of the nineteen districts have already been trained. Tano North District,
originally part of the Global Fund pilot districts is yet to train on the Artesunate- Amodiaquine
drug policy.
•         Artesunate –Amodiaquine received in two consignments in the region. The first
consignment consisted of 11,062 and 9,770 tablets in pediatric and adult doses respectively.
These are all used. The second consignment consisted of 300,000 and 4,800,000 tablets in
pediatric and adult doses respectively. The balance at the Regional Medical Stores reads zero for
the pediatric dose and 2,930,544 for adult dose.
•         There has not been any documented adverse effect due to the drug in the region
so far.




                                                                                              36
8.3.7 Home Based Care
Forty four chemical sellers and five hundred and four Community Based Surveillance
Volunteers have been trained in the region to offer education to help improve home
based care.
8.3.8 Transport
Twenty one Jailing motorbikes were supplied by Global Fund to boost malaria control
activities specifically and activities of other programmes in general
8.3.9 IEC
A total of 1,050 IEC sessions forming 9.3% of all sessions were conducted on malaria in
the region
Though there was an increase of 10% of the total cases that reported at the out patient
department due to malaria in the region in 2005 compared to 2004, however, there was
a 4% proportion decrease for the under five years.

8.4 Constraints/ Challenges

•   Funds release coinciding with a time that marks peak activities within the Ghana Health
Services
•   Inadequate ITNs
•   Low ITN re-treatment coverage
•   Periodic shortage of SP drug for smooth implementation of IPT
•   Slow inflow of data on malaria activities from the district level.
•   Side effects of artesunate – amodiaquine
•   Inadequate staff

8.5 Recommendations
•      ITN coverage to be assessed.
•      More ITNs should be available.
•      Functional retreatment centers need to be set up in the districts.
•      SP must be made available at all times in the districts.
•      More sensitization and education on the use of the Artesunate- Amodiaquine
needed.




                                                                                        37
9. HIV/AIDS CONTROL

The cumulative HIV/AIDS cases from 1986 to December 2005 are 12,711. In 2005
1,852 cases were reported compared with 1,836 in 2004. 17,102 blood donors were
screened and 876 were HIV positive in 2005. This constituted 5.2% compared with
4.2% in 2004.
Trend of reported cases in the region is as below:
1986 - 1999                                             2,779
2000                                                    1,324
2001                                                    1,459
2002                                                    1,629
2003                                                    1,832
2004                                                    1,836
2005                                                    1,864
Total                                                   12,723

              REPORTED HIV/AIDS CASES BY AGE GROUPS AND SEX IN THE BRONG AHAFO REGION JAN- DEC
                                                   2005.

        250




        200




        150




        100




         50




         0
                                                                                                                 NOT
              0-4   5-9   10-14   15-19   20-24   25-29   30-34   35-39   40-44   45-49   50-54   55-59   60+   STATE
                                                                                                                  D

  MALE        40     13    10      8       33      82      107     146     103     78      46      23     27      3
  FEMALE      51     9      9      15      121    238      225     175     104     90      51      20     32      5




                                                                                                                 38
                          REPORTED HIV/AIDS CASES BY AGE GROUPS IN THE BRONG AHAFO REGION-2004 AND 2005
                                                           COMPARED


                   450
                   400

                   350
                   300
No. oF CASES




                   250

                   200
                   150
                   100

                    50
                     0
                                                                                                                         NOT
                           0-4     5-9   10-14 15-19    20-24 25-29 30-34 35-39 40-44 45-49 50-54         55-59   60+   STATE
                                                                                                                          D

                   2004     64     22     9        18   166    291     386   311     233   141     93      40     58      4
                   2005     91     22     19       23   154    320     332   321     207   168     97      43     59      8




                         TREND OF HIV PREVALENCE AMONG BLOOD DONORS IN THE BRONG AHAFO REGION, 2000-2005



               6


                                                                                                                        5.2
               5


                                                                                                    4.2
               4
                                                                                   3.7

                                               3                 3.4

               3             2.9




               2


               1


               0
                          2000             2001               2002            2003               2004              2005




                                                                                                                          39
9.2 FACTORS FUELLING THE SPREAD OF HIV/AIDS IN BRONG AHAFO REGION
SOCIAL FACTORS
•     Funerals
•     Proliferation of Night Clubs
•     High illiteracy rate
•     Cultural Factors: festivals, widowhood inheritance, and the ‘kunaton” practice
(Kunaton is a practice whereby a widow has to go outside her community to have sex
with an unknown person as a way of purifying herself).
•     Economic factors: big commercial centers in the Region which attracts traders
from many places in the country and neighboring countries. The mining activities have
attracted other workers into the region. The long distance drivers transiting in the major
towns are also factors fuelling the spread.
•     Poverty
Vulnerable groups in the Region.
•     Commercial sex workers
•     The youth out of school
•     Women
•     Long distant drivers
•     Migrant population
•     Inhabitants of commercial centres and border towns.


9.2 MAJOR ACTIVITIES
The following major activities were carried out during the year under review
A 2-week training on VCT organised for 73 service providers in three batches
A 1-week training on Syndromic Management of Sexually Transmitted Infections
organised for 52 prescribers in 2 batches (20/6-1/7/5)
VCT/PMTCT sensitisation durbars organised in Sunyani and Dormaa
Organised 2-week income generating activity workshop for 30 PLWHA
Selected health staff trained on ART and Opportunistic Infections at national level.




                                                                                       40
VCT SERVICE OUTPUT
Centre             Counseling      Diagnostic        Walk in
Regional           471             417               137
Hosp
HFH                203             183               20
Techiman
HFH Berekum        25              2                 21
Kintampo           22              2                 18
Wenchi             39              43                40
Dormaa             40              51                40
Total              788             698               264


PMTCT OUTPUT
Centre        ANC         Counseling     tested      positive     Rec       +ve Post
              Regist.                                             results       counsel
Reg. Hosp     2440        815            796         20           10            486
Berekum       190         163            163         6            3             55
Wenchi        252         25             25          2            1             24
Sampa         57          16             16          2            2             16
Kintampo      127         31             31          5            5             5
Dormaa        1369        53             53          4            4             53
Techiman                  42             28          6            6             28
Total         4435        1145           1112        45           31            667


9.3 WAY FORWARD/AGENDA FOR 2006
•       Build and strengthen district capacity to develop and implement BCC
programmes through training.
•       Organize VCT and PMTCT training for service providers in 5 hospitals.
•       Organize refresher training for VCT/PMTCT counselors
•       Provide ART at regional Hospitals
•       Train 50 service providers in opportunistic infections.
•       Organize community sensitization durbars on VCT and adequate nutrition for
PLWA.



                                                                                          41
•      Monitor ART including treatment of opportunistic infection, VCT, PMTCT, STIs
and PEP services.


10. COMMUNITY BASED HEALTH PLANNING AND SERVICES (CHPS)
10.1 Introduction

The region has adopted CHPS as strategy for reorienting and relocating primary health
care from sub-district health centres to convenient community locations (close to client)
It involves mobilization of grass root action and leadership for heath. CHPS will reduce
health inequalities and promote equity of health outcomes.


10.2 ACHIEVEMENTS:
The number of functional CHPS zones in the Region increased from 4 as at December
2004 to 14 as at the end of 2005.
20 CHPS compounds are under construction and at various levels of completion.
All 19 districts have completed a roll out plan




                                                                                      42
CHPS ZONES IN BRONG AHAFO REGION 2005
  NO. DISTRICT                 NO.OF         NO. OF ZONES
                               SUBDISTRICT
  1.    KINTAMPO NORTH         7             21

  2.    KINTAMPO SOUTH         6             26

  3.    DORMAA                 8             32

  4.    TANO NORTH             5             18

  5.    TAIN                   5             18

  6.    JAMAN SOUTH            5             16

  7.    ASUNAFO SOUTH          5             9

  8.    NKORANZA               8             21

  9.    TANO NORTH             5             11

  10.   ASUTIFI                6             17

  11.   ASUNAFO NORTH          5             11

  12    SUNYANI MUNICIPAL      8             23

  13.   TECHIMAN MUNICIPAL     8             22

  14.   JAMAN NORTH            4             9

  15.   ATEBUBU                5             28

  16.   PRU                    6             25

  17.   WENCHI                 4             12

  18.   BEREKUM                4             17

  19    SENE                   5             17

        TOTAL                  109           353




                                                            43
10.3 Constraint/Challenges
The following posed serious challenge to the implementation of CHPS in the region:
•      Inadequate staff
•      High staff attrition rate
•      The inability of some communities to provide Community Health compounds because of
high cost
•      Inadequate transport; motorbikes and bicycles
•      Problem of sustaining volunteers
•      High construction cost of CHPS compounds
•      Inadequate funds for training and other implementation activities

10.4 WAY FORWARD
•     To advocate for increase in numbers in the training of CHNs & FTs for the region
•      To advocate for resources from DAs and other development partners for CHPS
implementation.
•      To establish one Community Health Volunteer core at the CHPS zone level
•      To train stakeholders on collaboration for Health
•      Conduct technical skills training for 26 CHOs by end of 2005
•      To convert under-utilized rural clinics in the region into community health    compounds
•      To establish 20 completed CHPS zones by end 2005
•      To help build the capacity of Sene district to become a CHPS demonstration district
•      To identify District Focal persons for CHPS implementation
•      Support      districts      to   institute   incentive   schemes     for      CHOs    e.g.
-      Accelerated promotion
-      Easier opportunities for further studies
-      Salary enhancement etc.




                                                                                              44
11. HEALTH PROMOTION
11.1 OBJECTIVES
•      To continue to build the capacity of district staff in Health Education through
training in Health Education, technical support visits and through the design and
production of health education materials
•      To advocate for and provide health education support for the regional priority
health programmes
•      To monitor health education activities and provide feedback to the districts


11.2 MAJOR HEALTH PROMOTION ACTIVITIES CARRIED OUT IN 2005
HEALTH PROMOTION CAPACITY BUILDING
As part of Health Promotion capacity building for district staff, District IE&C Coordinators
and Laboratory Technicians were trained on the use of Community Health Education
Skills Tool kit.
To strengthen the Health Education and counseling skills of service providers, a two-
weeks voluntary Counseling and Testing training was organized for 73 service providers
in 3 batches.
11.3     ADVOCACY,       INTERSECTORAL           COLLABORATION           AND      HEALTH
PROMOTION SUPPORT
Through out the year under review communication support was provided for all the
priotity areas.


11.4 WORLD AIDS DAY AND AIDS AWARENESS MONTH CELEBRATION.
The month of November has been designated AIDS Awareness Month. During this
month, HIV/AIDS prevention, care and support activities were intensified in all the
districts. There were radio talks and discussions, quiz competitions in schools and free
Voluntary Counseling and Testing services at the Sunyani Polytechnic. The highlight of
all these activities was the launching of Word AIDS DAY in Wenchi on the 1st of
December 2005.
Wenchi was selected for the launch because of it’s high HIV prevalence rate.




                                                                                         45
11.5 MONITORING AND EVALUATION OF HEALTH PROMOTION ACTIVITIES
The Unit has initiated a system since 1993 where by District IEC
Co-ordinators meet quarterly to review IEC activities carried out in the previous quarter
and plan for the next quarter. During the year under review only 1 out of 4 of such
planned meetings was held on 28 – 29/07/05.
The main constraint that came out from that review meeting was inadequate funds to
implement planned IEC activities at the district level.
Quarterly IEC Activities Reports from the districts were analysed and feedback sent to
the districts. Analysed IEC Activity Report for January to December 2005 is presented in
table 1 below.
Table 1: IEC ACTIVITY REPORT (January to December 2005)
Subject Area                  Session                     %
Child Health                  790                         9.7
Reproductive Health           1,367                       16.7
Environmental Health          460                         5.6
Nutrition                     1,683                       20.6
Immunization                  959                         11.7
Communicable Disease          1,157                       14.2
Non-communicable              214                         2.6
disease
Malaria                       755                         9.3
Health Insurance              384                         4.7
Others                        8,170                       4.9


Table 1 above shows the distribution of IEC sessions by subject area; 20.6% of the
sessions conducted covered Nutrition while only 2.6% covered Non-Communicable
diseases.
11.6 CONSTRAINTS
The District IEC Coordinators complained of inadequate funds to implement planned
IEC activities at the district and sub-district levels.




                                                                                      46
11.7 PLANS FOR 2006

11.7.1 REGIONAL LEVEL ACTIVITIES
Build capacity of districts in Health Promotion through training in Health Promotion and
technical support visits to the districts
   •   Provide communication support for the priority health interventions.
   •   Celebrate National and International Health Days
   •   Advocate for intersectoral action for health
   •   Disseminate Health Promotion Policy
   •   Monitor all Health Promotion activities


11.7.2 DISTICT LEVEL ACTIVITIES
   •   Organise community level IEC activities on the priority health interventions.
   •   Distribute health education materials to audience and partners
   •   Celebrate National and International Health Days
   •   Advocate for intersectoral action for health
   •   Disseminate Health Promotion Policy
   •   Promotion of healthy lifestyles.
   •   Monitor and report on all Health Promotion activities in the district




                                                                                       47
12 NUTRITION
IODATED SALT PROGRAMME
The region recorded 65.0% of household utilization of iodated salt in 2005 as against
66% in 2003. In 2004 the survey was conducted in four districts (Wenchi, Dormmaa,
Kintampo and Asunafo) which represented 79.5% of household utilization. However,
market availability of iodated salt increased from 22.6% in 2003 to 66.3% in 2005. Of
the 115 Annapurna salt tested 4 were below 15ppme, followed by 67 Pambros with 36
below 15ppme, out of the 392 salt tested in the various market.
Figure. 9




12. 3.3.4 ANAEMIA PROGRAMME
Anaemia control and prevention programme continued in the region where community
awareness was intensified through training and education. Emphasis was placed on the
following,
•      Early and regular attendance of ANC.
•      Prevention and early treatment of malaria.
•      Good diet during pregnancy
•      Compliance with iron/ folate supplements intake.
The region recorded 24.8% in 2005 prevalence of anaemia among pregnant women at
registration as compared to 33.9% in 2004 as shown in the figure below.




                                                                                  48
Figure 10.




The drop could be attributed to the region’s decision to intensify community awareness
on anaemia, which was in line with the national strategy of anaemia control.
All pregnant women are recommended to attend/ register at ANC as soon as possible
preferably within first trimester, in conformity with the Country protocol on Safe
motherhood initiative. However, the figure 11 below showed that, majority of the
pregnant women attend their first antenatal clinic within 2nd trimester with regional
percentage standing at 48%for 2005, Though there was a drop in prevalence of
anaemia among pregnant women at registration for this year as shown in figure 11,
regional registration of pregnancy for the 3rd trimester was 17%, which was also quite
high, and these pregnant women are at greatest risk, since at this stage is too late to
put in interventions, such as iron / folate supplementation to reduce the risk of mother
and foetus to anaemia. As a result of this, the region would continue with its decision to
intensify community awareness on anaemia control in 2006.




                                                                                       49
Figure.11.




There was also drop in prevalence of anaemia among children under five years of age
from 32.0% in 2004 to 25% in 2005 as in table below.
Table 5.
YEAR               TOTAL NO. OF NO.                    OF % OF CHILDREN
                   ANAEMIA             CHILDREN. 0 -4 0-4           WITH
                   CASES               WITH ANAEMIA       ANAEMIA
2001               15025               8481               56.4
2002               13148               7919               60.2
2003               15321               9544               62.2
2004               17239               5578               32
2005               20512               5090               25


COMMUNITY BASED ANAEMIA EDUCATION
As part of the efforts to reduce prevalence of anaemia among pregnant women and
children under five years of age in the region, the region has decided to train
community-based agent to carry out community level anaemia control and prevention
advocacy. This programme started in October 2005 in 3 districts namely Jaman North,
Jaman South and Berekum. In all 235 community based agents were trained made up
of CBS volunteers, Christian and Moslem representatives, Assembly men and women,
tailors, seamstresses and some health workers.




                                                                                50
These trained agents were expected to submit report to sub districts for further
submission to district and region. They visited the following places: churches, mosques,
community gatherings, houses etc.
DISTRICT                 NO.                   OF ESTIMATED
                         COMMUNITIES                   NUMBER           OF
                         VISITED/SUBMITTED AUDIENCE
                         REPORT                        REACHED
Berekum                  24                            4,092
Jaman South              17                            4113
Jaman North              0                             0
TOTAL                       41                         8,205


Jaman North has not submitted any report yet.
Region will extend this programme to other districts in 2006.


12.3.3.1 Vitamin A Supplementation For Children (6 – 59
Months)
Two rounds of mass vitamin A supplementation were conducted in the year.
The region covered a large number of children in both rounds i.e. April 495,419 and
November 498,281 in 2005 representing 106% and 107% respectively.
Below is the trend for the 5 - year period.
Figure. 6

                 Trend of VAS for 6 - 59 months children - 2001- 2005
                                 ( 1st & 2nd round )


  600000


  400000


  200000


            0        2001         2002         2003            2004       2005

    may /april      367285       353130       363023          150731     495419
    november        379368       362772       400289          462783     498281
                                                                                     51
In November 2005 round, coverage ranges from high of 114% in Jaman South District
to low of 97% in Tano South.


MATERNAL POST PARTUM VITAMIN A SUPPLEMENTATION
All districts are now dosing post partum mothers with vitamin A. In all 31,295 women
were fully dosed with vitamin A representing 68.0% as against 54.2% in 2004.
Coverage ranges from low of 49% in Tain district to high of 134% in Techiman district.




13. ADOLESCENT AND REPRODUCTIVE HEALTH SERVICES
13.1 INTRODUCTION
R.C.H. service in the Region is integrated to other services to make it accessible to all
individuals, within the context of PHC. Government and Non-governmental agencies
provide services.      This includes community-based activities with community’s
participation.
The Reproductive Health Care priorities are:
•      Safe Motherhood including Infant Health
•      Family Planning
•      STI/HIV AIDS prevention and Management
•      Post Abortion Care
•      Prevention and management of Cancers of Reproductive system.
Child Health Priorities are:
•      Neonatal Health
•      Prevention and management of Nutritional disorders
•      Prevention and control of infectious diseases and injuries
•      Clinical Care of the sick and injured child
•      Adolescent Health
•      School Health
•      Health-related interventions e.g. water and sanitation, female education etc.




                                                                                         52
REGIONAL OBJECTIVES
Objectives were set to monitor the above priorities taking into consideration the target
population, resources available, the prevailing constraints and the national goal.


Maternal Health
•      To achieve antenatal service coverage of 95%
•      To achieve TT2+ coverage 90%
•      To increase antenatal visits from 3.5 to 4
•      To achieve institutional supervised delivery service coverage of 40% - TBAs 20%
•      To achieve postnatal service coverage of 58%.
•      To achieve Family Planning acceptor rate of 48%
•      To protect 87,810 couples with Family Planning methods
•      To reduce maternal mortality rate from 240/100,000 to 200/100,000 live births
•      To reduce high Anemia in pregnant women from 8863 to 7500 through the use of
ITNs and IPT.
•      To carry out at least 3 review meetings with RCH staff during the year.

Child Health
To increase child welfare service coverage for: -
•      Children 0-11months at 100%
•      Children 12-23months from 66.5% to 68%
•      Children 24-59months from 16.9% to 18%
To achieve the following vaccination coverage of above 90% for children 0-11 months.
To increase School Health Service coverage from 38.4% to 40%
To train at least 200 frontline workers in districts who have not trained their staff on
Adolescent Health.


13.2 STRATEGIES
Strategies for achieving RCH Objectives and targets is based upon the following:
•   Providing quality service through facilitative supervision and monitoring.
•   Improving efficiency of service providers
•   Building the capacity of service providers
•   Instituting adequate supply and availability of logistics



                                                                                       53
•   Monitoring and submission of reports to headquarters
•   Fostering closer collaboration with other agencies.

Activities Carried Out

•      Family Planning Data Management Update
•      Interagency co-ordinating committee on contraceptive security in Ghana.
•      National Bi- Annual RCH Program Review.
•      Community IMCI meeting.
•      Trained Regional IMCI resource persons
•      Essential nutrition Actions (E.N.A) training workshop
•      Stakeholders meeting with SHEP coordinators.
•      Community Based Growth Promotion at Jaman South and Atebubu District.
•      TOT of resource person on CHPS

13.3 SCHOOL HEALTH SERVICES

This service aims to promote the health of pre-school (2-5years) and school age (5-
18yrs) children in all schools. This is done through effective collaboration with the G.ES
and World Vision International in some districts.
The following activities are carried out during School Health Service.
•      Physical examination of the children with emphasis on Pre-school, P1, P3, JSS1
and SS1
•      Risk detection and referrals to appropriate quarters
•      Immunisation and I.E.C.
•      Treatment of minor ailments including oral health
•      Environmental Sanitation.


Twelve thousand five hundred and twenty five (12,525) children were screened for eye
problems through the efforts between the Dormaa Hospital Eye specialist and the
District Public Health Unit.
Some of the eye conditions detected were:
•       Glaucoma -----------2
•       Conjunctivitis------21
•       Refractive Error----80



                                                                                       54
•           Matured Cataract----1
•           Ocular Tumor--------1
These children were referred to the hospital for treatment.
Coverage
There has been an increase in this area during the period under review. Out of 213,458
children enrolled in the various classes, 107058 in 1389 schools were examined and
received three (3) or more Health Education talks. This output gave coverage of 50.2%
as against 38.4%, an increase of 11.7% over 2004 achievement.
This service is run through effective collaboration with the Ghana Education Service and
the World Vision International in Atebubu and Sene districts.
Nkoranza and Tano South recorded the lowest coverage of 21.7% and 10%
respectively.

              SCHOOL HEALTH COVERAGE IN BRONG AHAFO JAN-DEC 2003-2005 COMPARED


    180.0

    160.0

    140.0

    120.0

    100.0

     80.0

     60.0

     40.0

     20.0

      0.0
             AS AS AS ATE     BER DO JA JA KIN KIN NK     SU RE TA TA TEC WE
                                                      SEN                     TAI
             UN UN UTI BU PRU EKU RM MA MA TA TA OR       NY GIO NO NO HIM NC
                                                       E                       N
             AF AF FI BU       M AA N N MP MP AN          ANI NA NO SO AN HI

     2003 60.6       76.7 156.     26.2 89.7      78.9 74.3     41.6 113. 47.1           66.1 59.4 27.4
     2004 36.7       55.1 33.7     36.1 29.1      18.4 64.3      7.6 79.0 54.7           41.1 54.0 51.6
     2005 38.7 85.1 93.4 63.5 22.6 37.3 73.2 72.9 65.4 84.4 75.1 21.7 99.2 91.0 0.0 31.0 10.0 47.3 33.9 29.1



Talks covered includes: -
•      Hand washing with soap at all levels.
•      Prevention of Anaemia
•      Drug and substance abuse
•      Prevention of Malaria
•      Family Life Education

                                                                                                               55
•     STI/HIV/AIDS Menace
•     Oral Hygiene
•     The adolescent and Develop /Problems
•     Sexual Health
•     Diet for the growing child
Health conditions seen and referred to hospital for treatment include infected skin
conditions rashes and patches, worm infestation, suspected anaemia, hearing and
seeing defects.


CONSTRAINTS
•     Inadequate staff in most districts
•     Low priority given to school health services compared to other services.
•     Inadequate resources for the programme
•     Inadequate co-ordination between GHS/GES to plan and implement activities
together.
•     School Health to be integrated into outreach package
•     Vast distribution of schools in the districts.
Recommendation
•     Other staff eg. Health Aides, Ward Assistant can be trained to assist where staff
is inadequate.
•     Proper Planning for logistics as for other programmes
•     The programme should be given the full attention it deserves by providing the
resources and staff motivated to carry on the working eg. Where the staff had to go far
for services, vehicles should be provided.
•     Budget for School Health Services.


13.4 ADOLESCENT HEALTH AND DEVELOPMENT

Sensitization of Health Workers

One Hundred and Eighty (180) frontline Health Workers from both public and private
sector benefited from the sensitization and training workshop in ADH issues in
Techiman and Wenchi Districts.




                                                                                    56
Nine Hundred and twenty one (921) School pupil, Apprentices and Artisans in the
Kintampo North District received Health Education talks and discussions during the
period under review.

Sensitisation of Communities
•      Five community durbars among Chiefs, Queen mothers and community
members on Adolescent health were carried out at Kintampo and Dormaa.
•      Five new Abstinence clubs have been formed bringing the number of abstinence
clubs to eleven.
Topics deliberated on include the following:
•      The HIV menace and its prevention
•      The importance of having a trade /profession
•      Personal and Environmental hygiene
•      Sexuality and Health
•      The problem of the Adolescent child
•      Prevention of unwanted pregnancy

STAFF DEVELOPMENT

Forty (40) facilities in charges and staff had orientation in ADHD counselling services in
the Techiman District.

ADOLESCENT FRIENDLY CORNERS

1.     Buoyem Sub-Municipality Adolescent Health Services will be a model for the
Municipality.
2.     Jinijini Health Centre has been earmarked for the service in the Berekum District

SERVICE AVAILABILITY FOR ADOLESCENTS
Safe Motherhood
Although there is no proper corners set up for these services, all facilities are rendering
services ranging from Focus Antenatal to Family Planning services. During the year
under review, 9,523 young women between the ages of 10-19 year had Antenatal Care.
Ten (10) died out of unsafe abortion and childbirth.
STI/family planning service
Three Hundred and Seventy five (375) visited these facilities for counselling. 138
Adolescents accepted family planning.


                                                                                        57
NGOs ACTIVITIES IN ADHD

Dothebaa and Redemption Care International in the Dormaa District trained 30 HIV
peer educators in the communities. Durbars have been organized and community
members sensitised on ADHD issues. Virgins Clubs continue to function in the District.
Youth Advocacy in the Techiman Municipality is also involved in providing the youth
with information about their sexual reproductive health, peer educator training,
community sensitisation on Adolescent Health, marketing of young and wise brands.
Young and Wise groups have been formed in ten schools in the municipality.
This NGO lacks logistics like audio visual aids, oware, ludo and other indoor games to
attract the attention of the youth.
CHALLENGES
•      Inadequate space in most facilities to render effective friendly services.
•      Inadequate reporting on services provided.
•      Delay in sensitising other health staff on ADHD issues by district.
RECOMMENDATIONS
•      DHMT members must sensitise and orientate other health workers in ADHD for
them to start in their small ways to implement.
•      DHMTs to involve the private sector in the provision of ADHD.
•      Regular reporting on services provided.


13.4 BABY FRIENDLY INITIATIVE
Exclusive Breast-Feeding
The number of Baby Friendly facilities remains 5. Lactation Management Training for
thirty providers in two districts had been carried out and mother support groups have
been formed. Assessment has been carried out in 9 facilities namely Bechem,
D/Nkwanta, Berekum Hospitals, Yamfo, Techimantia, Derma, Adrobaa, Jinijini, and
Koraso. All facilities passed the assessment. Meanwhile exclusive breastfeeding
promotion activities continued in all other facilities. Proportion of Infant-Mother pair
exclusively breast-fed on discharge was 97.3% as compared to 99.8% in 2004.
13.5 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)
COMMUNITY IMCI ACTIVITIES
In order to ensure optimal growth of children, C- IMCI i.e. third component of IMCI, which
focuses on growth monitoring and promotion, has been initiated in 2 districts namely Atebubu



                                                                                         58
and Jaman South. Each district selected 5 communities. The project involves registering all
children under two years of age in each community, weighing them every month and appropriate
counselling on feeding practices would be given to mothers based on child’s health situation.
Child health services such as immunization, vitamin A supplementation etc and family planning
education will also be provided during weighing sessions.The districts trained community
volunteers as Community Growth Promoters and baseline data was taken in the selected
communities.

CLINICAL IMCI
The Regional Resource Team has been formed. Twenty five (25) prescribers, Medical
Assistants, Midwives and CHOs have been trained and are working.


13.6 SAFE MOTHERHOOD PROGRAMME
The goal of the Safe Motherhood Programme is to improve women’s health in general
and especially, to reduce maternal morbidity and mortality and to contribute to reducing
infant morbidity and mortality.
Components:
•      Antenatal care
•      Labour and delivery care
•      Postnatal care
•      Family planning
•      Prevention and management of unsafe abortion
•      Health education.




                                                                                          59
13.6.1 ANTE-NATAL CARE
The antenatal cocerage was 90%; the same as achieved in 2004. The total number of
registrants for the period was73,960 as against 72,101 in 2004 representing an increase
of 1,889. Kintampo South recorded the least of 1,146 registrants (39.9%) and Techiman
Minicipality recorded the highest of 8,927 (113%)


                  ANC REGISTRANTS BY DISTRICTS IN BRONG AHAFO REGION
                             JAN-DEC 2003-2005 COMPARED

   15000

   10000

   5000

        0
            AS AS AS AT PR BE DO JA JA KIN KIN NK SE SU TA TA TEC WE TAI
            UN UN UTI EB U RE RM MA MA TA TA OR NE NY NO NO HIM NC N

    2003 765      433 103    382 649     507 416     475 347 761     394 840 589
    2004 803      452 964    376 520     446 396     450 318 740     409 782 547
    2005 462 303 423 300 434 384 673 239 331 377 114 459 283 764 174 263 892 341 172



Contribution to ANC by Organizations
ANC services in the region are provided in both public and private organizations and trained
TBAs.
Ante Natal Visits recorded by Ghana Health Service/MOH facilities were 145,770
(54.2%) Faith Based Institutions and Quasi government contributed 61251 (22.7%)
Private Hospitals and Maternity Homes form 45257 (16.8%) TBAs contributed 16,657
(6.2%)




                                                                                         60
                ANC CONTRIBUTIONS BY ORGANISATIONS JAN-DEC 2005




                                        TBAs
                PRIVATE/MAT
                                         6%
                   HOMES
                    17%


                                                     GHS/MOH
                                                       54%
                   FAITH
                BASED/QUASI
                    23%




Average No of Visits
Average number of visits for the period increase from 3.5 last year to 3.6 this year. Total
number of women making 4+ and more visits during the period increase from 41870 to
42167 given coverage of 56.4%.
Dormaa district and Regional Hospital recorded the highest number of clients making 4 visits.

13.6.2 SUPERVISED DELIVERY
Coverage
There has been an increase in the total delivery coverage for this year, from 57.8% to
62% in 2005. Skilled attendance delivery coverage increase from 35% to 50.3% in
2005. Techiman District recorded the highest of 5,436 followed by Dormaa, 3,349
during the period.      Kintampo South and Jaman North recorded less than 1000
supervised deliveries for the year.




                                                                                                61
                              TREND        OF   SUPERVISED           DELIVERY       2003-2005,      BRONG        AHAFO     REGION



    63

    62                                                                                                                                        62

    61

    60

    59

    58                                                                                     57.8

    57
                                        56
    56

    55

    54

    53
                                  2003                                               2004                                              2005
                                                                                      YEAR




                    SUPERVISED     DELIVERY       BY    DISTRICTS     IN    BRONG   AHAFO    REGION,     JAN-DEC    2003-2005        COMPARED



      90.0

      80.0

      70.0

      60.0

      50.0

      40.0

      30.0

      20.0

      10.0

       0.0
             ASUN ASUN                                               JAMA JAMA KINTA KINTA                               TANO TANO
                            ASUTI ATEBU             BEREK DORM                                    NKOR           SUNY                  TECHI WENC           REGIO
             AFO     AFO                    PRU                       N       N     MPO    MPO           SENE            NORT   SOUT                 TAIN
                             FI     BU                 UM     AA                                  ANZA            ANI                  MAN      HI            N
             NORT   SOUT                                             NORT   SOUT    NORT   SOUT                           H      H

       2003 55.2            78.6    40.7               74.5   68.6           53.3   29.9          63.5    41.6    61.7          53.6   69.2   46.7           56.0

       2004 55.2            78.4    46.9               83.0   57.4           52.4   38.7          53.2    49.1    68.4          55.6   63.9   60.7           57.8

       2005 55.0     38.7   67.2    28.1     42.9      75.3   49.2   27.9    63.3   52.8   25.4   42.6    19.4    61.5   50.4   60.6   68.0   45.2   41.9    62.0




Contributions made by various agencies are as follows: -
GHS                                 -                  22905 (45%)
Faith Based                         -                  9236 (18.1%)
GRMA/Private                         -                 9205 (18.0%)
TBAs                                -                  9643 (18.9%)


 Maternal Mortality Ratio – MMR
Eighty seven (87) institutional and eight (8) community deaths were reported during the
period as compared to 107 deaths in 2004. Community deaths were reported by Sene



                                                                                                                                                                    62
(6), Tain (1) and Tano South (1) districts. The Region was notified and auditing was
done in the communities and reports submitted.
Ninety three (93) deaths gave a ratio of 183/100,000 LB. Techiman district recorded the
highest maternal deaths of fifteen (15) followed by Berekum and Regional Hospital with
nine (9) deaths each.



                               TREND OF MATERNAL MORTALITY RATE IN BRONG AHAFO REGION
                                                     2003-2005

                      3.0
     MORTALITY RATE




                      2.5                                                                                   2.4
                      2.0                                  2.0
                                                                                                                                                                  1.8
                      1.5
                      1.0
                      0.5
                      0.0
                                                   2003                                             2004                                                  2005
                                                                                                     YEAR




                                      MATERNAL     MORTALITY      RATE    IN     BRONG    AHAFO     REGION,       JAN-DEC    2003    -2005          E
                                                                                                                                              COMPARE D



                 12.0


                 10.0


                      8.0


                      6.0


                      4.0


                      2.0


                      0.0
                             ASUNAF ASUNAF                                                        KINTAM KINTAM
                                                   ATEBU          BEREK   DORMA JAMAN JAMAN                     NKORA              SUNYAN TANO     TANO TECHIM
                               O      O    ASUTIFI         PRU                                       PO     PO              SENE                                   WENCHI   TAIN
                                                    BU             UM       A     NORTH   SOUTH                  NZA                 I     NORTH   SOUTH    AN
                             NORTH SOUTH                                                           NORTH SOUTH

                      2003    1.9            2.5    5.8            5.9     0.7             1.8      0.5             0.9      0.0    0.9             1.8     2.6      0.9

                      2004    1.2            2.8    5.5            2.7     0.0             0.6      2.5             4.0      0.0    2.1             3.7     3.9     1.4

                      2005     2.5    0.0    2.8    4.0     4.7    2.9     1.2     0.0     0.9      3.7     0.0     2.9      9.8     3.3    0.0     3.7     2.9      2.5     0.6




The major causes of deaths were:
DIRECT
1.                      PPH------------------------------------------------------16
2.                      Haemorrhage ------------------------------------------17
3.                      Obstructed Labour--------------------------------------5
4.                      Septicaemia secondary to unsafe abortion---------16




                                                                                                                                                                                   63
Maternal Death Audits
Maternal Death Audits had been improving over the years but not all deaths are
audited.     Out of 95 deaths reported 89.1% were audited with reports sent to the
Regional Health Directorate.
Post audit activities were carried out in most affected communities.


Post audit actions
•      Client’s relatives were counselled by Doctors, Maternity ward in-charges and
advised against self-medication and enema during pregnancy.
•      Collaborating with neighbouring facilities, especially referring patients to continue
with education in the communities depending on the cause of death.
•      Follow up by DHMTs in communities to assess cause of death and possible
education on local radio.
•      Blood donation campaign.
•      Health talk, durbars in the communities on early reporting and avoiding the use of
concoctions.
•      Safe motherhood message have been translated into Akan and pasted on wards
and walls.


13.6.3 POST NATAL SERVICES
Post-Natal Service aims at ensuring good health of newly delivered mothers and their
babies. This includes the maintenance of the physical and psychological well being of
mother and child.
Coverage: A total of 46,870 mothers were seen during period under review given a
coverage of 57.0%, an increase of 2% when compared to 2004. There was an increase
in the performance/coverages of all districts. Tano south and Tano North recorded the
highest coverage of 87.2% and 86.3% respectively.




                                                                                         64
              POSTNATAL        COVERAGE       BY    DISTRICTS         IN BRONG AHAFO            REGION,       JAN-DEC   2003-2005
                                                                      COMPARED


     160.0

     140.0

     120.0

     100.0

      80.0

      60.0

      40.0

      20.0

      0.0
             ASUN ASUN ASUTI ATEBU             BEREK DORM JAMA JAMA KINTA KINTA NKOR                           SUNY   TANO   TANO TECHI WENC
                                        PRU                                                            SENE                                       TAIN
             AFO   AFO    FI     BU                UM     AA         N      N      MPO    MPO   ANZA            ANI   NORT   SOUT   MAN    HI

      2003 46.0           64.0   54.0              51.6   69.2              68.1   26.4         62.1   67.9    50.0          72.2   47.5   42.7

      2004 50.3           77.4   41.1              62.7   62.8              55.7   29.0         50.8   52.1    75.6          74.4   43.0   54.3

      2005 51.3    60.5   55.9   37.8   32.6       58.9   36.1       33.5   63.5   34.2   49.1 136.0 76.4      49.2   72.8   66.3   59.0   34.7   38.4




Contributions made by other providers in the various facilities are as follows:
•      GHS                                                       -                 18982 (39.5%)
•      Faith B. Institutions                                         -             6195 (12.8%)
•      GRMA                                                      -                 5452 (11.3%)
•      Quasi and Private                                         -                 2091 (4.3%)
•      TBAs                                                      -                 15313 (31.8%)


2.1% of mothers who attended PNC had no previous ANC while 13.7% accepted a
method of family planning.


13.6.4 FAMILY PLANNING PROGRAMME

The objectives of the Programme are as follows: -

•      To provide information, education and communication to individuals and couples
to enable them decide freely and responsibly the number and spacing of their children.
•      To provide affordable contraceptive services and make available a range of safe
and effective methods.
•      To assist couples to achieve pregnancy and have babies and
•      Prevent and manage RTI including STIs and HIV/AIDS.
Coverage
The Regional coverage for this year 2005 is 41% as against 42.1% in 2004. This
represents a total of 194,496 as against 201,896 in 2004. Contraceptive devices were
available through the year.




                                                                                                                                                         65
                                        FAMILY PLANNING COVERAGE BY DISTRICTS IN BRONG AHAFO REGION,

  100.0
                                                                   JAN-DEC     2003-2005           COMPARED

  90.0

  80.0

  70.0

  60.0

  50.0

  40.0

  30.0

  20.0

  10.0

   0.0
          ASUNAF ASUNAF                                                             KINTAM KINTAM
                                ATEBU              BEREK   DORMA JAMAN JAMAN                      NKORA           SUNYAN TANO     TANO TECHIM
            O      O    ASUTIFI             PRU                                        PO     PO           SENE                               WENCHI   TAIN
                                 BU                  UM      A   NORTH SOUTH                       NZA               I   NORTH   SOUTH   AN
          NORTH SOUTH                                                                NORTH SOUTH

  2003     10.2            23.9      31.6           39.1    17.9             57.3    34.9                  18.9    31.6           28.2   41.1   69.0

  2004     13.4            29.0      28.2           79.3    23.7             70.6    52.3                  14.2    37.3           57.7   48.0   94.5

  2005     21.7   18.2     33.4      32.6   35.3    53.2    16.6    35.1     49.7    60.3   42.7    31.7   32.9    23.1   57.2    38.3   60.4   84.0   45.7




Method Preference
Depo Provera still remains the most preferred method used, accounting for 39.5% of all
acceptors. This is followed by oral Pill contributing 23.9% of total acceptors. Male
condom ranked third on the preference rate accounting for 21.5%. There has been an
increase in condom use because of increase awareness for dual purpose of preventing
unwanted pregnancy, STIs and HIV/AIDS.
For short-term methods, Depo ranked the highest followed by Oral Pill.
For long-term methods, Norplant ranked the highest

                      FP PREFERENCE BY METHOD IN BRONG AHAFO REGION JAN - DEC
                                 Foaming Tablets 2005
             Female Condom                                         1%                              IUD
                                                                                                                          Norplant
                  1%                                                                               0%
                                                                                                                            1%
                                                                                                                                         BTL
                         Mini Pill                                                                                                       0%
                           2%
     Natural
      3%
                                                                                                                                                              Depo-Provera
                                                                                                                                                                  43%


         Combine Pill
            27%


                                                                      Male Condom
                                                                          22%




                                                                                                                                                                             66
EMERGENCY CONTRACEPTION
Most service providers in the region have been trained to offer this service. The Region
has taken delivery of the Postinor 2 and so far 48 people have benefited from this
service.


COUPLE YEARS PROTECTION CYP BY METHODS
An achievement of 100,872 was made as against 85,214 CYP in 2004 was made by the
Public and Private Sector for Short Term and Long Term Methods. The breakdown is as
follows: -
•      Public Sector, comprising MOH, GHS, Faith Based and Quasi Government
institutions achieved 20,944.1 CYP for Long Term Methods and 77,544 for Short Term
Methods.
•      The Private Sector, namely GRMA, PPAG also contributed 2,022.2 for Short
Term and 362 for Long Term Methods.


DISCONTINUING OF METHODS
36 Norplant and 42 IUDs were removed for the period under review. The reasons for
removal are as follows:
•      Husband travelled
•      To deliver another baby
•      Expiration
•      Heavy bleeding leading to weight lost
•      Divorce/Separation
CAPACITY BUILDING
•      Three (3) midwives from Techiman, Pru and Wenchi benefited from four weeks
comprehensive family planning training.
CHALLENGES
•            Poor reporting on some important aspect of RCH
•            Incomplete report from districts
•            Inadequate skilled attendants at service delivery points
•            Inadequate equipments for providing BEOC eg. MVA aspirators and Vacuum
extractors.




                                                                                     67
•          Poor reporting on Long-Term Methods from the District Hospitals resulting in
Low CYP in long methods.


RECOMMENDATION
•       Provision of Equipment, logistics, supplies etc.
•       Training of practising Midwives in B.E.O.C
•       District Public Health Nurses should follow up report from Hospital to ensure
detailed and meaningful report.
•       Submission of Maternal Audit reports must be timely.
•       Conduct     training   and   retraining   of   service   providers   on   Emergency
contraceptives


13.6.5. GENERAL CONSTRAINTS AND CHALLENGES
•      Inadequate technical staff, which includes CHNS and Midwives, cuts across all
areas of service delivery as a result of high attrition.
•      High Maternal Mortality Rate
•      Increased low Birth weight and Still Birth rate.
•      Low pace of IMCI.
•      Inadequate office of accommodation making the establishment of Adolescent
friendly corners very difficult.
•      Inadequate residential accommodation for staff also inhibit posting of staff.
•      Inadequate equipment in most of the facilities e.g., BP apparatus, heamoglobin
scales, and delivery set.
•      Late submission of reports and failure by districts to pay for family planning
commodities delays supply from the national level.
•      Low coverages in some districts
•      Inadequate reporting on Essential RCH Components e.g. PAC, Cancers,
infertility and Adolescent Health & Development by districts.
•      Hard to reach and difficult terrain renders access to service delivery very difficult.




                                                                                           68
13.6.6. RECOMMENDATIONS

    •   All RCH returns submission to be included in the general league submission for districts
        to ensure timely submission.

    •   Failure to report an event means incomplete submission.
    •   Districts to liaise with assemblies to assist in acquiring accommodation to staff to
        boost their moral to work in deprived areas.
    •   Promote micro-planning techniques to improve coverage.
    •   Procurement of essential equipments like BP apparatus, delivery set for facilities
        to provide quality care.
    •   Districts should ensure early submission of both monthly and quarterly report and
        payment of family planning commodities is made at the end of every quarter to
        enhance regular supply.


13.6.7 WAY FORWARD
•       Appropriate strategies must be ensured further reduce Maternal Mortality rate in
the region.
•       Strengthen Maternal Death audit system in the District.
•       Scale up IMCI and Adolescent Health
•       Capacity building of service providers e.g. midwives in life saving skills.
•       Improve data management
•       Institute adequate supply and availability of logistics at all levels.
•       Provide Technical support visits and monitoring.
•       Improve school health services.


CONCLUSION
In spite of the numerous constraints and challenges, service performance increased
appreciably. However, there is more room for improvement for better health of all
people living within Brong Ahafo Region.
The Public Health Division of the Brong Ahafo Regional Health Directorate is grateful to
all staff who contributed immensely towards the achievements during this year.




                                                                                             69
14.              Clinical/Institutional care

OUTPATIENT ATTENDANCE

Outpatient attendance recorded during the year under review was, 1,487,680 which showed an
increase of 10.2% over the same period in the year 2004 (1,350,504).
The increase of year 2004 over 2003 was 7.3%
There has been a gradual increase in attendance from 1999 to 2004

                            trend in opd attendance, 1996 - 2005

                1,600,000
                1,400,000
                1,200,000
   attendance




                1,000,000
                 800,000

                 600,000
                 400,000
                 200,000
                        0
                            1996   1997   1998   1999   2000   2001   2002   2003   2004   2005
                                                           year

During the period under review, Government health institutions contributed 56.5% (840,056) as
compared to 29.3% (435,519) of the Mission health institutions and 14.2% (212,105) by the
Private institutions.

OPD attendance recorded during the period 2002 – 2005

Year              Government          Mission                  Private                TOTAL
2002              698,611 (58.8%)     395,126 (33.3%)          94,021 (7.9%)          1,187,758
2003              703,300 (56.2%)     402,047 (32.1%)          146,135 (11.7%)        1,251,482
2004              768,474 (56.9%)     386,637(28.6%)           195,393(14.5%)         1,350,504
2005              840,056 (56.5%)     435,519 (29.3%)          212,105 (14.2%)        1,487,680


Per Capita out patient attendance (OPD) during the period under review was 0.72 as compared to
0.67 in 2004.
Per capita OPD attendance has been increasing gradually since year 2002.


                                                                                                  70
Per Capita OPD attendance 2002 – 2005


Year                             Per Capita OPD attendance
2002                             0.62
2003                             0.64
2004                             0.67
2005                             0.72


                                          OUT PATIENT ATTENDANCE PER CAPITA, 2000 - 2005
                          0.74
                          0.72

                          0.70
  ATTENDANCE PER CAPITA




                                                                                                    0.72
                          0.68
                                                                              0.64
                          0.66
                                                0.62           0.62                        0.67
                          0.64
                                   0.61
                          0.62
                          0.60
                          0.58
                          0.56
                          0.54
                                   2000         2001         2002            2003          2004   2005
                                                                      YEAR




ADMISSIONS
Total admission recorded for the year under review was 77,798 which showed an increase of
11.3% over 2004 (69,931).
Twenty (20) hospitals contributed to the inpatient attendance. These are categorized as follows:
One (1) Regional Hospital
Seven (7) Government Hospitals
Ten (10) Mission Hospitals
Two (2) Private Hospitals (Annor Asare hospital of Kintampo and Emil hospital of Wenchi)




                                                                                                           71
Contribution to inpatient attendance 2002 - 2004
Facility                                                Year
type
                     2002             2003               2004                 2005
Regional             7,536            7,817 (11.7%)      7,832 (11.2%)        8,371 (10.8%)
hospital             (12%)
District             44,635           48,763 (72.8%)     49,581 (70.9%)       68,052 (87.5%)
hospitals            (71.4%)
Other                10,429           10,429 (15.5%)     12,518 (17.9%)       1,375 (1.8%)
hospitals            (16.6%)
TOTAL                62,600           67,009             69,931               77,798

RESULTING ADMISSION RATES, 2002 - 2005
Year                             Admission Rate Per 1,000 population
2002                             32.8
2003                             34.3
2004                             34.9
2005                             37.9



                               trend in admissions, 2000 - 2005

                90,000
                                                                                           77,798
                80,000
                                        65,211                       67,009
                70,000       64,735                   62,531                     69,931
                60,000
   admissions




                50,000
                40,000
                30,000
                20,000
                10,000
                    0
                             2000       2001          2002          2003      2004        2005
                                                             year




                                                                                                    72
During the period 2002 – 2005, the year 2005 registered the highest admission rate of 37.9 per
1,000.
Admission rate showed a gradual increase since year 2003 but a decrease in 2002 over 2001.
During the year under review admission rate increased by 3 per 1,000 over 2004 as compared to
an increase of 0.6 in 2004 over 2003



                           trend in hospital reported deaths, 2000 - 2005

                   4,500
                   4,000                               4,085
                                                                                    3,831
                   3,500                    3,369                                             3,173
                                 3,252
                                                                       3,063
   no. of deaths




                   3,000
                   2,500
                   2,000
                   1,500
                   1,000
                    500
                      0
                              2000       2001       2002          2003          2004        2005
                                                           year



During the year under review there was an increase in hospital admissions but a decrease in
reported deaths. The increase in hospital admissions was 11.3% as compared to a decrease of
17.2% of reported deaths during the same period (2005).


BEDSTATE STATISTICS
Over the years, government health institutions contributed the highest bed turnover. The
reviewed year showed a decrease of seven (7) over that of 2004
BEDSTATE STATISTICS
OWNERSHIP % Bed Occupancy                                         Bed Turnover
           2002   2003   2004                         2005        2002    2003         2004      2005
Regional   56.2   62.8   45.6                         51.9        53      47           34        36
Hospital
Government 59.7   64.7   61.6                         54.8        73           85      82        76
Hospitals
Mission    62.7   56.3   57.7                         59.5        42           39      44        41
hospitals



                                                                                                        73
The Regional hospital registered an increase of 6.3% in bed utilization during the year under
review over 2004 whilst the mission hospitals showed a slight increase of 1.8% during the same
period. Government hospitals registered a decrease of 6.8% of bed utilization
Bed Turnover measures the number of patients that used “a bed” in a ward for a period.
On the other hand percentage occupancy measures Bed Utilization in the Ward/Hospital for a
period


DISEASE PROFILE
TOP TEN CAUSES OF OUTPATIENT ATTENDANCE
Malaria continues to be the number one cause of OPD attendance, contributing 50.5% (605,488)
of all causes of OPD attendance during the period under review compared to 47.8% (534,560)
during the same period in 2004


The top eight diseases, which showed up in 2004 also emerged in the same period in 2005,
though the ranking was not the same. Diarrhoea took the fifth position while Intestinal Worms
took the sixth position contributing 32,293 and 32,166 respectively.


The top ten causes of OPD attendance accounted for 77% in 2005 as compared to 75.1% in 2004




Hypertension and Anaemia which have not been showing up among the top ten Outpatient
conditions during the previous years took the ninth and tenth positions respectively.


                                                                                                74
Hypertension contributed 1.9% (22,783) and Anaemia 1.4% (17,351) during the year under
review.
TOP TEN CAUSES OF OUTPATIENT ATTENDANCE 2004 AND 2005 COMPARED

                             NO. OF      % OF                                 NO. OF      % OF
 No.   DISEASE FOR 2004      CASES       TOTAL    No.   DISEASE FOR 2005      CASES       TOTAL

   1   MALARIA                534,560      47.8     1   Malaria                605,488         50.5

       UPPER RESP.                                      Upper Resp. Tract
   2   TRACT IFN                73,777      6.6     2   Inf. (URTI)              76,615         6.4

       DISEASES OF SKIN                                 Skin diseases &
   3   & ULCERS                 46,305      4.1     3   ulcers                   46,421         3.9
                                                        Home / Occupational
   4   ACCIDENTS                35,616      3.2     4   Accidents                32,755         2.7
       INTESTINAL
   5   WORMS                    29,844      2.7     5   Diarrhoea Diseases       32,293         2.7

       DIARRHOEAL
   6   DISEASES                 26,828      2.4     6   Intestinal Worms         32,166         2.7
       GASTRO
   7   ENTERITIS                25,809      2.3     7   Acute Eye Infection      31,608         2.6
       ACUTE EYE                                        Rheumatism & Joint
   8   INFECTION                24,191      2.2     8   pains                    25,628         2.1

       PREGNANCY&
   9   REL. COMPL.              22,191      2.0     9   Hypertension             22,783         1.9

       RHEUMATISM
 10    &JOINT PAINS             20,567      1.8    10   Anaemia                  17,351         1.4

       TEN TOP TOTAL          839,688      75.1         TEN TOP TOTAL          923,108         77.0
       OTHER                                            OTHER
       CONDITIONS             277,989      24.9         CONDITIONS             276,137         23.0
       TOTAL NEW                                        TOTAL NEW
       CASES                 1,117,677    100.0         CASES                 1,199,245    100.0



CAUSES OF HOSPITAL ADMISSION
The top ten causes of all admissions accounted for 63.8% (51,463) during the period under
review as compared to 62.2% (46,358) in 2004
Malaria contribution was 27.2% (20,685) in 2005 and 20.6% (15,366) in 2004.
Malaria accounted for 12.6% (425) of all deaths in 2005 as compared to 7.3% (273) in
2004 with case fatality of 20.5 per 1,000 in 2005 and 17.8 per 1,000 in 2004. Malaria was the
first cause of death during the year under review as compared to its third position in 2004.
AIDS was the fourth cause of death in 2005 while in the year 2004 it was the second cause of
death contributing 226 (6.7%) and 292 (7.8%) respectively.



                                                                                                      75
           TOP TEN CAUSES OF HOSPITAL ADMISSIONS,
                         2005, BAR

                                                              Malaria
                   OTHER                                      27.2%
                 conditions
                   33.8%
   Gastroenteritis
       (GIT)
       1.5%
   Typhoid fever                                                        Deliveries
       1.8%                                                              14.3%
        URTI
        1.8%
                                                                        Anaemia
        Abortion                                                         10.2%
         1.9% Hypertension                      Inguino scrotal
                    2.3%         Pneumonia            dis.
                                   2.5%              2.7%


Top ten causes of Hospital Admission 2004 and 2005 compared

                                                                          CASES
CASES FOR 2004                                                            FOR 2005

                                                                          CAUSES
                                       % OF           CAUSES OF           OF              % OF
CAUSES OF ADMISSION           TOTAL    TOTAL    No.   ADMISSION           ADMISSION       TOTAL
MALARIA                       15,366     20.6     1   Malaria                 20,685        27.2
DELIVERIES                    12,680     17.0     2   Deliveries              10,896        14.3
ANAEMIA                        6,594      8.9     3   Anaemia                  7,734        10.2
                                                      Inguino scrotal
INGUINO SCROTAL DIS.           2,349      3.2    4    dis.                        2,093      2.7
PNEUMONIA                      1,804      2.4    5    Pneumonia                   1,901      2.5
GASTROENTERITIS(GIT)           1,760      2.4    6    Hypertension                1,736      2.3
TYPHOID FEVER                  1,715      2.3    7    Abortion                    1,450      1.9
URTI                           1,428      1.9    8    URTI                        1,397      1.8
ABORTION                       1,427      1.9    9    Typhoid fever               1,396      1.8
                                                      Gastroenteritis
HYPERTENSION                   1,235      1.7   10    (GIT)                       1,148      1.5
                                                      TOTAL TOP
TOTAL TEN TOP                 46,358     62.2         TEN                       50,436      66.2
                                                      OTHER
ALL OTHERS                    28,122     37.8         CAUSES                    25,733      33.8
TOTAL                         74,480    100.0         Total                     76,169     100.0




                                                                                                   76
             TOPT TEN CAUSES OF HOSPITAL REPORTED
                         DEATHS, 2005

                                               MALARIA
                                                12.6%
       ALL OTHERS                                         ANAEMIA
         42.8%                                             8.6%

                                                      SEPTICAEMIA
                                                         6.7%


                                                      AIDS
                                                      6.7%
        HYPERTENSION
            2.6%                                   PNEUMONIA
            RENAL FAILURE                             5.8%
                                               CVA
                 2.7%       CARDIAC HEPATITIS
                                              4.8%
                            FAILURE   4.1%
                              2.7%



Case fatality rate for anemia was 37.6 per 1,000 admitted cases during the period under review
compared to 59.1 per 1,000 admitted cases during the same period in year 2004.
Anaemia which showed up as the second cause of death contributed 8.7% (291) as compared to
its third position in 2004, contributing 9.6% (7,734)
Hypertension showed up both among the top ten causes of admission and death during the
review year.

TOP TEN CAUSES OF HOSPITAL REPORTED DEATHS 2004 AND 2005 COMPARED


                                       % OF                                          % OF
 No.   DISEASE 2004          TOTAL     TOTAL      No.      DISEASE 2005    TOTAL     TOTAL
   1   ANAEMIA                   390       10.4       1    MALARIA            425       12.6
   2   AIDS                      292        7.8       2    ANAEMIA            291        8.6
   3   MALARIA                   273        7.3       3    SEPTICAEMIA        228        6.7
   4   CVA                       209        5.6       4    AIDS               226        6.7
   5   SEPTICAEMIA               202        5.4       5    PNEUMONIA          195        5.8
   6   PNEUMONIA                 187        5.0       6    CVA                164        4.8
   7   SEPSIS                    143        3.8       7    HEPATITIS          138        4.1
       CEREBRAL                                            CARDIAC
   8   MALARIA                   131        3.5       8    FAILURE             91        2.7
   9   HEPATITIS                 128        3.4       9    RENAL FAILURE       90        2.7
 10    MENINGITIS                108        2.9      10    HYPERTENSION        88        2.6
       TEN TOP TOTAL           2,063       55.1            TEN TOP TOTAL     1,936      57.2
       ALL OTHERS              1,683       44.9            ALL OTHERS        1,448      42.8
       TOTAL                   3,746      100.0            TOTAL             3,384     100.0



                                                                                                 77
CASE MORTALITY RATES PER 1,000:

Indicator                                       Year
                              2002      2003       2004         2005
Infant mortality rate per     13.4      12         12.6         10.7
1,000 live births
Under five mortality rate     3.6       3.0        2.2          1.9
per 1,000 live births
Under five malaria case       30.5      25.8       19.9         18.1
fatality rate per 1,000
cases


During the review year Infant mortality rate decreased by 1.9 over the year 2004.
Under five mortality rate as well as under five malaria case fatality rates have been decreasing
over the three year period.

THE CLINICAL CARE UNIT

The clinical care unit is primarily responsible for clinical care services in the region.
It is to ensure effective services, good quality of care and maximum utilization of services within
health institutions in the region
The key functions of the clinical care unit are:

    •   Develop clinical, operational guidelines and protocols for health institutions
    •   Monitoring and supervision of health institutions
    •   Monitor service and performance standards, quality and utilization
    •   Collaborate with PHD in planning and working towards coordinated and improved
        standard of promotive, preventive, curative and rehabilitative care between the curative
        and preventive services
    •   Provide technical and management skills and support to the District Health Directorate to
        manage and supervise service delivery in health care institutions


During the year under review the following activities were undertaken:
    •   COPE (Client Oriented Provider Efficiency services) training for three districts:
        Berekum, Sunyani and Jaman
    •   Technical support visits on infection prevention in Sunyani district
    •   Rational Drug use monitoring


                                                                                                   78
   •   Drug samples sent to Food & Drugs Board for analysis
   •   Disposal of expired drugs
   •   Formation of drugs & therapeutic committee at the Regional Hospital
   •   Development of SOP (Standard Operating Procedures) for pharmaceutical services.
   •   Quality Assurance teams were formed in the regional hospital as well as the other
       hospitals (except the Ahmadiyya hospital, Techiman) as far back as the year 2000. The
       proportion (%) of hospitals in the region with a functioning QA team is 15%.
   •   Systems for managing patients complaints; The regional hospital, Bechem Government
       hospital and the Presbyterian Hospital, Dormaa Ahenkro have complaints and
       information desk which deals with complaints from clients and also gives information as
       required. The rest of the hospitals have suggestion box in place.
   •   Quality Assurance Trainings
   -   A 4 day training/retraining was done for a total number of twenty-five (25) staff from
       seven (7) district hospitals.
   •   Client surveys carried out
   -   Surveys carried out in Bechem Government Hospital and Dormaa Presby Hospital.
   •   Compliance with the use of partograph in Labour;
   - Midwives in almost all the health facilities in the Region use partograph to monitor labour
   •   Infection Prevention and control
   -   A total number of 160 staff of all categories from the Jaman North District and the
       Regional Hospital were trained in Infection Prevention and Control practices. The areas
       which have been improved include;
   -    Hand washing
   -   Provision of veronica buckets
   -   Provision of hand towels
   -   Better ways of disposing of waste (Burning & burying.
   -   Using the appropriate gloves at the appropriate times
   -   Proper processing of instruments
Engender Health has been supporting the training of the staff in this region in Infection
Prevention and Control since 2000.


ACTIVITIES CARRIED OUT IN 2005


   -   2005 Drugs procurement plan drawn and operationalized.


                                                                                                79
   -   600 copies each of EDL (EML) 2004, and STG 2004 obtained from the GNDP in Accra
       and distributed.
   -   Official Regional Launch of the National Drug Policy carried out in February 2005.
   -   Survey on Rational Use of Medicines (RUM) carried out
   -   Monitoring visit to some facilities in Tano, Asutifi and Asunafo carried out.
   -   Four stock taking exercises were carried out.
Specialist services       No. Of        No. Of cases      No. Of visits   No. Of cases
                          visits 2004   seen 2004         2005            seen 2005
From Region to
district
Obs/Gynae                 10            925               12              1,459
Surgery (Berekum)         -             -                 12              OPD - 333
                                                                          Operations -
                                                                          68
Surgery (Kintampo)        -             -                 3               OPD – 45
                                                                          Operations -
                                                                          3
Surgery (Sampa)           -             -                 6               OPD – 45
                                                                          Operations –
                                                                          52
Surgery (Dormaa)          -             -                 4               OPD – 19
                                                                          Operations -
                                                                          5
Eye Care                  52            10,687            24              Operations -
                                                                          460
Dental Care
Dormaa                    -             -                 3               60
Sampa                                                     1               25
Nsoatre                                                   1               36
Outside region to
Regional Hospital
*Orthopedic (within       27            954                               985
region)
Urology                   4             22                2               12
Dermatology               12            849                               775
TOTAL                     117           13,538                            4,411




                                                                                            80
COMMENTS ON SPECIALIST OUTREACH SERVICE


UROLOGY:
Four urologists from Korlebu Teaching Hospital, who were returning from Sunyani after an
outreach service at the Regional Hospital, were involved in a Road Traffic Accident on the
Apedwa – Accra road on 27th August 2005.
Three of the Urologists died on the spot. They are:
   •   Emeritus Professor John Kwateiboi Marmon Quartey, 1922 – 2005
   •   Dr. Isaac Kofi Bentsi, 1941 – 2005
   •   Dr. Benjamin Osei-Wiafe, 1970 - 2005


With the tragic death of the three Urologists, the Director General of Ghana Health Service is
working towards getting another urological team for the region.


Obstetric /Gynaecology Dormaa
The majority of cases seen have been with infertility.
In 2003 – 6 clients achieved pregnancy
  2004 – 5 clients achieved pregnancy
  2005 – 18 clients achieved pregnancy
A total of 29 pregnancies as a result of the outreach in Dormaa since year 2003
Neurosurgeon is now stationed in the Regional Hospital since February 2005


QUALITY ASSURANCE
At a mortality meeting of the Regional Hospital, there was a report of inadequate surgical skills
of young doctors in some district hospitals.
The head of the RCC Division reacted by writing to the Regional Director of Health services and
had consultations with the Heads of Departments of surgery and Obgyn as well as Director,
Diocesan Health services of the Sunyani Diocese.
As a result – 2 young doctors came for attachment at the 2 surgical departments (OBgyn and
Surgery) 1 month at a time since October 2005.




                                                                                                 81
WAY FORWARD:


  o   Increase of membership of Regional Clinical care Division.
  o   Motivation of Specialists to undertake outreach services.
  o   Formation and Training of QA Team at all levels of Services Delivery.
  o   Extension of specialist outreach services in Obgyn to Techiman and Duayaw Nkwanta as
      well as Surgery to Goaso.
  o   Re-activate Rational Use of Medicine activities




                                                                                        82
OFFICE OF THE REGIONAL DIRECTOR OF HEALTH SERVICES


15.    INSERVICE TRAINING


The Vision of the Regional Training Unit is to provide quality driven, result oriented, client
focussed and affordable Health Services through In-Service Training.


The Mission is to equip staff with the requisite knowledge and skills to deliver quality health
services in a humane, effective and efficient manner.


TARGET SET FOR THE YEAR 2005
1.     To train 1/3 of health workers in the Region
2.     To organize at least 20 training sessions at the Regional level
3      Conduct at least one technical support visit to each district and hospitals
4.     Conduct one training programme for IST Coordinators in the Region
5.     To collect and collate all training reports in the region


ACTIVITIES


       Developed Annual ISTPlan For Implementation
       Conducted Training Needs Assessment
       Organized 21 Training Sessions At Regional Level
       Maintained Training Information System
       Supported IST In The Region


TRAINING SESSIONS CARRIED OUT:
During the review year 89 Training sessions were carried out as follows:
Structured             27
Remedial               62




                                                                                                  83
TOPICS TREATED
TRAINING OF TRAINERS
     Health Insurance
     New Anti Malaria Drug Case Management Policy.


  OTHER TRAINING SESSIONS:
  Infection Prevention
  Voucher Scheme on Malaria Control
  Tb Management
  VCT/ PMTC
  Vaccine Wastage & Management
  IMCI for Prescribers
  IMCI for Community Child Growth
  Promoters
  Standards of Pharmaceutical Care/SOP
  Syndromic Management of STI
  Femoral Tapping Skills
  Facilitative Supervision
  Planned Preventive Maintenance
  Management of Anaemia
  Orientation of New Entrants/ Inductions
  Staff Performance Appraisal
  Data Management
  Legal & Ethical Issues in Nursing
  Life Style Diseases
  Proper Taking of Samples for Lab. Investigation
  Adolescent Reproductive Health
  Filariasis Elimination
  Environmental Sanitation
  New Public Sector Law & Disciplinary Code for GHS
  Quality Assurance




                                                      84
NUMBER OF STAFF BY DISTRICT COMPARED TO NUMBER TRAINED BY
REGION


Region/ District      Total number of staff   Number Trained        % Trained
RHD/Reg hosp          570                     211                           37.0
ASUNAFO               174                     86                            49.4

ASUTIFI               188                     72                            38.3
ATEBUBU               265                     106                           40.0
BEREKUM               347                     46                            13.3

DORMAA                325                     138                           42.5

JAMAN                 261                     154                           59.0
KINTAMPO               171                    26                            15.2

NKORANZA              186                     72                            38.7

SENE                  52                      49                            94.2

SUNYANI               116                     103                           88.8

TANO                  335                     142                           42.4

TECHIMAN              300                     102                           34.0

WENCHI                219                     97                            44.3

TOTAL                 3266                    1076                          32.9



Total number of staff who received In-Service Training were 1076 during the review year

NO     STAFF CATEGORY             TOTAL       NO TRAINED            RATE (%)
                                  NUMBER
                                  OF
                                  STAFF
1      DOCTORS                    89          32                    36%
2      NURSES                     778         333                   43%
3      PHNs                       32          30                    94%
4      MIDWIVES                   143         138                   97%
5      MAs                        47          51                    104%
6      PHARMACISTS                12          11                    92%
7      ADMINISTRATOR              173         41                    24%
8      TOs                        491         208                   42%
9      CHOs                       0           2                     0%
10     OTHERS                     1533        230                   15%
11     TOTAL                      3266        1076                  33%




                                                                                          85
FREQUENCY OF IST BY DISTRICT

NO     REG/DIST                FREQUENCY
1      RHA/REG. HOSP           21
2      ASUNAFO                 9
3      ASUTIFI                 5
4      ATEBUBU                 6
5      BEREKUM                 4
6      DORMAA                  7
7      JAMAN                   14
8      NKORANZA                8
9      SENE                    6
10     SUNYANI                 12
11     TANO                    8
12     TECHIMAN                6
13     WENCHI                  6
14     TOTAL                   99


CLASSIFICATION OF IN-SERVICE TRAINING COURSE (TYPES)
2002 – 2005

PERIOD            STRUCTURED    %            REMEDIAL   %
2002              23            32.9%        47         67.1%
2003              4             4%           100        96%
2004              12            18.8%        52         81.2%
2005              27            30%          62         70%

Broad Areas Covered During The Review Year

Total number of
sessions

                  TYPES NUMBER AND PERCENTAGE
YEAR     SESS     PUBLIC
                  HEALTH    CLINICAL   MANAGEMENT
2002     70       35  50%   13   18.6% 22     31.4%
2003     104      57  55%   15   14%   32     31%
2004     64       50  78.1% 4    6.3% 10      15.6%
2005     89       51  57.3% 26   29.25 12     13.5%




                                                                86
EXPENDITURE ON IST
2002                           ¢560,669,870
2003                           ¢247,753,700
2004                           ¢762,924,348
2005                         ¢1,598,872,077


During the review year Two Staff benefited for Long courses and four for short courses

NEW PRIORITIES FOR 2006

1.     To conduct at least one Training and a Review meeting for IST Coordinators

2.     To sensitize BMC Heads to buy into Regional Programmes.

3.     Support Training Management in CHAG Institutions.

4.     Support Post Training Assessment.




                                                                                         87
16.       FINANCE DEPARTMENT

ACTIVITIES:


      •   TECHNICAL SUPPORT VISITS
      •   TRAINING
      •   SUBMISSION OF FINANCIAL RETURNS
      •   VALIDATION OF FINANCIAL RETURNS
      •   INFLOW OF FUNDS
      •   DISBURSEMENTS
      •   CONSTRAINTS
      •   WAY FORWARD

TECHNICAL SUPPORT VISITS: -

A technical team made up of the Regional Accountant and the two (2) Regional monitors were
able to embark on technical support visits to 12 out of the 19 Districts.
The team tried to visit one hospital, the DHD and at least 2 Health facilities in each District
visited. The team advised management on more technical issues bothering on the books of
accounts and internal control measures.

TRAINING: -

There were plans to organize refresher training on good financial management practices for
BMC heads and Accountants and also one on ATF rules implementation for the Accountants and
some selected support staff.
These could not come on due to financial constraints. However, the technical support visits made
to some facilities gave an opportunity to offer on the job training to some of the incharges
especially at the Health Centres.

SUBMISSION OF FINANCIAL RETURNS: -
Late submission of financial returns continued to be a major problem during the review year. The
region insists on all BMCs to submit timely returns.
Failure to submit financial returns on time has its own implications and could attract some
sanctions, e.g. Reverting Managing BMCs to BMCs of Record.




                                                                                                  88
VALIDATION OF FINANCIAL RETURNS: -

National Validation for the year 2004 accounts could not come on due to some problems.
The Regional Validation for the first three quarters for 2005 came on in Sunyani successfully at
the appropriate periods. This facilitated the submission of the consolidated regional report to
headquarters in time.
The Validation for the 4th Quarter returns has been scheduled to take place in Sunyani from
16th – 20th January 2005.

INFLOW OF FUNDS:

DPF: -
Transfers of funds were just on time. By the 1st week of July 2005, transfers of the 3rd and 4th
quarters’ allocation had been received.
A total transfer of ¢26,241,089,319 was received for year 2005 out of which 16,328,910,238 was
for financing recurrent expenditure.
The table below shows the distribution for the last three (3) years.
  DISTRICT/BMC                   2003                  2004                    2005
RHD                           2,097,215,000           4,245,736,616           1,870,119,497
RHD (PROJECTS)                                                                9,912,179,081
ASUNAFO NORTH                   436,167,223           1,086,870,000           1,097,432,014
ASUNAFO SOUTH                                                                   422,324,451
ASUTIFI                         160,725,809             361,320,000             349,515,684
ATEBUBU                         403,631,553           1,125,230,000           1,091,830,195
AMANTEN
PRU                                                                            512,344,204
BEREKUM                         145,509,106             350,030,000            339,533,006
DORMAA                          186,984,203             434,718,000            421,678,089
JAMAN NORTH                                                                    966,457,489
JAMAN SOUTH                     380,756,603             998,860,000            432,630,767
KINTAMPO NORTH                  401,131,944           1,074,420,000          1,091,477,114
KINTAMPO SOUTH                                                                 467,441,869
NKORANZA                        165,946,835             496,820,000            388,820,056
SENE                            187,722,956             400,842,000          1,093,277,861
SUNYANI                         987,652,526           1,027,086,000          3,181,350,638
TANO NORTH                                                                     387,667,786
TANO SOUTH                      393,085,280           1,024,432,000            938,939,005
TECHIMAN                        166,367,565             389,552,000            410,725,412
WENCHI                          425,199,796             457,298,000            442,923,251
TAIN                                                                           442,421,850
TOTAL                         6,539,096,399          13,473,214,616         26,241,089,319




                                                                                                   89
GOG / SERVICE


Release of funds has not been very regular and reliable. Whilst the release for the 1st Quarter
allocation was received on 21st January 2005, the releases for the 2nd and 3rd quarters were
received on 31st October 2005 and 9th December 2005 respectively.
The 4th Quarter 2005 allocation had not been received as at 31st December 2005. This same
problem was experienced for the year ending 2004.
On the whole, a total amount of ¢2,460,515,000 was transferred into the region to support
regional and district programs for the year 2005.
The table below shows the comparative releases for the past three (3) years.

  DISTRICT/BMC                   2003                  2004                    2005
RHD                             368,555,522            334,063,000             282,755,000
RHD (PROJECTS)
ASUNAFO NORTH                   177,346,916            223,033,000             150,161,000
ASUNAFO SOUTH                                                                   75,692,000
ASUTIFI                          59,075,990             74,149,000              56,992,000
ATEBUBU                         113,992,358            230,905,000             155,462,000
AMANTEN
PRU                                                                             47,130,000
BEREKUM                          53,093,064              71,829,000             55,210,000
DORMAA                           63,700,053              89,209,000             68,569,000
JAMAN NORTH                                                                    168,334,000
JAMAN SOUTH                     121,283,429            207,290,000              41,576,000
KINTAMPO NORTH                  121,963,613            230,905,000             187,513,000
KINTAMPO SOUTH                                                                  46,314,000
NKORANZA                         45,084,359             82,257,000              63,224,000
SENE                             61,820,360             95,002,000             134,613,000
SUNYANI                         297,432,995            587,444,000             554,587,000
TANO NORTH                                                                      28,702,000
TANO SOUTH                      127,963,258            198,636,000             161,908,000
TECHIMAN                         54,380,709             86,891,000              66,786,000
WENCHI                           55,094,431             93,843,000              72,130,000
TAIN                                                                            42,589,000
TOTAL                         1,720,787,057          2,605,456,000           2,460,515,000




                                                                                                  90
GOG (ADMIN): -
Parent warrants for the various quarters were not received on time from headquarters. This
seriously affects the timely assessing of GOG-ADMIN. Funds, since a lot of processes also has
to be followed before Expenditure Authorization (EA) could be obtained.

QUARTER                       DATE PARENT                    DATE APPLICATION
                              WARRANT WAS                    FOR EA SIGNED
                              RECEIVED
1                             14/04/05                       06/05/05
2                             18/07/05                       22/08/05
3                             21/10/05                       16/11/05
4                             13/12/05                       20/12/05

Administratively, this had its own implications and effects on BMCs operations for the year
2005.
Approval for Expenditure Authorization (EA) from Treasury Headquarters became a problem for
some facilities. The RHD was hardly hit because EA for both the third and fourth Quarters could
not be obtained. Whereas for the other BMCs EA for the 4th Quarter could not be obtained
because it was alleged the funds allocated to the entire MOH had been exhausted.
Because of this problem, a total amount of ¢1,318,894,631 out of¢3,833,433,889 could not be
assessed and utilized. Table below shows inflows for the past 3 years.




                                                                                              91
  DISTRICT/BMC     2003           2004            2005
RHD               318,804,306     386,739,239     379,332,708
RHD (PROJECTS)
ASUNAFO NORTH     130,833,961     167,961,841     263,334,768
ASUNAFO SOUTH                                      82,508,525
ASUTIFI            38,806,382      61,681,977     159,792,861
ATEBUBU           122,873,753     167,081,580     263,946,671
AMANTEN
PRU                                                 78,087,214
BEREKUM            37,513,151      58,620,162      182,317,055
DORMAA             45,508,632      71,892,515      132,163,137
JAMAN NORTH                                        234,429,438
JAMAN SOUTH       142,572,054     154,645,376      178,612,338
KINTAMPO NORTH    142,997,205     171,092,478      288,719,099
KINTAMPO SOUTH                                     124,196,889
NKORANZA           53,644,383      66,344,792      111,095,407
SENE               53,194,804      73,498,515      107,382,043
SUNYANI           338,692,167     186,771,422      529,133,452
TANO NORTH                                          87,562,024
TANO SOUTH        142,623,928     157,427,353      287,708,087
TECHIMAN           42,403,249      70,041,486      135,454,234
WENCHI             47,548,084      75,596,209      129,570,725
TAIN                                                78,087,214
TOTAL            1,658,016,059   1,869,332,945   3,833,433,889




                                                                 92
ADHA: -

As at 1st January 2005, ADHA payment was in 3 months arrears.
By 31st December 2005, a total amount of ¢56,124,840,150 had been transferred and disbursed to
BMCs. This represents payment of 3months arrears for the year 2004 and ADHA from January
to September 2005. Arrears of three months ( i.e October – December 2005 ) was carried into
the year 2006.

        PERIOD                                AMOUNT
                                              TRANSFERRED
        OCTOBER 2004                                  3,202,650,000
        SEPT – OCT. TOP UP 2004                       2,328,000,000
        NOVEMBER/DECEMBER 2004                        6,405,300,000
        JANUARY/FEBRUARY 2005                         8,733,300,000
        NOV. /DEC. 2004 TOP UP                          232,000,000
        MARCH 2005                                    4,366,650,000
        APRIL 2005                                    4,366,650,000
        MAY 2005                                      4,366,650,000
        JUNE 2005                                     4,366,650,000
        JULY 2005                                     4,366,650,000
        APRIL 2005 TOP UP                               853,680,000
        AUGUST 2005                                   4,366,650,000
        MAY 2005 TOP UP                                 853,680,075
        SEPTEMBER 2005                                4,366,650,000
        JUNE 2005 TOP UP                                853,680,075
        TOTAL TRANFERS                               56,124,840,150




                                                                                              93
INTERNALLY GENERATED FUNDS (I G F):


For the year under review a total amount of 35,454,496,206.00 was generated through the
hospitals and sub-district activities.
The table below shows how IGF revenue has been generated for the past two years:

    DISTRICT/BMC                 2004                      2005
RHD
RHD (PROJECTS)
ASUNAFO NORTH                              2,454,456,388                 2,638,276,020
ASUNAFO SOUTH
ASUTIFI                                      789,676,400                 1,213,588,250
ATEBUBU AMANTEN                              616,441,650                   799,457,896
PRU
BEREKUM                                       92,253,678                   322,021,010
DORMAA                                       331,935,527                   431,297,986
JAMAN NORTH                                                              1,609,119,793
JAMAN SOUTH                                1,179,491,823                   809,314,872
KINTAMPO NORTH                             3,036,474,458                 3,681,300,608
KINTAMPO SOUTH                                                              96,709,500
NKORANZA                                     342,709,845                   941,815,468
SENE                                         229,549,541                   164,174,560
SUNYANI                                   13,630,380,298                18,876,722,529
TANO NORTH                                                                 455,498,000
TANO SOUTH                                 2,187,061,320                 2,340,541,882
TECHIMAN                                     300,996,407                   757,110,671
WENCHI                                       305,712,177                   317,547,161
TAIN
TOTAL                                     25,497,139,512                35,454,496,206




                                                                                          94
DISBURSEMENTS:


DONOR POOLED FUNDS (DPF): -


Out of the total amount of 26,241,089,319 received as inflows for the year under review, a total
amount of 28,520,815,467 was utilized. The excess expenditure of 2,589,323,719 over inflows
for recurrent items came as a result of balances brought forward at the beginning of the year.
Included is an amount of 9,602,581,510 paid to contractors executing development projects, and
an amount of 18,918,233,957 paid as recurrent expenses. As at the close of the year 2005 an
amount of 309, 597,571 out of the development projects inflows was still outstanding.
The table below represents the expenditure pattern for the past three years:

  DISTRICT/BMC                  2003                  2004                      2005
RHD                          2,731,461,155           4,373,172,616             2,358,391,556
RHD (PROJECTS)                                                                 9,602,581,510
ASUNAFO NORTH                  487,698,883             975,846,114             1,066,085,602
ASUNAFO SOUTH                                                                    455,829,978
ASUTIFI                        174,324,905             330,234,374               385,699,951
ATEBUBU                        444,450,685             961,243,349             1,124,923,917
AMANTEN
PRU                                                                           283,598,560
BEREKUM                        154,923,237             266,300,178            360,831,202
DORMAA                         208,551,364             408,313,210            462,984,386
JAMAN NORTH                                                                 1,043,033,170
JAMAN SOUTH                    327,035,410             919,920,625            470,923,715
KINTAMPO NORTH                 417,149,587           1,152,506,214          2,496,092,107
KINTAMPO SOUTH                                                                436,713,606
NKORANZA                       143,428,566             389,942,835            434,186,546
SENE                           217,351,151             393,791,653            571,440,196
SUNYANI                      1,076,898,551           2,213,785,062          4,265,951,847
TANO NORTH                                                                    719,405,365
TANO SOUTH                     408,107,050             808,579,999          1,074,207,782
TECHIMAN                       164,388,257             430,400,884            424,678,839
WENCHI                         225,632,257             466,729,190            471,130,095
TAIN                                                                           13,125,537
TOTAL                        7,181,401,058          14,090,766,303         28,520,815,467




                                                                                                 95
GOG SERVICE:


For the year under review a total amount of 2,914,704,097 was spent out of an amount of
2,460,517,000 released. This showed an excess of expenditure over income within the same year
of 454,187,097, which is as a result of balances brought forward by BMCs as at the beginning of
the year.
The table below shows the trend of expenditure for the past three years:

  DISTRICT/BMC                  2003                  2004                  2005
RHD                            331,610,500            147,157,595           368,513,812
RHD (PROJECTS)
ASUNAFO NORTH                  153,658,392            245,167,040           210,030,479
ASUNAFO SOUTH                                                                36,202,000
ASUTIFI                         57,422,494             80,661,768            77,302,200
ATEBUBU                        117,376,318            192,082,388           192,854,351
AMANTEN
PRU                                                                           10,433,000
BEREKUM                         23,721,416             67,770,092             70,267,150
DORMAA                          56,887,774             92,746,532             79,687,771
JAMAN NORTH                                                                  183,770,557
JAMAN SOUTH                    111,523,898            148,357,146             98,541,700
KINTAMPO NORTH                 124,749,098            212,019,667            344,612,288
KINTAMPO SOUTH                                                                31,422,000
NKORANZA                        51,827,744             42,081,813             84,643,573
SENE                            61,237,736             88,963,973             83,946,400
SUNYANI                        275,548,634            500,667,881            517,083,597
TANO NORTH                                                                   141,496,273
TANO SOUTH                     158,748,409            126,326,788            145,136,686
TECHIMAN                        82,735,892             42,503,865             94,432,715
WENCHI                          51,894,912             86,792,389            105,727,950
TAIN                                                                          38,599,595
TOTAL                        1,658,943,217          2,073,298,937          2,914,704,097




                                                                                             96
GOG ADMIN (2):


Out of a total warrant of 3,833,433,889 issued an amount of 2,514,539,258 was utilized. An
amount of 1,318,894,431 part of which is the third quarter allocation for the RHD and the total
fourth quarter warrant issued to all the health facilities in the region could not be assessed
because it was alleged the total amount allocated to MOH had exhausted.
The table below demonstrates the expenditure for GOG admin for the past three years:

  DISTRICT/BMC                   2003                   2004                    2005
RHD                             301,027,005             325,621,750             243,834,756
RHD (PROJECTS)
ASUNAFO NORTH                   122,227,005              173,873,421             187,794,568
ASUNAFO SOUTH                                                                     42,117,411
ASUTIFI                          38,724,937               54,315,973              90,977,318
ATEBUBU                         105,671,871               99,175,400             185,685,251
AMANTEN
PRU                                                                               37,696,100
BEREKUM                           35,278,986              44,880,000             113,501,512
DORMAA                            45,508,634              54,195,000              82,297,214
JAMAN NORTH                                                                      151,228,575
JAMAN SOUTH                     142,442,811               56,913,479             109,768,374
KINTAMPO NORTH                  140,006,769              108,144,000             199,119,264
KINTAMPO SOUTH                                                                    55,381,346
NKORANZA                         66,204,757               51,726,969              70,704,293
SENE                             50,447,940               40,693,152              66,990,929
SUNYANI                         332,592,167              148,620,566             434,517,495
TANO NORTH                                                                        37,696,100
TANO SOUTH                      142,573,301               81,808,899             202,239,540
TECHIMAN                         42,180,091               38,458,870              85,588,310
WENCHI                           47,544,500               49,689,926              79,704,802
TAIN                                                                              37,696,100
TOTAL                         1,612,431,269            1,328,117,405           2,514,539,258




                                                                                                  97
INTERNALLY GENERATED FUND (IGF):


Out of a total amount of 35,454,496,206 generated within the year under review, an amount of
30,578,704,940 was disbursed to run the various programmes.
The table below shows the expenditure pattern for IGF for the past two years:

    DISTRICT/BMC                           2004                           2005
RHD
RHD (PROJECTS)
ASUNAFO NORTH                                2,069,586,669                  2,642,166,266
ASUNAFO SOUTH
ASUTIFI                                        575,314,694                  1,028,789,045
ATEBUBU AMANTEN                                757,030,150                    611,631,799
PRU
BEREKUM                                         72,967,015                    148,336,047
DORMAA                                         212,210,045                    378,156,343
JAMAN NORTH                                                                 1,435,389,711
JAMAN SOUTH                                    980,597,149                    561,559,497
KINTAMPO NORTH                               3,017,288,116                  1,826,668,073
KINTAMPO SOUTH                                                                 53,319,996
NKORANZA                                       235,167,693                    585,034,287
SENE                                           205,136,641                    167,785,297
SUNYANI                                     12,414,989,329                 16,918,502,512
TANO NORTH                                                                    431,916,491
TANO SOUTH                                   1,864,514,289                  2,529,275,565
TECHIMAN                                       226,507,356                    635,243,681
WENCHI                                         225,767,322                    624,930,330
TAIN
TOTAL                                       22,857,076,468                 30,578,704,940

PAYMENTS FOR CONSTRUCTIONAL WORKS: -
Within the year under review a total amount of ¢9,912,179,081.00 was received from
headquarters for the payment of development projects executed in the region.


EXEMPTIONS: -
An amount of ¢1,509,950,000 and ¢2,344,000,000 were received for re-imbursement to facilities
for General and Delivery exemptions respectively.
Whilst that for payment of general exemptions was transferred to the RHD for disbursement to
facilities, that for the payment of delivery exemptions was paid directly to the districts who made
disbursement to facilities under them.




                                                                                                98
NID:
A total amount of ¢3,932,292,956 was received from headquarters to finance NID activities for
the year.

OTHER PROGRAMME FUNDS: -
A total amount of ¢2,766,087,321 was also received for the running of other programme
activities in the region for the year under review.


CONSTRAINTS
   1. Late submission of all financial returns (including ADHA / NID / Programme Activities,
       e.t.c)
   2. Difficulty and the cumbersome nature in assessing GOG (Admin) funds.
   3. Late retirement of accountable imprest still exist.
   4. Inaccuracies in financial reports
            -   IGF reporting still a problem
   5. Late release of funds from headquarters – GOG Service.
   6. Non utilization of Regional Monitoring team by the BMCs
   7. Inadequate supervision of sub-district accounts records by District Accountants.


WAY FORWARD:-
   1. Timely submission of financial returns to be enforced
   2. Intensify supervision of sub-district accounts records
   3. Refresher training on ATF rules implementation for support accounts personnel.
   4. Institute more sanctions on officers who fail to retire imprest on time.
   5. Orientate sub-district managers in revenue accounting and reporting.




                                                                                            99
17.    HEALTH ADMINISTRATION AND SUPPORT SERVICE (HASS)

MISSION STATEMENT:

To provide the necessary Administrative and Support Services to facilitate the Technical Service
Delivery in the region by ensuring:
       Timely supply of Inputs: Supplies and Logistics
       Efficient and effective use of available resources
       Adherence to and sustenance of interest in scheduled meetings



GENERAL ADMINISTRATION

During the year under review meetings planned and held were as follows:
Meetings:                    Planned/Held
RHMT                                  12/7
Reg. Health Committee                 4/4
Reg. Fin. & Audit C’tee                4/1
RHMT/DDHS                             4/4
ADHA                                  12/16
Procurement Committee
Weekly Unit Heads                     52/48
RHMT/CHAG                             4/4
Staff Durbar                          4/2


Supervisory Visits
Regional Supervisory                  13/5
HASS Facilitative                      13/0




                                                                                             100
16.1 ESTATE MANAGEMENT
STATE OF INFRASTRUCTURE AGAINST BUILDING PLAN
The Region has 68 numbers of projects in its investment plan for (2006-2008)
Number per facility
       1.     Hospitals                               13
       2.     Health Centres                          25
       3.     Rural Clinics                           25
       4.     CHPS                                        8


WORKDONE


       (29) Twenty-nine projects are on-going
       14 of these projects have been completed and interim handing over done
       5 five projects have also been handed over to the contractors.
       5 of the projects are at the sub-structure stage
       5 of the projects are at the super structure


WAY FORWARD


       1.     To procure consultancy and contractors for 2006 projects
       2.     Complete facility survey exercises
       3.     Organise contract management training for medical superintendents, District
              Directors and planning officers at District Assembly
       4.     Complete fixed Assets and Contract Register




                                                                                            101
16.2 TRANSPORT POSITION IN THE REGION
General position with statistics on serviceable and non-serviceable
TREND OF REGIONAL TRASPORT POSITION 2003 – 2005
TYPE             2003             2004           2005
VEHICLE          95               95             97
MOTORBIKE        137              168            233
BICYCLE          317              333            349
BOAT             3                3              3

FLEET INVENTORY BY AGE BLOCK (VEHICLE/MOTORBIKE)
FOUR WHEEL          No.    %                     MOTORBIKE AGE        No    %
AGE
1 – 5 years         50     51.5                  1 – 3 years          88    37.8
6 – 9 years         15     15.5                  4 – 5 years           0     0
 >10 years          32     33                    > 6 years            145   62.2
TOTAL               97     100                   TOTAL                233   100


PROPORTION OF SERVICEABLE AND UNSERVICEABLE
VEHICLES/MOTORBIKES
FOUR WHEEL          No       %                   MOTORBIKE            No    %
Serviceable         73       75                  Serviceable          154   66
Unserviceable       24       24.7                Unserviceable        79    34
TOTAL               97       100                 TOTAL                233   100




                                                                                   102
DISTRIBUTION OF MOTORBIKES BY BUDGET AND MANAGEMENT CENTER
(BMC)
DISTRICTS/INSTITUTIONS              SERVICEABLE           UNSERVICEABLE             TOTAL
RHD                                 5                     1                         6
REG. MED. STORES                    1                     -                         1
REG. HOSP.                          4                     -                         4
KINTAMPO HOSP.                      1                     -                         1
SAMPA HOSP.                         2                     -                         2
ASUNAFO SOUTH DIST.                 14                    4                         18
ASUTIFI DIST.                       8                     5                         13
ATEBUBU DIST.                       11                    12                        23
BEREKUM DIST.                       8                     3                         11
DORMAA DIST.                        10                    5                         15
JAMAN SOUTH DIST.                   5                     8                         13
KINTAMPO SOUTH DIST.                15                    2                         17
NKORANZA DIST.                      6                     8                         14
SENE DIST.                          10                    10                        20
SUNYANI                             9                     3                         12
TANO SOUTH                          7                     6                         13
TECHIMAN DIST.                      8                     7                         15
WENCHI                              10                    5                         15
PRU                                 3                                               3
TAIN                                4                                               4
KINTAMPO NORHT DIST.                3                                               3
TANO NORTH                          4                                               4
JAMAN NORTH                         3                                               3
ASUNAFO NORTH DIST.                 3                                               3
TOTAL                               154                   79                        233

DRIVER SITUATION
There are fifty four (54) drivers in the region which includes four casuals.
Driver vehicle ration in the region stands at 1:1.2, this is an indication that driver situation is
grossly inadequate.
During the review year the Region received an allocation of Two (2) four wheel vehicles, Sixty-
five (65) Motorbikes and Sixteen (16) bicycles.


INCEDENTS/ACCIDENTS
Three Motorbikes were stolen from the Regional Hospital, Sunyani, Jaman, and Nkoranza
District Health Directorates.
During the period Six Vehicles were involved in accident within the region which were recorded
from the Regional Health Administration, Jaman south and Atebubu District Health Directorate.
Necessary Administrative actions were duly taken.


                                                                                                      103
  AUCTION
  Twenty-four (24) vehicles and nineteen (19) motorbikes were valued and awaiting auction.

  16.3. EQUIPMENT SITUATION
  The Clinical Equipment Unit (CEU) carried out the following activities during the period under
  review:


  Planned Preventive Maintenance (PPM)
  The National Team supported the Regional Equipment Manager to visit all the District Hospitals
  in the region to carry out PPM


  SERVICE CALLS
  The Unit attended to four out of five service calls received:
Facility      No/
              Call      Equipment                                           Remarks
Bechem        2         Autoclave, Mortuary                                 Equipment Repaired

Goaso         2         Mortuary, Gem. Set, Operating Lamps, Suction        Equipment Repaired
                        Machine
Atebubu       1         Blood Bank Fridge                                   Equipment Repaired



  NEW EQUIPMENT INPUT

FACILITY                                ITEM                      SOURCE
Goaso Hospital                          Hospital Beds             Mother and Child Foundation
Kwame Danso Hospital                    Hospital Beds             Mother and Child Foundation
Atebubu Hospital                        Ultrasound Scanner        Assemblies of God Church, Atebubu

  JICA EQUIPMENT SURVEY
  The Unit visited all facilities that benefited from the supply of Primary Health Care equipment
  by JICA and ten others to
        (1)       Access the present state of those equipment.
        (2)       Evaluate the output on health care delivery to the communities and compare
               communities, which had none.


  SURVEY FINDINGS
        The major findings as a result of JICA equipment supply are as follows:


                                                                                                 104
         1. Release stress to the health care providers.
         2 Provided special care previously available only to some district hospitals (Fetal
              Doppler).
         3.    Have low maintenance cost
         4. Improved Attendance
         5. Improved Quality of care


Users exhibited Inadequate maintenance, and Lack of ownership and care.


Challenges with the CEU
   (a)        Lack of tools for routine maintenance
   (b)        Weak vehicle for service calls
   (c)        Broken down of office computer


RECOMMEMDATIOMS
   To improve infection control in all health institutions, the CEU suggests the following:
              1. All health facilities are provided with autoclaves.
              2. Establish district CSSD, where districts and sub-districts could autoclave their
                 materials.
              3. The Regional Unit be equipped with access to Electronic mail facility.


WAY FORWARD
   (1)        Induct and orientate National Service Personnel
   (2)        Train Nurses & Staff Midwives on use of clinical equipment
   (3)        Update the Inventory of Equipment
   (4)        Decommission Unserviceable equipment and recommend its replacement




                                                                                                    105
16.4   HUMAN RESOURCE DEVELOPMENT

VISION: TO HAVE VALUED AND HIGHLY MOTIVATED WORK FORCE
PROVIDING GOOD QUALITY HEALTH CARE TO ALL PEOPLE LIVING IN THE
REGION.


MISSION: To recruit, deploy and retain optimum numbers of appropriately trained health
workers, distributed and motivated to deliver quality health care in areas that their services are
most needed.

CURRENT HUMAN RESOURCE POSITION

The staff strength of the region stands at 2,161 during the year under review as against 2,080 in
2004. However, the established norms require that the region should have 2,895 complement of
personnel implying that there is a gap (deficit) of 734 as depicted by the Staffing Norms table
below. The doctor population ratio was 1:25,358 whilst the nurse population ratio was 1:1,821


GHANA HEALTH SERVICE STAFFING NORMS 2004 AND 2005 CMPARED, BRONG
AHAFO REGION
                                             2004                               2005
                                REQ'D       NO. AT      SHORT REQ'D             NO.     SHORT
STAFF CATEGORY                  NORMS       POST        FALLS NORM              AT      FALLS
                                                              S                 POS
                                                                                T
MEDICAL OFFICERS                90          66          24          90          58       32
PRO/AUX NURSES                  820         720         91          820         794      26
PHARMACIST                      20          17          3           20          13        7
TECHNICAL                       200         121         79          200         132      68
OFFICERS/TECHNICIANS
HASS                            145         134         11          145         124      21
OTHERS                          1620        1013        607         1620        1040    580
TOTAL                           2895        2080        815         2895        2161    734




                                                                                                  106
HUMAN RESOURCE DEVELOPMENT STRATEGIES

  i)     Retention of Staff


         1.     BMC's continue to assist newly posted staff to secure accommodation
                especially in instances where government staff quarters are not available
         2.     Newly qualified SRNs are posted directly to the District Hospitals for their
                rotation. This will let them familiarize themselves with the environment
                thereby making it quite easy for them to willingly accept postings to those
                areas.
         3.     Continued sponsorship/support to SRN trainees and serving officers pursuing
                various post basic courses.
         4.     Involvement of the District Assemblies in the sponsorship of trainees.


  ii)    Equitable Distribution of Staff
         1.     Staff redistribution exercise has began in earnest and shall be continued to
                cover all staff that have stayed at their current position for at least five years
  iii)   Attainment of Requisite Staffing Levels
         1.     BMCs encouraged to identify their own needs and sponsor personnel to
                pursue courses relating to their needs at both basic and post basic levels
         2.     Housemanship training for newly qualified medical officers at the Regional
                Hospital, Holy Family Hospital, Techiman and Holy Family Hospital,
                Berekum has started. Currently, there are twenty house officers at those
                training sites. 12 have completed their 1st and 2nd rotations
         3.     Feasibility studies completed and report submitted in respect of the region’s
                readiness to commence the Nursing Assistants aka Enrolled Nurses training
                programme at St. Elizabeth’s Hospital, Hwidiem




                                                                                                107
            Efficient Human Resource Management
            4.      Staff motivation by way of distributing 36 GHS staff saloon cars under the
                    Hire purchase scheme equitably in the region
            5.      Orientation of DDHS and Medical Superintendents on Human Resource
                    Management
            6.      Streamlining promotion to cover all eligible staff in the region
            4       JICA has supported the HR Unit with a computer and its accessories as well
                    as shelves to help set up a modern personnel documentation centre for the
                    region

CHALLENGES
       1.        Poor staffing levels in the region with Sene, Atebubu/Amanten, Pru, Jaman North
                 and Tain districts as worse hit areas
       2.        Limited staff accommodation facilities
       3.        Inadequate staff to handle administrative and HR issues at all levels
       4.        Incomplete HR data base
       5.        Poor records management systems and structures
       6.        Inability to secure financial clearance for some newly appointed staff in the region
                 (Contract appointees, re-engaged staff, Health Aides, etc.)

WAY FORWARD
  1.        Pursue appointment of Senior Executive Officers to handle administrative and HR
            issues at all levels
  2.        Develop regional HR plan
  3.        Build a reliable HR database
  4.        Establish efficient records management systems & structures.




                                                                                                 108
17 HEALTH TRAINING INSTITUTIONS

17.1.   RURAL HEALTH TRAINING SCHOOL, KINTAMPO
The Ministry of Health established the Rural Health Training School (RHTS) in 1969 as a pre-service
training institution. Its mandate is to produce appropriate health human resource for the implementation of
the Basic Health Services (BHS), now Primary Health Care (PHC) to meet the essential health needs of the
people of Ghana.


The guiding principle as enshrined in the motto of the school is to produce human resource that would be
capable of providing health services, which is
                             Simple in operation;
                             Extensive in scope;
                             Economic in its cost;
                             Efficient in its quality.


The current six (6) categories of human resource trained by the school are
1. Medical Assistants (MA)
2. Technical Officer (Community health)
3. Technical Officer (Health Information Management)
4. Field Technician (Community Health)
5. Community Oral Health Officers (COHO)
6. Medical Laboratory Technician




                                                                                                        109
                 DISTRIBUTION OF STUDENT BY CLASS -2005


                          Programme                                          No
                          Medical Assistant (MA)                              47
                          Community Oral Health Officer (COHO)                9
                          Technical Officer 3rd Year (CH)                     61
                          Technical Officer 3rd Year (HI)                     35
                          Technical officer 2nd Year (CH)                     40
                          Technical officer 2nd Year (HI)                     21
                          Technical officer 1st Year (CH)                     70
                          Technical Officer 1st Year (HI)                     52
                          Technical Officer 1st Year (LAB)                    30
                          Field Technicians (CH) 2nd Year                     69
                          Field Technicians (CH) 1st Year                    100
                          Total                                              535


    PARTNERSHIP (INTERNAL AND EXTERNAL)
    The school enjoy partnership with bilateral and multi lateral agencies and the donor community such as
    Danida, DFID, WHO, UNICEF, GE etc.
    The school has also established links with the Health Learning Material Development Centre in
    Kumasi, School of Public Health in Legon, the School of Medical Sciences (UDS) and the Kintampo
    Health Research Centre.


STAFFING:
Teaching staff
The teaching staff comprised fourteen (33) full time tutors and 40 part-time tutors. The number of part time
tutors present at any point in time varies depending on the term and academic activity.
A number of students from UCC also came at different times for their teaching practice at the school.
Among the subjects they handled were RCH, First Aid and Basic Nutrition.




                                                                                                         110
Transport
The school has 5 (five) vehicles. This includes 1 (one) old bus (which is very costly to maintain), 1(one)
Toyota 33 Seater Coaster bus, 1 (one) Mazda Double Cabin Pickup and One Land Cruiser. 1 bus is
currently on loan to Tanoso NTC.
The school currently has 10 funtioning motorbikes which are used for motorbike training. This comprises of
6 Jialing and 4 AGs. Two of the schools AG motorcycles were stolen in the year under review. There are
some old bushman motorbikes but these have all broken and cannot be used for training students.


FIELD WORK/ATTACHMENT
                                         No. OF WEEKS                         PERIOD
PROGRAMME

Technical Officer (CH)                          11                      21/03/05 – 28/05/05
Technical Officer (HI)                          11                      28/03/05 – 1/05/05
Medical Assistants                               8


      Output

      Final qualifying examination were conducted for 38 (thirty-eight) Medical Assistants, 5 (nine) COHO, 61
      Technical Officers (CH), 22 (twenty two) Technical Officers (HI) and seventy nine Field Technicians.


      CRITERIA FOR GRADING FINAL EXAMINATION SCORES.
         TOTAL SCORE                                                 QUALIFIED GRADE
I        80 + Consistency across board                               Distinction
II       75 - 79 Consistency across board                            Credit
III      50 – 74                                                     Pass
IV       Less than 50 in a paper                                     Referred
V        Less than 50 overall score                                  Fail




                                                                                                             111
PERFORMANCE STUDENTS IN FINAL QUALIFYING EXAMINATION (ALL CATEGORIES) -2005


                                MEDICAL ASSISTANTS
Grade                           No. of Candidates             Percentage
Distinction                            0                          0%
Credit                                 1                          3%
Pass                                   37                        97%
                                       0                          0%
Referral
Total                                  38                         100


                                     COHO
Distinction                            0                          0%
Credit                                 0                          0%
Pass                                   5                         100%
Referral                               0                          0%
Total                                  5                          100
                            TECHNICAL OFFICER (HI)

Distinction                            1                          5%
Credit                                 0                          0%
Pass                                   14                        64%
Referral                               7                          32
Total                                  22                         100


                            TECHNICAL OFFICER (CH)
Distinction                            0                          0%
Credit                                 10                        16%
Pass                                   37                        61%
Referral                               14                        23%
Total                                  61                         100




                                                                              112
                                    FIELD TECHNICIAN

Distinction                                3                               4%
Credit                                     3                               4%
Pass                                       68                             86%
Referral                                   5                                   6
Total                                      79                              100




    COMPARISON OF OUTPUT FOR 1998 - 2004
  PROGRAMME                   2000       2001      2002          2003              2004   2005
  Medical Assistant            41         27           29         29                38       38
  COHO                          -          -           -          -                 9        5
  Technical Officer (CH)       27         28           24         34                44       61
  Technical Officer (HI)       15         09           9          5                 15       22
  Field Technician              -         32           -          36                -        79
  Totals                       83         96           62        104               106    205


Grading system for the Semester Unit
    LETTER GRADE              % MARK                       GP                  DESCRIPTION
              A               80 – 100                     4.0          Excellent
              A-               75 – 79                  3.75            Very Good
              B+               70 – 74                     3.0          Good
              B                65 – 69                  2.75            Good
              B-               60 – 64                     2.5          Average
              C+               55 – 59                     2.0          Pass
              C                50 – 54                     1.5          Pass
              D                 0 - 49                     1.0          Fail




                                                                                                  113
ACHIEVEMENTS
The main achievements include:
       Provision of additional computers (6) to the computer library & staff offices
       Improved telecommunication network
       More textbooks and reference materials for the library
       Additional audio-visual teaching equipment
       Facilitated successful independent monitoring of 4 rounds of NIDs – 2005 in collaboration with
       WHO & GHS
       Second congregation held successfully
       Laboratory Technician programme taken off
       Expansion of students field sites
Challenges
       Inadequate Classrooms
       Inadequate student residential accommodation
       Inadequate staff accommodation
       Encroachment on school lands
       Stray animals disturbing the serene school environment
       Inadequate full-time tutors
       Low remuneration for tutors
       Inadequate catering facilities for the large number of students


WAY FORWARD
       Increase intake with completion of new classrooms & hostel
       Attract more tutors with the construction of new staff bungalows
       Fencing of school premises
       Sensitization and advocacy for pre-service/direct intake for MA/COHO programmes
       Set up electronic library/internet cafe
       Pursue improved remuneration tutors.
       Seek assistance from stake-holders to improve catering facilities esp. construction of bigger dining
       hall and kitchen.




                                                                                                        114
17.2   NURSES TRAINING COLLEGE - SUNYANI
MAIN AREAS OF WORK AND TARGETS
•Teaching of first, second and third Semester courses

•Accommodating of 140 students
•Supervision of students
                    st
•Official opening/ 1 matriculation
•Recruitment of Students



ACHIEVEMENTS
•Recruitment of 100 students during the 2005 – 2006 academic year

•Construction of accommodation units to house 140 students

•Lobbied for a tutor from headquarters


NEW PRIORITIES
•Acquisition of Demonstration room equipment

•Acquisition of Library books
•Recruitment of supporting Staff/ tutors
•Accommodation of new students for the new academic year

•Hospitals for clinical practice



KEY CHALLENGES DURING THE YEAR
•Inadequate accommodation for staff

•Inadequate Demonstration Room for equipment

•Inadequate Library books
•Inadequate supporting staff for the school

•Inadequate teaching staff
•Increase of recruitment of students from 60 to 100



GENERAL OUTLOOK FOR THE COMING YEAR
•The student population is expected to increase as the college enters its third year.

•Identification of new hospitals for students’ practical experience.

•Lobby for the increase of tutorial and supporting staff strength
•Acquisition of Demonstration room for equipment

•Acquisition of Library books


                                                                                        115
17.3 BEREKUM NURSING AND MIDWIFERY TRAINING COLLEGE
Main priorities during the year 2005
1. Improving on the academic performance of the students
Provide quality tuition to students, Monitor & evaluate students’ performance
2. Continuing infrastructural development
MEETINGS
        4 staff durbars held
         12 faculty meetings with tutors held
         4 procurement meetings held
         4 District Health Service meetings held
         4 Quarterly meetings with HRHD-MOH held


ACHIEVEMENTS
    •   RENOVATIONS
    - Kitchen and dining hall
    - Floors of the offices
    - Floors of corridors
    - Paintings of the entire college
        Recruitment- Intake of students increase by 16% over 2004/2005
         Five (5) New tutors joined the tutorial staff
        Installation of a corn mill in the kitchen.
        Purchasing of 14 swivel chairs.
        Installation and Connection of internet server
        Tutors embarked on clinical supervision of students during the semester break and within the
        semester.
        Received Text books and models from Engender Health through MOH
         The Two phone booths which were installed last year have now been connected and in use.
        Tutors embarked on clinical supervision of students during the semester break and within the
        semester.
        Received Text books and models from Engender Health through MOH




                                                                                                       116
  STUDENT POPULATION
             Class                                   No. of Students

              1st Year                                  105
              2nd Year                                   90
              3rd Year                                   87
         Total Student Population                       282
              Male students                              71
              Female students                           211


  STUDENTS INTAKE FOR 2005/2006 ACADEMIC YEAR
  Numbers of candidates recruited under the following programmes are:
  •    Registered General Nursing              -76
  •   Direct Midwifery                         -29
  Total number of students admitted            -105
  The 2005/2006 academic year saw an increase of 16% intake over year 2004/2005 academic year


  HUMAN RESOURCE SITUATION
  The school has a total staff population of thirty nine (39)
      The college now has teaching staff strength of nine (9)
      Five (5) new tutors joined the tutorial staff at the beginning of the semester to add up to the nine (9)
       Seven (7) part-time tutors.
       Twenty-nine (29) non-teaching staff of which three (3) are new.
       One Peace Corp volunteer.


CHALLENGES
      Inadequate and late release of funds
       Inadequate Tutors
       Inadequate Classroom
       Lack of a bigger bus (68 seater)
       Lack of a bigger library complex
       Lack of a photocopier for the library
       Lack of a Store Keeper
       Frequent Electricity Power Cut


                                                                                                         117
    WAYFORWARD
        Improve and strengthen the commitment of tutors and non-teaching staff
           Embark on preceptor training for clinicians on the practical sites
           Hook onto the internet
           Completion of the Hundred Capacity Hostel
           Commencement of additional classroom block


17.4    COMMUNITY HEALTH NURSES TRAINING SCHOOL, TANOSO
During the 2005/2006 academic year 131 students were selected for training which were made up of 117
females and 14 males.
The total student population stands at 220.


HUMAN RESOURCE
The school has a total staff strength of seventeen (17) of which six (6) are permanent and eleven (11)
casuals.


INFRASTRUCTURAL DEVELOPMENT
    •   The Brong Ahafo Regional Co-coordinating Council has rented two residential accommodation for
        two tutors.
    •   The Tano North District Assembly is pitting up an 80 capacity hostel for the female students. It has
        also rented a hostel accommodation for 21 male students.


ACHIEVEMENTS
    •   The school is provided with double decker pick-up
    •   The school land has been demarcated with all necessary document being prepared
    •   A new class room block has been provided for the school
    •   All the 28 final year students are being sponsored by the various Districts in the Brong Ahafo
        Region


CHALLENGES
    •   No school bus for field practice and other activities
    •   Inadequate computers
    •   Inadequate library books
    •   Inadequate accommodation for staff


                                                                                                         118
   •   Inadequate accommodation for students
   •   Inadequate security on the campus


   WAY FORWARD
   •   Lobby for a school bus
   •   Provide maximum security for the school by fencing it
   •   Lobby for the provision of staff accommodation
   •   Ensuring that the casual workers are given permanent employment
   •   Lobby for hostel facilities for the new intake
   •   Ensure that more tutors are posted to the school



   NATIONAL HEALTH INSURANCE SCHEME


The year 2005 was described as a very busy year with both planned and unplanned activities.
Among the planned activities programmed for the year 2005 were as follows:
   •   To prepare all providers on their roles and responsibilities, on contract signing and
       efficient claims administrations.
   •   To train providers and all GHS staff on implications of the National Health Insurance Act
       650 and LI 1809.
   •   To strengthen and to further equip the regional health insurance office
   •   To monitor early problems of implementation
   •   To continue to provide technical assistance to schemes.
   •   To train the scheme staff and their Board members.
   •   To conduct research into implementation issues.
   •   To institute health services costing studies
   •   Assist schemes to acquire vehicles, including motorbikes and bicycles for health
       Insurance staff and field workers
   •   Schemes were assisted to re-organize for them to set up in accordance to Act 650 and LI
       1809.
   •   By the close of December 2005, 16 schemes had started providing services to members,
       covering 19 administrative districts
   •   The only district that was yet to offer services to its members is Tain. (which is still
       registering members).



                                                                                                  119
   •   Schemes have been assisted and they now have the following equipment for efficient
       operations: additional computers, scanners, photocopiers, Laminators and Digital
       cameras.
   •   Regional Collaborative Health Insurance Team has been formed and working.
   •   The region completed the orientation of health staff in Health Insurance implementation.
   •   Education was given to patients about the commencement of Health Insurance
ENROLMENT, UTILIZATION AND COST (SEPTEMBER – DECEMBER 2005):


   Total Insured: 562,155
   Total Premium collected: ¢13,060,153,953
   Total Insured Outpatient attendance: 264,335
   Total Insured Outpatient Cost: ¢12,235,795,338.63
   Total Insured Admissions: 10,245
   Total Insured Admission Cost: ¢4,899,910,576
   Grand Total for Insured Attendance (Outpatient + Admission): 274,580
   Grand Total for Insured Attendance Cost (Outpatient + Admission): ¢17,135,885,914.63




   THE POLICY THRUST FOR 2006


   The Summary Priority Policy Thrust will be the same as the National Agenda for the year
   2005-2006 as follows:
       •   Improve Maternal and Child mortality rates
       •   Scale up of priority health interventions
       •   Improve the quality of clinical services
       •   Improve control of Non Communicable Diseases
       •   Enhance performance measurement, monitoring and use of information to improve
           productivity in the sector
Detailed will be found in the 2006 Brong Ahafo Regional Programme of work (POW)




                                                                                             120
   ANNEX

                  TREND ANALYSIS OF REGIONAL PERFORMANCE, 2005
                             BRONG AHAFO REGION
                INDICATORS                                           2003            2004              2005
                Infant mortality rate per 1,000 live
                births                                                  12            12.6              10.7
                Under five mortality rate per 1,000 live
                births                                                   3             2.2              1.9
                Maternal Mortality per 100,000                         200             230              183
 HEALTH         % Under five years who are
 STATUS         malnourished                                       5.10%               8.6             14.3
                Population to doctor ratio**                       28,334         20,659**           25,358
                Population to nurse ratio**                         2,566          2,181**            1,821
                Outpatient visit per capita                           0.64            0.67             0.72
                Hospital admission rate                               34.3            34.9             37.9
                Total number of completed CHPS
 ACCESS         compound                                                 6                4              14
                % of maternal audits to maternal deaths               73.8            71.3            89.47
                Under five malaria case fatality rate                 25.8            16.8             18.1
 QUALITY        % Tracer drug availability                              91              92               82
                HIV seroprevalence (among
                reproductive age): sentinel data                   3.70%                4.5
                Data from blood donors:                             3.4%             4.2%                5.2
                Tuberculosis cure rate                                62.8            60.7
                Number of guinea worm cases                            492             336               287
                AFP non polio rate                                     1.5             1.6               1.8
                % Family planning acceptors                           35.5              43              39.5
                % ANC coverage                                        97.1              90                90
                % PNC coverage                                        54.1              55              58.5
                % Supervised deliveries (skilled
                attendance)                                             56            57.8              50.2
                Bed occupancy rate                                    59.3            57.9              57.3
                EPI coverage PENTA3                                   81.8            82.5              94.6
EFFICIENCY EPI coverage Measles                                       87.7            86.7              91.6
                Total budget allowed                      9,477,175,131 14,391,697,190        58,077,357,333
                Total GOG recurrent budget                3,378,803,116     4,474,788,845      6,293,950,889
                Total Health Fund                         6,539,096,399 14,845,900,616        16,328,910,238
                                                          10,209,747,23
                Total IGF                                                9 17,701,043,247     35,454,496,206
FINANCIAL Total amount spent on exemptions                1,068,753,724         1,772,660      3,803,563,580
  **Includes all doctors & nurses in private practice as well as the Cuban doctors




                                                                                              121
                            FAMILY PLANNING, 2005 BAR

      DISTRICT       DISTRICT         TARGET        NUMBER OF     ACCEPTOR RATE
                    POPULATION      POPULATION      ACCEPTORS
Asunafo North            113,446          27,227          5911              21.7
Asunafo South              83,448          20,028          3637             18.2
Asutifi                    95,587          22,941          7667             33.4
Atebubu Amantin            93,508          22,442          7314             32.6
Pru                        91,285          21,908          7731             35.3
Berekum                   105,487          25,317         13475             53.2
Dormaa                    170,050          40,812          6782             16.6
Jaman North                79,514          19,083          6707             35.1
Jaman South                88,325          21,198         10546             49.7
Kintampo North             94,183          22,604         13622             60.3
Kintampo South             71,874          17,250          7362             31.7
Nkoranza                  145,906          35,017         11098             32.9
Sene                       92,963          22,311          7347             20.0
Sunyani                   202,709          48,650          9729             20.0
Regional Hospital              0               0           1486             57.2
Tano North                 70,298          16,872          9656             38.3
Tano South                 69,322          16,637         6372              60.4
Techiman                  197,544          47,411         28644             84.0
Wenchi                     94,799          22,752         19119             45.7
Tain                       93,740          22,498         10291             39.5
TOTAL                   2,053,988         492,957       194,496             39.5




                                                                            122
      IMPROVING OF QUALITY OF CARE - 2005

       DISTRICT      TOTAL NO. OF        NO. OF MATERNAL    % MATERNAL
                    MATERNAL DEATH       DEATHS AUDITED    DEATHS AUDITED
Asunafo North             6                      6              100
Asunafo South               0                   0                0
Asutifi                     7                   7               100
Atebubu Amantin             4                   4               100
Pru                         7                   7               100
Berekum                     9                   9               100
Dormaa                      4                   4               100
Jaman North                 0                   0                0
Jaman South                 2                   2               100
Kintampo North              7                   0                0
Kintampo South              0                   0                0
Nkoranza                    7                   7               100
Sene                 7 (6 Com. Deaths)          7               100
Sunyanu                     0                   0                0
Regional Hospital           9                   9               100
Tano North                  0                   0                0
Tano South                  6                   6               100
Techiman                    15                 15               100
Wenchi                      4                   2                50
Tain                        1                   0                0
TOTAL                       95                 85               89.47




                                                                        123
  REPRODUCTIVE AND CHILD HELTH - ANNUAL REPORT, 2005

   DISTRICT          TARGET                               PNC            SUPERVISED
                     POPULA-   ANC                                       DELIVERIES
                       TION      COV.    REGIS.    COV.     REGS.   COVERAGE     REGIS
Asunafo North       4538       101.8    4620      51.3     2329     54.9        2494
Asunafo South       3338       90.9     3034      60.5     2018     38.7          1293
Asutifi             3823       110.8    4237      55.9     2136     67.1          2568
Atebubu Amantin     3740       80.4     3008      37.8     14164    28.1          1051
Pru                 3651       119.1    4347      32.6     1191     42.9          1568
Berekum             4219       91.1     3842      58.9     2486     75.3          3178
Dormaa              6802       99.0     6731      36.1     2458     49.2          3349
Jaman North         3181       75.4     2398      33.5     1067     27.8          886
Jaman South         3533       93.7     3310      63.5     2242     63.2          2236
Kintampo North      3767       110.1    3770      34.2     1290     52.8          1989
Kintampo South      2875       39.9     1146      49.1     1413     25.3          730
Nkoranza            5836       78.6     4590      136.0    7936     42.5          2486
Sene                3719       76.3     2838      76.4     2842     19.3          720
Sunyani             8108       63       5107      50.3     4082     27.9          2263
Regional Hospital   0          31.2     2534      22.6     1838     33.6          2725
Tano North          2812       62.2     1748      72.8     2048     50.3          1416
Tano South          2773       95.0     2634      66.3     1838     60.5          1679
Techiman            7902       113.0    8929      59.0     4660     68.0          5374
Wenchi              3792       90.0     3413      34.7     1316     45.1          1713
Tain                3750       46.0     1726      38.4     1438     41.9          1572
TOTAL               82160      90.0     73960     58.5     48034    50.2          41290




                                                                            124
INCREASING ACCESS TO HEALTH CARE 2005, BRONG AHAFO REGION

                                            OPD
                                            PER     NUMBER                                        NO. OF
                  OPD                       CAPI    OF             ADMISSION         BED          SPECIALIST
                  ATTENDA      POPULATI     TA      ADMISSIO       RATE PER          OCCUP        VISITS FROM
     DISTRICT     NCE 2005     ON 2005      2005    NS             1,000 POP.        ANCY         REGION
     ASUNAFO
 1   NORTH           91,405      113,446    0.81          4,718              51.6         113.7
     ASUNAFO
 2   SOUTH           22,660       83,448    0.27    **                               **
 3   ASUTIFI         98,607       95,587    1.03          4,107              41.7         107.8
 4   ATEBUBU         27,029       93,508    0.29          3,319             122.8          38.7
 5   BEREKUM        178,768      105,487    1.69          6,178              34.6          73.8
 6   DORMAA         113,672      170,050    0.67          4,418              38.9          42.8
     JAMAN
 7   NORTH           34,047       79,514    0.43          5,385             158.2          56.0
     JAMAN
 8   SOUTH           98,602       88,325     1.12         3,945              40.0          58.5
     KINTAMPO
 9   NORTH           45,073       94,183    0.48          5,024             111.5          99.8
     KINTAMPO
10   SOUTH             9,669       71,874   0.13    **                               **
11   NKORANZA         88,628      145,906   0.61          4,174              47.1          49.7
12   PRU              34,069       91,285   0.37          4,638             136.1          66.5
13   SENE             30,885       92,963   0.33             49               1.6           9.7
14   SUNYANI         304,017      202,709   1.50          8,825              29.0          33.1
15   TAIN             33,394       93,740   0.36    **                               **
16   TANO NORTH       57,989       70,298   0.82          2,401               41.4         58.7
17   TANO SOUTH       47,982       69,322   0.69          3,854               80.3         51.3
18   TECHIMAN        129,053      197,544   0.65         13,483             104.5          49.6
19   WENCHI           42,131       94,799   0.44          3,280               77.9         38.3
     TOTAL         1,487,680    2,053,988   0.72         77,798               52.3         59.3
                                                    ** No facility for Admissions




                                                                                                  125
INCREASING ACCESS TO HEALTH CARE, 2005 BRONG AHAFO REGION

             POP.        NO. OF   POP.         NO. OF   POP       NO. CHPS           NO. CHPS
                         DOCTO    DOCTOR       NURSES   NURSE     COMPOUNDS.         COMPOUNDS
                         RS       RATIO                 RATIO     COMPLETED          STARTED
DISTRICT
ASUNAFO                  2            56,723   30         3,782   0                  0
NORTH          113,446
ASUNAFO                  1            83,448   25         3,338   3                  3
SOUTH           83,448
ASUTIFI         95,587   3            31,862   59         1,620   1                  1
ATEBUBU         93,508   2            46,754   44         2,125
BEREKUM        105,487   7            15,070   113          934   2                  2
DORMAA         170,050   5            34,010   91         1,869   0                  0
JAMAN                    1            79,514   59         1,348   0                  0
NORTH           79,514
JAMAN                    1            88,325   18         4,907   0                  0
SOUTH           88,325
KINTAMPO                 10            9,418   40         2,355   0                  0
NORTH           94,183
KINTAMPO                 0                     28         2,567   0                  0
SOUTH           71,874
NKORANZA       145,906   4            36,477   75         1,945   1                  1
PRU             91,285   1            91,285   20         4,564
SENE            92,963   1            92,963   20         4,648   2                  2
SUNYANI        202,709   25            8,108   248          817   1                  1
TAIN            93,740   1            93,740   15         6,249   0                  0
TANO NORTH      70,298   4            17,575   63         1,116   0                  0
TANO SOUTH      69,322   2            34,661   50         1,386   0                  0
TECHIMAN       197,544   8            24,693   130        1,520   3                  3
WENCHI          94,799   2            47,400   54         1,756   1                  1
TOTAL        2,053,988   81           25,358   1,128      1,821   14                 14




                                                                               126
IMPROVING QUALITY OF CARE

            TOTAL NO.   NO. OF    %         TOTAL    TOTAL   TOTAL     UNDER FIVE
            OF          MATERN    MATERN    NO. OF   UNDER   UNDER     MALARIA CASE
            MATERNA     AL        AL        CASES    FIVE    FIVE      FATALITY
            L DEATHS    DEATHS    DEATHS    ADMIT    MALA    DEATHS
                        AUDITED   AUDITED   TED      RIA     DUE TO    PER 1,000
                                            WITH     ADMIS   MALARIA
                                            MALAR    SIONS
DISTRICT                                    IA
ASUNAFO                 6         100       1346     489     4         8.2
NORTH       6
ASUNAFO                 0         0         0        0       0         0
SOUTH               0
ASUTIFI             7   7         100       547      304     9         29.6
ATEBUBU             4   4         100       719      378     8         21.2
BEREKUM             9   9         100       636      497     4         8.0
DORMAA              4   4         100       4058     1927    3         1.6
JAMAN                   0         100       2615     309     11        35.6
NORTH               0
JAMAN                   2         100       2092     819     5         6.1
SOUTH               2
KINTAMPO                0         0         1714     991     30        30.3
NORTH               7
KINTAMPO              0           0         0        0       0         0
SOUTH               0
NKORANZA            7 7           100       733      362     9         24.9
PRU                 7 7           100       1756     799     28        35.0
SENE                7 7           100       11       4       0         0
SUNYANI               0           0         233      57      0         0
MUNICIPAL           0
REGIONAL              9           100       2299     888     22        24.8
HOSPITAL            9
TAIN                1 0           0         0        0       0         0
TANO                  0           0         159      111     1         9.0
NORTH               0
TANO                  6           100       559      319     6         18.8
SOUTH               6
TECHIMAN           15 15          100       1481     1023    29        28.3
WENCHI              4 2           50        366      220     2         9.1
TOTAL              95 85          89.5      21,324   9,497   171       18.0




                                                                       127
HEALTH FINANCING 2005, BRONG AHAFO REGION

DISTRICT   AMOUNT           TOTAL            TOTAL            %          AMOUNT            AMOUNT
           ALLOCATED        EXPENDITU        REVENUE          REVENUE    SPENT ON          SPENT ON
                            RE               GENERATED        GENERAT    EXEMPTIONS        EXEMPTIO
                                                              ED FROM                      NS FOR
                                                              INSURANC                     THE POOR
                                                              E SCHEME
RHD         2,532,207,205    2,970,740,124
ASUNAFO     4,149,203,802    4,106,076,915    2,638,276,020                 321,785,679
NORTH
ASUNAFO      580,524,976      534,149,389
SOUTH
ASUTIFI     1,779,888,795    1,582,768,514    1,213,588,250                 192,450,286
ATEBUBU-    2,310,696,762    2,115,095,318      799,457,896                 249,088,484
AMANTEN
PRU           637,561,418      331,727,660                                   20,798,561
BEREKUM       899,081,071      692,935,911      322,021,010                 235,063,322
DORMAA      1,053,708,212    1,002,125,714      431,297,986                 392,451,863
JAMAN       2,978,340,720    2,813,422,013    1,609,119,793                  65,060,979
NORTH
JAMAN       1,462,133,977    1,240,793,286     809,314,872                  265,520,453
SOUTH
KINTAMP     5,249,009,821    4,866,491,732    3,681,300,608                 272,078,728
O NORTH
KINTAMP      734,662,258      576,836,948       96,709,500
O SOUTH
NKORANZ     1,504,954,931    1,174,568,699     941,815,468                  234,155,816
A
SENE        1,499,447,464      890,162,822      164,174,560                 111,300,000
SUNYANI    23,122,063,619   22,136,055,451   18,876,722,529                 319,951,878
TANO          959,429,810    1,647,090,619      455,498,000                  20,888,886
NORTH
TANO        3,729,096,974    3,634,283,183    2,340,541,882                 367,613,463
SOUTH
TECHIMA     1,370,076,317    1,239,943,545     757,110,671                  334,284,288
N
WENCHI        962,171,137    1,281,493,177     317,547,161                  401,070,894
TAIN          563,098,064       89,421,232
TOTAL      58,077,357,333   54,926,182,252   35,454,496,206                3,803,563,580




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