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HEALTH SECTOR HALF YEAR PERFORMANCE REPORT-UPPER WEST REGION DR

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HEALTH SECTOR HALF YEAR PERFORMANCE REPORT-UPPER WEST REGION DR Powered By Docstoc
					HEALTH SECTOR HALF YEAR PERFORMANCE
REPORT-UPPER WEST REGION


DR. ALEXIS NANG-BEIFUA, REGIONAL DIRECTOR OF
HEALTH SERVICES

8/12/2010
INTRODUCTION

This report contains unedited reports that show the performance of the health sector in
the region. The report will be finalize after the midyear review slated for the 18th to 20th
August, 2010 services amongst others.
It includes basic demographic information and the number of facilities in each district of
the region.

Demographic characteristics
The projected population for 2010 based on the 2000 Population and Housing Census
using a growth rate of 1.7% is 682,451. There are 989 settlements. Table 1 shows the
total projected populations of the various districts from 2007 to 2010. The region
covers a total land area of 18,476 km2, with a population density of 32 persons per
square kilometre. The Sissala district has the lowest population density of 11 persons
per square kilometre, whilst Lawra district has the highest of 94 persons per square
kilometre. This low population density implies much movement is needed to be able to
deliver health services to the people. The bad nature of roads and the poor road
network in some districts makes movement even more difficult especially in Wa East
district. Illiteracy rate is high. It is estimated that only about 29.9% of the adult
population of the region are literate (GLSS, 2008).

Population of UWR Projected from 2000 Census population - (GR-1.7%)
 District           2007 Projection    2008 Projection    2009 Projection    2010 Projection
 Jirapa             108,962            110,814            63,549             64,629
 Lambussie          -                  -                  49,149             49,985
 Lawra              98,487             100,161            101,864            103,596
 Nadowli            93,076             94,658             96,267             97,904
 Sissala East       50,916             51,782             52,662             53,557
 Sissala West       45,227             45,996             46,778             47,573
 Wa East            55,900             56,162             63,645             64,727
 Wa Municipality    112,049            114,513            116,229            118,205
 Wa West            84,180             85,741             80,900             82,275
 UWR                648,797            659,827            671,043            682,451


The projection of the regional population using a general constant growth rate of 1.7%
could lead to misleading statistics that are used as denominators.
Health Structures
In all, there are sixty-five sub-districts, five district hospitals located in four districts, a
regional hospital in the regional capital and eighty-seven functioning CHPS compounds
as shown in the table below.

Health Facilities per District




                                                     RCH Centre
                     Hospitals




                                                                         Maternity




                                                                                               Hospitals
                                 Centres




                                                                         Homes
                                                                         Private



                                                                                     Private


                                                                                               Private
                                           Clinics




                                                                                     Clinics
                                 Health




                                                                  CHPs
District




                                                                                                           Total
Jirapa                   1            7       0           0         8           0         0          0      16
Lambussie                0            6       0           0         9           1         1          0      17
Lawra                    2            8       0           2       10            0         0          0      22
Nadowli                  1          12        0           0       13            0         0          1      27
Sissala East             1            6       0           0         5           1         0          0      13
Sissala West             0            4       0           0         7           0         0          0      11
Wa East                  0            6       1           0         9           0         0          0      16
Wa Municipal             1            6       3           0       13            1         3          2      29
Wa West                  0            6       0           0       13            1         0          0      20
Reg Total                6          61        4           2       87            4         4          3     171
There are also at least 885 Traditional Birth Attendants, 1165 community based
surveillance volunteers and 184 guinea worm volunteers who are providing services in
the communities with supervision from sub district health staff.


Community participation in health delivery is facilitated at all levels through the
community representation on various health committees at Regional, District and Sub
district levels. The Community Health Action Plan (CHAPs) which is the “P” component
of CHPS also create another platform for planning and implementing health activities at
the community level.


Structure of the Report
This report is a draft version of the 2010 half year health sector performance of the
upper west region.
Disease Surveillance
Introduction
Disease Surveillance is an important component on disease control and prevention

activities. It involves both passive and active systems in health facilities and community

levels. Records were reviewed at the facilities for targeted diseases and Community

Based Surveillance Volunteers also reported suspected cases and events from their

communities for follow-ups by their respective Sub-district staffs.

In the first quarter the region experienced meningitis outbreak in Jirapa and responded

to



Key Activities carried out during the first half of the year 2010 (Jan.-June)
•    Regular routine reporting with weekly/monthly feedback
•    Health information management and provision of feedback.
•    Monitoring and support visit to districts.
•    Monitoring Trends of Epidemic prone diseases.
•    Held about ten regional epidemic committee meetings
•    Supported districts in investigating, and responding to communicable diseases
     outbreaks.
•    Carried out public education on communicable diseases like CSM H1N1, Guinea
     Worm
•    Collection and transportation of specimens to the PHRL and NOGUCHI
•    Case investigations, response and management of an outbreaks
•    Mass/SIAs campaigns on Polio, CSM and H1N1 (3 rounds of NIDs).
•    Training for districts and sub-districts staff.
•    Logistics support to districts and sub-districts.
•    Prepared epidemic preparedness plan for 2010
•    Distributed meningitis treatment protocol and case definitions booklet to all DHMTs
     and Hospitals
•    Written half year report 2010
•    Held stakeholders in health meeting
•    Held about 10 times meeting with Regional Epidemic Committee Members

The period under review, the region achieved some gains as follows;
   •     All core indicators on AFP were met. Stool timeliness and stool adequacy as at
         first quarter was below 80%, and 60 day, followed up conducted for the six
         cases.
   •     Measles 16 suspected cases were reported with samples collected on all the
         cases for investigation.
   •     Improvement in proportion of suspected meningitis cases having LP (60.4%)
         during the period under review
   •     Blood specimen were collected from reported 5 Jaundice cases and sent to
         Accra for yellow Fever investigation. All turn out to be negatives for yellow fever
         IgM

Timeliness and Completeness Submission of Weekly (CD1) Reports


This indicator in all the districts is encouraging compared with previous years except for
Sissala East which declined drastically. However completeness all the districts had
been maintained 100% for the three year periods.

Table 1 Timeliness and Completeness of Weekly (CD 1) Reports from Districts


                  2008                    2009                   2010
                  Timelin    Complete     Timeli    Complet      Timeliness     Completene
                  ess        ness         ness      eness                       ss
Jirapa            84.5       100          76.9      100          91.6           100
Lamb.             84.5       100          92.3      100          87.5           100
Lawra             76.9       100          50.0      100          91.6           100
Nadowli           92.3       100          69.2      100          70.83          100
S. East           92.3       100          88.5      100          45.83          100
S. West           80.8       100          65.4      100          71.2           100
Wa East           65.4       100          65.4      100          75             100
Wa Mun            84.5       100          92.3      100          91.8           100
Wa West           100        100          65.4      100          62.5           100


Monthly Reports:
Monthly reports submission from the districts has not being good. This has not improved
as expected. Most districts had maintained the score but Sissala West, Lawra and Wa
East had below 50%. In terms of completeness, all districts scored 100% except Lawra,
Wa East and Wa Municipal. Lawra and Wa East had declined in all the two indicators
during the period under reporting.
Table 2 Timeliness and Completeness of Monthly Reports from Districts
Districts      2008                 2009              2010
               Timel   Compl        Tim Compl         Timeline Complet
               iness   etenes       eline etenes      ss       eness
                       s            ss    s
Jirapa         17      100          83.3   100        83.3          100
Lamb.          17      100          66.7   100        100           100
Lawra          33      100          66.7   100        50            83.3
Nadowli        83      100          66.7   100        66.7          100
S. East        67      100          100    100        83.3          100
S. West        50      100          50.0   100        50            100
Wa East        33      100          83.3   100        33.3          83.3
Wa Mun         50      100          83.3   100        83.3          83.3
Wa West        50      100          66.7   80         66.7          100


Immediate reportable Diseases:

Meningitis
Table 3: Meningitis Reported Cases and Deaths Jan-June, 2008-2010 Compared.
                             2008                     2009                        20010
    District
                       Cases    Deaths      Cases          Deaths         Cases       Deaths
Jirapa
                         7           1           1           0             112            15
Lambussie
                         0           0           2           0             14             0
Lawra
                        12           3           10          0             78             4
Nadowli
                         6           0           4           2             73             7
Sissala East
                         3           0           5           0             17             0
Sissala West
                         1           0           1           0              2             0
Wa East
                         0           0           13          2              1             0
Wa Municipal
                        58           5           30          3             55             12
Wa West
                         7           0           14          0             25             0
Total
                     94           9          83               7              376              38
Case Fatality             9.6%                    8.4%                           9.8%




Lumbar Puncture Performance
68.8% of the total reported cases of meningitis had their lumbar puncture performed as
against 42.2% of the last year’s reported cases. With 68.8% LP done 39.09 %
representing 147 cases were negatives. The remaining cases had the following
organisms isolated as indicated in the table below.




Table 4: Meningitis by organism type isolated 2010
Districts       C    D    CF     L/P   L/P    N       N           NM     S       HI       Other    Not
                          R            Not    M       M           W13    P       P        s        org.
                                       Don    A       C           5                                See
                                        e                                                          n
Jirapa          11   1           10
                 2   5 13.4       5      7        1       0         22       1        0       1      67
Lambussi
e               14   0    0.0      0    14        1       0          0       1        0       0       0
Lawra           78   4    5.1    59     20        1       0          5       0        0      11      34
Nadowli         72   7    9.6    50     23        1       0          0       7        0       0      20
Sissala
East            17   0    0.0    12      5        0       0          1       3        0       0       8
Sissala          2   0    0.0      0     2        0       0          0       0        0       0       0
West
Wa East        1   0     0.0    0      1      0   0     0      0     0       0     0
Wa                 1
Municipal     55   2 21.8      34     22      2   0     5      3     0       0    18
Wa West       25   0     0.0    0     25      0   0     0      0     0       0     0
Total         37   3           26
               6   8 10.1       0    118      6   0    33     15     0      12   147




Measles
During the period sixteen Measles cases were reported which majority come from Wa
Municipal and Wa West. Blood samples were taken for all the cases for investigation
and confirmation for Measles IgM.



Table 5: Reported Suspected Cases and Deaths of Measles Jan-June, 2008-
2010Compared.
                       2008                2009               2010
   District
                Cases    Deaths     Case     Deaths   Cases        Deaths
                                      s
Jirapa             0          0       0          0        0           0
Lambussie          0          0       1          0        0           0
Lawra              1          0       2          0        0           0
Nadowli            0          0       0          0        1           0
Sissala East       0          0       0          0        0           0
Sissala West       0          0       0          0        0           0
Wa East            0          0       0          0        0           0
Wa Municipal      14          0       2          0       11           0
Wa West            0          0       2          0        4           0
Total             15          0       7          0       16           0



Acute Flaccid Paralysis (AFP)
Acute Flaccid Paralysis (AFP) surveillance is one of the Polio Eradication Initiative
strategies. During the period six cases were reported as against twelve (12) cases for
2009 and three (3) cases for 2008 respectively.
60 days follow-up were conducted for the cases and report sent to national for final
classification. The region score 100% for stool timeliness 83% for stool adequacy and
4.08 for annualized Non-Polio AFP rate for the half year.

 Table 6: Reported AFP Cases Jan-Jun 2008-2010,


                       2008               2009                 2010
   District     Cases    Deaths    Case     Deaths     Cases      Deaths
                                    s
Jirapa             1          0       0          0        3           0
Lambussie          0          0       1          0        2           0
Lawra              0          0       0          0        1           0
Nadowli            0          0       1          0        0           0
Sissala East       0          0       1          0        0           0
Sissala West       0          0       2          0        0           0
Wa East            0          0       3          0        0           0
Wa Municipal       0          0       2          0        0           0
Wa West            2          0       2          0        0           0
Total               3         0          12      0           6            0




Yellow Fever
Table 7: suspected YF cases by districts
                                  2009                       2010
        District
                        Cases        Deaths          Cases          Deaths
Jirapa                    0              0             4              0
Lambussie                 0              0             0              0
Lawra                     0              0             0              0
Nadowli                   0              0             0              0
Sissala East              0              0             0              0
Sissala West              0              0             0              0
Wa East                   0              0             0              0
Wa Municipal              1              0             1              0
Wa West                   5              0             0              0
Total                     6              0             5              0


Challenges
  • Late submission of monthly reports.
  • Data discrepancies still exist between districts and region between cd1 and cd2.
  • Not using the proper reporting/investigation formats



Way Forward
  • Intensify regular monitoring/supportive supervision to all districts especially the
     poor performing districts.
  • Encourage the use of every opportunity to screen mothers/caregivers and
     children for immunization
  • Orientate health staff on epidemic preparedness plan.
  • Give frequent feedback to districts.
  • Actively involve CBAs/CBSVs in outreach activities and defaulter tracing.
Expanded Programme on Immunization (EPI)
EPI in Ghana aims at protecting every child against the nine common childhood
communicable disease; namely tuberculosis, poliomyelitis, diphtheria, neonatal tetanus,
whooping cough, hepatitis B, haemophilus influenza type B, measles, and yellow fever.
Our mission is to promote and provide immunization services in a comprehensive
manner with a view to reducing the magnitude of the problem due to vaccine
preventable diseases (VPDs) with the help of current and new technologies, also
contributing to the overall poverty reduction.
The immunization of children within the EPI target population of 0-11months was carried
out in all health facilities and outreach sites in the region. Tetanus Toxoid was also
administered to pregnant women during the period under review.


Objectives of the programme
   •   To increase immunization coverage through reaching every district and Child
       approach
   •   To maintain zero mortality for measles
   •   To maintain the region and Ghana polio free status
   •   To help reduce morbidity and mortality due to vaccine preventable diseases
   •   To maintain the 80% of Penta 3 achieved and increase antigens with low
       coverage
   •   To try and address high and negative dropout rates
   •   To support hard to reach and low performing sub districts and district improve
       upon their coverage
   •   To promote injection safety and reduce vaccines wastage rates
   •   To conduct NID campaign
   •   To improve AEFI and Vitamin A reporting
   •   To improve our technical support and supervision.
   •   To strengthen surveillance for VPD and creased disease control activities


Activities Carried Out in January to June 2010
Routine immunization: immunization of children 0-11moths was carried out in all health
facilities and outreach session. Antigens of the nine vaccine preventable diseases were
provided to all children 0-11month children and Tetanus Toxoid administed to pregnant
women during the period.
Strategies employed to improve routine coverage were;
Static immunization services;
Static immunization services were provided at all facility daily routine immunization.


Outreach immunization services;
Outreach services were provided in communities and catchment areas that do not have
static clinic to provide immunization services or human resources for the static child
welfare clinics to reach out to every child in such communities’ routinely in the region.
Mop-ups
Mop-up exercises were organized in areas with low coverages and difficulties to reach
with the aim of reaching every child.


Child Health promotion week celebration
The Child Health promotion week celebration was organizes in May to support create
and sustain the awareness of the many services available in the health system. It also
promote the healthy growth and prevent the common childhood communicable disease
in the under five (5) years. It also sensitizes the general public on importance of child
birth registration.
Other strategies used include;
•   Regular routine reporting with monthly/quarterly feedback to districts
•   Monitoring Trends of Vaccine Preventable Diseases/immunization coverage.
•   Health information management and provision of feedback.
•   Monitoring and support visit to districts and facilities.
•   Mass campaigns on Polio (2 rounds of NIDs).
•   H1N1 vaccination exercise
•   Training for districts and sub-districts staff on EPI.
•   Cold chain management (Maintenance) training.
•   Logistics support to districts and sub-districts.




EPI Performance in detail


Timeliness and Completeness Submission of Monthly Reports
Generally there has been an improvement in the submission of monthly reports for the
year under review as compared to previous years except for Wa East decline in their
timeliness from 83% to 50% and 100% completeness to 83%.


Table 1: Timeliness and Completeness of Monthly Reports from Districts
                  2008                 2009                     2010
District    Timel    Compl     Timel    Complet         Timel    Complet
            iness    etenes iness       eness           iness    eness
                     s
Jirapa      17       100       83.3     100             100      100
Lamb.       17       100       66.7     100             100      100
Lawra       33       100       66.7     100             67       100
Nadowli     83       100       66.7     100             67       100
S. East     67       100       100      100             83       100
S. West     50       100       50.0     100             67       100
Wa East     33       100       83.3     100             50       83
Wa Mun      50       100       83.3     100             100      100
Wa West     50       100       66.7     80              83       100


Below are the performances of each district for the first half of the year 2008 to 2010.
The table below shows annual populations and monthly target populations of children
aged 0-11months that districts are expected to vaccinate monthly with the routine
vaccines.
Table 2: EPI Annual and Monthly Target Population by Districts 2008-2010
                      2008                 2009              2010
  District
               Month     Annual     Month    Annual      Month    Annual
Jirapa         228       2,736      212      2542     215        2585
Lambussie      141       1,697      164      1966     167        1999
Lawra          334       4,006      340      4075     345        4144
Nadowli        316       3,786      321      3851     326        3916
Sissala East   173       2,071      176      2106     1791       326
Sissala West   153       1,840      156      1871     159        1903
Wa East        209       2,503      212      2546     216        2589
Wa             381       4,571      387      4649     394        4728
Municipal
Wa West        265       3,182      270      3236     274        3291
Total          2199      26,393     2237     26842    2275       27298




Table 3: Expected Antigens Coverage and Acceptable Vaccine Wastage Rates
                % Coverage                  Acceptable           Acceptable
     Antigen                                Wastage Rate (%) Dropout rate (%)
                Annual       Half Year
BCG             95           47.5           50                   < 10
Polio           90           45             20                   < 10
Penta           90           45             10                   < 10
Measles         90           45             30                   < 10
Yellow Fever    80           40             30                   < 10
Tetanus        80          40           20                 < 10
toxiod




Figure 1: Regional Antigen Performance Coverage 2008-2010




Table 4: BCG Performance by Districts Jan-June 2009-2010
                      2008                     2009                       2010
District                                                              #
            # Vaccinated        % Cov   # Vaccinated   % Cov                     % Cov
                                                                  Vaccinated
Jirapa                 1290            47.2            1379          54.2        1295           50.1
Lambussie               941            55.4            896           45.6         888           44.4
Lawra                  1989            49.7            1743          42.8        1742           42.0
Nadowli                1793            48.7            1642          42.6        1428           36.5
Sissala East            870            42.0            1030          48.9         929           43.4
Sissala West           1127            67.3            984           52.6         918           48.2
Wa East                1356            54.2            1519          59.7        1362           52.6
Wa Municipal           3307            72.3            3467          74.6        3414           72.2
Wa West                1667            52.4            1540          47.6        1589           48.3
Total                 11340            54.3           14200          52.9        13565          49.7


   The minimum expected BCG coverage for the first half of the 2010 year under review is
   50 %, the region BCG performance as at June is 50% exactly the target. The districts
   performance range from 72.2% in Wa Municipal as the highest to 36.5% the least in
   Nadowli district as shown in table below. Generally BCG performance in 2010 have
   reduce as compared to 2009 coverage with the exception of Wa West where it rather
   increased by 0.7%.




   Table 5: Penta 3 Performance by Districts Jan-June 2008-2010
                              2008                     2009                       2010
         District        #                        #                          #
                                     % Cov                    % Cov                      % Cov
                    Vaccinated                Vaccinated                Vaccinated
   Jirapa             1146           41.9       1146          45.1          1144         44.3
   Lambussie            845          49.8        865          44.0          764          38.2
   Lawra              1456           36.3       1502          36.9          1406         33.9
   Nadowli            1456           36.3       1587          41.2          1431         36.5
   Sissala East       1793           43.9        921          43.7          823          38.4
   Sissala              805          43.8        816          43.6          800          42.0
West
Wa East           1545           61.7       1442           56.6          1358        52.5
Wa
                                            2304           49.6          2329        49.3
Municpal          2325           50.9
Wa West           1563           49.1       1461           45.1          1514        46.0
Total            12209           46.3      12044           44.9        11569         42.4


Table 8 above shows the performance by districts on Penta 3 vaccination. The region’s
performance in 2008 is still the highest as compared to 2009 and 2010. Although the
region’s performance is slightly lower than the minimum expected coverage of 45%, the
districts namely Wa East, Wa Municipal and Wa West managed to achieve above the
target as shown in table 8 above.




Table 6: OPV 3 Performance by Districts Jan-June 2008-2010
                          2008                    2009                     2010
     District   Vaccinate                Vaccinate                Vaccinate
                                 % Cov                   % Cov                    % Cov
                     d                      d                        d
Jirapa             1426          52.1      1190          46.8       1141          44.1

Lambussie           845          49.8      879           44.7       763           38.2
Lawra              1456          36.3      1502          36.9       1406          33.9
Nadowli            1456          36.3      1587          41.2       1410          36.0
Sissala East       1640          43.3      858           40.7       823           38.4
Sissala West        861          41.6      816           43.6       827           43.5
Wa East            1532          61.2      1407          55.3       1351          52.2
Wa Municpal        2323          50.8      2304          49.6       2329          49.3
Wa West            1566          49.2      1459          45.1       1506          45.8
Total              12454         47.2     12002          44.7      11556          42.3
   From table 10 below the regional performance of Measles for the half Jan - June 2010
   stands at 44.5% slightly below last year’s coverage of 44.7%. Thus only three districts,
   which are Wa East, Wa Municipal and Wa West districts could meet the 45% coverage.
   Lawra district was the worst with 33.0% coverage.


   Table7: Measles Performance by Districts Jan-June 2008-2010
                             2008                           2009                       2010
   District                                                            %         #
                # Vaccinated         % Cov       # Vaccinated                                 % Cov
                                                                      Cov    Vaccinated
Jirapa              1190              43.5             1242           48.9     1061           41.0

Lambussie            856              50.4             944            48.0      789           39.5
Lawra               1748              43.6             1678           41.2     1384           33.4
Nadowli             1704              45.0             1463           38.0     1389           35.5
Sissala East         862              41.6             936            44.4      830           38.7
Sissala West         929              50.5             842            45.0      954           50.1
Wa East             1291              51.6             1359           54.4     1362           52.6
Wa Municpal         2617              57.3             2455           52.8     2923           61.8
Wa West             1603              50.4             1576           48.7     1461           44.4
Total               12800             48.5           12521            46.6     12153          44.5




   Yellow Fever regional performance has also drop by 1.2% over the previous year.
   Sissala West, Wa East and Wa Municipal only achieved the target. Lawra district
   recorded the least performance of 33.8% followed by Nadowli 35.9% then Sissala East
   district with 38.7 % and Lambussie with 39.5% which are all below the minimum target
   of 45% for the period.


   Table 8: YF Performance by Districts Jan-June 2008-2010
                            2008                     2009                       2010
    District
                 # Vaccinated       % Cov    # Vaccinated     % Cov     # Vaccinated    % Cov
Jirapa               1043          38.1       1244         48.9         1067          41.3
Lambussie             730          43.0        921         46.8            789        39.5
Lawra                1748          43.6       1690         41.5         1400          33.8
Nadowli              1827          48.3       1475         38.3         1406          35.9
Sissala East          779          37.6        887         42.1            830        38.7
Sissala West          787          42.8        841         44.9            954        50.1
Wa East              1203          48.1       1399         54.9         1364          52. 7
Wa Municipal         2615          57.2       2445         52.6         2923          61.8
Wa West              1596          50.2       1408         43.5         1476          44.8
Total               12328          46.7       12310        45.9         1476          44.8


   TT2+ performance for the region improve slightly by 2.9% from the previous year (35.0)
   % as compared to 2008 (35.4%) and 2009 (35.0%) of the same period. Sissala West
   and Lawra are the least performing districts with coverage 26.3% and 29.2% as
   indicated in table 12 below. Generally TT2+ coverage needs to be improved as only two
   districts could attain 40% coverage.


   Table 9: TT2 Performance by Districts Jan-June 2008-2010
                            2008                  2009                       2010
   District                                                %           #
                 # Vaccinated      % Cov   # Vaccinated                             % Cov
                                                          Cov     Vaccinated
Jirapa                772          28.2        998        39.3        1026          39.7
Lambussie             559          32.9        575        29.2        667           33.4
Lawra                1614          40.3       1426        35.0        1320          31.9
Nadowli              1628          43.0       1447        37.6        1563          39.9
Sissala East          503          24.3        752        35.7        829           38.7
Sissala West          442          24.0        482        25.8        500           26.3
Wa East               849          33.9        832        32.7        1185          45.8
Wa Municpal          1759          38.5       1773        38.1        2015          42.6
Wa West              1217          38.3       1113        34.4        1244          37.8
Total                9343          35.4           9398           35.0          10349       37.9




  Table 10: Dropout Rate by Antigen by District for 2010
             BCG-            %            Penta1-                   OPV 1-                MLS-
                                                                                                  %
District      MLS                         Penta 3         %         OPV 3          %      YF
Jirapa        234           18.1           105           9.7            -56        -5.2    -6     -0.6
Lambussie      99           11.1            -45          -6.3           -44        -6.1    0      0.0
Lawra         358           20.6            94           7.2            -112       -8.7   -16     -1.2
Nadowli        39           2.7            126           9.7            -128      -10.0   -17     -1.2
Sissala        99           10.7            69           7.7            69         7.7     0      0.0
East
Sissala        -36          -3.9            -15          -1.9           -42        -5.4    0      0.0
West
Wa East        0            0.0            -146          -12.0          -145      -12.0    -2     -0.1
Wa Mun.       491           14.4            -24          -1.0           -64        -2.8    0      0.0
Wa West       128           8.1             42           2.7            51         3.3    -15     -1.0
Total         1412          10.4           -397          -3.6           -471       -4.2   -56     -0.5
Figure 3: District dropout rate for 2010




Table 11: % Dropout Rate of Antigen by District 2009- 2010
District          % BCG-MLS           % Penta1-Penta          OPV 1-OPV 3     %MLS-YF Gap
                                                  3
                 2009       2010       2009           2010    2009    2010    2009    2010
Jirapa            0.9       18.1           -5.7       9.7     -11.7   -5.2     -0.2   -0.6
Lambussie        -5.4       11.1       -22.2          -6.3    -23.6   -6.1     2.4    0.0
Lawra             3.7       20.6           -6.9       7.2     -6.9    -8.7     -0.7   -1.2
Nadowli          10.9        2.7           -6.7       9.7     -6.7    -10.0    -0.8   -1.2
Sissala East      9.1       10.7           -1.0       7.7      9.9    7.7      5.2    0.0
Sissala          14.4        -3.9          18.4       -1.9     1.0    -5.4     0.1    0.0
West
Wa East           8.8        0.0            0         -12.0   -0.9    -12.0    1.0    -0.1
Wa Mun.          29.2       14.4           2.8        -1.0     2.1    -2.8     0.4    0.0
Wa West          -2.3        8.1           8.1        2.7      8.3    3.3      10.7   -1.0
Total           11.8%       10.4       -0.7%          -3.6    -1.8%   -4.2    1.7%    -0.5
Table 12: Antigens Drop Out for 2009-2010 by districts Absolute figures
District          BCG-MLS                Penta1-Penta 3        OPV 1-OPV 3        MLS-YF Gap
                2009       2010          2009          2010     2009    2010      2009       2010
Jirapa           137       234            -62          105      -125    -56           -2       -6
Lambussie        -48        99            -157         -45      -168    -44           23       0
Lawra            65        358            -97          94        -97    -112          -12     -16
Nadowli          179        39            -99          126       -99    -128          -12     -17
Sissala East     94         99             -9          69        94      69           49       0
Sissala          142       -36            152          -15       8      -42           1        0
West
Wa East          134        0              0           -146      -13    -145          14       -2
Wa Mun.         1012       491            67           -24       50     -64           10       0
Wa West          -36       128            128          42       132      51        168        -15
Total           1679       1412           -77          -397     -218    -471       211        -56




Table 13: District Immunization Wastage Rate in Percentage Jan-Jun 2010
District                         Penta                        Measles (30)
               BCG (50%)                        OPV (20)                                    TT (20)
                                  (10)                                         YF (30)
Jirapa             48             10              35              35             34           39
Lambussie          50              7              32              38             39           30
Lawra              59             14              40              33             30           41
Nadowli            44              7              35              27             28           30
Sissala East       74              7              35              62             60           31
Sissala                           15                              31
                   51                             25                                          38
West                                                                             26
Wa East            52              8              32              37             37           23
Wa Mun.              11            2            30            1              1            18
Wa West              73           13            42            55             53           47
Total                53            9            34            35             34           33


Generally vaccine wastage is high in the region. Almost all districts could not the various
antigens wastage rate for the period under review. Most especially the polio vaccine no
district has been able to meet the target. Particular concern is Wa West which could not
meet any of the antigens target. The next districts are Lawra and Sissala West.




Table 14: NIDs Campaigns
District     March 2010 -Round 1                     April 2010-Round 2
             Target       Vaccinated %               Target        Vaccinated %
Jirapa       13934        13926         99.9         13934         12911          92.7
Lambussie 10059           10387         103.3        10218         10299          100.8
Lawra        18302        18215         99.5         18302         18010          98.4
Nadowli      17654        17735         100.5        17654         16892          95.7
Sissala      12555        12522         99.7         12555         12534          99.8
East
Sis. West    10883        10692         98.2         10883         10828          99.5
Wa East      16181        15987         98.8         16158         15538          96.2
Wa Mun.      29077        29249         100.6        29077         28580          98.3
Wa West      19320        20879         108.1        19320         19281          99.8
Total        147965       148409        100.3        147965        144873         97.8
Figure 4: Comparison of Coverages for Round 1 and Round 2 2010 NIDs




The figure indicates that almost all districts had lower coverages in the second round
than in the first round. Regionally the coverage for the first round was 100.3% which is
higher than 97.8% recorded in the second round.
   Table 15: 2010 Routine Immunization Performance Regional and Districts
           Ann   Mont       BCG             Penta 3          OPV3             Measles       Yellow Fe
District   ual   hly    Perfor   %       Perform %       Perfor   %         Perfor   %      Perfor   %
                        mance    Cove    ance    Cove    mance    Cove      mance    Cove   mance    C
           Targ Targ             rage            rage             rage               rage            ra
           et   et
Jirapa     215   2585    1295     50.1    1144    44.3    1141    44.1      1061     41.0   1067     4

Lambus     167   874     888      44.4    764     38.2    763     38.2       789     39.5    789     3
sie
Lawra      345   1479    1742     42.0    1406    33.9    1406    33.9      1384     33.4   1400     3

Nadowli    326   1428    1428     36.5    1431    36.5    1410    36.0      1389     35.5   1406     3

S. East    179   929     929      43.4    823     38.4    823     38.4       830     38.7    830     3

S. West    159   778     918      48.2    800     42.0    827     43.5       954     50.1    954     5

Wa East    216   1139    1362     52.6    1358    52.5    1351    52.2      1362     52.6   1364     5

Wa         394   2910    2910     72.2    2329    49.3    2329    49.3      2923     61.8   2923     6
Mun.
Wa East    274   1589    1589     48.3    1514    46.0    1506    45.8      1461     44.4   1476     4
  Total       227      1242             12421       49.9      11569         42.4   11556      42.3       12153               44.5      1476     4
              5        1




       Table 16: Results from Child Health Promotion Week celebration 2009 & 2010
                                                       EXPANDED PROGRAMME ON IMMUNIZATION
                                        2009 ANTIGEN                                                               2010 ANTIGEN
                                                                            Measles
                    Penta 1

                              Penta 2

                                          Penta 3




                                                                                               Penta 1

                                                                                                         Penta 2

                                                                                                                   Penta 3
                                                                            Yellow
                                                    OPV 1

                                                            OPV 2

                                                                    OPV 3




                                                                                                                               OPV 1

                                                                                                                                       OPV 2
                                                                            Fever




District
            BCG




                                                                                        BCG




s
Jirapa      96       87       80          65         87     80      65 102 102
Lambus      70       68       41          49         68     41      49      69     67   59     36        37        40           36     37       40

Lawra      163      171       131 119               171 131 119 147 147 152 148 132 110                                       148 132          110

Nadowli     10      117       83 103                117     83 103          51     51
Sis.
East        78       70       46          49         70     47      48      59     59   72     72        38        39           72     38       39
Sis.
West        38       50       21          22         50     21      22      21     21   63     90        34        43           80     35       46
Wa
East        79       71       66          66         70     65      66      82     78 106 102 106                  76         101 106           75
Wa
Mun           197   142       144 148              142 144 148 218 218 127 174 162 134                                 175 162          141
Wa
West           61    23               16     18     23       16     18      22     22    90 108       97         81    108       97         81

Total         792   799       628 639              798 628 638 771 765 669 703 460 523                                 720 607          532




        Table 17: Results from child Health Promotion Week celebration 2009 & 2010
                                                                      VITAMIN A SUPPLEMENTATION
                                                                                                    2010                   2010
                    2009 Children                  2009 Capsules            2009 Capsules         Children               Capsules
                       doses                         Supplied                   Used               doses                 Supplied
                          6-11 mths




                                                                                                   6-11 mths
                                                   100,000



                                                                  200,000



                                                                             100,000



                                                                                        200,000




                                                                                                                       100,000


                                                                                                                                 200,000
                                           12-59




                                                                                                               12-59
                                           mths




                                                                                                               mths
        Districts
                                                   iu



                                                                  iu



                                                                             iu



                                                                                        iu




                                                                                                                       iu


                                                                                                                                 iu
      Jirapa                                        1303          10500          258     1420
      Lambussi
      e                                              345           2000          345     1451     113           486      392          723

      Lawra                                          349           8500          322     1613     120           258      992      1685

      Nadowli                                       1780          13000          432     3175
      Sis. East                                     1000           6800            24     668       50          308      700      1000

      Sis. West                                      305           5802          305     1613     116           281      638          991
      Wa East                                        637           9000          637     4590     639          1982     1522      2329
      Wa
      Municipal                                     1635          23709          1505   17737     163           202      650      4695
      Wa West                                        694           9015          325     3253     351          1823      500      2413
      Total                                         8048          88326          4153   35520     1552         5340     5394 13836
          Table 18: Results from child Health Promotion Week celebration 2009 & 2010


                           GROWTH MONITORING (WEIGHING)                         CHILD HEALTH RECO
                           2009                          2010                          2009
   District       0-      12-       24-        0-         12-        24-        No.        No.
                 11mt    23mth    59mths     11mths      23mth     59mths      Rec’d      Distr’d    R
                  hs
Jirapa           1100     989      1924                                         989           1038
Lambussie         940     787       139        916       1020        1564       390           240
Lawra            1999    2208      2816       1683       1577        2976       902           283    1
Nadowli          1591    1810      2748                                         640           312
Sis. East         977    1046       820        952        725        1191        95            95    1
Sis. West         968     783      1312        954        836        1437       250           197
Wa East          1315    1364      2167        874        939        1662       300           300
Wa Municipal     5221    5105      8991       2586       3236        4539                            1
Wa West           876    1171      1760       1538       1870        2496       600           600    1
                 1498    13116     22677      9503       10203      15865       4166          3065   6
Total             7
            Table 19: Results from child Health Promotion Week celebration 2009 & 2010h



                                   2009                                                       2010
                                   BEDNETS RE-TREATMENT                                        BEDNETS R
            SALE OF BEDNETS        AND RE-TREATMENT KITS             SALE OF BEDNETS           AND RE-TRE


                                   No. of     No.      of   No. of                            No.    of    No
                                   Treatm     Treatmen       Bed                              Treatme      Tre
                   Preg    Total   ent Kits   t      Kits     net           Preg   Total      nt   Kits    Kit
            Chn    Wom     Bed     Receive    distribute    treate   Chn    Wome   Bed        Receive      dis
Districts   <5yr    en      net    d          d                d     <5yr    n      net       d            d
Jirapa         0     48       48      2756         1606      2494
Lambussi
e              0       0       0       115         1402      1375       0      0          0          217
Lawra         11     12      33*      3585         2809      2809      29     17      50             923
Nadowli        0       0       0      2906         3568      3568
Sis. East      2       0       5      1472         1381      1784       0      0          0           28
Sis. West      0       0       0       150           912      912       0      0          0       1397
Wa East        0       0       0      1200         1200      1194       0      0          0
Wa Mun.        0       0       0      1704         1611      1611       0      0          0       1136
Wa West        0       0       0      1694         2104      2104                                     48
Total         13     60       86     15582        16593     17851      29     17      50          3749
           Table 20: Results from Child Health promotion Week Celebration 2009-2010
                     2009 Birth Registered                                 2010 Birth registered
                                                                             0-11     12-59 months   Total Birth
                  0-11 months 12-59 months              Total Birth        months                    Registered
District                M         F        M        F   Registered    M         F      M        F
Jirapa             50        56       0        0          106
Lambussie         100       114       0        0          214         139      143    13        19     314

Lawra             132       169       0        0          301         34       35      0        0       69

Nadowli           154       166       10       8          338
Sissala East      195       161       1        2          359         107      115     0        0      222
Sissala
West               72        77       0        0          149         11        7      1        0       19
Wa East            67        67       0        0          134          0        0      0        0        0
Wa Mun.           101       112       0        0          213                                           70
Wa West           273       265       20       14         572         52       58      0        0      110
Total            1144       1187      31       24         2386        343      358    14        19     804




           HIV/AIDS/STIs


           Introduction
           The Strategic plan for the health sector include the delivery of the package of
           interventions to reduce HIV transmission, the delivery of the package of care and
           support services for PLHV, the delivery of information on HIV/AIDS for action and the
           Provision of essential technical support to all MDAs in the implementation of their
           programmes.


           The AIDS/STI control Programme is responsible for the coordination and the
           implementation of HIV/AIDS related activities in the region. The objectives of the
Programme are to decrease the spread of infection, to properly manage Sexually
Transmitted Infections (STI) and to decrease the impact of positive HIV status on the
individuals, families and communities. The region work inline with the National Strategic
Framework (NSF II) 2006-2010 with its Key Components as:


     1.   Policy advocacy and enabling environment
     2.   Prevention and behavioural change communication
     3.   Treatment care and support
     4.   Mitigating the social, cultural, legal and economic impact
     5.   Coordination management and institutional arrangements
     6.   Research Monitoring and evaluation
     7.   Resource mobilisation

The key issues emanating at the beginning of the year which the region focused on
were:

1.   High death rate among clients on ART
2.   High defaulter rate
3.   Poor PMTCT and ART linkage
4.   Staff attrition

Activities carried out

     1.  Post training follow up and monitoring of recently trained counsellors
     2.  Training of 16 staff in Sissala East district supported by SHANET
     3.  Biobehavioral study by Nouguchi in Wa Municipal and Nadowli district
     4.  Took delivery of syphilis reagents and drugs, chemistry reagents, diaries
     5.  Review meeting with coordinators
     6.  Orientation on syphilis screening and introduction on updated formats
     7.  Dissemination of HIV sentinel survey
     8.  Meeting with NGOs
     9.  Three nurses from Tumu and Jirapa hospitals received award for providing
         quality services at ART centres.
     10. Conducted monitoring to all districts and hospitals
     11. Opened an infirmary for Water company



CT/PMTCT service data
Generally, there have been slight increase in client load over same period and this
could be due to the increase in the number of sites, outreach/mobile CT as well as
sensitisation carried out in facilities and communities. There has been an improvement
in the number of clients counselled. The positivity rate increased generally with the
highest being in the Lawra district and Regional hospital. Positive clients were linked to
ART sites for further management. It was realised that most clients referred did not
honour it. Client load for the period under review is as below:

CT Service Data by Sex- Half 2008 - 2010, UWR
Category                  2008                2009                     2010
                   M     F     Total    M     F           Total   M    F        Total
Number Pre-test    103 197 3009         176 384           5615    2755 333      6088
counselled         1     8              9     6                        3
Number Tested      100 129 2299         170 359           5306    2735 331      6046
                   3     6              5     9                        1
Number Positive    140 190 330          114 149           263     148  241      389
Number Post test   817 991 1808         166 340           5065    2731 329      6025
Counselled                              7     0                        2

CT by district /Facility- Half year 2010
Facility        No. Pre test  No.     No.       No. Post test   %
                Counselled    Tested Positive   counselled      Positive
Jirapa                    669     665       55              664      8.27
Lambussie                 397     383         4             383      1.04
Lawra                   1373    1369       151            1364     11.02
Nadowli                   864     864       58              864      6.71
Sissala East              278     278       12              278      4.37
SissalaWest               376     361        2              361      0.55
Wa East                   414     410         2             344      0.48
Wa Munic.               1315    1316        17            1314       1.29
Wa West                   149     147         7             147      4.76
Reg Hosp.                 324     324       84              324    25.92
Total                   6088    6046       389            6023       6.43

Know Your Status Campaign (KYS)
Know your status or outreach/ mobile HIV screening is an initiative adopted by the
country to give the public opportunity to know their HIV status for early diagnosis and
management. This was initiated in July 2008 and all districts implemented the activities.
The region received funds from National AIDS/STI Control Programme to support all
districts. The DDPH also organised programmes n Tertiary institutions, prison etc.
Know your status campaign by district /Facility- Half year 2009-2010
District                     2009                           2010
                 No. Pre      No.    No.    No. Pre test     No.     No.
                 test         Teste Positiv Counselled       Tested  Positive
                 Counselled d        e
Jirapa                    45      45      0           2865      2811        14
Lambussie                297    297       0           1966      1917         7
Lawra                      0       0      0           3735      3724        52
Nadowli                  415    415       5           1626      1472         1
Sissala East           1038    1038       5             928      928         5
SissalaWest                0       0      0             833      795         0
Wa East                  134    134       1             861      847         2
Wa Municipal           1303    1261       7           4241      4240        18
Wa West                  121      54      0              43       43         0
Total                 15201 14161        56          17098     16777        99

PMTCT Service Data, Half year 2008-2010 UWR
Category                                         2008        2009          2010
ANC Registrants                                  8571       10505         13154
No Pretest Counselled for HIV                    6684        9839         12790
No of clients Tested for HIV                     6544        9081         12346
No positive for HIV                               101         116           138
No Post test counselled for HIV                  6474        8850         11997
No screened for Syphilis                          174         989          4835
No Positive for Syphilis                            3          55            77
No Treated for Syphilis                             3          51            55

PMTCT by district – Half year 2010
District     ANC           No. Pretest            No       No         %
             Registrants   Counselled             Tested   Positive   Positive
Jirapa                1421                1525        1476          9       0.31
Lambussie             1410                1372        1368          6       0.00
Lawra                 1727                1864        1778        57        3.20
Nadowli               1775                1724        1702        13        0.76
Sissala East           872                 597         578          5       0.86
Sissala West           804                 858         783          8       0.93
Wa East               1141                1053         920          6       0.65
Wa Municipal          1681                1619        1619        14        0.86
Wa West               1480                1442        1382          6       0.41
Regional               695                 583         582          9
Hosp                                                                        1.55
Care and Support Package for PLHV
The aim of the above service is to improve the quality of health and prolong life of the
Persons Living with HIV (PLHV). Interventions provided within the Care and Support
package include Anti-Retroviral Therapy (ART), Continuous Supportive Counselling,
Prevention and management of OIs and holding working sessions with PLWHA and
their associations.


Antiretroviral Therapy
All the hospitals in the region initiated ART services between January 2007 to March
2008. Clients within the catchments’ area of these hospitals benefiting from ART were
referred to those facilities for management. All hospitals took delivery of CD4 count
machines as well as drugs. The four spectrophotometer and chemistry analysers were
installed and on site training conducted for staff by Namaka. The client load is as below:

Clients on HAART, Half year 2009– 2010, UWR
Indicators                           2009                                   2010
                      Adults        Paediatric        Tota Adults           Paediatric       Total
                      Mal Fema Male Femal l                  Mal Fema Mal Fema
                      e      le             e                e      le      e     le
No. on clinical care   55      131    12       3      201 142         264    13      16      435
No. on Anti-
                       36      103     8       2      149 61          155     3      9       228
Retroviral Therapy
No. with change of
regimen due to          1       5      0       0        6      1       4      0      0         5
drug toxicity
No. of deaths           6       12     0       0       18      7       25     2      2        36
No. lost to follow-
                        1       1      0       0        2     12       16     0      0        28
up
No. on second line      0       0      0       0        0      0       0      0      0         0
No. of new clients
on co-trim.
Prophylaxis            52      105    17       3      177 94          205    12      14      325
The total number of clients on ART increased in the first quarter of 2010. There has
been an increase in the death rate within the same period.


Opportunistic Infections (OI)
The region took delivery of drugs for the treatment of Opportunistic Infections from
NACP and these were distributed to the districts and hospitals for use. A total number of
957 clients with Opportunistic Infections were treated in the first quarter compared with
836 clients in 2009 as shown in the table below:
Opportunistic Infections recorded, Ha1f year, 2009 – 2010, UWR
Indicators                        2009                           2010
                       0-14 15-49 50+         Total 0-14 15-49 50+
# Receiving OI
Prophylaxis             110 2007 240          2357 184        2679 307       3170
(Cotrimoxazole)
# Receiving OI
                           2     61      6       69      1      53      6      60
Prophylaxis (Diflucan)
OI treatment              64 1376 128         1568 127        1998 170       2295
There has been doubling in the number of clients. This may be due to improved drug
availability.


People Living with HIV Association (PLWH)
Sixteen PLHV associations have been identified in the region. These associations hold
regular monthly meetings on Saturdays in the month. One monitoring visit was
conducted to associations to assess their progress and also support them plan their
Income Generating Activity (IGA) and meetings.


One meeting was also held with the executives of the associations to discuss their
progress report on the funds received for the meetings and IGA. All associations have
submiited reports on the implementation of their IGA and monthly meetings. The detail
number by associations is below:


HIV Sentinel Survey (HSS)
There was dissemination of 2009 HIV Sentinel Survey (HSS). The prevalence of HIV
infection was 2008 is 1.6% and increased to 3.1% in 2009. The region recorded the
highest prevalence.



HIV Sentinel Surveillance, 2005– 2008, UWR
Site                     2005         2006         2007         2008         2009
Jirapa                      2.8         3.5          1.4          2.0          4.5
Wa                          3.2         3.2          5.8          2.0          2.0
Nadowli                     1.7         0.7          1.9          0.3          2.6
Upper West                  2.6         2.5          3.3          1.6          3.1
Region
Ghana HSS                   2.7         3.2          2.6          2.2          2.9
HIV prevalence among adult population                1.9          1.7          1.9

Blood Safety
As a national policy, all blood and blood products meant for transfusion are tested for
HIV antibody among other tests. In line with this all Laboratories in the region were
provided with the necessary test kits for HIV screening. The table below shows the
prevalence of HIV among donors. There has been increase in number positive among
blood donors in almost all facilities as seen below:




Prevalence of HIV among blood donors by Hospital – Half 2009-2010
                   2008                   2009                           2010
         No          No          No         No             No             No
         Screene Positiv         Screene Positiv           Screene        Positiv
Hospital d           e       % d            e          % d                e          %
                                                         1                            16.
Jirapa          229      18 8          451        52 2          224            38       9
                              1                                                       13.
Lawra           463      49 1           37         2 5            29            4       8
Nadowli         125       4 3          106         7 7          468            43     9.2
Nando                                                    1                            25.
m              271       12 4         847        118 4         268             69       8
Tumu            117       3 3          156         6 4          146             5     3.4
Reg.                                                     3                            29.
Hosp            855      55 6         1817       706 9         1559           464       8

Sexually Transmitted Infection (STIs)
STIs issues are of importance to the region because of the complications as well as its
correlation with HIV. During the period under review, STIs reported declined as seen in
the below:

STI cases reported – Half year 2008 to 2010
 Syndrome                              2008            2009             2010
 Urethral discharge                     67               57                         164
 Male Genital Ulcer                     21               8                           51
 Female Genital Ulcer                   40               38                          71
 Vaginal Discharge                      89               93                         218
The total STI cases increased from 2010 compared to 2009. Vaginal and urethral
discharge were the commonest diagnosis within the period compared.
HIV Preventive activities
Preventive activities and condom promotion and use was organised in all the districts.
Sensitisations was also organised in CT/PMTCT, ART etc. This tool received sufficient
publicity to encourage safer sex practices among the general public. CT was also
organised at all regional launchings as part of the effort to promote ‘Know Your Status
Campaign. The region also received support from NACP/Global fund for regional and
district monitoring and also know your status campaigns in the region. This improved on
the awareness creation in the region.

TB/HIV Collaboration
The region disseminated the National policy/Technical guidelines on TB and HIV
activities. The region has streamlined TB and HIV activities from the regional level down
to the lower level. Coordination, Training, monitoring and services provided are being
synchronized to avoid duplication and gaps. The region also develop TB/HIV plan of
action. Monitoring, trainings etc were synchronized.
Challenges
1.   High death rate
2.   High defaulter rate in Regional Hospital.
3.   Inability of clients to pay for ART services resulting in huge outstanding bills
4.   Staff attrition
5.   Coordination of activities generally to avoid duplication and gaps.
6.   Destruction of some CT sites by rainstorm

Way forward
1. Training on Adherence counselling
2. Organise onsite meeting with Nandom ART team
3. Strengthen Support visit to TB/HIV sites
4. Continue KYS
5. Orientation on Model of Hope.
Challenges
  • Late and incomplete submission of monthly reports.
  • Data discrepancies still exist between districts and region.
  • Poor cold chain and vaccine management

Way Forward
  • Intensify routine immunization especially TT.
  • Continue to orientate health staff on vaccine/cold chain management, and proper
     documentation.
  • Give monthly/quarterly feedback to districts.
  • Intensify regular monitoring/supportive supervision to all districts especially the
     poor performing districts.
  • Encourage the use of every opportunity to screen mothers/caregivers and
     children for immunization
  • Advocate for active involvement of CBAs/CBSVs in outreach activities and
     defaulter tracing.

Tuberculosis


The objective of the tuberculosis control programme is to decrease morbidity and
mortality due to tuberculosis. This is to be attained by detecting 70% of existing cases at
anytime and to cure 85% and less than 10% defaulter rate. The strategies used by the
region include capacity to diagnose, manage cases, provision of drugs, logistics and
education to increase awareness about tuberculosis.


Achievements
• The region successfully carried out the World TB activities in the form of case
   search in Lambussie and Sissala West districts. The others also successful launch
   the week in their various districts.
• Held training for managers, TB coordinators and other health staff on improving Tb
   case detection (SOP).
• There has been no stock out of drugs, reagents and other logistics.
• Had 83.1 success rate as compared with 2008 66.3

•   The region’s performance in the area of case detection is not encouraging in first
    half of the year.
•   Carried out data Validation in all the districts from 2007-2009
•   Training of coordinators in TB management and documentation
•   The region held two successful review meetings
Analysis of all forms of TB – 2008 to 2010 half year
                 Annual Expected     Actual TB cases        Case Detection
Year              cases (All TB         detected.                rate          Cure rate
                     cases)
2008                   1881                118                    6            66.7
2009                   1909                129                    6            83.1
2010                   1967                137                    6


Case Detection by district for NSP – half year 2008 to 2010
District                      2008                   2009                    2010
Jirapa                         11                     7                       12
Lambussie                                             0                       6
Lawra                          16                    16                       13
Nadowli                         6                    12                       13
Sissala East                    3                     2                       2
Sissala West                    0                     1                       5
Wa East                         2                     0                       4
Wa Municipal                   19                    22                       19
Wa West                         3                     8                       4
Region                         60                    68                       78
There has been a gradual continuous increase in the total number of cases detected.

Categories of Cases reported by Districts – half year 2010
District                       NSP         Relapse             NSN            Extra P.
Jirapa                          12               0               9                 1
Lambussie                       6                0               0                 0
Lawra                           13               1              16                 5
Nadowli                         13               1               2                 0
Sissala East                    2                0               1                 0
Sissala West                    5                0               0                 0
Wa East                         4                0               0                 0
Wa Municipal                    19               3               6                 0
Wa West                         4                0               0                 0
                                78               4              34                 6
Treatment Outcome (New Smear Positive) – half year 2007 to 2009
                               2007                   2008                    2009
 Indicators
                        No            %        No             %        No             %
 Cured                  29        45.3          27            45       45            63.4
 Completed              18                      13                     14
 Treatment                        28.8                       21.7                    19.7
 Died                    9        14.1          6             10        4            5.6
 Defaulted               1            1.6       0             0         2            2.8
 Failed                  3            4.7       9             15        4            5.6
 Transferred out         3            4.7       2            3.3        2            2.8


Treatment result by districts 2009 half year
              Cured   Completed Died         Defaulted   Failed     Transferred Success
District
                      Treatment                                     out         rate
Jirapa        42.9      14.3           0.      28.6          14.3       0.            57.1
Lambussie       0         0             0        0            0
Lawra         68.8      12.5           6.3       0            0.       12.5            81
Nadowli       92.3       7.7            0        0            0         0.            100
Sissala
              100.        0            0.       0.            0         0             100
East
Sissala                                                                               100
               50        50             0        0            0         0
West
Wa East         0         0             0        0            0         0              0
Wa                                                                                    82.6
              65.2      17.4           8.7       0            8         0
Municipal
Wa West       12.5      62.5          12.5       0           12.5       0              75
Regional      63.4      19.7           5.6      2.8          5.6       2.8            83.1
Treatment outcomes/result by districts for 2009




Treatment outcomes/result by districts for 2008




Treatment outcomes/result by districts for 2007
The death rate has reduced from 14.1in 2007 to 5.6 in 2009. This has also contributed
to a good success rate for 2009 83.1. However some districts do not evaluate cases
reported.

Success rate trends by years in 2007-2009


Success Rate                           Success rate

2007                                   73.2

2008                                   66.7

2009                                   83.1

Challenges
  1. Still low case detection in the region.
  2. Low cure rate
  3. High death rate
  4. Poor case holding/follow up care
  5. Some coordinators still had problem with documentation(wrong formats, not
      evaluating some cases etc)

Way forward
  1. Active case search in the districts
  2. Active implementation of Standard Operating procedures.
  3. Hold the 3rd and 4th quarters review in the all the levels(Districts and regional)
  4. Frequent facilitative and monitoring support visits to facilities including the
      laboratories and private.
   5. To Improve the Quality of TB microscopy services and carryout 3rd and 4th EQA
      monitoring..
   6. To audit all the death cases




Guinea Worm
Activities:
   v Sensitization of Health workers and stakeholders on IDSR.
   v Training of Health workers on Integrated Disease Surveillance and Response
       (IDSR).
   v Implementation of IDSR
   v Monitoring and support visits to districts and sub districts.
   v On the job training of other health personnel who did not benefit the previous
       trainings during monitoring/supervision
   v Integrated Case searches.
   v Investigation of Rumours/Suspect cases

Main Findings:
  • No case of Guinea worm detected during the period of reporting
  • Suspect case investigations
  • Suspect case reporting is still very low in some districts
  • Documentation now improving gradually
  • Volunteer motivation needs to be strengthened in some districts
  • Sub district reporting registers not adequate
  • Number of communities in some sub districts keeps changing month by month
  • Quarterly meetings with volunteers in some districts not conducted due to lack of
      funds
  • Late submissions of reports from the districts
  • Some CHPS compounds do not pass reports through their mother Sub districts
      to the districts

Recommendations:
  ü Integrated Disease Surveillance and Response needs to be intensified to sustain
     the gains made in the previous years.
  ü Districts/Sub districts are urged to improve on prompt reporting to higher levels
  ü It is very necessary that Districts look for avenues to acquire funds to continue
     the quarterly meetings with the CBS Volunteers as a source of motivation.
  ü The Regional Health Administration should arrange to print more registers for
     districts.
GUINEA WORM CASES BY DISTRICTS


DISTRICT            2008                    2009                   2010
                   CASES                   CASES                  CASES
            Ind.    Imp.    Cont.   Ind.   Imp.    Cont.   Ind.   Imp.    Cont.
Jirapa      0       1       1       0      0       0       0      0       0
Lawra       0       0       0       0      0       0       0      0       0

Nadowli     0       0       0       0      0       0       0      0       0

Sissala     0       0       0       0      0       0       0      0       0
East
Sissala     0       0       0       0      0       0       0      0       0
West
Wa          0       0       0       0      0       0       0      0       0
Municipal
Wa West     0       0       0       0      0       0       0      0       0

Wa East     0       0       0       0      0       0       0      0       0

TOTAL       0       1       1       0      0       0       0      0       0

Ind; Stands for Indigenous
Imp; Stands for Imported

Guinea worm disease is a great set back to economic activities in many of our
communities that principally depend on farming. It also leads to loss of man hours both
for education and other alternative livelihood.
The region has achieved a dramatic improvement in the area of public education
leading to a high level of awareness in the prevention of the disease.
As mentioned in the summary, the Wa East district that used to be endemic, has been
able to refrain from their negative ways, therefore supported the efforts of Health
workers and the front line GW staff to break indigenous transmission in the district.
The last indigenous case was recorded in November 2007 in a village called Chawili in
the Holomuni Sub district of the Wa East District.
The biggest challenge now is the prompt detection, reporting and management of
suspected cases in the region.
Having attained the status of a Recently Freed Region, the Upper West region joined
her colleague Freed regions to benefit from the support of WHO/GWE to strengthen
surveillance through the IDSR concept which was introduced around 1980 in the MOH.
IMPLEMENTATION OF IDSR IN UWR:
After the Surveillance training in September and November 2009, the region was set for
the implementation of IDSR.
Districts and Sub districts identified focal persons to supervise the Community Based
Surveillance Volunteers and submit their reports timely to the next level.

Monitoring & Supervision:
All districts were visited at least once a Quarter for monitoring and supervision.
Continuous on the job trainings are ongoing in the Sub districts during supervisory
visits.
Integrated Case searches were conducted in all districts and suspect cases were
investigated in Wa Municipal, Nadowli and Wa East.

Surveillance:
Surveillance is maintained by the CBS Volunteers and Disease Control personnel in the
sub district staff supported by the District and Regional Supervisors.



Meetings:
Thirteen Volunteer meetings and twenty-one weekly meetings with Guinea Worm (GW)
field staff of the Wa East district were held by the Regional Guinea Worm Coordinator to
strategize on our activities.

Health Education:
The Regional Public Health Unit continuously educates the masses through radio
programmes on three FM radio stations in the region. This has become possible
through the support of WHO/GWEP and collaboration with Radio Upper West and
Radio Progress. The Wa East District has been urged to intensify their house-house
health education in the previously endemic villages in the district.

Collaboration:
We continued to hold meetings with partners like CWSA, PLAN (GH) and ProNET North
to advocate for provision of potable water to needy communities.

Ducie Water Project:
The Small Town Water system in Ducie is still functioning very well and community
members are paying their tariff punctually.

ACHIEVEMEENTS:
100% reduction in cases since the last indigenous case was recorded in November
2007.
ProNET North has sited a spot for drilling in Tanina and fixed a Borehole and an
Institutional latrine in Goripie. Loggu was also fortunate to benefit one Institutional
Latrine for their school.
Plans are far advanced for the installation of a Small Water System for Manwe and
rehabilitation of Hand dug wells Bulenga and Baayiri.


YEAR REPRODUCTIVE AND CHILD HEALTH REPORT 2010
Introduction
This report covers compilation of service data and other information on Reproductive and Child Health Service
delivery from all levels in the Region during the half year of 2010 comparing it with data for 2008 and 2009.
The goal of the Safe Motherhood Programme is to improve women’s health in general and to
reduce maternal morbidity and mortality and also to contribute to the reduction of infant
morbidity and mortality.
Components of safe motherhood
        q   Antenatal care
        q   Labour and delivery care
        q   Postnatal care
        q   Family planning
        q   Prevention and management of unsafe abortion
        q   Health education

The current strategy for delivering ANC services is focused antenatal care service which is geared toward promoting
individualized, client centered and comprehensive services. It is also for disease detection and not risk assessment.
Antenatal care has beneficial impact on pregnancy and birth outcomes through early diagnosis and treatment of
complications as well as promoting the health of the pregnant woman through nutrition education. It also creates the
opportunity for the woman and her care providers to establish a delivery plan based on her needs, resources and
circumstances.

For effective antenatal care, it is ideal that services are initiated early in pregnancy and adequate number of visits
made for the woman to enjoy the full package of services delivered during antenatal care. The current package of
services provided includes malaria prevention through chemoprophylaxis or Intermittent Preventive Treatment and
promotion of use of insecticide treated mosquito nets, nutrition education, iron folate supplementation, tetanus
immunization, clinical examination, laboratory investigations, CT and PMTCT, family planning education,
education on breastfeeding and care of the newborn.
Utilization of Antenatal Care Services
The following indicators are usually considered in measuring ANC utilization;
    • Proportion accessing service

    •    Proportion making adequate number of visits ( 4+)

    •    Timing of initiation of Antenatal Care
     •      Service received


Antenatal registrants
Antenatal coverage for 2010 decreased greatly comparing it to 2009 coverage. Wa Municipal recorded the highest of
58.4 and the least recorded by Lawra district 34.6%. All other districts recorded values between 40.2% - 54.5%.
Antenatal registrants 2008-2010
 District              2008                                  2009                        2010
                    Numbers         %              Numbers      %                Numbers    %
 Jirapa                  1,028              41.1      1,310           51.5           1278        49.4
 Lambussie                 657               34         758           38.6            803        40.2
 Lawra                   1,285              32.1      1,595           39.1           1434        34.6
 Nadowli                 2,450              64.7      2,566           66.6           1749        44.7
 Sissala E                 928              44.8      1,015           48.2            963            45
 Sissala W                 632              34.4        733           39.2            854        44.9
 Wa East                 1,339              39.1      1,245           48.9           1411        54.5
 Wa Mun                  2,475              54.3      2,522           54.2           2763        58.4
 Wa West                 1,553              45.3      1,398           43.2           1638        49.8
 Region                12,347               46.8    13,142                 49       12893        47.2




4	
  Plus	
  Visit	
  2008-­‐2010	
  	
  
The national Reproductive Health policy recommends a minimum of four visits per client. In 2010, 67% of ANC
registrants did 4 plus visits, which is a decrease as compared to 2009 figure of 78%. Pregnant women in almost all
the districts have done more than 50% visits in the half year. Double counting of pregnant women for 4 plus visits
was observed during monitoring and support visits to the districts by the Reproductive and Child health Unit. This
was corrected and it is hoped that the districts would do the necessary correction.
4 plus visits 2008-2010
                                        2008                        2009                    2010
 District
                    Number                   %     Number             %         Number          %
 Jirapa
                          499                49     1,164             89          1077          84
 Lambussie
                          268                41       565             75           555          69
 Lawra                    956                74     1,431             90          1157          81
 Nadowli                1,230                50     1,294             50          1195          68
 Sissala E                677                73     1,008             99           552          57
 Sissala W                712               113     1,344            183           524          61
 Wa East            559           42        590         47         685           49
 Wa Mun             800           32      1,752         69        1924           70
 Wa West            857           55      1,098         79        1005           61
 Region           6,558           53   10,246           78        8674           67




Percentage of women receiving TT 2 Immunization
 District                   2008                2009                         2010
               Number      %           Number     %          Number      %
 Jirapa             733           29      1,074         42        1110        42.9
 Lambussie
                    588           30        624         32         732        36.6
 Lawra            1,586           40      1,601         39        1237        29.9
 Nadowli          2,012           53      1,629         42        1724           44
 Sissala E          588           28        811         39         716        33.4
 Sissala W          538           29        604         32         566        29.7
 Wa East            813           24        802         32        1142        44.1
 Wa Mun           1,334           29      1,767         38        1963        41.5
 Wa West          1,276           37      1,214         38        1411        42.9
 Region           9,468           36    10,126          38     10601          38.8




Percentage of women receiving Tetanol immunization has increased by 0.8% comparing it to that of the 2009 figure.
Wa East and Nadowli recorded the highest of 44.1% and 44% respectively. Sissala West however recorded the
lowest 29.7%. All the other districts recorded values between 29.9% and 42.9%.




Gestational age at registration
Third trimester registration at ANC
For effective antenatal care pregnant women are supposed to visit the ANC clinic in their first trimester for early
identification of pregnancy related problem and management of complications. The year under review, had the
same percentages in women who registered their pregnancy in the third trimester with that of 2009. This has
implication for the service received by pregnant women as they would not have full service of intermittent
preventive treatment for malaria in pregnancy (IPT). This could account for the dropout rate between IPT1 and IPT
3.   Wa East recorded the highest percentage for this indicator with 17%. Apart from Jirapa, and Wa east which
experienced some increase of pregnant women registering their pregnancy in the third trimester, all the other
districts dropped between 1% -8%. Districts would have to intensify education on early registration at ANC to
access service early to benefit from the package available at ANC. Below is the table showing district coverage.
Third trimester registration at ANC 2008- 2010


 District                        2008                      2009                   2010

                Number       %              Number     %           Number    %

 Jirapa
                       128           12         158           12       160          13
 Lambussie
                        39            6          95           13        58              7
 Lawra                  77            6         214           13       119              8
 Nadowli               475           19         488           19       260          15
 Sissala E
                       165           13         159           16        78              8
 Sissala W              43            7         100           14        76              9
 Wa East               119            9         148           13       235          17
 Wa Mun                302           12         256           10       249              9
 Wa West
                       138            9         205           16       189          12
 Region
                     1,486           12        1,608          14      1424          11




Adolescent Pregnancy
Early Teen
Pregnancy registered by women age 10-14 years has increase for the year 2010 by 4. A total of 13 early teen
pregnancies were recorded in the half year which was an increase compared to the figure 9 in 2009. Lambussie
recorded the highest with 5 followed by Wa East, Wa Municipal, Wa West, Lawra recorded 2 cases each. The rest
of the districts did not report any case.


Early Teen 2008-2010
 District                        2008                      2009                  2010
 Jirapa                  1           0            1           0         0           0
 Lambussie
                         2           0            3           0         5           1
 Lawra                   0           0            1           0         2           0
 Nadowli                 0               0            0          0            0          0
 Sissala E               0               0            1          0            0          0
 Sissala W               2               0            0          0            0          0
 Wa East
                         0               0            2          0            2          0
 Wa Mun                  1               0            1          0            2          0
 Wa West                 1               0            0          0            2          0
 Region                  7               0            9          0        13             0



Late Teen 15-19 years 2008-2010
District                  2008                                2009                    2010
                 Number       %              Number       %          Number       %
 Jirapa
                        74          7            176            13       152            12
 Lambussie
                        54           8            89            12       140            17
 Lawra
                        48           4           162            10       125             9
 Nadowli
                        94           4           283            11       230            13
 Sissala E
                       172          13            78             8        97            10
 Sissala W
                        58           9            94            13        80             9
 Wa East
                       116           9           140            12       187            13
 Wa Mun
                       159           6           248            10       204             7
 Wa West
                        92           6           160            12       166            10
 Region
                       867           7          1,242           11      1381            11



Late teen pregnancy regionally has remained the same with 2009 figure 0f 11% of all pregnancies registered at the
ANC clinic. Jirapa, Lawra, Sissala West, Wa Municipal and Wa West saw some reduction in late teen pregnancy.
The other districts experienced increase. Intensification of Adolescent Health programme would help to address this
anomaly.




35 years plus
In 2010, 14% of pregnant women who registered at the ANC clinic were 35 years old and above. Wa East and
Sissala East had 16% of pregnant women registering at age 35 years old. All the other districts recorded values
above 10%.
Family planning education would have to be repositioned to reduce the number of older women getting pregnant
because it carries a lot of risk.
35 years plus
 District                       2008                           2009                            2010
               Number      %              Number                 %    Number               %
 Jirapa                                                          12                              14
                      93              9           155                            179
 Lambussie                                                       28                              11
                      42              6           207                                 90
 Lawra                                                           13                              13
                    125           10              218                            180
 Nadowli                                                                                         14
                    390           16              526            21              242
 Sissala E                                                                                       16
                    244           19              138            14              157
 Sissala W                                                                                       11
                      78          12              106            14                   94
 Wa East                                                                                         16

                    166           12              153            14              226
 Wa Mun                                                          13                              13
                    359           15              403                            347
 Wa West                                                         16                              14
                    144               9           265                            232
 Region                                                          20                              14
                   1,641          13         1,836                              1747




 Anemia at Registration
 District                      2008                     2009                 2010
 Jirapa
                    113          13        221            17           189     18.3
 Lambussie
                     54           8         28             4             1      0.5
 Lawra
                    385          18        697            43           104       9
 Nadowli
                      1          11        348            14           155     11.1
 Sissala E
                    127          14        114            11            54     11.1
 Sissala W
                     74          13         67             9           136     16.7
 Wa East             33           8         88             8           182     23.8
 Wa Mun
                    270          18        383            15           357     14.8
 Wa West
                     94          11         57             4            10      2.2
 Region            1,151         14       1,751           16          1188     13.6



Percentage of pregnant women anaemic at registration decreased from 16 in 2009 to 13.7 in 2010.
Wa East recorded the highest of 23.8%. Lambussie, and Wa West Districts however recorded values below 5%. This
is so because they do not have the facilities to check HB. HB check is also very low at the ANC clinics throughout
the Region.
Anaemia at 36 weeks
 District                               2008                      2009                      2010
                    Number         %            Number        %           Number        %

 Jirapa                      28             4           80           6             31         11
 Lambussie
                             22             4            3           0              1         8.3
 Lawra                     176             19          196          12             45         9.8
 Nadowli                     29             1          119           5             49          9
 Sissala E                   18             5           56           6             30         30
 Sissala W
                               1            0            9           1              6         2.8
 Wa East                     18             4           30           3             27        16.8
 Wa Mun                    136              9           77           3             16         3.2
 Wa West                     61             7            0           0              1         2.1
 Region                     489             6          510           5           206          8.9



Not many     pregnant women get their HB checked at 36 weeks this accounted for only 8.9% of pregnant women
recorded as being anaemic in the Region. Sissala East district had the highest percentage of pregnant women not
having their HB checked at 36weeks. Nutrition education would have to be carried out in the Districts.




Supervised delivery
 District                      2008                    2009                      2010
               Number      %           Number      %              Number     %

 Jirapa          1035        41.4       1079         42.4          1116          43
 Lambussie
                  564        29.2        517         26.3           527          26
 Lawra           1171        29.2       1057         25.9          1267          31
 Nadowli         1118        29.5       1084         28.1          1084          28
 Sissala E        710        34.3        901         42.8           771          36
 Sissala W        672        36.5        663         35.4           647          34
 Wa East          967        42.5        981         38.5           847          33
 Wa Mun          2298        50.4       2285         49.2          2017          43
 Wa West          871        25.4        802         24.8           877          27
 Region          5979        22.7       8394         31.3          9153          34



Supervised delivery has increased slightly in 2010 by 2.7%
TBA and Skilled Delivery
The fifth Millennium Development Goal (MDG 5) is to reduce the maternal mortality ratio world wide by 75%
between 1990 and 2015. An essential strategy for achieving MDGs is to ensure that all births are managed by skilled
health professionals. All births in the region are not managed by skilled health professionals due to geographical
access to health facilities and the limited number of midwives in our facilities. In 2010, 22.9% of expected
deliveries were skilled delivery as compared to 17.9% in 2009. This exceeded the percentage of TBA deliveries of
11% and 13.2% in 2010 and 2009 respectively. As skilled delivery increase, TBA deliveries decrease. This is a
positive trend and efforts will be put in place to promote skilled delivery since some women still prefer delivering
with their mother in-laws.




Skilled and TBA delivery
 District                            2008                   2009                    2010

                     skilled    TBA         skilled     TBA         skilled     TBA

 Jirapa                27.3          14.1      31.1          11.3      35               8
 Lambussie             16.7          12.5      17.2           7.5     21.7              5
 Lawra                 20.3          10.2      20.9           5.1     28.1              2
 Nadowli               19.1          10.4      20.5           7.7     21.3              6
 Sissala E             11.3          23.0       17           25.8     15.9             20
 Sissala W              8.2          28.4       11           23.6     11.6             22
 Wa East                7.3          35.2       7            31.5      6.8             26
 Wa Mun                31.2          19.2      34.2          15.0     35.2              7
 Wa West                 7           19.6       7.5          17.2     10.2             16
 Region                11.3          11.6      17.9          13.2     22.3             11



Caesarean section delivery 2008-2010
The percentage of births by caesarean section is an indicator of access to and utilization of care
during child birth. It is estimated that between 5% and 15% of all births in a population will involve a
complication that requires an intervention such as caesarean section. Caesarean sections are
lifesaving procedures and it is generally agreed that rates lower than 5% may mean that women do
not have access to these lifesaving operations. Without this service, many pregnant women with
complications will die or develop disabilities.
Facilities for caesarean section exist in only five districts in the Region. Four new districts do not
have facilities for caesarean section. Caesarean section rate for 2010 was 4.8% an increase
compared to 3.4% in 2009. The minimum of 5% has not been reached. As with many indicators,
there are district variations. While Regional and Jirapa hospital have exceeded 5%, Lawra and
Nadowli had below 5%. The unavailability of doctors in the region at a point in time accounted
for the low caesarean section rate.
Caesarean Section Deliveries

 District                      2008                 2009                      2010
 Jirapa                  8.9                 6.6                    7.7
 Lambussie                0                   0                      0
 Lawra                   4.1                 2.6                    2.8
 Nadowli                 0.8                  0                     2.6
 Sissala E               2.3                 2.6                     5
 Sissala W                0                   0                      0
 Wa East                  0                   0                      0
 Wa Mun                 10.4                 7.4                    8.9
 Wa West                  0                   0                      0
 Region                  4.6                 3.4                    4.8



Post natal care
 District                           2008                    2009                        2010
                  Number        %          Number     %             Number       %
 Jirapa                 820      32.8        1,021         27.6       1463            56.6
 Lambussie              622      32.2         598          30.4           584         29.2
 Lawra              1,098        27.4        1,197         29.4       1100            26.5
 Nadowli            1,305        34.5        1,095         28.9       1191            30.4
 Sissala E              564      27.2         724          34.4           609         28.4
 Sissala W              668      36.3         641          34.3           614         32.3
 Wa East                981      28.6         843          33.1       9963            37.2
 Wa Mun             2,008        44.1        2,060         44.2       1697            35.9
 Wa West            1,112        32.4         942          27         1087             33
 Region            9,172         34.8        7,972         28.3       9308            34.1


Postnatal coverage for 2010 was 34.1% an increase compared to 2009 (28.3%). Jirapa recorded the highest with
56.6% followed by Wa Eastl 37.2%. Lawra recorded the least of 26.5%.
Maternal deaths
 District                           2008                     2009                       2010
              Number           00/00       Number      00/00        Number           00/00

 Jirapa                                       2            0.21           0             0
                    1           0.12
 Lambussie
                   0            0          0           0           0            0
 Lawra                                     3         0.29          2           1.8
                   2           0.1
 Nadowli           0            0          1         0.09          1           1.2
 Sissala E         2          0.35         3         0.36          3           9.2
 Sissala W                                 0           0           0            0
                   0            0
 Wa East                                   0           0           0            0
                   0            0
 Wa Mun                                   14         0.63          8            5
                   5          0.22
 Wa West           0            0          0           0           0            0
 Region           10          0.11        23         0.28         14           2.4


A total of 14 institutional maternal deaths were recorded in the region which was a significant decrease over that of
2009 figure of 23. Training on safe motherhood was organized for staff providing obstetric care to
improved their skills and knowledge. Stakeholders were also sensitized to actively play their roles to
help reduce maternal mortality situation in the region. Districts upon the regional maternal death
audit meeting implemented their emergency preparedness plans and the situation is improving a lot.
More however still needs to be done.


.Maternal death audit 2010
 District                                                                    2010
                       Number of deaths      Number audited        % audited
 Jirapa                         0                     0                          0
 Lambussie                      0                     0                          0
 Lawra                          2                     2                        100
 Nadowli                        1                     1                        100
 Sissala E                      3                     3                        100
 Sissala W                      0                     0                          0
 Wa East                        0                     0                          0
 Wa Mun                         8                     8                        100
 Wa West                        0                     0                          0
 Region                        14                    14                        100
Causes of death

           Sickle	
  cell	
                                        Severe	
  
           crisis	
  and	
                                       Anaemia,	
  2
          anaemia,	
  1
                                                                           Cerebral	
  
 Eclampsia,	
                                                             malaria	
  or	
  
     1                                                                    meningitis,	
  
       Haemorrha                                                              1 Pulmonary	
  
           ge,	
  2
                                                                                      TB	
  &	
  
                                                                                  Encephalitis	
  
                              Puerperal	
                                          secondary	
  
                               sepsis,	
  2                                         to	
  	
  HIV	
  …
The audits show that the direct causes of maternal death remain haemorrhage, pregnancy induced
hypertension, obstructed labour and sepsis. Underlying factors include delay in seeking care, non-
availability of key staff at facility to take decision to intervene and non-availability of blood.
A confidential inquiry into hospital based maternal deaths found that care provides to women


Stillbirth Rate
District          2008                        2009                 2010
Jirapa                   32          1.5             26    2.4            14           2
Lambussie                8           0.8             2     0.4             2           0
Lawra                    35          1.5             16    1.5            25           2
Nadowli                  9           0.4             0     0.0             2           0
Sissala E                27          1.8             14    1.6            13           4
Sissala W                8           0.6             1     0.2             3           1
Wa East                  14              0.9               0             0.0             1               1
Wa Mun                163                3.5              89             3.9            75               5
Wa West                  12              0.7               2             0.2             7               2
Region                304                1.9              150            1.7            142              2


The still birth rate is an indirect measure of the management of pregnancy, labour and delivery. Still
birth rate increased in 2010 (2%) as compared to (1.7%) in 2009. Wa Municipal recorded the highest of 5%
followed by Sissala East with 4%.
Low birth rate
Infant deaths 2008-2010
District          2008                             2009                         2010
Jirapa                   7               0.7              23             2.4            19               2
Lambussie                0               0.0              0              0.0            0                0
Lawra                    4               0.3              2              0.2            2                0
Nadowli                  1               0.1              5              0.5            0                0
Sissala E                3               0.5              7              0.8            6                2
Sissala W                1               0.1              0              0.0            0                0
Wa East                  1               0.1              3              0.3            0                0
Wa Mun                   28              1.3              14             0.6            32               2
Wa West                  1               0.1              12             1.5            7                2
Region                   46              0.6              66             0.8            66               1




Baby friendly facilities
Mother- to – Mother –Support Group (MTMSG)


School health
 District                                      2008                             2009                               2010

                  No. of      Schools          %        No. of       Schools    %             No. of   Schools     %
                 schools       visited                 schools        visited                schools    visited
 Jirapa
                     98            34           34.7           552        98     17.8           135          149    101
 Lambussie
                     79            59           74.7           135        15     11.1            83          118    142
 Lawra              180           345          191.7       1,005         188     18.7           157           84       54
 Nadowli            107         151        141.1        753         184           24.4      143         109        76
 Sissala E          101          23         22.8        518            51          9.8       76          57        75
 Sissala W            87         66         75.9        451            64         14.2       87         209       240
 Wa East              97         83         85.6        416         175           42.1       94         219       233
 Wa Mun             192         133         69.3        882         100           11.3      207         156        75
 Wa West            115          36         31.3        534            63         11.8      127         157       124
 Region            1056          930        88.1       5,246        938           17.9     1109        1258       113


Percentage of schools visited in 2010 was higher as compared to 17.9% in 2009. The challenge that might still be
affecting coverage is non-corporation on the part of school authorities. Schools that were not visited meant that the
school children were not also examined.




Percentage of School children examined 2008 -2010
 DISTRICT                2008      2009        2010
                  NUMBER %    NUMB %    NUMBER %

 JIRAPA                1,257 12.7     849   8                       1133   7.3
 LAM                   2,838 47.4     401 13                       10234 217.6
 LAWRA                19,091 164.8 14,948 124                       8023 71.7
 NAD                   7,357 60.6 11,486 95                         4749 36.6
 SE                    1,155 17.9 2,491 37                          3463 33.5
 SW                    2,250 30.9 1,900 25                          4746    63
 WE                    9,387 163.9 19,107 318                       7976 110.2
 WM                    4,128 23.1 8,984 45                         12373 51.4
 WW                    2,566 28.6 3,758 51                         14420 155.3
 REGION              50029    58.2 63,924 75                       67117 65.3



Percentage of School children referred 2008 -2010
 DISTRICT                   2008                 2009                           2010
                 NUM       %           NUMB        %           NUMBE        %
                 BER                                           R
 JIRAPA
                     26           2         61         7.2          47            4
 LAM                 98           3           2        0.5           1            0
 LAWRA               121           1        172         1.2           112         1
 NAD                  76           1         63         0.5            23         0
 SE                   78           7          0           0           179         5
 SW                   73           3        142         7.5           101         2
 WE                   40           0         31         0.2            39         0
 WM                   77           2        114         1.3           122         1
 WW                   57           2         57         1.5            47         0
 REGION              646           1        642           1           671         1




Percentage of School receiving 3 health talks 2008 -2010
 DISTRICT                                2008                 2009                        2010


                                            %                    %                           %
 JIRAPA
                                             5                    1                         10
 LAMBUSSIE                                   9                    0                         25
 LAWRA                                       7                    9                         17
 NAD OWLI                                   28                    0                         33
 SISSALA E AST                              11                    4                           8
 SISSALA W EST                               8                    4                         25
 W A EAST                                   19                    2                         40
 WA M UNICIPAL                              14                    1                         25
 WA WEST                                     2                    4                         47
 REGION                                     11                    3                         26

Baby Friendly Health Facilities Initiative

The Baby Friendly Health Facilities Initiative (BFHFI) seeks to promote optimal breastfeeding
practices starting from the Health Care Facility.

All the districts were asked to prepare facilities for designation as Baby Friendly
Adolescent Health
      •   Adolescence simply means growing up.

      •   It is a transitional period from childhood to adulthood. Major changes do occur during this period and
          shape structure could be physical, mental, psychological or social.

      •   What happens or does not happen during this time has significant implications
Monitoring and support visit
   • High attrition of trained personnel resulting in inequity in distribution of trained personnel.

    •    Inadequate knowledge and skills for some health workers.

    •    Both adults and adolescents utilize the adolescent health and PMCTC facilities. (Health facilities partially
         adolescent friendly). Inadequate supervision of school health club programmes.

    •    Lack of interest in programme activities.

    •    Poor collaboration with NGOS and agencies.

    •    Wa municipal is a step ahead of other districts-(with the presence of a number of NGOS collaborating with
         them).


Challeges
   • Lack of funding for programme implementation.

    •    Poor collaboration with NGOS and Agencies.

    •    Inadequate knowledge and skills on programme.

    •    Inadequate educational and recreational materials for youth

    •    Inequity in distribution of trained personnel.

    •    Inadequate awareness to availability and allocation of services.

    •    Deficiencies in reporting format-(under reporting).




Strategies and way forward
    • Districts to integrate ARH activities into routine RCH activities document and report monthly.

    •    Train all district coordinators and frontline health workers who will open more adolescent health corners
         and school health clubs.

    •    DHMTS to try to solicit support and collaboration with NGOS, individuals and agencies.

    •    Apart from target group health workers could also target the general public especially mother to mother
         support groups to create awareness of availability and location of the services.

    •    Integrate adolescent health issues with maternal health issues during forth coming stake holders meeting



Family Planning
Contraceptive use reduces maternal mortality and improves women's health by preventing unwanted
and high-risk pregnancies and reducing the need for unsafe abortions. Some contraceptives also
improve women's health by reducing the likelihood of transmissions of infections such as HIV.
Child survival is improved through adequate birth spacing, prevention of births among very young
women, and prevention of births among women with four or more children. Having too many
children also places children's health at risk. Using contraception to end childbearing after four births
helps reduce infant mortality rates.
Family Planning services include methods and practices to space births, prevent unwanted
pregnancies and limit family size. The goal of family planning is to assist couples and individuals to
achieve their reproductive health goals and improve their general reproductive health. Family
planning services are linked to other reproductive health services including the management of
reproductive tract infections.
The family planning acceptor rate decreased from 27.7% in 2009 to 21.5% in 2010.

Family Planning Acceptors

 DISTRICT                                 2008                       2009                      2010
                        NUMBER        %              NUMBER      %          NUMBER         %
 JIRAPA                      6345          23.9          4411        28.9           3544       22.8
 LAMBUSIE                         0              0       1228     10.41             2046       17.1
 LAWRA                       6097          25.4          9082     37.31             5539       22.3
 NADOWLI                     5758          25.3          7002        30.3           4997       21.3
 SISSALA EAST                4274          34.4          3353     26.52             3332       26.4
 SISSALA WEST                1603          14.5          2698     24.03             2036       17.8

 WA EAST                     3379          16.4      *2914        19.07             3225       20.8
 WA MUNICIPAL                7602          27.8          9691     34.74             8586       30.3

 WA WEST                     4881          36.3          4236     21.81             4318       21.9
 REGION                     39939          25.2         44615        27.7       37623           23




Family planning acceptor rate
 Jan – June Acceptors
 Indicators                                           2008       2009        2010
 New acceptors/First ever users                      11634      10584       12324
 Continuing acceptors                                29088      34031       25299
 Total                                               40722      44615       37623
 CYP                                                  9447      10550   8740.89



The Couple Years of Protection is a measure of couples that have been protected against unwanted/
unplanned pregnancy.
Challenges
    •    Poor documentation of family planning services
    •   Inadequate coordination of family planning services at all levels
    •   Delay in submission of reports by districts
    •   Delay in payment of funds by some districts.
    •   Low patronage of some devices e.g. IUD and female condoms
    •   Lack of male involvement in family planning activities
    •   Limited resource / support e.g. contraceptives not included in NHIS




Recommendations
Though there is much improvement in the quality, accuracy and completeness of reports, there is still room for
improvement. It will be appreciated if some narratives could be provided for the statistical figures.
 • Districts should try to improve upon the timeliness of report submission and documentation as there are still
     disparities in the stock levels and physical stock.
 • They should also endeavor to submit family planning funds alongside the reports submitted to enable the
     region pay the national quota on time.
 • Men should be involved in all reproductive activities.
 • Family planning should be in cooperated into NHIS.




Nutrition service


Nutrition intervention activities carried out during the first half of 2010 include the
following:
    • Growth monitoring and promotion
    •   Vitamin A supplementation
    •   Community-based management of severe Acute malnutrition
    •   Nutrition and Malaria Control for Child Survival
    •   Supplementary feeding
    •   Nutrition Surveillance
    •   Child Health Promotion Week Celebration

Summary of Achievement during the Half year
Indicator                          Half          year Achievement                  Remarks
                                   Target
Underweight                        18.0                   25.3                     Routine GMP
Chronic           Malnutrition 20.0                       25.3                     Nutrition
(Stunting)                                                                         survellance
Acute         malnutrition 10.0               15.8                 Nutrition
(Wasting)                                                          survellance
CWC Registrants              80.0             39.6
Vitamin                   A 30.0              29.3                 Routine data
Supplementation
(Maternal)
Vitamin                    A 45.0             98.3                 April NID
Supplementation        (0-59
months)
Exclusive   Breastfeeding 90.0                84.3                 Nutrition
Rate                                                               survellance
Timely   Complementary 100.0                  95.4                 Nutrition
Feeding Rate                                                       survellance




1.1 Growth Monitoring and Promotion of Children 0-23 Months
This activity is carried out at outreach and static points in all sub-districts. The only
indicator used here is underweight for children aged 0-23 months.
During the first half year of 2010 data from all growth monitoring sessions in the region
shows a substantial increase in underweight among children 0-23 months in Jirapa,
Lambussie Nadowli, Wa Municipal, and Wa West districts (Table 1a). The data showed
a continuous worsening in nutritional status of children in Jirapa, Lambusse and
Nadowli since 2008. There was a reduction in the prevalence of underweight in Sissala
West, Lawra, and Wa East.
Generally the regional prevalence of underweight among children 0-23 months
increased by 1.5 percentage points as at June 2010 (that is, from 23.4% to 25.4%). The
reasons for this unstable nutritional status in the region could be attributed to household
food insecurity, poor environmental/personal hygiene, and improper child care practices
among others.
Data collection errors including measurement errors, reading and recording errors
cannot be ruled out.

Table: 1a Trends in Nutritional Status of children 0-23 months
                 Number      of    children Prevalence of underweight for 0-23months
Districts        weighed                    children at out reaches and static clinics
                 2008      2009     2010    2008              2009             2010
                                            #          %      #         %      #          %
Jirapa           3359      4543     2462    658        19.6   982       21.6   943        38.3
Lambussie        1784      1411     1711    466        26.1   453       32.1   862        50.3
Lawra            4754      3289     4140    1512       31.8   1258      38.2   426        10.2
Nadowli          3,847     3809     3508    781        20.3   1020      26.8   1214       34.6
Sissala East     2291      2062     2135    542        23.7   486       23.6   336        15.3
Sissala West     1744      1906     2297    563        32.3   702       36.8   775        33.7
Wa East          3,700     3956     3501    1155       31.2   1329      33.6   673        19.2
Wa Municipal     30,556 6631        4811    10,843 35.5       847       12.8   1268       26.3
Wa West          3439      3439     3334    794        23.1   794       23.1   1012       30.3
Regional         55,474 31,046 27899 17,314 31.2              7,871     25.4   7509       26.9

Table 1b shows the prevalence of underweight among children by age groups as of
June 2010. The 24-59 months age group was worst off nutritionally. The 2008 GDHS
reports shows 14% of children under five are underweight in the Upper West region.
The current 25.3% (table 1b) far exceed the GDHS 2008 figure. This also falls outside
the WHO acceptable cut-off prevalence of less than 10%. This implies a critical
malnutrition situation in the region.
In terms of districts variation Jirapa, Lambussie and Nadowli are worst off with a
prevalence exceeding 30%.
A number of factors including household food insecurity, inadequate maternal and child
care and unsanitary/inadequate health services are important causes of these high
rates of underweight.
Table 1b Prevalence of Underweight (%) by Age Groups in the Districts

District       Prevalence of underweight (%)
               0-23                 24-59 months           0-59 months             Remarks

               2009      2010       2009        2010       2009       2010
Jirapa         21.6      38.3       36.8        28.4       36.6       33.9         High
Lambussie      32.1    50.3        36.9     49.4      33.9          49.9        high
Lawra          38.2    10.2        42.5     14.6      39.9          11.9
Nadowli        26.8    34.6        48.7     31.2      35.1          33.2        High
Sissala East   23.6    15.3        19.4     13.3      22.5          15.2        High
Sissala        36.8    33.7        40.5     14.9      37.5          14.9
West
Wa East        33.6    19.2        36.4     19.5      27.1          20.5
Wa             12.8    26.3        15.1     32.2      13.1          28.1        High
Municipal
Wa West        23.1    30.3        24.5     32.8      23.5          31.2        High
Regional       25.4    26.9        33.4     29.2      29.9          25.3        High




1.2 Coverage of Growth Monitoring and Promotion (GMP) of Children 0-59 Months

The GMP coverage for the first half of the year is shown on table 2. As of June only two
districts, Wa East and West had registered above 80% of children 0-23 months. Sissala
West and Nadowli registered the lowest number of children, below 50%. This shows
that most of these are not covered during child welfare services. Districts that covered
lessthan 80% need to improve outreach strategies for the rest of the half year to cover
more children. The region as a whole covered 67.0% of the 0-23 months and 39.6 of 0-
59 month’s children. This shows that more attention is given 0-23 month’s age group
than the 24-59 months group.


Table: 2 Coverage of Growth monitoring and promotion (children 0-59) months


District          Estimated target pop, 2010         GMP Coverage n (%)
                  0-23 months       0-59 months      0-23 months           0-59 months
Jirapa                     5,170          12,926             69.8              43.97
Lambussie                  3,999           9,997             54.9              34.84
Lawra                      8,288          20,719             66.4              40.25
Nadowli                    7,832          19,581             37.7              21.55
Sissala East              4,285          10,712            51.3            24.25
Sissala West              3,806           9,515            49.7            24.74
Wa East                   5,178          12,945            90.4            58.18
Wa Municipal              9,456          23,641            78.6            45.39
Wa West                   6,582          16,455            92.6            55.71
Regional                  5,170         136,490            67.0            39.64


2.0 Supplementary Feeding Programme (SFP)

2.1 Coverage of the SFP
There is high demand for the supplementary feeding programme in the region. Three
districts enrolled more children than the targets given. They are Jirapa/Lambussie,
Nadowli, Wa East and Wa West districts. For lactation and pregnant women all the
districts exceeded the targets. This is an indication of serious food insecurity at the
household level.

Table 3 Coverage of Supplementary Feeding Programme
Districts       Target No. Enrolled. Total      Coverage Target Coverage of PG &
                  for                           %        for PG LA women
               children                                  & LA
                (6-59) Male Female                                  n      %
               months
Jirapa/Lam. 1121       671     729      1400    124.9      429      636    148.3
Lawra          1084    445     482      927     85.5       371      444    119.7
Nadowli        764     413     461      874     114.4      406      378    93.1
Sissala        1188    456     653      1109    93.4       522      691    150.3
East
Sissala        887     408     402      810     91.3       266      292    109.8
West
Wa East        2181    1024    1174     2198    100.8      458      604    131.9
Wa             932     382     383      765     82.1       278      445    160.1
Municipal
Wa West        434     453     457      910     209.7      162      492    303.7
Regional       8,591   4,252 4,741      8,993 104.7        2,892    3,982 137.7
2.2 Prevalence of malnutrition in SFP Communities
The prevalence of malnutrition in the supplementary feeding communities remained
relatively low. There was even a further reduction in all the indicators during the period
under review (Table 4). Stunting and Wasting reduced substantially over the period.
Acute malnutrition (wasting) of 3.5% was within the WHO acceptable cut-off of less than
5% in healthy normal population.

Over the period there was regular supply of food by WFP to the districts and this might
have contributed to this improvement.
Table 4: Comparison of malnutrition rate among children aged 6-59 months for
the past three years

                                           Malnutrition Rate n (%)

Indicator                       2008             2009                2010

# Weighed                                                            10,108
                                   718 (7.2)        536 (6.1)
Underweight (WAZ < -2 SD)                                            551(5.50)
                                   531(5.3)         666 (7.7)
Acute malnutrition (WHZ <                                            354 (3.5)
-2 SD)
                                   403 (4.0)        712 (8.2)
Chronic malnutrition (HAZ                                            252 (2.5)
< -2 SD)



3.0 Community-based management of Severe Acute Malnutrition (CMAM)
CMAM is a community-based approach to managing malnutrition cases at the
community level. The programme fully started in five districts at the end of the second
quarter. These five districts will be closely monitored this year before scaling up to the
rest of the districts. Severe Acute Malnutrition (SAM) without medical complications is
managed at the out-patient level in the communities under the supervision of health
facilities in the communities. Ready-to-use therapeutic food and routine medication are
used at the OPC level. SAM cases with medical complications are referred to in-patient
facilities for care until the complications are resolved then they are referred back to
OPC.
About 146 health staff were trained in five districts on the management of SAM at OPC.
Plans are far advance to train clinical staff for the in-patient level in August this year.

Table 5: Registered and Treatment of Severe malnourished cases by districts

District          #       of # Cured        #      Non- # Died          Remarks
                  Cases                     recovered

Jirapa            80         0              0              0

Lawra             104        0              0              0

Wa East           17         2              0              1

Wa Municipal 43              0              0              0

Wa West           0          0              0              0            Started      in
                                                                        July

Total             244        0              0              1




4.0 Control Micro-nutrient Deficiencies
Micro-nutrient deficiencies, especially those of vitamin A, iron and iodine remain a
significant public health problem in the region. Promotion of dietary diversification
through nutrition counseling, supplementation and food fortification are some of
interventions currently being implemented to address the problems. Currently 8
communities have been selected to start rebagging of iodated salt at the community
level and 6 communities for flour fortification.


4.1 Vitamin A supplementation
To boost the vitamin A status of both children and post partum women every opportunity
is been utilized to do supplementation. In April 2010, vitamin A supplementation was
integrated with NID and was repeated during the Child Health promotion Week (CHPW)
in May. Table 6 shows the coverage of the April NID vitamin A supplementation while
table 7 shows that of the CHPW coverage. There was over 90% coverage recorded by
the region. Five districts, Sissala east, Sissala west, Wa east Wa municipal and Wa
west dosed over 100%. Lambussie, Lawra and Nadowli recorded less than 90%. The
strategy of house-to-house which was used during the exercise was very effective.
The mass campaigns are observed to be more effective than the routine
supplementation.

Table 6 Coverage of vitamin A supplementation among Children 6-59 months
during April 2010 NID

District           Target (18% of # Dosed with          % Coverage           Remarks
                   pop)            Vit. A
Jirapa                             11,384                                    High
                          11,633                               97.9
Lambussie                          6,456                                     Low
                           8,997                               71.8
Lawra                              15,922                                    Low
                          18,647                               85.4
Nadowli                            14,915                                    Low
                          17,623                               84.6
Sissala East                       10,138                                    Very high
                           9,640                               105.2
Sissala West                       8,808                                     Very high
                           8,563                               102.9
Wa East                            13,108                                    Very high
                          11,651                               112.5
Wa Muni.                           24,481                                    Very high
                          21,277                               115.1
Wa West                            15,601                                    Very high
                          14,810                               105.3
Region                             120,813
                      122,841                                  98.3

The CHPW coverage of vitamin A was relatively low (Table 7). This was because only
children who were missed during the April campaign were eligible and considering the
high coverage during the NID one would expect very few eligible children to be dosed.
Interestingly Jirapa the lowest district during the April NID had the lowest again in the
CHPW campaign of 1%. The highest coverage was observed in Wa East and Wa west
district, that is 22.5% and 14.6% respectively. All other districts recorded less than 10%.


Table 7 Coverage of vitamin A supplementation among Children 6-59 months
during CHPW
               Target                              Coverage (%)          Remarks
District       Pop,         # dosed
               2010
               2010      2008     2009     2010    2008 2009      2010

Jirapa                   5373     1596     113     47.8   13.9    1.0
                11,633
Lambussie                4390     1796     599     50.5   20.3    6.7
                8,997
Lawra                    8092     1933     378     44.9   10.5    2.0
                18,647
Nadowli                  9816     3136     847     57.6   18.1    4.8
                17,623
Sissala East             2728     641      358     29.3   6.8     3.7
                9,640
Sissala West             4566     1918     397     55.4   22.8    4.6
                8,563
Wa East                  5065     5194     2618    49.4   45.3    22.5
                11,651
Wa                       15,560 22152      365     75.1   105.9 1.7
Municipal       21,277
Wa West                  7342     3245     2174    47.6   22.3    14.6
                14,810
Regional                 62,932 41,611 7,849 52.9         34.4    6.4
             122,841
There was general improvement in maternal vitamin A supplementation over the period
under review. The coverage of post partum vitamin A supplementation in the region
increase by 4.6 percentage points (Table 8). Most of the districts achieved more than
30% of the annual target of 60%. Nadowli and Sissala west districts who recorded less
than 20% need to improve on their strategies for the rest of the half year. Though there
are general improvements in the region there is the need to improve on the following:
Ø Documentation.
Ø Postnatal services.
Ø Supervised deliveries.
Table: 8: Maternal vitamin A supplementation
Districts   Target (4 % of total 2008                             2009              2010
            pop)

            2008         2009     2010     #     %        #     %        #     %
                                           dosed coverage dosed coverage dosed coverage
Jirapa      -            2542              -     -        1105 43.5      1008 38.9
                                   2585
Lambussie -              1966                                     598      30.4     718      35.9
                                   1999 -             -
Lawra       4006         4075                                     1,399    34.3     1175     28.4
                                   4144 578           14.4
Nadowli     3786         3851                                     719      18.7     592      15.1
                                   3916 658           17.4
Sissala     2071         2106              251        12.1        74       3.5      508      23.7
East                               2142
Sissala     1840         1871              180        9.8         692      36.9     377      19.8
West                               1903
Wa East     2246         2546                                     1108     43.5     780      30.1
                                   2589 318           14.2
Wa          4581         4649              654        14.3        1497     32.2     1226     25.9
Municipal                          4728
Wa West     3430         3236                                     546      16.9     1608     48.9
                                   3291 418           12.2
Regional    26393 31350 27298 4030                    15.3        7,738    24.7     7992     29.3




5.0 Promotion of Exclusive Breastfeeding
Exclusive breastfeeding practices in the region are high as shown in the table below.
Early initiation is however low. The nutrition surveillance shows a relatively high
coverage (75.3%) in early initiation than the routine coverage. Documentation need to
be improved to make data more reliable.
Table 9: Coverage of Exclusive Breastfeeding
District        #   of    Lact.    Initiation    of       BF Mothers practicing     #
                Mothers seen      within 1hour of birth       Continuous EBF for MTMSG
                                                              Children 0-6 months   formed
                                                              Target      (2% %     #
                                  #                           Tot. Pop
                                                %
Jirapa          1,537         655                                            61
                                                42.6       1,293      80.3
Lambussie       1,066         655                                            33
                                                61.4       1,000      78.0
Lawra           5,063         762                                            52
                                                15.1       2,072      78.0
Nadowli         4,408         1161                                           170
                                                                      146.
                                                26.3       1,958      1
Sissala         5,601         597                                            27
East                                                                  309.
                                                10.7       1,071      0
Sissala         1,390         654                                            44
west                                                                  103.
                                                47.1 951              0
Wa east         2,795         1,919                                          107
                                                                      286.
                                                68.7       1,295      1
Wa mun          6,162         2,341                                          69
                                                                      179.
                                         38.0              2,364      4
Wa west         5,089         1,026                                          26
                                                                      241.
                                                20.2       1,646      2
Total           33,111        9,770                                          589
                                                                      164.
                                                29.5    13,649        8



5.0 Nutrition Surveillance
Nutrition Surveillance was conducted in 90 sentinel communities by 6 districts to assess
the nutritional status and feeding practices of children 0-59 months and adults 15-45
years. Three districts did not submit report for the exercise (i.e Lambussie, Wa east and
Sissala west)
The prevalence of under nutrition as measured by the three key nutrition indicators is
shown by the table below:
Table 9 Prevalence of malnutrition among children aged 0-59 months in the
districts

                   Total no.   Indicator
   District        examined    Underweight     Global      Acute   Chronic
                   (n)         (WAZ < -2 SD)   malnutrition        malnutrition
                                               (WHZ < -2 SD)       (HAZ < -2 SD)
                               n (%)           n (%)               n (%)
Jirapa             581         22.5               8.1                 21.7
Lambussie          -           -                  -                   -
Lawra              373         27.3               18.2                24.3
Nadowli            793         16.5               16.3                19.0
Sissala East       617         10.5               18.1                26.0
Sissala West       -           -                  -                   -
Wa East            -           -                  -                   -
Wa Municipal       952         22.9               15.7                26.2
Wa West            382         19.6               20.2                41.1
Regional           3,698       19.5               15.8                25.3
5.2 Prevalence of under nutrition in the adult population
Most of the adults in Lawra district were seen to have fallen below the normal BMI
(<18.5). This clearly suggests inadequate food availability in the district. The results
from the other districts are not different. As many as 459 women weighed below 45
kilogram in the region.
Table 9b Prevalence of under nutrition among adults in the districts

             Total no.       Indicator (BMI)                                    Weight     of
District     examined                                                           women      <
             (n)                                                                45 Kg
                          Under-      Normal      Overweight       Obesity      (%)
                          nutrition   (18.5-25)   (26-30) (%)      (> 30) (%)
                          (BMI <18.5) (%)
                          (%)
Jirapa          1021         15           75          8                2          58
Lambussie
Lawra             572           55.0             44.0          1.4           0.0        10
Nadowli           1928          21.5             68.6          7.3           2.6        275
Sissala           948           13.7             75.0          10.7          0.6        64
East
Sissala
West
Wa East
Wa                1671          5.9              76.6          13.5          4.1        52
Municipal
Wa West           2499          44.3             50.0          4.7           1.3
Regional          8639          25.7             64.6          7.8           2.1        459



6.0 Promotion of Child Feeding Practices
Data on child feeding practices were collected as part of Nutrition Surveillance. About
84.3% of women with children less than 6 months interviewed were exclusively breast
feeding (Table 10). The practice of exclusive breastfeeding was highest in the Lawra
district while the lowest practice seen in Wa west. The high exclusive breastfeeding rate
in the region does not reflect the current nutritional status of the as one would have
expected. Wa west had the worst chronic malnutrition prevalence which also reported a
very low rate of exclusive breastfeeding and timely complementary feeding.

Table 10: Comparison of key child feeding behaviours/practices in the districts
District                                                Indicators

              Early Initiation              Exclusive          Continued    Timely
              of                            Breastfeeding      Breast-      Complementary
              Breastfeeding                 Rate               feeding Rate Feeding Rate
              Rate                                             (2 years)


              #          %             #          %            #      %      #      %
Jirapa        99         68.3          29         67.4         5      41.7   26     100
Lambussie     103        68.7                                  130    86.7   91     60.7
Lawra         143        96.6          58         100          8      100    17     100
Nadowli        109      92.4     33          94.3       11     91.7      21        95.5
Sissala East 74         67.3     16          88.8       74     78.7      16        88.8
Sissala
West
Wa East
Wa             96       58.9     136         88.6       71     61.2      116       74.3
Municipal
Wa West        94       74.6     84          66.6       87     69.0      67        53.2
Regional       718      75.3     356         84.3       386    75.6      354       95.4



6.0 Nutrition and Malaria Control for Child Survival Programme
This programme currently runs in five districts and 183 communities. Seven hundred
and twenty (720) growth promoters are already trained to routinely weigh and counsel
care takers according to weight of the child.

The remaining four districts have also received TOT and in the process of community
sensitization and training of growth promoters. It is expected that all districts would have
fully implemented the programme in August this year.

The NMCCSP is aimed at strengthening child health activities like growth monitoring
and promotion, vitamin A supplementation immunization use of ITN etc.

The four districts trained include: Jirapa, Lambussie, Lawra and Wa municipal.



7.4 Challenges /Constraints

♦ Delay in the release of funds for planned activities (for example, NMCCSP)
♦ Late and incomplete submission of reports by districts



8.0 Way Forward

♦ Organize refresher course for all nutrition officers.
♦ Conduct more on the job training especially for CMAM
Health Promotion
Introduction:
Health promotion is a continuous process with new focus on communication for development. Health issues in 2010
were tackled with developmental view focusing on community development as a whole. Educational programmes in
2010 employed evidence based strategies for behaviour development and social change.
Concerned areas during the first quarter
At the end of 2009 there were certain challenges that needed to be addressed early. These included
    • Lack of interest of some districts in health promotion returns
    • Districts not showing interest in identifying programme communication areas for material development.
    • Inadequate number of news articles for the health forum
    • Regular quarterly meeting with districts health promotion focal persons.
For reasons beyond the control of the unit these concern were neither met in the first quarter nor the second quarter.
However activities within the capacity of the unit in the two quarter were carried out.

Activities planned and carried out during the second half of the year
The following activities were planned and implemented:
     1. Regenerative health and nutrition training and sensitization
Between 5 and 6 people from each district totaling 48 were trained as trainers. The training covered Maternal and
child health, Environmental sanitation, Nutrition and personal hygiene.

Emphasis was particularly laid on Water as medicine, Vegetables as medicine, physical exercise as medicine and
rest as medicine.

     2. Sensitization on meningitis
As the region is meningitis prone the disease began to raise its ugly face as early as February in some districts. With
the support of Plan Ghana, awareness creation was intensified through the radio. A jingle was prepared and aired in
four languages at all the FM stations. More radio programmes were aired when the situation was critical especially
in Jirapa District where there was an outbreak. The radio programmes informed the public of the progress in the
prevention, management and control of the disease. The radio was also used to curb public anxiety and panic.

    3.   Social mobilization for NIDs
In February 2010 the first round immunization of the year was carried out. Micro planning was
done to include plans for communication at the district and community levels.
During the district training participants were taken through social mobilization techniques and a
designed reporting format was discussed with them. However, only three of the nine districts
submitted but uncompleted forms.
The major social mobilization activity that was commonly reported and actually seen being
carried out was the gong-gong beating. In most of the districts, the gong-gong beating was given
to the CBAs and the small funds given to them as a motivation. This was proved during the rapid
assessment where the volunteer was mentioned as the main source of the information.
Results of rapid assessment were not analyzed and the health promotion unit did not have access
to the assessment forms. However, as members of the monitoring teams the health promotion
officers took part in the assessment and noticed the following.
    -­‐ Awareness was quite high. Only a few visitors who just arrived on the day of the exercise
        did not hear the messages disseminated.
    -­‐ Apart from the health staff, the gong-gong beater who at that time was the volunteer was
        the most common source of information about the NID.
Public Address System on vans was also prominently mentioned in the districts where their
pickups mounted loudspeakers
     4. Video script writing.
The unit wrote a video script on environmental sanitation with the view to producing a film. The script tried to
portray poor sanitation particularly in the district capitals and the connection of such conditions to the disease
pattern in those district capitals. Unfortunately the shooting could not be carried out due to the absence of the video
camera at the time it was needed.

    5. Kangaroo Mother Care Programme
 The steering committee of the above programme held its annual review meeting in February and came out with the
concerns for the year:
1. Shyness of mothers to put their babies in the Kangaroo position
2. Lack of space in some of the facilities to practice Kangaroo Mother Care
3. Lack of interest of some managers
4. Little or no funding for KMC
5. Irregular quarterly meetings
6. Follow up was still a problem due to lack of transportation for those in the hospitals
7. Low awareness of KMC in the communities
Achievements of KMC for the first quarter-2010
                                                  LOW                               TOTAL
                            TOTAL                 BIRTH                             KMC             N0                    NO
INSTITUTION                 DELIVEREIES           WEIGHT          PRETERM           BABIES          SURVIVED              DEAD
Wa West                                    135                7                 5              12                10              2
Sissala West                                                  3                 7              10                  8             2
Sissala East                               148               4                  0               4                 4              0
Jirapa DHA                                                  11                  0              11                11              0
Jirapa Hospital                                             19                  7              26                26              0
Wa East                                    107               8                  0               8                 8              0
Nadowli Hospital                           108              10                  5              15                15              0
Regional Hospital                                            0                 16              16                14              2
Nandom Hospital                               0              0                  0               0                 0              0
Lawra Hospital                               0               0                  0              0                  0              0
Total                                      498              62                 40            102                 96              6
        KMC coordinators planned their way forward as below
INSTITUTION          ACTIVITY                               TIME FRAME                                 ACTION BY
Jirapa DHA           Continuous Sensitization of other Ongoing                                         DHA members
                     health staff
                           Orientation of mother to mother                May          KMC coordinators
                           support groups
Jirapa Hospital            Refresher training for all midwives            April/May    KMC coordinators
                           Erection of KMC bill board                     May          Hospital Management
Wa East                    Sensitization during community                 May/June     DHA
                           durbars
                           Orientation of mother to mother                June         DHA
                           support groups
Wa West                    Follow up on KMC registration by all           April-June   KMC coordinator
                           facilities
Wa municipal               Train all CHOs in KMC                          May/June     Gynaecologist/Chairpe
                                                                                       rson
Regional Hospital          Plan and train district and hospital June                   Hospital and MHA
                           midwives
                           Live KMC once a week                 Every week             Both Managements
                           Erect KMC Bill board                 June                   Hospital Management
Nadowli Hospital           Continued       education       and Ongoing                 KMC
                           encouragement                                               coordinator/DHA
Sissala East               Introduction of KMC to staff at Every month                 KMC coordinator
                           monthly meetings


Some of the activities were also not planned such as epidemics and other emergencies

    6. Meningitis campaign and control (community sensitization )
The region intensified sensitization with support from Plan Ghana again. Sensitization durbars
were held in all the communities in the Jirapa district. The region deployed some vans from
Information services department to enter the districts and communities. These durbars were well
patronized in the evenings. After an entertaining video show, the health staff attached to the vans
gave the sensitization messages on the causes, signs and symptoms and prevention of meningitis.
They stressed on the need to report very early to the nearest health facility when the least
symptoms are realized. Every talk was followed by s series of questions from the communication
participants. CBAs, who were trained in community dialoguing went from house to house to
convince people on the need to have large and open windows. The volunteers also met with
social groups such as mother-to-mother support groups, Christian mothers and some youth
groups.
A total of 683 communities covering the most prone districts were visited by the Van and one
thousand six hundred and eighty seven(1,687) communities were covered by the CBAs. Below is
the breakdown by districts.
    District       Communities Communities Total
                   covered       by covered     by
                   CBAs              Van
    Jirapa                     450                  85            535
    Lambussie                  150                  68            218
    Lawra                  250                 70          320
    Nadowli                190                 80          270
    Sissala East           180                 55          235
    Sissala West           102                 42          144
    Wa East                 95                 82          177
    Wa Municipal           150                 90          240
    Wa West                120                111          231
    Total                   87                683          2370


A jingle was prepared to the taste of the youth and played in the two FM stations in Wa. Copies
of the jingle were sent to the districts with FM stations namely Sissala East and Lawra.
Twelve radio discussions were made. This was to inform the public on the situation on daily and
weekly basis. The Deputy Director of Health Services alone went on air 8 times and four times
with other health staff. There were many phone-ins with a lot of anxious questions that indicated
the fear people had for the disease. The first few radio discussions however, were to alert the
public of the possible epidemic and explained the situation that was to lead to the epidemic. As
the prevalence rate began to reduce, the public was continuously told not to panic. At this stage a
second jingle was developed and played in the FM stations reassuring people of the safe control
of the disease.
Public announcements and education were made at churches and mosques. During their homilies
and preaching pastors and Imams allayed the fears of their congregation.
At the district levels consultative and policy making meetings were held with the chiefs and
assembly men and women. After a series of such meetings with the Regional Minister as the
Chairman, a ban on funerals was enforced.
    7. Lessons learnt
People listen to health messages more keenly when there is a perceived threat of the health issue.
People never rushed to the health promotion unit to ask for information on any of the diseases
such as malaria, leprosy, pneumonia etc as they did for meningitis. The local media showed their
social responsibility towards health promotion in the region because they were also at risk.

    8. National Immunization Days – the second round
The second round of the national immunization days was also very successful. Announcements
were made in the local languages and English for five days. In many of the districts sensitization
was well done by the volunteers. The main source of information was the health worker followed
by the radio. Many community members expressed interest in the Public Address System on
pickups and information vans

   9. Child health promotion week celebration
With the theme “Men, be on board for healthier children” the child health week celebration was
successfully carried out in all the districts. Prior to the celebration, districts were briefed on the
theme and the package which included Vitamin A, supplementation (Only children who are due)
Immunisation, Growth monitoring/promotion and Birth registration.

    10. Training of TBAs funded by Plan Ghana
Since the TBA’s role are in health service delivery is changing, Plan Ghana saw the need to
orient them on their new roles. With funding from Plan Ghana the Region in collaboration with
the Sissaala west and East districts ran two week training workshop for TBAs in the two
districts. A total of one hundred and eighteen TBAs were taken through ANC, PNC, Referral,
Delivery, Kangaroo Mother Care and Dialoguing.

    11. H1N1 education.
A team of nine officers from Information Services Department, Ghana Red Cross, Ghana
Education Service, NADMO and Ghana Health Service were called to Tamale for
communication workshop in H1N1. The team developed a work plan from which UNICEF
selected orientation of teachers, CBAs and Other Volunteers from Red Cross, Public education
using the van and radio etc to fund. The team was given a CD on H1N1 technical content and
educational messages.

   12. Emergency preparedness
With the onset of rains, the region began to prepare for any eventuality. A workshop was
organized to train people on hazards and risk deduction. Participants were put in groups of
specialty to draw action plans.

    13. Review of emergency preparedness plan 2010
The review meeting was organized by NADMO in collaboration with the United Nations Office
for Coordination of Humanitarian Affairs (UN-OCHA). The objectives were:
    a. To come up with a preparedness plan on Floods, draughts, epidemic diseases, fires and
        lighting (domestic and wild fires)
     b. To translate the working document into actions.
The meeting was chaired by the Council of State member for the Upper West Region, Naa Seidu
Braimah and was declared open by the Deputy Regional Minister. In his submission he
acknowledged that the workshop was timely and appropriate. The workshop was timely, because
the rains had just set in with their attendant floods and rain storms and it was appropriate because
it had drawn participants from various disciplines. He urged participants not to concentrate on
only the physical disasters such as floods, rain storm and fires but also on hunger as a disaster
and the spiritual disasters as well.
Participants were taken through hazard mapping and made to review the 2009 plan which was
not fully implemented.
     14. Communication For Development training (C4D)
Four officers from Ghana Red Cross, Pronet, Plan Ghana and Ghana Health Services were
initially invited to a trainers training at Tamale but only two from Plan Ghana and Ghana Health
Service attended. The workshop The Objective of the TOT was to create capacity at the regional
and district levels for communication for development in the three northern regions and Central
region, realising that behavior change can only take place when there is total human
development.
During the second a regional TOT for C4D was organized and 35 participants were trained. The main objective
was to build capacity in the region in C4D planning and implementation and share research
findings. However the specific objectives were as follows:
    1 Introduce the purpose and objective of the C4D strategy as supporting the achievement of
        the GHS child policy and strategy.

     2   Set out the development process to date and the potential role of the Inter-Agency
         Coordinating Committee for Health Promotion (ICC HP)

3    Share the findings from the qualitative and quantitative research

 4    Set out some of the challenges, implications and possible actions by the strategy as
      identified from the above research, review of the available evidence from the literature and
      findings from a situational analysis report.

     5   Begin to action plan, identify partners for the strategy and agree on the next steps for the
         region

     Radio Programmes
     Activity
                               2008             2009                        2010
                         Target Achieved Target   Achieved                  Target          Achieved
     Discussion topics   8          6            6            6             6               5
     Jingles             6          3            6            4             4               4
     Announcements       16         15           26           17            8               7
     Radio Dramas        4          3            8            4             2               1
     TOTAL               34         27           46           31            20              17


   Announcements were made on the NIDs, Meningitis, Child health Promotion week
   celebration, and H1N1. Radio discussion covered NID, meningitis and Fistula as well as
   H1N1.
   15. Health Education Activities by Districts.
District carried out health education activities in accordance with regional and national priorities.
The most common topics treated during quarter under review included:
   1. HIV/AIDS
   2. Exclusive breast feeding and infant feeding
   3. Tuberculosis
   4. Meningitis
   5. Regenerative health and nutrition
    6. Bird flu
Below is the coverage of themes, topics and participants groups by districts.




Some districts double count the topics treated. This is clear in the number of topics treated by Wa Municipal ( 707)
as against the number of sessions (414). Meanwhile a topic can be treated in several sessions, but if the topics are
rather more than the sessions the figures are questionable.

Challenges
  • Some districts continued to exaggerate in their health promotion returns
  • The Health Forum (Newsletter) is almost dead as articles cannot be obtained from the
      districts.

Way forward
Organise meetings with health promotion focal persons to discuss reporting format.
Create interest of managers in health promotion
Visit districts to collect news articles.
Create district capacity for C4D
Investigate the effectiveness of health education messages in the districts.




INTERNAL AUDIT


The purpose of the Internal Audit Unit is to assist GHS achieve the programme
and operational goals and objectives of the Service through the conduct of
audits and professional evaluations of GHS activities. Internal Audit Unit also
provides advice and counsel as needed to GHS management on matters such
as risk exposure within an activity/structure, proposes new controls and changes
in management practices/procedures.
The Upper West Region has a total number of twenty (20) Budget Management
Centres (BMCs). This is made up of six (6) Hospitals, one (1) Municipal Health
Directorate, eight (8) District Health Directorates, four (4) Training Schools and
the Regional Health Directorate.

The Internal Audit Unit as part of its activities for the half-year planned to;
   1. Carry out routine audit inspection of seven (7) major Budget
       Management Centres (BMCs) in the region.
   2. Attend Regional Internal Auditors meeting.
   3. Participate in annual stocktaking exercises within BMCs.
   4. To train audit staff on audit procedures, evidence gathering and reporting
   5. To sponsor one (1) audit staff to GIMPA on Health Administration and
       Management (HAM) course.
   6. Attend at least one (1) Continuing Professional Development (CPD)
       training to improve our capacity and productivity.


ACHIEVEMENTS

The region was able to achieve the following targets;
   1. Carried out routine inspection of four (4) BMCs out of the seven (7) BMCs
      planned representing 57% coverage.
   2. Pre-audited six hundred and four (604) payment vouchers (PVs) to the
      tune of one million five hundred and six thousand, five hundred and four
      Ghana cedis forty pesewas (GH¢1,506,504.40) emanating from the
      Regional Health Administration for compliance with laws, rules and
      regulations.
   3. Participated as observers in the annual stocktaking exercises.
   4. Advised management on proper financial management and compliance
      with relevant laws, regulations, policies and procedures.


CHALLENGES

Despite the region’s modest achievement, we are however confronted with the
following difficulties
    1. Lack of continuing professional development (CPD) programme for audit
       staff
       Since the inception of the Unit in Upper West Region none of the staff has
       benefited from any CPD programme either within or outside the country.
   2. Inadequate funding
      The Unit derives its funding from the GOG budget allocation of the Office
      of the Regional Director which tends to be erratic and inadequate.

   3. Lack of better understanding of the relevance of internal auditing
      There is a greater challenge of educating senior managers on the
      relevant role the internal auditors play in achieving their goals and targets.



WAY FORWARD

Based on our planned activities, achievements and its accompanying
challenges we would like to recommend the following;
   1. Provision of adequate financial resources to conduct regular audit
      inspections to BMCs. This can be better achieved by all BMCs contributing
      to a common pool to be managed by the Region.
   2. That audit staff are supported to attend Continuing Professional
      Development (CPD) trainings in line with current trends within the audit
      profession to build capacity, to which end we implore the Division to assist
      is this regard.
   3. That a workshop should be organized for senior managers to deepen
      their understanding on the relevance of internal auditing function.
   4. Organize audit hearing for all BMCs on their responses to external auditor’s
      queries




KEY AUDIT FINDINGS

   1. Non-compliance with procurement law, policies and procedures
        o No procurement planning and budgeting
        o Absence of procurement register
        o Insufficient documentation to authenticate transactions
   2. No fixed assets register or failure to update them
   3. Non-acquittal of payment vouchers
  4.   Indebtedness to BMCs by NHIS
  5.   Low recovery of staff advances
  6.   Items not routed through stores
  7.   Granting of study leave without prior approval from Headquarters
  8.   Poor keeping of accounting records at Health Centres
  9.   GCRs not kept under lock and key

RECOMMENDATIONS TO KEY FINDINGS

  1. BMCs should be made to adhere to the procurement policies and
     procedures if fraud is to be avoided
  2. Management should ensure that assets are maintained to keep track of
     all assets. Besides, all assets should be embossed. Also, there should be
     coordination among procurement Unit, Finance Unit and Estate Unit in
     respect of fixed assets procurement.
  3. Heads of BMCs and Finance Officers should ensure that payment
     vouchers have all the relevant supporting documents before approving
     them.
  4. Management of facilities should liaise with the management of the
     various District Health Insurance Scheme to ensure claims submitted are
     vetted on time and reimbursement for services provided to clients.
  5. Management of BMCs should determine the terms of repayment of salary
     advances before granting it.
  6. There should be full accountability for items purchased
  7. Management has to review study leave applications in general based on
     their human resource development pragramme and priority areas of
     study and also seek for approval from a higher authority where necessary.

  8. Management is entreated to organize regular in-service training for staff
     at the Health Centre level to improve their financial records keeping skills.
     Also the Accountants should intensify their monitoring and supervisory role
     through regular visits to these Health Centres to assist them on their
     accounting records.
  9. Management is advised to procure safes to safeguard all value books
     particularly GCRs and daily cash collections against theft and to also
     restrict access to unauthorized persons.
National Health Insurance Scheme
During the period under review, a meeting was organized for service providers and
schemes managers to discuss feasible ways of claims management.

Management information systems
The District Wide Health Information Management (dhims) software is operational in all
the districts and hospitals in the region. However, its use is plagued with challenges
such as incomplete and timely submission due to the existence of parallel reporting
systems.

Malaria
With regards to malaria, the indoor residual spraying was also implemented in five out
of the nine districts. It was also envisaged that 90% of all clinically diagnosed malaria
cases have access to Rapid Diagnostic/ Laboratory Testing. As part of efforts to
strengthen monitoring, evaluation and operational research, new malaria reporting
formats were distributed to all districts.

In addition to this, insecticide treated nets (ITNs), Chemoprophylaxis for pregnant
women (IPT), Early detection and appropriate prompt treatment (HBC), Rapid
Diagnostic Testing of all clinical malaria cases (RDT), Advocacy and social mobilisation,
and Prescription of ACT to all malaria patients.

Malaria cases & deaths 2008-2010
Indicator                                              2008        2009         2010
Total OPD Cases                                        219,491     163,842      208566
Total malaria cases (OPD)                              76,992      78,410       81718
% malaria cases                                        39.7        47.9         39.2
Malaria in children under 5years                       18881       2821         31387
% Malaria cases in children under 5years               24.5        3.6          38.4
Malaria in pregnant women                                                                9036                261                 3548
Total deaths                                                                             559                 288                 507
Total deaths due to malaria                                                              99                  84                  117
%Deaths due to malaria                                                                   23.1                32.2                23.1
Malaria deaths in children under 5years                                                  35                  27                  47
%Malaria deaths in children under 5years                                                 8.2                 9.4                 9.3
Malaria deaths among pregnant women                                                      4                   2                   8




Health Infrastructure
ACHIEVEMENTS
During the year under review, the unit was able to achieve the following:


   1.    Carry	
  out	
  repair	
  works	
  on	
  some	
  Quarters,	
  Bungalows	
  and	
  Offices.	
  
   2.    Clearing	
  of	
  silt	
  and	
  dead	
  leaves	
  from	
  	
  roofs	
  and	
  rain	
  gutters	
  
   3.    Cleaning,	
  Weeding	
  around	
  office	
  facilities	
  and	
  dislodging	
  of	
  septic	
  tanks	
  	
  
   4.    Conduct	
  an	
  inventory	
  of	
  existing	
  infrastructure.	
  Properly	
  plan,	
  monitor	
  and	
  update	
  
         developmental	
  projects	
  
   5.    Develop	
  strategy	
  to	
  complete	
  uncompleted	
  essential	
  structures	
  	
  
   6.    Develop	
  and	
  implement	
  plan	
  to	
  rehabilitate	
  run	
  down	
  structures	
  (using	
  local	
  rent	
  deductions)	
  
   7.    Negotiated	
  for	
  a	
  parcel	
  of	
  land	
  for	
  HATS	
  	
  
   8.    Collaborate	
  with	
  the	
  Accommodation	
  Committee	
  to	
  regularly	
  discuss	
  on	
  staff	
  accommodation	
  
         issues.	
  
   9.    Up-­‐dated	
  assets	
  register	
  and	
  embossment	
  of	
  new	
  items.	
  	
  
   10.   Support	
  Districts	
  to	
  create	
  and	
  update	
  their	
  Assets	
  Registers	
  
   11.   Construction	
  of	
  a	
  Cold	
  Room	
  for	
  the	
  region.	
  


CONSTRAINTS/CHALLENGES


   The Unit encountered the following challenges during the period under review


   •     Difficulty in getting building materials for maintenance works on defects in buildings
   •     Power fluctuation at the RHD block resulting in frequent fusing of lights and breakdown of electrical
         gadgets thus hindering productivity at work places
   •     Uncoordinated procurement and movement of assets making it difficult to update assets register.
   •     Inadequate office and residential accommodation for staff
   •     Poor maintenance culture among staff.
   •     Difficulty for the Unit to get means of transport for official errands.
   •     A number of furniture and office equipment are obsolete and therefore difficult to maintain them.
WAY FORWARD, 2010


     •                   Effective means for generating fund for maintenance works.
     •                   Ensuring the availability of building materials for maintenance works.
     •                   Electrical Re – wiring of Directorate block.
     •                   Secure stabilizers for office equipments at the Directorate.
     •                   Levelling and asphalting of RHD and Medical Stores Compound
     •                   Training for maintenance Staff
     •                   Completion of all suspended and outstanding projects.
     •                   Construct an engine room for generator at the Regional Health Directorate
     •                   Construction of Transit Quarters and Conference Hall for staff in the Region.
     •                   Legal acquisition of title for the site for the Regional Health Directorate.
     •                   Refurbishment of offices
     •                   Maintenance of good environment and sanitation


Human Resource Development
The Upper West Region continuous to grapple with the inadequate number of some
categories of staff notably Midwives, Medical Assistants and Medical Doctors.
Though the region has seen some appreciation in the numbers of the frontline staff
mainly community health nurses, certain critical areas still poses a challenge.
The table below indicates the distribution of selected categories of Nurses by Districts
as at June 2010

                             SPECIAL        Lamb       Na SS. SS. W             Tota
 CAT                         ITY      Jira .     Law   d    E    W   M   WE WW l
                             Anaesth      3    0     2    0    2   0   3  0   0   10
                             CCN          1    0     0    0    0   0   0  0   0    1
                             Edu          8    0     0    0    0   0   1  0   0    9
                             ENT          0    0     0    1    0   0   1  0   0    2
  Professional Nurse s




                             Midwives   32     6   16    20    9   3  56  7   5 154
                             Ophth        3    0     4    1    1   0   4  1   1   15
                             PON          2    0     2    0    0   0   1  0   0    5
                             Psych        1    0     2    1    0   0   2  1   1    8
                             Psycho       0    0     0    0    0   0   0  0   0    0
                             PHNs         7    2     4    2    1   1   6  0   1   24
                             Gen        24     0   19    22   13   3  48  2   7 138
Medical
Assistants                                        4          1         4       2        1        0        1    0    0    13
CHNs                                            35         23         69      60      23       14        60   19   17   320
The following are measures put in place to address this challenge:
   1. Identify staffs with the potentials and right attitude and support them to be trained
       and fill the available vacancies
   2. Support the training schools to expand so they can admit and train more
       especially Midwives
   3. certificate training in midwifery to start this academic year.
   4. Introduce a sustainable incentive package to attract and retain the required staffs
   5. Embark on accommodation hunt to cater for the influx of staff expected in the
       region

Challenges
• Address infrastructural issues
      – Provision of residential and office accomodation
      – Construction of CHPS, upgrading of health centres into district hospitals etc
• Continue the implementation of developed systems
      – Facilitative Supervision (FSV)
      – Referrals
• Improving services at RMS and MTC
• Low TB case detection rate
• High death rate among clients on ART and TB.
• Strengthening disease surveillance/disaster preparedness & response/control
• Sensitization of stakeholders on the high impact rapid delivery strategy/interventions
• Address the poor nutritional status of children
• Campaign on non-communicable diseases such as diabetes, hypertension etc

Way forward
• Infrastructural development to increase access to;
      – Basic primary health services ( CHPS)
      – Essential services (Construction of Polyclinics)
      – Specialised services (Construction of Regional Hospital)
      – HR development (Midwifery and HATS training schools)
• Continue the implementation of developed systems
      – Facilitative supervision
      – Referrals
• Planning and budgeting for 2011
• Integration of activities at all levels e.g disease surveillance
•   Provision of technical support for hospitals
        – Advocate for more health professionals to be posted
        – Lobby for locum doctors
•   Support the operation and participation of private sector
        – Desk to coordinate the operations of NGOs, Traditional practitioners, media
           relations
•   Strengthening disease surveillance/disaster preparedness & response/control
•   Continue the implementation of global fund supported programmes among others
•   Sensitization of all stakeholders HIRD strategy
•   Addressing the poor nutritional status of children through
        – CMAM
        – Exclusive breastfeeding
        – Micronutrient supplementation
•   Advocate for active involvement of CBAs/CBSVs in outreach activities and defaulter
    tracing.
•   Implement the new malaria control measures will be introduced
•   Undertake HIV sentinel survey and early infant diagnosis of HIV.
•   Introduction of two new vaccines in 2011

				
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