Ghana Health Services...2010 Annual Report Ghana Health Service Page 5 of 76 LIST OF TABLES Table 1:...

GHANA HEALTH SERVICE

2010 ANNUAL REPORT

2010 Annual Report Ghana Health Service

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FOREWORD

In 2010, the Ghana Health Service reviewed its working strategies under the five health sector objectives

as a result of the development of a new Health Sector Medium Term Development Plan. The new strategic

objectives that guided the implementation of services during the year 2010 were:

1. Bridge the equity gaps in access to health care and nutrition services and ensure sustainable

financing arrangements that protect the poor

2. Improve governance and strengthen efficiency in health service delivery, including medical

emergencies.

3. Improve access to quality maternal, neonatal, child and adolescent health services.

4. Intensify prevention and control of communicable and non-communicable diseases and promote

healthy lifestyles

5. Improve institutional care including mental health service delivery

This 2010 report outlines the GHS‟ experiences in implementing the strategies under the planned action of

work. It also highlights some overarching issues that require attention in the near future, these include;

Delays and inadequacy of funds given to the Districts

Inadequate numbers of skilled personnel particularly, midwives and medical assistants

The decline in EPI coverage for all the antigens

Despite these drawbacks a lot of progress has been made in the fight to eradicate Guinea worm disease. In

the year under review, only eight cases of Guinea worm were reported. They were all contained. The

country is on the verge of eradicating Guinea worm.

Our goal towards eradicating Polio is also on course, during the year under review no case of wild polio

virus was isolated.

I wish to acknowledge the effort that all the staff of the Ghana Health Service, especially those working in

very difficult circumstances has contributed to realizing the goals of the Health Sector.

Our commitment towards achieving the Global targets for health remains unwavering.

With our experiences in these four years of implementing our strategic health plan, and as we move into

the final year, I believe that we have been able to not only develop a deeper understanding of some of the

complexities and challenges of our health sector, but also prepared our minds and hearts towards a greater

commitment, coordination and participation in order that we may harness the benefits and richness of

quality and accessible healthcare for all Ghanaians.

Thank you.


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EXECUTIVE SUMMARY

The Ghana Health Service (GHS) is the largest autonomous national executive body responsible for

implementing all national health policies in Ghana. Established in 1996, the GHS in liaison with the

Ministry of Health (MOH) is dedicated to bringing quality health care and services to every door step and

household with the commitment to achieve optimum quality of life in every community in Ghana. The

GHS Annual Review of 2010 and the annual report, summarizes the Service‟s operations and performance

in 2010 under the revised five health sector objectives under the health sector Medium Term Development

Plan:

To accelerate the push towards achieving the MDGs 5 and to some extent 4, the MDG 5 Accelerated

Framework (MAF) document was developed during the year under review. An Emergency Obstetric and

Neonatal care facility survey was also undertaken.

During the year under review, the GHS initiated the development and use of information technology to

improve information management and service delivery. Infrastructure for health has been expanded to

support effective and efficient services delivery. Strategic direction for District Health Systems

Strengthening Initiatives was provided (UWR CHPS Initiative, GEHIP, MoTeCH and GAVI). Selected

activities outlined in the GAVI HSS project were carried out to improve service delivery in the districts.

Work on reviewing the District Health Information Management System (DHIMS) was initiated. The

improvement in the health workforce and distribution continued during the year under review. However,

the numbers of midwives and medical assistants are still not adequate in most districts.

With regards to CHPS implementation, there has been an increase in the numbers of functional CHPS

zones. This has been driven mainly by the increasing availability of community health nurses. The number

of functional CHPS zones increased from 868 in 2009 to 1,023 in 2010.

All the service indicators showed some improvement. The nurse-to-patient population ratio has improved

to 1: 955 in 2010 in comparison to 1:1079 in 2008 and to 1:971 in 2009. OPD per capita also increased to

0.91 in 2010 following similar increases over previous years (0.77 in 2008 and 0.81 in 2009). TB

treatment success rate increased from 85.5% in 2008 to 87.0% in 2009. Antenatal coverage increased

marginally from 92.1% to 92.2%. Skilled delivery rate improved nationally from 45.6% in 2009 to 48.9%

in 2010 and Institutional Maternal Mortality Ratio decreased from 169.9/100,000LB in 2009 to

163.2/100,000LB in 2010. Guinea worm cases fell from 242 in 2009 to 8 in 2010.

Despite these positive achievements,immunization coverage declined in all the antigens compared to the

previous year 2009. Family planning coverage fell from 31.1% in 2009 to 23.8% in 2010.

Funds flow for district level activities continue to be erratic. Although total funding appears to have

increased, the increase has been for earmarked funding.


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The year under review saw an improvement in the reimbursement of facilities by the National Health

Insurance Authority. There is now a lag period for payment of on the average of three months compared to

about six months previously.

The challenges facing the service are in the area of ensuring adequate and timely funding for district level

activities. The inadequate numbers and mal-distribution of critical staff like midwives and medical

assistants continue to affect service delivery.

There is the need for strategies to improve on the equitable distribution of critical health staff and improve

the quality of care at all levels.


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LIST OF TABLES

Table 1: Trend of OPD per capita by Regions………………………………………………… 31

Table 2: Trend in Doctor Population ratio by Regions (2007-2010)……………………………… 31

Table 3: Trend in Nurse Population ratio by Region (2007-2010)……………………………. 32

Table 4: Progress in the implementation of CHPS by Regions (2008-2010)…………………….. 33

Table 5: Percentage of facilities given provisional accreditation by NHIA by Regions…………. 34

Table 6: Trend in Health Sector Budget for the period (2007-2010)………………………….. 35

Table 7: Statement of Receipts and Expenditures for GHS 2010…………………………………. 36

Table 8: GHS Fleet size as at December 2010……………………….. …………………… 37

Table 9: Key Sector performance indicators (2006-2010)……………………………………… 38

Table 10: Trend of skilled Delivery by Regions……….. ………………………………….. 39

Table 11: Trend of Penta 3 coverage by Regions ……. …………………………………….. 39

Table 12: Summary of core surveillance indicators Jan- Dec 2010……………………………. 42

Table 13: Distribution of H1N1 vaccination and AEFI by Regions……………………………. 43

Table 14: Top 3 agents involved in poisoning in 2010………… …………………………… 46

Table 15: Top 10 Diseases from OPD 2010……. ………………………………………….. 48

LIST OF FIGURES

Fig 1: Trend in functional CHPS zones………………….………………………………….. 32

Fig 2: Accredited facilities by grades……….………………………………………………. 34

Fig 3: Trend of early child hood mortalities in Ghana (DHS) ……………………………………. 40

Fig 4: Trend of notified cases TB 2005-2010 ……………………………………………………. 41

Fig 5: Proportion of OPD cases attributed to Malaria 2006-2010……………………………… 44

Fig 6: Proportion of Total cases and deaths attributed to Malaria……………………………….. 45

Fig 7: Under five malaria case fatality rate ……………………………………………………… 45

Fig 8: Reported Poisoning Trends by Agents………………………………………………………46

Fig 9: Male Female distribution among cases of Hypertension seen in health facilities…………...47

Fig 10: Age Distribution of Hypertension cases seen at OPD………………………………………47


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CONTENTS

FOREWORD .................................................................................................... 1

EXECUTIVE SUMMARY ................................................................................. 3

LIST OF TABLES ............................................................................................. 5

LIST OF FIGURES ........................................................................................... 5

CONTENTS ...................................................................................................... 6

ACRONYMS & ABBREVIATIONS ................................................................... 9

INTRODUCTION ............................................................................................ 11

PERFORMANCE BY OBJECTIVES ................................................................ 12

HO1: Bridge Equity Gaps in access to health care and nutrition services and ensure sustainable financing

arrangements that protect the poor .............................................................................. 12

Access to Health Care .............................................................................................. 12

Human Resources Planning, Recruitment, Deployment Retention and Management 12

Gender and Equity .................................................................................................... 14

National Health Insurance Scheme ........................................................................... 14

HO2: IMPROVE GOVERNANCE AND STRENGTHEN EFFICENCY IN HEALTH SERVICE

DELIVERY, INCLUDING MEDICAL EMERGENCIES .......................................... 16

Information Technology to Improve Health Information Management and Service Delivery 16

eHealth ..................................................................................................................... 16

ICT Governance-GHS ICT Enterprise Architecture (EA) ......................................... 16

ICT Training ............................................................................................................ 16

Financing Mechanism and Financial Management Systems ...................................... 16

Management Systems and Scale-up leadership Training ............................................ 17

Infrastructure to Support Effective and Efficient Service Delivery ............................. 17

HO3: IMPROVED ACCESS TO QUALITY MATERNAL, NEONATAL, CHILD AND

ADOLESCENT HEALTH SERVICES ...................................................................... 19

Access to Quality Maternal Newborn and Reproductive Health Services .................. 19

HO4: INTENSIFY PREVENTION AND CONTROL OF COMMUNICABLE AND NON-

COMMUNICABLE DISEASES AND PROMOTE HEALTHY LIFESTYLES ......... 21

Health Promotion and Awareness Creation of Risk Factors ...................................... 21

Non-Communicable Diseases ................................................................................... 21

Malaria ..................................................................................................................... 22

HIV/AIDS ................................................................................................................ 22

Tuberculosis (TB) .................................................................................................... 23


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Yaws ........................................................................................................................ 24

Guinea Worm ........................................................................................................... 24

Buruli Ulcer ............................................................................................................. 24

H1N1 Influenza ........................................................................................................ 25

Disease Surveillance, Emergency Preparedness and Response .................................. 25

Environmental And Occupational Health And Safety ............................................... 26

Occupational health .................................................................................................. 26

Environmental health ............................................................................................... 26

Poison control programme .........................................................................................27

Research and development ........................................................................................27

HO-5 IMPROVE INSTITUTIONAL CARE, INCLUDING MENTAL HEALTH SERVICE

DELIVERY ................................................................................................................ 29

KEY PERFORMANCE INDICATORS BY OBJECTIVES ................................. 31

TABLES AND FIGURES .................................................................................. 31

HEALTH OBJECTIVE ONE: Bridge Equity Gaps in access to health care and nutrition services and

ensure sustainable financing arrangements that protect the poor .................................. 31

Outpatient Attendance ............................................................................................. 31

Community Based Health Planning and Services ..................................................... 32

National Health Insurance Scheme. .......................................................................... 34

HEALTH OBJECTIVE TWO: IMPROVE GOVERNANCE AND STRENGTHEN EFFICENCY IN

HEALTH SERVICE DELIVERY, INCLUDING MEDICAL EMERGENCIES .......... 35

Financing mechanism and financial management systems ......................................... 35

HEALTH OBJECTIVE THREE: IMPROVE ACCESS TO QUALITY MATERNAL, NEONATAL,

CHILD AND ADOLESCENT HEALTH SERVICES ................................................ 38

Institutional Maternal Mortality ratio ........................................................................ 38

Ante natal Care ........................................................................................................ 38

Skilled Delivery ....................................................................................................... 39

Immunization ........................................................................................................... 39

HEALTH OBJECTIVE FOUR: INTENSIFY PREVENTION AND CONTROL OF COMMUNICABLE

AND NON-COMMUNICABLE DISEASES AND PROMOTE HEALTHY LIFESTYLES 41

Selected core surveillance indicators: ....................................................................... 42

HEALTH OBJECTIVE FIVE: IMPROVE INSTITUTIONAL CARE, INCLUDING MENTAL

HEALTH SERVICE DELIVERY .............................................................................. 48

CHALLENGES ............................................................................................... 49

Objective 1: Bridge gaps in access to health care and nutrition services and ensure sustainable financing

arrangements that protects the poor ............................................................................. 49

Human Resource ...................................................................................................... 49


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Objective 2: Improve governance and strengthen efficiency in health service delivery, including medical

emergencies. ............................................................................................................... 49

Objective 3: Improve access to quality maternal, neonatal, child and adolescent health services 50

Objective 4: Intensify prevention and control of communicable and non-communicable diseases and

promote healthy lifestyles. .......................................................................................... 50

Objective 5: Improve institutional care including mental health service delivery .......... 51

THE WAY FORWARD FOR 2010 .................................................................... 52

Objective 1:Bridge the equity gaps in access to health care and nutrition services and ensure sustainable

financing arrangements that protect the poor. .............................................................. 52

Objective 2:Improve governance and strengthen efficiency in health service delivery, including medical

emergencies. ............................................................................................................... 52

Objective 3:Improve access to quality maternal, neonatal, child and adolescent health services. 53

Objective 4:Intensify prevention and control of communicable and non-communicable diseases and

promote healthy lifestyles. ........................................................................................... 53

Objective 5: Improve institutional care including mental health service delivery. ........ 54

ANNEXES: TRENDS IN SECTOR INDICATORS ............................................ 56

Doctor to Population Ratio ......................................................................................... 56


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ACRONYMS & ABBREVIATIONS ACCPAC- Accounting Package

ADB - Agricultural Development Bank

ANC - Ante Natal Care

BCC - Behavior Change Communication

BMCs - Budget Management Centers

CHEW - Community Health Extension Worker

CHO - Community Health Officer

CHPS - Community Health Planning Service

DC - Disease Control

DDHS - District Director of Health Services

DFID - Department for International Development

DHIMS - District Health Information Management Systems

DISHOP - District Health System Operationality

EMD - Estate Management Department

EPI - Expanded Programme on Immunization

FDB - Food and Drugs Board

GAIN - Global Alliance for Improved Nutrition

GAVI - Global Alliance for vaccines and Immunization

GHS - Ghana Health Service

GIS - Geographical Information System

GOG - Government of Ghana

GRB - Gender Responsive Budgeting

GSCP - Ghana Sustainable Change Project

GTZ - German Technical Cooperation

HASS - Health Administrative Support Services

HI - Health Information

HIRD - High Impact Rapid Delivery

HIV - Human Immune Deficiency Virus

HIV/AIDS - Human Immune Virus/ Acquired Immune Deficiency Syndrome

HR - Human Resource

HRD - Human Resource Division

ICD - Institutional Care Division

ICT - Information Communication Technology

IDSR - Integrated Disease Surveillance and Response

IEC - Information Education & Communication

IGF - Internally Generated Funds

IMCI - Integrated Management of Childhood Illness

IPT - Intermittent Preventive Treatment

IRS - Indoor Residual Spraying

IST - In Service Training

KATH - Komfo Anokye Teaching Hospital

KNUST - Kwame Nkrumah University of Science and Technology

KRHTS - Kintampo Rural Health Training School

Lab - Laboratory

LDP - Leadership Development Program

MAF - MDG 5 Accelerated Framework.

MDAs - Ministries Department and Agencies


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MDBS - Multi-Donor Budget Support

MDG - Millennium development Goal

MHAPP - Mental Health and Poverty Project

MoH - Ministry of Health

MTT - Multidisciplinary Ministerial Task Team

NACP - National Aids Control Programme

NGOs - Non-Governmental Organizations

NHI - National Health Insurance

NHIS - National Health Insurance Scheme

NHRC - Navrongo Health Research Centre

NMCCSP - Nutrition and Malaria Control for Child Survival Project OHS - Occupational health Strategy

OI/ART.STI- Anti Retroviral Therapy/ Sexually Transmitted Infections

OPD - Out Patient Department

PMTCT - Prevention of Mother to Child Transmission

PPM - Planned Preventive Maintenance

PPME - Policy Planning Monitoring and Evaluation

QA - Quality Assurance

QHP - Quality Health Partners

RHS - Regional Health Service

SBS - Sector Budget Support

ToTs - Training of Trainers

U5 - Under Fives

UNICEF - United Nations International Children‟s Emergency Fund.

WAWI - West African Water Initiative

WVI - World Vision International


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INTRODUCTION

The Ghana Health Service (GHS) 2010 Annual Report details the activities of its fourth-year program of

work (4th

/ 5YPOW) which overlaps the health sector Medium Term Development Plan. Thus 2010 report

has been restructured to reflect changes in the health sector performance objectives as captured in the

Health Sector Medium Term Development Plan (2010-2013). The report covers all the various activities

undertaken during the year 2010 and how these activities have contributed to the much needed boost in the

quality of life of the Ghanaian.

The new five health sector objectives around which this report was written are:

1. Bridge equity gaps in access to health care and nutrition services and ensure sustainable

financing arrangements that protect the poor;

2. Improve governance and strengthen efficiency in health service delivery, including medical

emergencies;

3. Improve access to quality maternal, neonatal, child and adolescent health services;

4. Intensify prevention and control of communicable and non-communicable diseases and

promote healthy lifestyles;

5. Improve institutional care including mental health service delivery.


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PERFORMANCE BY OBJECTIVES

HO1: Bridge Equity Gaps in access to health care and nutrition services

and ensure sustainable financing arrangements that protect the poor

Access to Health Care

The increase in OPD per capita continued for the year 2010. From 0.49 in 2001, it has increased to 0.77 in

2008 and 0.81 in 2010. In 2010 it rose to 0.91. The main drivers for this trend appear to be the health

insurance and the improvement in the spread of health infrastructure. The National Health Insurance

addresses financial accessibility whilst the improvement in the spread of health infrastructure addresses

the geographical accessibility, which are the main challenges to access to health care in Ghana.

Human Resources Planning, Recruitment, Deployment Retention and Management

To ensure that the Human Resource Development Division delivers on its mandate, the division in 2010

introduced some interventions to improve the human resource management.

Key Activities undertaken were:

Compilation and update of GHS Headquarters staff database covering seven out of the ten

Directorates at GHS HQ were covered.

Compilation and update of nominal roll for GHS. The total staff population for GHS according to

the nominal roll was 33,426 as at August 2010. This represented 0.08% increase over the 2009

figure of 33,169.

Appointments made during the year under review: 54 officers were appointed into various senior

management positions; 3,075 newly qualified nursing staff (including general nurses, midwives,

community Health Nurses, Psychiatric Nurses, Enrolled Nurses); 167 contract appointments; 241

Technical and Support Service Staff and 257 replacements.

Implementation of policy on the three-year continuous service eligibility for promotion after first

appointment (1st level promotion). Officers who had first appointment between 1

st January, 2004

and 31st December 2006 were interviewed for promotion to the next grade. Promotion interviews

for the last two grades of the HND class were also decentralized to the regions. Overall, promotion

of 419 staff, comprising 215 nursing staff and 204 non-nursing staff were approved by GHS

Council in 2010.

Approval of staff grade conversions and Upgrading. A total of 305 applications were approved for

conversion and 209 for upgrading. The approval was based on the consideration of the additional

academic qualifications and the programme of study of the applicants.


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Processing of Applications of 1014 disengaged staff. This comprised retirement (816); vacation of

post (107); resignation (52) and death (39).

Approval of 358 Leave applications. This comprised study leave with pay (186), study leave

without pay (78) and leave of absence (94).

Revision of existing staff appraisal form. The new appraisal form was disseminated and circulated

for use at the various institutions and service levels.

The GHS in conjunction with the MOH engaged the Fair Wages and Salary Commission to

undertake re-evaluation of the health sector jobs and devise a means of determining market

premium for health workers.

The Leadership Development Programme (LDP), which is intended to strengthen the capacity of

healthcare managers in leadership and management, was rolled out at GHS Headquarters and in

the following regions - Ashanti, Volta, Greater Accra and Western Regions. Overall, 276 officers

benefited from the programme.

The GHS in conjunction with the Human Resource for Health Division (HRHD) of the Ministry of

Health (MoH) made a submission to the Fair Wages Commission in respect of internal relativity

distortions created by the proposed Single Spine Salary Structure. The Ministry is currently

engaging the Commission to address the concerns raised.

The GHS assisted with the development of curriculum for training of Nurse Aneasthetists at Ridge

Hospital. The training programme commenced in October 2010 with 25 students.

The GHS in conjunction with the School of Public Health, University of Ghana, organized a

training programme aimed at Improving Management of Public Health Interventions (IMPHI). A

total of 11 senior managers from GHS benefited from the training.

The GHS collaborated with GIMPA to organize a four week course in Health Administration and

Management for selected staff in GHS. Two sessions were organized in March and July 2010. A

total of 157 senior health managers drawn from public, quasi-governmental, private and Christian

Health Association of Ghana (CHAG) institutions attended the training programme.

The Service also supported in the development and review of training curriculum for pre-service

training institutions.

Observations from the Payroll Data Analysis

The overall number of health workforce on the Ministry of Health payroll as at December 2010 was

50,206 compared to 49,318 in 2009 with corresponding monthly wage bill of GH¢ 31,088,770 in GH₵

27,129,935.92. There was an increase of 12.73% in the December 2010 monthly wage bill over the


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December 2009 monthly wage bill of. In terms of numbers, the total figure increased by 1.8% from the

2009 figure of 49,318 to 50,206 in 2010.

The distribution of the health workforce on the payroll by agencies was as follows: the GHS (72%),

Christian Health Association of Ghana – CHAG (15%), Korle-Bu Teaching Hospital (6%), Komfo

Anokye Teaching Hospital (5%) and Tamale Teaching Hospital (2%).

The analysis of the payroll data further indicated that overall, 61.53% of the health workforce as at

December 2010 were females. For Doctors, about 27% constituted females while the remaining 73% were

males. The analysis also showed that health workers aged between 25 and 34 years constituted about

37.1% (18,611) of the total workforce. This implies that over one-third of the total health workforce is

made up of quite young workers. However, it is important to note that workers aged between 55 and 60

formed about 15% (7,520). This relatively high proportion of health workers would be moving out of the

Service in the next 5 years. Management staff constituted 9% (2,768) of this age segment. Within the

same age bracket (i.e. 55 – 60 yrs), nurses constitute about 46.8% (3,520) with about half of them (1,531)

being midwives.

Gender and Equity

Special efforts were made within the year to ensure gender mainstreaming within programs and activities

of the GHS. The GHS undertook a rapid appraisal of the current gender mainstreaming approaches. The

aim was to assess progress, understand the challenges of implementation and allow for correction to better

consolidate gender mainstreaming in the GHS.

The Ghana Health Service assessed equity of enrollment in the NHIS and looked at community

perceptions vis-à-vis schemes, providers as well as community attitudes and beliefs. A household survey

was conducted in the Central and Eastern Regions of Ghana. The results were translated into a set of clear

policy recommendations.

National Health Insurance Scheme

At the end of the year 2010, 65% of GHS facilities had been accredited. Most passed, but only a few were

given grade A. About 20% failed and will need to be assisted to pass. The major reasons for failing

included; inadequate staffing, poor infrastructure/equipment and poor management. Some GHS facilities

have not applied for accreditation. Poor management control systems within the GHS accounts for these

refusals.

Upper West Region presented the lowest number of facilities for accreditation with the NHIA. None of

the GHS facilities that applied for accreditation failed. However, some facilities were given provisional

accreditation .Upper West had the highest proportion of facilities accredited grade A followed by Greater

Accra and Northern regions whilst Volta, Ashanti and Brong Ahafo regions had the highest proportion of

facilities awarded grade D.

The NHIA conducted clinical audits around the country and some deductions to the submitted claims were

made. Major reasons for the deductions included poor folder retrieval, poor hand writing, diagnosis not


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matching with treatment, poly pharmacy (in the prescription of antibiotics) and up coding. Although some

facilities were assisted to retrieve some of the funds, many could not retrieve them.

.

The GHS supported the work towards the Capitation Pilot Payment in the Ashanti Region. Work was not

completed to enable the pilot to take off. Work is still on-going.

GHS contributed to the draft review of the NHIS law which was completed and submitted to MOH and

the Attorney General Department.

A Health providers‟ forum has been formed and two meetings have been held. The group proposed that

GHS conduct some sample costing of the health services that is provided by Regional and District

Hospitals, Health Centres and CHPS before the review of tariffs. This will ensure that GHS negotiates for

the new tariffs with empirical evidence.


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HO2: IMPROVE GOVERNANCE AND STRENGTHEN EFFICENCY IN

HEALTH SERVICE DELIVERY, INCLUDING MEDICAL

EMERGENCIES

Information Technology to Improve Health Information Management and Service Delivery

The GHS has initiated the development and use of information technology to improve information

management and service delivery. It is collaborating with other partners to improve the collection,

collation, analysis and reporting of health information.

Some of the key activities undertaken to improve the health information management system were:

Deployment of and provision of technical support for iHOST (electronic medical records) in some

Hospitals.

Deployment f smart phones for collecting service data in Kintampo South and Asuogyaman as part

of GAVI HSS

Replication of MOTECH in Senya Breku district in the Central Region.

Initiation of transition from DHIMS to web-based DHIMS 2 is ongoing.

Initiation of Management processes to ensure local managers validate and use the data that they

generate.

eHealth

As a follow up to the launch of the eHealth Policy by the Ministry of Health, meetings were held during

the year to set the platform for implementing the policy.

ICT Governance-GHS ICT Enterprise Architecture (EA)

The GHS continued to work with the National Information and Telecommunication Authority (NITA) in

the area of ICT governance. NITA during the year under review initiated the deployment of the fibre optic

backbone that Ministry, Departments and Agencies (MDAs) are going to be linked onto. The Ghana

Health Service has strategically placed itself in a position to benefit from this roll-out.

ICT Training

There was capacity building in ICT across various levels of the service. Teams from the ICT department

and Centre for Health Information Management (CHIM) attended trainings on Free Open Source Software

(FOSS), Networking, Google applications and DHIS 2. The Bachelor of Science program in Health

Informatics was started at the School of Public Health, Legon.

Financing Mechanism and Financial Management Systems

A strategic plan was developed for the Finance Division for the Service. The GHS prepared its

consolidated financial statement for 2010 on time. Two review meetings were held with the Regional


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Finance officers. Quarterly financial data validation and consolidation were carried out in all ten (10)

regions. The GHS Headquarters was linked to the MOFEP in readiness for GIFMIS Roll-out. Finance

and Non Finance Managers in all ten (10) Regions were trained in the revised ATF. The Service coordinated the ten (10) year audit of Global Fund by the Office of the Inspector General (OIG).

Management Systems and Scale-up leadership Training

Based on recommendations made after the assessment of the performance review of 2008, the conduct of

performance review has been restructured to reflect organizational accountability.

Key activities undertaken under management system:

Coordinated GHS Retreats and Performance Reviews of 2009 POW

Produced the 2008 GHS Annual Report

Produced “Facts and Figures 2009”

Supported the development of Monitoring & Supervision Checklists including one for NHIS)

Reviewed the National Malaria M&E plan

Developed SOPs: Programmes for monitoring, improved data collection and feedback systems

To improve performance within the Service, management systems were strengthened by building capacity

of various professionals.

In the area of improving financial management and accountability, the leadership and management of the

GHS carried out the following activities:

a. Developed 2009 policies and priorities for GHS

b. Championed stakeholder fora to discuss HSS issues -including the review of the policy on CHPS

c. Coordinated development of 2009 MTEF plans and budgets and collated this into a national plan.

Infrastructure to Support Effective and Efficient Service Delivery

The GHS with funding through the NACP and EPI constructed three incinerators in selected districts.

Installation of emergency obstetric equipment in Ashanti, Western, Northern and Brong-Ahafo Regions

was completed.

The Service initiated the procurement, delivery and distribution of emergency obstetric equipment in

Central, Eastern and Upper East Regions

A nationwide needs assessment for the development phase of the ORIO grant to improve TB case

detection in Ghana was conducted. To improve the quality of service delivery, a number of equipment were repaired in various facilities.

Among the equipment repaired were: One defective operating table for Tema General Hospital and


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defective x-ray equipment donated by General Electric (GE) at Axim and Apam Hospitals. X-ray

equipment at Bole, Kintampo and Ashanti Mampong Hospitals are awaiting spare parts for repairs.

New fleet of vehicles were procured: 332 Great Wall pick-ups, 13 Hover SUV vehicles and GAVI funded

pick-ups,

The proportion of pick-ups to 4-wheel vehicles has increased from 57% in 2000 to 79% in 2010. The

growth corresponds to expansion of services such EPI, TB, HIV, new districts and upgrading of health

centers to hospitals.

The national average age of vehicles has reduced from 7.8 years in 2008 to 5.6 years in 2010. Similarly,

the national average age of motorcycles has reduced from 6.6 years in 2008 to 2.8 years in 2010.

The service procured back-up spare parts for vehicles and bikes deployed into the system. Each RHD is

required to establish a Revolving Fund using the spare parts as seed-capital.

Data on health facilities in all the then regions have been updated.

The service undertook a survey of all uncompleted GHS/ MoH projects in all the ten regions (excluding

the Teaching Hospitals) to ascertain their actual number, stage of completion and the cost of outstanding

works. The report was accepted by MoH for implementation.

Proposed Capital Budget for the year 2010 amounted to GH¢ 19.5m. The priority areas included the

completion/rehabilitation of health facilities, staff accommodation and CHPS facilities

101 out of the 120 projects planned in the 2010 Capital budget were procured or considered on-going.

However, actual work took place on only 24 project sites.

In spite of allocation of funds in the approved 2010 budget, there were practically no funds available to

pay contractors and consultants. Many contractors therefore, pulled out of most of the project sites due to

lack of payment of outstanding claims. The outcome was the submission of a small number of certificates

by the regions for processing in 2010.

The Ghana Health Service submitted entries on Corporate Innovations to the African Union for

consideration of awards. The Service also submitted its proposal on Boat Operations (The Hardest-to-

Reach) in response to a call for papers to an International Development and Innovations conference in

Yale University. The proposal was also accepted for presentation in 2011.


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HO3: IMPROVED ACCESS TO QUALITY MATERNAL, NEONATAL,

CHILD AND ADOLESCENT HEALTH SERVICES

Access to Quality Maternal Newborn and Reproductive Health Services

During the year under reveiw, a number of guidelines, plans and policy documents were developed to

improve maternanal and newborn health. PMTCT Scale-up Plan 2011 – 2015 was finalized in

collaboration with UNICEF and Ghana Aids Commission(GAC). NACP collaborated with the

Reproductive and Child Health (RCH) department to review policy guidelines on PMTCT in line with

the new WHO recommendations. A new HIV and Infant feeding policy was developed based on the new

WHO recommendations. There was a review of the Matenal Death Audit guidelines. Guidelines for

community care of the newborn was developed with UNICEF.

The Service in collaboration with FOCUS Regions project has started the process of developing job aids

for newborn care. The process is being led by an obstetrician/gynaecologist and a paediatrician.

An MDG Accelerated Framework(MAF) and action plan were developed in collaboration with other

stakeholders during the year under review.

The Under-five Child Health policy was also finalized and printed. Its disseminated has started.

Dissemination has been done for Greater Accra,Central, Brong Ahafo,Ashanti Regions, the Medical

Superintendents Group and the Paediatric Society of Ghana.

Shortened versions of the IMCI in-service training modules that were developed in 2009,have been

pretested in two training workshops in Central and Eastern regions.

The 2010 Child Health Promotion Week was launched on 3rd

May 2010 at Sunyani. This was followed by

a week long celebration across the nation under the theme “ Men on board for healthier children”

In the area of adolescent health, the Ghana Strategic Plan for the Health of Adolescents and Young People

was completed. A thousand copies have been printed.

Monitoring tools for the use of the Adolescent Health Service Delivery Standards were developed and

field-tested in three ecological zones. The tools were finalized and one thousand and five hundred copies

have been printed. An expert task team on the use of the tools have been formed and the dissemination of

the tools to all stakeholders was done during the year under review.

To improve the skills of staff and service quality, a number of trainings were done. They included:

• Training Of Trainers (Refresher) on Safe Motherhood Clinical Skills for Regional Resource

Teams of Northern, Upper West and Volta Regions.

• Comprehensive Abortion Care training and distribution of MVA kits for midwives in Eastern,

Western and Volta Regions

• Dissemination of Safe Motherhood and FP protocols in all 10 regions


Page 20 of 76

• A 5 day training of trainers (T.O.T.) workshop on Lactation Management was organized for 28

participants from Northern, Upper East, Upper West, Brong Ahafo and Ashanti Regions in April

2010. The training was held in Sunyani.


Page 21 of 76

HO4: INTENSIFY PREVENTION AND CONTROL OF

COMMUNICABLE AND NON-COMMUNICABLE DISEASES AND

PROMOTE HEALTHY LIFESTYLES

Health Promotion and Awareness Creation of Risk Factors

The GHS carried out educational campaign through the mass media on Regenerative Health, the

prevention of cholera and the H1N1 outbreaks. Special activities were carried out on the launch of the

World Diabetes day.

Non-Communicable Diseases

Draft document on the Strategic framework for controlling and managing NCD has been completed.

Strategic document on Sickle cell disease and cancers are currently being finalised

There was a consultative meeting to look at Policy guidelines for managing breast cancer. An alcohol

policy development working group was also formed.

One of the key interventions in the control of non-communicable diseases is health promotion.

Some key Health promotion activities carried out were:

Celebration of world and national events – tobacco, diabetes, heart, cancer, Sickle cell disease

Making of some Press releases - cancer, healthy lifestyles

Organisation of Radio talk shows on various NCDs at all levels

Launching of “Good Life. Live it Well” Campaign in Nov 2010 in collaboration with John

Hopkins University.

Organization of GHS Health Promotion Seminar in Feb 2010 - „Diet and physical activity‟

Promotion of Health walks – It is now becoming a part of celebration of several national events

and anniversary of several companies and churches

An agency with the support of the MOH launched an SCD project on April 23, 2010

Started developing posters on cancers in late 2010

With regards to cancer screening early detection and management the following activities were held:

Acquisition of a GoG loan of $700,000 to support cancer prevention, early detection and palliative

care.

Provision of HPV vaccination (Cervarix) at Ridge Hospital

Organization of meetings on the introduction of HPV vaccine.


Page 22 of 76

The following studies on NCDs were completed during the year under review:

1. Prevalence of risk factors for NCDs among patients reporting to KBTH

2. Prevalence of Risk factors for Cardiovascular Diseases among students in University of Ghana

3. WHO Study on global AGEing and adult health (SAGE) nationwide study in 5,573 adults and

elderly (18 years +)

4. Systematic review of hypertension in Ghana

Malaria

The Ghana Health Service has been implementing strategies to improve on malaria case management.

After successfully changing and revising the Anti-Malaria Drug Policy, focus has been on early case

detection and prompt treatment at all levels, with emphasis on cases in the most vulnerable groups,

children under five, non-immune visitors and pregnant women. In a bid to equip health workers with the

most current knowledge and skills, treatment guidelines and training manuals were revised and printed.

During the period under review, both public and private facilities throughout the country were supplied

with Artesunate-Amodiaquine tablets for the treatment of uncomplicated malaria. A total of 600,000 Rapid

Diagnostic Test (RDT) kits were also supplied to the health facilities to help with the laboratory

confirmation of cases.

In Ghana, the diagnosis of malaria has been predominantly clinical. However, with the rapid scale up of

proven interventions and their possible impact on malaria epidemiology, expert advice through the WHO

recommends a parasitological confirmation of all cases prior to treatment. There has therefore been the

need to scale up laboratory diagnosis either by microscopy or RDTs. To ensure that malaria cases are lab

confirmed before management is started, the training of laboratory staff on diagnosis which commenced in

the previous year was continued with the training of 373 peripheral health workers on laboratory diagnosis

(microscopy/RDTs). The USAID/PMI IMad project also conducted onsite training and supportive

supervision for lab technicians on microscopy. Sixty health facilities (60) including regional and district

hospitals as well as health centres with labs were visited and given technical support in lab diagnosis of

malaria in the first phase of the programme.

The total number of malaria cases seen at the OPD showed an upward trend from 3,694,671 in 2009 to

3,740,055 for the year under review. The proportion of malaria to total OPD also increased from 32.5% to

34% during the same period. Overall case fatality for malaria also worsened from 1.22% in 2009 to 1.44%

in 2010. Admissions for malaria however declined during the same period.

HIV/AIDS

In 2010, the GHS supervised the establishment of seven hundred and seventy four (774) testing centers

compared to two hundred and eighty-four (284) for the year 2009.


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Ghana adopted the combination antiretroviral therapy, as a policy since 2006, for PMTCT.

In 2010, five hundred and twenty thousand, nine hundred (520,900) pregnant women got to know their

HIV status compared to the three hundred and eighty-one thousand, eight hundred and seventy-four

(381,874) pregnant women got to know their HIV sero-status in 2009. Ten thousand, nine hundred and

eighty four (10,984) were positive (2.9%) compared to six thousand six hundred thirty-four (6,634)

representing 1.7% who were found to be positive among the pregnant women tested in 2009. Out of these

positive pregnant women, 55% were given Anti-retroviral (ARVs) as prophylaxis. The rest were not

eligible to receive their ARVs and they were subsequently lost to follow-ups.

Tuberculosis (TB)

In 2010, the National TB Programme entered its final year of successful implementation of the Global

Fund Round 5 Grant.

TB control activities continued to be integrated into the GHS structure at primary, secondary, and tertiary

levels of care.

In 2010, a total of 15,145 cases of TB were registered representing a case notification rate of 62%

compared to a total number of 15,286 registered in 2009 (64%). Fifty-five per cent (55%) of all registered

TB patients were pulmonary smear positive TB cases while 30% and 10% were pulmonary smear negative

and extra pulmonary TB (EPTB) cases respectively. Since 2004, the proportion of EPTB cases has gone

up by 52%.

TB treatment success rate however showed an upward trend reaching 87.0% for the 2009 cohort compared

to 85.1% for the 2008 cohort. For the 2009 cohort, 79.1% were cured compared to 77.9% cured for the

2008 cohort.

Some of the activities undertaken during the year:

Conduction of a National Stakeholders Review Meeting;

Organized an International conference on Improving TB case detection in Ghana.

Implemented a new intervention for improving TB case finding as a pilot in Accra Metropolitan Area with

support from CIDA and WHO.

Developed the National Infection Prevention and Control Policy in collaboration with the Institutional

Care Division of Ghana Health Service;

Developed Standard Operating Procedures for Intensified TB case finding at the facility level;

Conducted supervisory visits to regional and district levels to monitor TB activities;

Coordinated meetings of various sub-groups and the National TB Advisory Board.

Received technical assistance missions from various partner agencies such as WHO, KNCV, MSH and

TB CAP.


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Mobilized resources by developing grant proposals for Global Fund National Strategic Approach and

Round 9 call for proposals and WHO/CIDA call for proposals on implementing innovations to improve

TB case detection.

Conducted advocacy, communication and social mobilization activities for TB control.

Conducted operational research towards improved programme management.

Yaws

Support visits were made to 9 regions during the year under review.

In the area of capacity building, 35 core Regional Health Directorate members were trained on yaws

diagnosis (picture cards), elimination strategies and data tools for routine and baseline data collection.

Central Region DHA and the DDHS group in Volta Region had training in yaws diagnosis and

management. Some of the consumables distributed by the National Program to the Districts included:

100,000 data collection tools (TS, ADR, Reg), 3,500 picture cards, 1.549 million vials of BP (1.2 MU)

and 28,000 (2.4 MU) (1.5 million vials 1.2 MU taken at end of year)

The number of cases of Yaws detected during the year under review was 9,778 which was far below the

2009 cases of 36,328 and 28,080 in 2008. The drop in the cases detected can be attributed to the decrease

in the surveillance for Yaws in some of the districts and poor reporting. The current national prevalence of

yaws is approximately 700 cases per 100,000 in the population under 15 years (2008 Rapid Survey by

National Yaws Elimination Program).

Guinea Worm

Major advancement was made during the year to finally eradicate guinea worm in Ghana. For the year

under review, only eight (8) cases were reported. All of them were detected before the worms emerged

and were treated in the case containment center, leaving no room for them to contaminate water sources.

The last case was on 11th May, 2010, and since then no case has been detected in the country. There are

only four currently endemic villages located in three districts all in the Northern region of the country. The

National reward scheme was launched in July 2010 followed by vigorous sensitization across the country.

However, no report has been made yet. Two hotline numbers were made available for reporting rumors;

12 rumors /suspected cases were notified through the lines: from the Northern Region (7), Volta Region

(2), Western Region (2) and Central Region (1). All were promptly investigated and discarded as not

being guinea worm disease. The National Certification Committee was inaugurated in July 2010 and has

since visited three (3) regions. Namely Northern Region, Brong Ahafo Region and WesternRegion.

Buruli Ulcer

Strategies were put in place to ensure early case detection. For the year under review, 1,005 cases were

reported. This ranged from 124 cases in Ashanti Akim North alone followed by Ga West with 121 cases.

The National case detection rate is 1.16/100,000. The programme collaborated with some research centers


Page 25 of 76

including Noguchi to improve the diagnosis of Buruli ulcer using Polymerase Chain Reactions (PCRs).

Case management using antibiotics was strengthened through training of health workers. Surgical

outreach services were organized to support some districts to manage their cases.

H1N1 Influenza

Following the high incidence rate of Pandemic Influenza H1N1 in 2009, some measures were taken to reduce the

impact of the pandemic on health and minimize disruption to society and the economy. Among these were the

development of a National Action Plan, technical support visits and training of regional and district teams in

surveillance and management of the disease. The most prominent measure, however, was the deployment of

2,300,000 doses of PandemrixTM Pandemic Influenza Vaccine to priority groups of the population. The vaccination

campaign was undertaken to protect the public - reduce morbidity and mortality and the transmission of the virus

within communities.

Disease Surveillance, Emergency Preparedness and Response

Key activities undertaken under Disease Surveillance included:

Installation of Data entry templates for all regions

On-site orientation of staff on use of Epi-Info in managing IDSR data (weekly and monthly

reports)

Printing of 12,300 copies of CBS Registers (support from WHO)

Production of weekly and monthly bulletins on priority diseases and provision of feedback;

o Weekly - 43 / 52 (82.6%)

o Monthly – August produced / October

Completion of Yellow Fever risk assessment

Evaluation of IDSR (by Email)

Creation of Cholera awareness and improvement surveillance on diarrhoeal diseases in coastal

regions; Volta Central, Greater Accra, Western

Response to Cholera Outbreaks

Technical Support visit to the 3 Northern regions & BAR on meningitis

Supported- investigations into Meningitis Outbreaks in Jirapa & Bongo Districts

Initiation of assessment of core capacities –IHR

Carrying out of Port Health Activities


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Holding of quarterly NPEC and NCC meetings were held during the period under review

Provision of Guinea Worm technical support to Eastern, Volta, Western and Greater Accra

Regions

Conduction of Local STOP activities

Sensitization of clinicians on selected priority diseases (Polio, Measles, Yellow fever, Pandemic

Influenza, Meningitis etc)

Supported Records review in some health facilities.

Environmental And Occupational Health And Safety

The Occupational and Environmental Health Unit has three (3) technical areas, namely Occupational

Health, Environmental Health and Poison Control.

Occupational health

Key Activities

Dissemination of Occupational Health and Safety Policy

Orientation of Regional, Institutional and District focal persons in Batanya, in the Central Region

Environmental health

Key Activities :

Conducted monitoring visits to Healthcare Waste Management (HCWM) in pilot project in

Swedru Hospital and Kwanyako Health Centre

Scoping exercise done for Strategic Health Impact Assessment for Oil & Gas sector carried out

with technical support from WHO

Completion of draft report on Situational Analysis & Needs Assessment (SANA) on the Strategic

health & environment alliance as part of implementation of the Libreville Declaration.


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Poison control programme

Key Activities

• Responded to enquiries on poisoning; managed 24 patients with poisoning.

• Trained various staff on basic toxicology awareness and prevention of poisoning as well as first aid

for poisoning: Seventy two (72) community health nursing staff and 4 public health nursing staff

from 49 polyclinics, 4 hospitals, 4 reproductive and child health units, 2 maternity homes and 1

municipal health directorate within the Accra Metropolitan and Ledzokuku-Krowor Municipal

District of the Greater Accra Region.

• Trained Seventy-nine (79) farm workers from Ga East & Dangme West in safe handling of

chemicals.

• Trained some farmers, Agriculture Extension Officers, Environmental Protection Agency (EPA)

staff, pesticides dealers and health workers on recognition of effects of poisoning

Research and development

The Research and Development Division of the GHS became operational in January 2009 with the

mandate to generate information through relevant research, strengthen decision- making, fine-tune and set

health priorities

For the year 2010, the division;

conducted two supervisory visits to three (3) centres, - Navrongo, Kintampo and Dodowa,

Organized eight (8) local scientific meetings

Participated in five (5) international research output presentations.

Communication amongst the research centers and the international research community was ensured by

the effective and efficient maintenance of internet connectivity and access to HINARI, AGORA and

OARE.

Capacity development activities in the year comprised of:

training of a librarian in computer indexing to strengthen the documentation centre and support

provision of support to staff (4) to attend short courses

The GHS Ethical Review Committee reviewed 207 proposals within the year and approved of 152 for

implementation.

Some of the current research activities in the division include:


Page 28 of 76

Strategies for Health Insurance for Equity in less Developed Countries (SHIELD) which aims at

evaluating existing inequities in health care and the extent to which health insurance mechanisms

could address equity challenges

ABBA, which aims to determine impact of scaling-up HIV/AIDS interventions on human

resources by identifying the health services most severely affected by HIV/AIDS and proposing

relevant health service indicators to inform sector needs.


Page 29 of 76

HO-5 IMPROVE INSTITUTIONAL CARE, INCLUDING MENTAL

HEALTH SERVICE DELIVERY

Some of the activities undertaken in institutional care included

The GHS introduced a customer care program with support from Ecobank. The Bank supported the

development and launching of handbooks and posters on Customer Care. A video on customer care was

also developed and trainers for all the Regions were trained using the same support.

40 pharmacist, obstetricians and other health staff were trained on the pharmaceutical management of

uterotonics and a stakeholders meeting on the use of uterotonics was held.

Outreach services in Oral health and Eye Care were targeted at deprived areas .

The number of cataract surgeries done per one million population increased from 600 to 713. Although

this figure is still below the actual service need of 2,500 surgeries per million population, it is an

indication of our collective resolve to work harder to clear cataract cases which contributes about 45% to

the burden of blindness in Ghana.

A study to assess the quality of care for sick children in hospitals in selected hospitals was carried out as

part of the Better Medicine for children‟s project. The key findings were as follows:

Generally hospital support systems were adequate (running water, electricity, backup generator, soap etc)

Laboratory support was also good and laboratory results could be obtained in reasonable time: within two

hours, although some hospitals did not carry out cerebrospinal fluid microscopy

Drugs needed for management was most often available at the pharmacy but emergency drugs were not

readily available on the wards and emergency areas

There was shortage of professional nurses and in most of the facilities sick children were cared for by

student nurses, health care assistants and ward aides who had inadequate skills and knowledge to do this

job

There were gaps in the case management of common childhood illnesses, especially the management of

diarrhoea and malnutrition. Case management protocols and guidelines were most often not available.

Best practice was observed in the management of children with HIV/AIDS where there were protocols

and staff had been trained in their use.

The GHS signed a cooperative agreement with CDC aimed at strengthening clinical laboratories.

Activities under the agreement include;

Development of National Strategic Plan and Policy

Establishment of quality management systems

Preparation of selected labs for WHO accreditation


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Piloting of Lab health information management system

Other partners who supported the laboratory services are IMAD, JSI/ DELIVER

The Taylor and Taylor project is ongoing and in 2010, the company started the replacement of laboratory

equipment that was supplied in the first phase projected

Mental Health

The poor quality of mental health at Accra Psychiatry hospital was brought to public domain in a

documentary by a Ghanaian journalist. As a result of which several interventions were put in place to

improve quality of care; some of these include

Provision of bore holes

Decongestion by discharging patients who have been stabilized and have been on admission for more than

5 years

Disciplinary measures against those who were found to have breeched regulations and rules

Security beefed up with 24hr security at the hospital

Seminars on medico legal issues, code of conduct and disciplinary procedures and quality assurance

Procurement of food supplies was streamlined


Page 31 of 76

KEY PERFORMANCE INDICATORS BY OBJECTIVES

TABLES AND FIGURES

HEALTH OBJECTIVE ONE: Bridge Equity Gaps in access to health care

and nutrition services and ensure sustainable financing arrangements

that protect the poor

Outpatient Attendance

OPD attendance nationally has generally increased

significantly since 2008 from 0.77 to 0.98. Three

regions, Brong-Ahafo, Volta Region and Eastern

Region which showed a decline in OPD per capita in

2009 all showed increases in 2010. All the Regions

showed increase in OPD per capita. Upper East region

continue to show a consistent improvement in per

capita OPD attendance since 2006 when it recorded

0.55, and subsequently increasing to an OPD per capita

of 1.47 in 2010. Northern Region with its large land

mass and few facilities present a challenge to access

and this is shown in the low OPD per capita. Volta

Region is also similarly challenged, with its high patient to doctor ratio in comparison to the other regions

The doctor population ratio for Ghana, looking

at doctors on the government payroll improved

from 1 doctor to 11,929 to 1 doctor to 10,423.

Northern Region showed remarkable

improvement from one doctor to 50,751 in

2009to one doctor to 18,257 in 2010. The

improvement is due mainly to the efforts of the

Chief Executive of the Tamale Teaching

Hospital to attract doctors to the Hospital. There

is the need for the service to look at the

strategies that was used in Tamale to see how

REG 2007 2008 2009 2010

ASH 0.72 0.73 0.89 1.04

BAR 1.02 1.30 1.15 1.25

CR 0.70 0.68 0.71 0.81

ER 0.94 0.97 0.95 1.04

GAR 0.60 0.51 0.51 0.97

NR 0.31 0.49 0.53 0.54

UER 0.69 1.01 1.37 1.47

UWR 0.65 0.70 0.72 0.91

VR 0.51 0.73 0.69 0.76

WR 0.72 0.86 0.99 1.16

National 0.69 0.77 0.81 0.98

Region 2007 2008 2009 2010

ASH 10,667 9,537 8,288 7,184

BAR 22,479 21,475 16,919 22,967

CR 29,260 26,140 22,877 18,218

ER 18,141 17,571 16,132 15,801

GAR 5,202 4,959 5,103 4,099

NR 92,046 68,817 50,751 18,257

UER 30,111 33,475 35,010 31,214

UWR 43,265 43,988 47,932 27,050

VR 28,269 27,959 26,538 32,605

WR 33,794 31,745 33,187 31,190

National 12,591 12,713 11,929 10,423

TABLE 1: TREND OPD PER CAPITA BY REGION (2007-2010)

TABLE 2: TREND IN DOCTOR POPULATION RATIO BY REGION (2007-2010)


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replicable this can be in other regions. With this improvement in Northern Region‟s doctor to population,

Volta Region now has the worst doctor patient ratio (1:32,190)

Compared to the previous year there appear

to be a worsening of the nurse to population

ratio. This may be due to the source of data

that was used in the previous years. The

number of midwives have been taken out of

the total number of nurses for the year 2010

resulting a lower total number of general

nurses. Unfortunately correction could not be

done for the previous years to make it

comparable. Overall however, there has

been improvement in the ratio as a result of

increase production and reduction in the

brain drain.

Community Based Health Planning and Services

39 55 84190 270 345 409

8681034

0200400600800

10001200

2002 2003 2004 2005 2006 2007 2008 2009 2010

Num

ber

of fu

ncti

onal

CH

PS

zone

s

Years

Fig 1. Trends in Functional CHPS Zones (2002-2010)

Region 2007 2008 2009 2010

ASH 2,028 1,336 1,173 1,156

BAR 1,964 1,140 993 1,245

CR 1,476 895 811 1,200

ER 1,175 959 832 953

GAR 979 881 874 800

NR 1,953 1,534 1,367 1,426

UER 1,132 956 805 926

UWR 1,209 870 750 842

VR 1,266 892 800 1,090

WR 2,004 1,413 1,213 1,398

National 1,342 1,079 971 1,077

TABLE 3: TREND IN NURSE POPULATION RATIO BY REGION (2007-2010)


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There have been an increase in community health officers in all districts; most of them have already had

training in CHPS service delivery as part of their pre-service training. To make use of the increase

availability of trained Community Health Officers, many districts have taken the advantage to expand

CHPS in their districts. Functional CHPS have increased from 345 in 2007 to 1,034 in 2010. A functional

CHPS zone being defined as a geographically well defined area within a sub-district, which has been

assigned to a CHO, who has started offering service by home visits to clients in the zone, although one or

more key milestones like provision of a compound has not been achieved. The population covered by

CHPS moved from 15.3% in 2009 to 18.7% in 2010.

Table 4: Progress in the Implementation of CHPS by Region, 2008-2010

Region

2008 2009 2010

Funct

Funct

Funct

Ashanti 8 8 36

B/Ahafo 9 62 46

Central 46 68 93

Eastern 86 298 315

G/ Accra 5 20 83

Northern 39 75 78

U/ East 88 104 96

U/ West 41 85 93

Volta 42 50 71

Western 45 114 123

Totals 409 868 1034


Page 34 of 76

National Health Insurance Scheme.

Upper west region presented the lowest number of facilities the NHIA for accreditation. None of the GHS

facilities failed, however facilities given provisional accreditation were in the following regions

Table 5. Percentage of facilities given provisional accreditation by Regions(Round2)

Region % facilities that were assessed and given

provisional accreditation

Brong Ahafo 19

Upper East 2

Volta 19

Western 2

Upper West had the highest proportion of facilities accredited grade A, followed by Greater Accra and

Northern regions whilst Volta, Ashanti and Brong Ahafo regions had the highest proportion of facilities

awarded grade D.

Fig 2. Accredited Facilities by grades (all facilities types) National Health Insurance


Page 35 of 76

HEALTH OBJECTIVE TWO: IMPROVE GOVERNANCE AND

STRENGTHEN EFFICENCY IN HEALTH SERVICE DELIVERY,

INCLUDING MEDICAL EMERGENCIES

Financing mechanism and financial management systems

Table 6: Trends in Health Sector Budget for the period 2007-2010

TOTAL HEALTH SECTOR

BUDGET 2007 2008 2009

2010

SOURCE

BUDGET

(000) BUDGET BUDGET

BUDGET

(„000)

GOG

248,190.00

268,517.00

344,398.00

400,451.00

HEALTH FUND/SBS

18,900.00

126,731.00

63,981.00

79,823.00

EARMARKED FUNDS

78,583.50

92,191.00

18,602.00

243,294.00

IGF

52,100.00

115,070.00

108,312.00

208,180.00

NHIF

175,909.70

235,430.00

462,940.00

480,908.00

HIPC

9,500.00

6,485.00

11,427.00

8,000.00

TOTAL HEALTH SECTOR

BUDGET

583,183.20

844,424.00

1,009,660.00

1,420,656.00

The overall budget for health increased for the year 2010. Most of the increase however, was in IGF with

an increase of 92.2%. The shift of source of funding from GOG to internally generated fund is shifting

funds from public health to clinical care. The public health units at the District level do not generate any

IGF. They depend heavily on the GOG to run their activities. The present situation is making it very

difficult for District Health Directorates to implement their planned activities for the year. The increase in

the earmarked funding from 18,602 Ghana cedis to 243,294 Ghana cedis inhibits district initiatives for


Page 36 of 76

service delivery as the earmarked funds are allocated to very specific activities at the District level which

might not be the priority of the district.

Table7: Statement of Receipts and expenditure for GHS for the Year 2010

Statement of Income and Expenditure

Source Receipt Exp % diff

GoG 5,916,700.99 14,977,067.50 -153.1%

IGF 219,719,142.10 217,488,775.18 1.01%

SBS 3,104,377.79 2,874,417.02 7.4%

Programme 86,924,059.95 72,021,992.64 17.1%

Total 315,664,280.83 307,362,252.34 2.6%

For the total non-wage recurrent receipts, 69.6% of total receipts for the year 2010 came from internally

generated funds. The decrease in receipts from GOG is a source of concern. GOG constitute only 1.9% of

total receipts for the year 2010. The over expenditure for the GOG for the year 2010 was as a result of

money received in late 2009 that was used in the early part of 2010.


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There was an improvement in the fleet size of the service, with the introduction of the facilities vehicle

hire purchase schemes. Other programs also procured vehicles for both the Regions and Districts. More

motorbikes were also provided for the districts.

Table 8: GHS FLEET SIZE AS AT DEC 2010

REGION VEHICLE MOTORBIKE

ASHANTI 120 532

BRONG-AHAFO 150 764

CENTRAL 109 457

EASTERN 170 756

GREATER ACCRA 127 340

NORTHERN 183 871

UPPER EAST 131 640

UPPER WEST 102 582

VOLTA 130 696

WESTERN 94 627

HEADQUARTERS 225 47

TOTAL 1,541 6,312


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HEALTH OBJECTIVE THREE: IMPROVE ACCESS TO QUALITY

MATERNAL, NEONATAL, CHILD AND ADOLESCENT HEALTH

SERVICES

TABLE 9: KEY SECTOR PERFROMANCE INDICATORS (2006-2010)

Indicator

2007 2008 2009 2010

Institutional MMR (per 1000 live births) 224 200 169.9 163.2

HIV prevalence among pregnant women 15-24 yrs 2.6% 2.2% 2.9% 2.0

ANC coverage 91.1% 97.4% 92.1% 93.3%

% Deliveries attended by a trained

Health worker

32.1% 44.2% 45.6% 49.5%

PNC coverage 56.7% 57.5% 56.0% 61.6%

FP Acceptor Rate 23.2% 33.8% 31.1% 24.9%

Penta 3 coverage 87.8% 86.6% 89.3% 87.1%

Measles coverage 88.6% 86.5% 89.1% 87.7%

Institutional Maternal Mortality ratio

There has been a gradual decrease in the institutional maternal mortality ratio. It has reduced from

169.9/100,000LB to 163.2LB. Although the decreases have not been so significant, it is a reflection of all

the interventions that have been put in place towards achieving MDG5. Volta Region has a high maternal

mortality ratio(209.6/100,000LB) compared to the other Region with Northern Region recording lowest

Institutional Maternal mortality ratio of 137.2/100,000LB. One of the factors that influence Institutional

Maternal mortality ratio is the utilization of facilities, Northern Region with its low skilled delivery of

36.8%, need to ensure that women are not dying within the communities

Ante natal Care

Efforts to provide quality maternal care services continue to be high priority in the GHS. This focus is

yielding positive results in the coverage of skilled attendance across the country. There was a marginal

increase in the ANC coverage an improvement over the previous year when there was a decrease. Efforts

in addressing the MDG5 through the posting and training of midwives to health centers and CHPS

compounds may be responsible for this trend.


Page 39 of 76

Skilled Delivery

Skilled delivery rate improved nationally from 45.6%2009 to

49.5%2010. However, there are inter-regional variations: Upper

East, Western, Northern, Ashanti and Brong Ahafo Region

have all shown consistent increase in skilled delivery from the

year 2008. Greater Accra recovered from the drop in 2009 and

increase coverage to 54.4% this may be a reflection of

improvement in data collection from the private sector. There

has been a reduction in coverage in the Volta and Eastern

Region. Skilled delivery coverage which is delivery made by a

trained health worker is dependent on the distribution of these

staff. Volta Region has seen a worsening in the midwife to

population ratio during the year 2010. Also most of their

nurses are old, so they are not practicing.

Immunization

General performance in immunization as

measured by Penta III coverage dropped from

89.3%2009 to 87.1 %2010. The drop in coverage

was in all the regions with the exception of

Ashanti Region. Several factors are

contributing to this decline. Some of the

reasons are: Poor data capture especially in the

Greater Accra Region. Inadequate and delays

in the release of funds for district activities

also affected the outreach services organized

by district to provide immunization service for

hard to reach communities resulting in low

coverage. Funds for district service activities

were released to the Districts in late May 2010.

The best time for immunization activities is during the dry season from January to April, when most

communities are accessible.

SUP-DEL 2007 2008 2009 2010

ASH 26.7 35.0 42.4 53.4

BAR 34.5 49.8 53.7 54.0

CR 22.3 56.3 52.5 51.6

ER 43.1 48.0 52.1 48.2

GAR 43.1 50.2 47.9 54.4

NR 27.7 26.0 36.1 36.8

UER 43.5 40.4 52.6 59.7

UWR 32.9 40.6 36.7 46.5

VR 33.3 37.5 39.4 36.9

WR 17.6 39.1 42.6 49.6

National 32.1 42.2 45.6 49.5

Region 2007 2008 2009 2010

ASH 72.0 76.8 83.7 86.5

BAR 100.0 97.3 95.0 94.3

CR 93.0 92.2 96.6 94.3

ER 93.0 93.0 94.5 93.6

GAR 68.0 68.3 72.7 70.1

NR 124.0 114.5 123.0 109.2

UER 102.0 94.8 106.0 83.1

UWR 94.0 87.5 90.1 81.7

VR 84.0 83.8 82.9 81.4

WR 93.0 89.0 88.6 86.4

National 87.8 86.6 89.3 87.1

TABLE 11: TREND OF PENTA III COVERAGE BY REGION

(2006-2009)

TABLE 10: TREND SKILLED DELIVERY BY REGION (2006-2010)


Page 40 of 76

Figure 3 TREND OF EARLY CHILDHOOD MORTALITIES IN GHANA

The trend in early child mortalities in Ghana has

shown a gradual decline in neonatal, infant and under-five mortality. This augurs well for the country‟s

bid to achieve the MDG4. There have been no deaths from measles in Ghana for the past seven years.

Most of the decline in childhood mortality has been in the under five, where immunization has contributed

greatly to reducing preventable deaths. Neonatal mortality has however shown little decline and there is

the need to concentrate efforts in reducing this further.


Page 41 of 76

HEALTH OBJECTIVE FOUR: INTENSIFY PREVENTION AND

CONTROL OF COMMUNICABLE AND NON-COMMUNICABLE

DISEASES AND PROMOTE HEALTHY LIFESTYLES

FIGURE 4 TREND OF NOTIFIED CASES OF TB (2005 -2009)

The Service is not doing too well with regards to TB case notification. After the increase from 2007 of

57/100,000 population to 64/100,000 in 2009, there was a decline to 63/100,000 pop in 2010. This might

be partly due to low level of suspicion of TB by prescribers and the low numbers of Laboratories to do the

sputum microscopy for the diagnosis.


Page 42 of 76

Table 12: Summary of core surveillance indicators, Jan – Dec 2008 - 2010

Indicator Target 2008 2009 2010

Timeliness of Monthly ≥ 80% 74 92 86

Annualized non polio AFP rate per

100,000 Pop chn. < 15yrs.

≥ 2.0 2.24 2.53 1.82

% Adequacy of stool ≥80% 78.0 75.3

% of Districts reporting at least

one suspected case of measles

investigated with blood specimen

≥80% 90.6 81.1 80.5

% of Districts reporting at least

one suspected case of yellow fever

investigated with blood specimen

≥80% 59.0 48.0 59.4

Meningitis case fatality rate ≥10% 21.4 18.8 >10

Cholera case fatality rate (%) ≥1% 1.7 0.7 1.8

Selected core surveillance indicators:

Focal Outbreaks of H1N1 occurred mostly in schools – Eastern, Volta and Brong Ahafo Region

All regions reported suspected cases; Upper East Region did not confirm any suspected H1NI cases. There

were 75% of Confirmed cases in Greater Accra Region and 5.5% in Eastern.


Page 43 of 76

Table 13 Distribution of H1NI vaccination and AEFI by Regions.

Regions Total

Population

Target 10% of total

population

Total

Vaccinated Coverage Total AEFI

Ashanti 5,014,536 501,454 288,454 57.5 29

Brong-Ahafo 2,323,878 232,388 108,357 46.6 14

Central 1,961,997 196,200 135,700 69.2 60

Eastern 2,420,925 242,093 156,918 64.8 172

Greater Accra 4,469,506 446,951 280,804 62.8 455

Northern 2,399,912 239,991 163,505 68.1 -

Upper East 1,026,458 102,646 77,099 75.1 28

Upper West 682,452 68,245 52,605 77.1 2

Volta 1,974,112 197,411 142,864 72.4 54

Western 2,637,135 263,713 171,737 65.1 11

National 24,910,911 2,491,091 1,578,043 63.3 825

Cholera and Meningitis: A review of the core surveillance indicators in 2010 showed that cholera case

fatality rate increased from 0.7 in 2009 to 1.8 in 2010 whereas that of meningitis decreased from 18.8 in

2009 to just above 10% in 2009.

More need to be done on the clinical management of meningitis, although the case fatality have reduced

from 18.8 to just above 10%, it is still unacceptably high. Late reporting of cases to facilities also

contributes to the poor outcomes.


Page 44 of 76

FIGURE 5. PROPORTION OF OPD CASES ATTRIBUTED TO MALARIA (2006 -2010)

The proportion of total OPD attributed to malaria continues to increase. With the introduction of the rapid

diagnostic tests (RDTs) for malaria it was believed that the proportion of OPD attributed to malaria was

going to decrease. Unfortunately this has not happened, and for the 2010 year there was actually an

increase. It has been found that there is the need to train clinicians and prescribers on how to manage cases

with fever as most diagnose anyone with fever as having malaria and treating them as such. This has been

found to be the case even when RDTs are used and the results have been negative for malaria parasites.


Page 45 of 76

FIGURE 6: PROPORTION OF TOTAL CASES AND DEATHS ATTRIBUTED TO MALARIA, 2006-2010

34.10 of total admissions in health facilities were attributed to malaria and 19% of total deaths in health

facilities were also attributed to malaria( Fig 6). The results shows an increasing trend in the admissions

and death attributed to malaria. This is in contrast to the decreasing malaria case fatality rate in children

under five years. There is the need for a study to ascertain whether these admissions and deaths attributed

were really malaria cases.

FIGURE 7: UNDER 5YRS MALARIA CASE FATALITY RATE 2002-2010


Page 46 of 76

Although the total cases of malaria seen at the OPD have increased, there has been a reduction in deaths

caused by Malaria in children under-5 years. This is a good sign that the fight against malaria is making a

head way.

Statistics on Poisoning

Figure 8: Reported Poisoning Trends by Agents

Kerosene is an important agent that is involved in poisoning in children under ten years old. This is due to

the high availability of kerosene in most homes. It is used as fuel for domestic cooking and lightening in

most low income homes. It is often stored in discarded water or soda drink containers. This increases the

risk of child mistaking it for water and drinking it.

Table 14: Top Three (3) Agents Involved in Poisoning in 2010 by Age

Under 5 YO 5 – 10 YO 11 – 24 YO

(Adolescents)

25+ YO

(Adults)

Kerosene -

(4/17)

Kerosene – (2/4) Pesticide (all types)

– (5/12)

Pesticide [all types] -

(9/23)

Soap – (4/17) Foreign body (coin)

– (1/4)

Kerosene – (2/12) Snake bite - (4/23)

Pharmaceuticals

– (3/17)

Snake bite – (1/4) Dettol – (2/12) Alcoholic & non-alcoholic

drink related – (4/23)


Page 47 of 76

Non communicable Diseases – Hypertension

Analysis of 2010 morbidity data indicates that there were twice as many female cases of hypertension than

men. This could be due to that fact that more females attend hospitals than men.

Fig 9: Male female distribution among cases of Hypertension seen in health facilities

Source CHIM

The age distribution for all cases (Males and females) showed a fairly even distribution among ages above

35yrs age groupings. Slightly higher percentage was observed in the 70+ age group which is to be

expected but for the younger age groups 35-49 the proportion of cases being similar to the older

populations is of concern which requires further investigation.

Fig 10: Age Distribution – Hypertension cases OPD Morbidity 2010 CHIM

Source CHIM


Page 48 of 76

HEALTH OBJECTIVE FIVE: IMPROVE INSTITUTIONAL CARE,

INCLUDING MENTAL HEALTH SERVICE DELIVERY

Malaria was the commonest condition seen at the OPD accounting for about 44% of all

conditions seen.

Table15: Top Ten Diseases seen at the OPD

Malaria

All Other Diseases

Other ARI(Acute Respiratory

Infection)

Skin Diseases & Ulcers

Diarrhoea Diseases

Hypertension

Rheumatism and Joint Paints

Intestinal worms

Acute Eye infection

Anaemia

Pregnancy and Related

Complications

Acute Urinary Tract Infection

Typhoid/Enteric Fever


Page 49 of 76

CHALLENGES

Objective 1: Bridge gaps in access to health care and nutrition services

and ensure sustainable financing arrangements that protects the poor

Human Resource

Lack of updated and comprehensive HR database

Swelling health sector wage bill

Inequitable distribution of available staff

Poor monitoring system to track disengaged staff

High attrition rates

Delayed promotions

Inadequate support from Regional and Divisional Directors on HR activities particularly the

updating and submission of nominal rolls on quarterly basis.

Objective 2: Improve governance and strengthen efficiency in health

service delivery, including medical emergencies .

Lack of payment for vehicle maintenance services which is threatening to collapse the Central

Mechanical Workshop

Blatant disregard for GHS Capital Investment Plan by MoH

Lack of spare parts particularly for corrective maintenance of laundry equipment

Inadequate number and aging artisans

Lack of commitment on the part of some institutional managers to commit funds and logistics

towards maintenance of health infrastructure

Poor coordination in the supply and installation of medical equipment by various programme,

donors and BEU


Page 50 of 76

Objective 3: Improve access to quality maternal, neonatal, child and

adolescent health services

Inadequate numbers and poor distribution of midwives to provide deliveries by skilled attendants.

Lack of Blood bank facilities in most Hospitals

Inadequate medical equipment.

Inadequate resources for in-service training, fellowship and other management and leadership

training

Out-dated staffing norms for facilities, making re-distribution of essential health staff difficult.

Objective 4: Intensify prevention and control of communicable and non -

communicable diseases and promote healthy lifestyles .

• Delays in getting results of YF investigations from Institute de Pasteur (Dakar)

• Erratic supply of yellow fever reagents to the NPHRL

• Inadequate reporting during outbreaks including observance of daily reporting

• Poor use of existing case definition

• There is little idea about index of suspicion of cholera cases

• Vehicle for Rapid Response activities not performing optimally

• Inadequate documentation of surveillance activities

Non-use of outbreaks/rumour logbooks.

General low awareness on NCDs

Inappropriate care behaviour – low utilization, late reporting

General lack of national screening programmes for NCDs

Limited diagnostic or screening equipment for NCDs

Inadequate or absent treatment guidelines for NCDs

Counselling at health facilities for NCDs – weak, or not well done

Limited palliative services


Page 51 of 76

Objective 5: Improve institutional care including mental health service

delivery

Compliance to national guidelines is low especially at the lower level where clinical care structures

are very weak , this coupled with non availability in most of the facilities

Inadequate Staffing in health facilities coupled with maldistribution and poor attitude affect

quality of services

In the earlier part of the year delayed payment of claims by NHIA affected service provision

The coverage of Clinical care interventions (IPC, Patient Safety, Customer Care) is very low and

thus their impact cannot be felt

Poor quality of some of the clinical care data


Page 52 of 76

THE WAY FORWARD FOR 2010

Objective 1:Bridge the equity gaps in access to health care and nutrition

services and ensure sustainable financing arrangements that protect the

poor.

Scale out standard HR tool (WAHO HRIS Software) to support HR Planning and budget at National

and Regional Level.

Forecast HR needs of the GHS.

Complete reviewing staffing norms

Production of HR Bulletin (Newsletter)

Updating of Nominal Roll

Headquarters levels

Regional Levels

Reconciliation of Nominal roll with Payroll

Provide Technical Support to other HR Units and Regions Scale out standard HR tool (WAHO HRIS

Software) to support HR Planning and budget at National and Regional Level.

Forecast HR needs of the GHS.

Complete reviewing staffing norms

Production of HR Bulletin (Newsletter)

Updating of Nominal Roll

Headquarters levels

Regional Levels

Reconciliation of Nominal roll with Payroll

Provide Technical Support to other HR Units and Regions

Objective 2:Improve governance and strengthen efficiency in health

service delivery, including medical emergencies .

Undertake Planned Preventive and Corrective Maintenance Programmes – transport, equipment

and buildings

Promote the use of Standard Designs and Specifications for construction of various types of health

facilities

Develop criteria for prioritization of infrastructure development

Healthcare Waste Management programme – conduct regional trainings with EHCU and construct

13 incinerators in selected health facilities.


Page 53 of 76

Collate information and monitor civil works procurement plans of all RHDs and GHS HQ

Pursue the Completion of the GHS Hq. Rehabilitation Project including the construction of access

road to the 28th February crossing road

Implement GHS Capital Plan and provide technical support for ADB PIU, OPEC PIU,

Bolgatanga Regional Hospital PIU

Revamp the Boat Management System

Develop Standard Transport Operating Procedures (STOPs) also known as Transport Manual to

guide the operational management of transport resources

Sustain new initiative for vehicle replacement – Hire Purchase Scheme.

Work towards strengthening Procurement and Logistics systems in the GHS.

Liaise with PPA in the training of the ETC Members and Practitioners.

Advocate for establishment of the Central Procurement Account.

Objective 3:Improve access to quality maternal, neonatal, child and

adolescent health services.

• Improve on Monitoring & Supervision (maternal, newborn & nutrition surveillance)

• Implement EMONC Assessment recommendations

• Provide modern equipment – sonicaid, portable Ultrasound, CTG Monitors for health facilities

• Build Capacity of Staff to offer quality care.

• Improve on Technical support to Regions, Districts, Division, Programmes and Partner agencies

• Strengthen Health Promotion Department & Resource Centre to provide materials for behaviour

change communication.

Objective 4:Intensify prevention and control of communicable and non -

communicable diseases and promote healthy lifestyles.


Page 54 of 76

Strengthen the skills and practices of health personnel in the core surveillance functions through

structured and integrated in-service training and enhanced facilitative supervisory support visits

Complete adaptation of Second Edition of IDSR Technical Guidelines and its Training Modules to

address declining core functions

Print and distribute 400 copies of revised IDSR technical guidelines

Organize zonal surveillance review meetings for District Surveillance Officers

Installation of Data entry templates for all regions and on-site orientation of staff on the use of

Epi-Info in managing IDSR data (weekly and monthly reports)

Update database (inventory) for Community Based Surveillance

Produce weekly and quarterly bulletins on priority diseases and provide feedback to the regions.

This would be done in collaboration with Program managers and Center for Health Information

Management in this direction.

Expand screening centres for cervical cancer

Strengthen cancer registration, early detection, palliative care

Scale up newborn screening SCD

Continue advocacy for more NCDCP staff and Regional Focal Persons

Objective 5: Improve institutional care including mental health service

delivery.

The will be steps to initiate the establishment of the District Clinical care teams as defined in the

Act 525.

Some of Gaps identified in the quality of care for sick children in hospitals will be addressed

through the provision of clinical care guidelines, engaging the Paediatric Society, collaborating

with the better Medicine for Children‟s project a

Improving collaboration between public health and clinical care at all level should be placed on

GHS agenda

The Impact of clinical care interventions will be felt if there is scaling up to all health facilities

such as infection prevention and control, patient safety, customer care, accidents and emergency,

data quality audit, clinical audit In this regard, performance of health facility managers must be

linked to the implementation of clinical care interventions

National clinical lab will be strengthened to enable it coordinate the implementation of GHS CDC

cooperative and other lab agreements


Page 55 of 76

Continue collaboration with NHIA in the accreditation program. In addition GHS facilities that fail

or awarded provisional accreditation will be supported to gain accreditation

Introduce clinical data quality audit

Complete draft clinical care guidelines and disseminate

Continue specialist outreach service

Intensify clinical supervision

Undertake research on neonatal care and baseline A and E services

Contribute to programs that will improve maternal health and make blood available and safe


56

ANNEXES: TRENDS IN SECTOR INDICATORS

Doctor to Population Ratio

2010 2009 2008

Number of Doctors Doctors Population

ratio Number of Doctors

Doctor Population

Ratio Number of Doctors

Doctor Population

Ratio

ASHANTI 684 7,184 589 8,288 495 9,537

BRONG AHAFO 99 22,967 134 16,919 103 21,475

CENTRAL 113 18,218 84 22,877 72 26,140

EASTERN 163 15,801 148 16,132 134 17,571

GREATER CCRA 935 4,099 839 5,103 827 4,959

NORTHERN 134 18,257 46 50,751 33 68,817

UPPER EAST 33 31,214 29 35,010 30 33,475

UPPER WEST 25 27,050 14 47,932 15 43,988

VOLTA 64 32,605 73 26,538 68 27,959

WESTERN 75 31,190 77 33,187 78 31,745

TOTAL 2,325 10,423 2,033 11,929 1,855 12,713


57

Nurse to Population Ratio

Region

2010 2009 2008

Number of nurses Nurse population

ratio Number of Nurses

Nurse Population

Ratio Number of Nurses

Nurse Population

Ratio

ASHANTI 4,252 1,156 4,161 1,173 3533 1,336

BRONG AHAFO 1,826 1,245 2,283 993 1940 1,140

CENTRAL 1,715 1,200 2,369 811 2104 895

EASTERN 2,703 953 2,871 832 2454 959

GREATER CCRA 4,793 800 4,897 874 4656 881

NORTHERN 1,716 1,426 1,708 1,367 1480 1,534

UPPER EAST 1,112 926 1,262 805 1051 956

UPPER WEST 803 842 895 750 758 870

VOLTA 1,914 1,090 2,421 800 2132 892

WESTERN 1,673 1,398 2,107 1,213 1753 1,413

TOTAL 22,507 1,077 24,974 971 21,861 1,079


58

Hospital Bed Utilization Statistics

Region Percentage Occupancy Average Length of Stay

2010 2009 2008 2010 2009 2008

ASHANTI 69.4 65.5 63.3 3.9 4.0 4.2

BRONG AHAFO 62.2 57.9 60.5 3.8 3.5 3.9

CENTRAL 50.5 51.4 52.5 3.6 3.5 4.0

EASTERN 57.4 55.9 55.6 4.2 4.2 4.4

GREATER CCRA 86.1 78.3 72.0 6.4 6.0 6.4

NORTHERN 71.0 59.1 61.3 3.0 2.2 2.7

UPPER EAST 52.5 49.7 42.2 2.7 2.8 2.9

UPPER WEST 66.1 62.1 59.4 3.5 3.5 3.4

VOLTA 52.9 54.1 51.1 4.2 4.5 4.9

WESTERN 53.8 52.0 51.5 3.3 3.3 3.7

TOTAL 63.2 59.8 58.3 3.9 3.8 4.2


59

Region

Turnover Per Bed Turnover Interval

2010 2009 2008 2010 2009 2008

ASHANTI 64.6 59.7 54.7 1.7 2.1 2.5

BRONG AHAFO 60.5 59.8 56.6 2.3 2.6 2.6

CENTRAL 51.0 54.2 47.9 3.5 3.3 3.6

EASTERN 49.7 49.0 46.1 3.1 3.3 3.5

GREATER CCRA 49.5 47.3 41.4 1.0 1.7 2.5

NORTHERN 87.8 98.2 81.6 1.2 1.5 1.7

UPPER EAST 72.0 65.0 52.8 2.4 2.8 4.0

UPPER WEST 68.9 64.0 63.2 1.8 2.2 2.4

VOLTA 46.3 44.1 38.4 3.7 3.8 4.7

WESTERN 60.3 57.0 50.6 2.8 3.1 3.5

TOTAL 58.8 57.1 51.1 2.3 2.6 3.0

2010 Annual Report Ghana Health

Service

60

Outpatient Attendance by Region

Region 2010 2009 2008

Ashanti 5,131,216 4,323,256 3,427,329

Brong Ahafo 2,838,250 2,612,168 2,869,659

Central 1,659,856 1,370,625 1,281,602

Eastern 2,668,644 2,272,375 2,279,528

Greater Accra 3,731,034 2,179,283 2,105,980

Northern 1,325,727 1,245,261 1,113,699

Upper East 1,516,610 1,387,025 1,018,813

Upper West 616,939 484,513 459,309

Volta 1,585,643 1,335,027 1,378,484

Western 2,724,881 2,538,306 2,140,855

National 23,798,800 19,747,839 18,075,258

Outpatient Attendance per Capita

Region 2010 2009 2008

Ashanti 1.04 0.89 0.73

Brong Ahafo 1.25 1.15 1.30

Central 0.81 0.71 0.68

Eastern 1.04 0.95 0.97

Greater Accra 0.97 0.51 0.51

Northern 0.54 0.53 0.49

Upper East 1.47 1.37 1.01

Upper West 0.91 0.72 0.70

Volta 0.76 0.69 0.73

Western 1.16 0.99 0.86

National 0.98 0.81 0.77


Service

61

Inpatient Admissions by Region

Region 2010 2009 2008

Ashanti 225,629 207,089 145,316

Brong Ahafo 123,187 111,521 104,976

Central 79,562 77,620 60,658

Eastern 139,159 127,050 121,985

Gr. Accra 132,975 112,314 79,974

Northern 118,499 116,818 66,146

Upper East 66,538 56,324 48,507

Upper West 51,605 44,287 42,061

Volta 101,653 93,829 83,093

Western 121,263 115,246 94,037

National 1,160,070 1,062,098 846,753

Hospital Admission Rate

Region 2010 2009 2008

Ashanti 45.92 42.42 30.78

Brong Ahafo 54.18 49.19 47.46

Central 38.65 40.39 32.23

Eastern 54.03 53.21 51.81

Greater Accra 34.69 26.23 19.50

Northern 48.44 50.04 29.13

Upper East 64.60 55.48 48.30

Upper West 76.31 66.00 63.75

Volta 48.71 48.43 43.71

Western 51.84 45.10 37.98

National 47.87 43.79 35.91


Service

62

PUBLIC HEALTH SERVICES

HIV Prevalence among pregnant women attending ANC clinics by Region

Region 2010 2009 2008

Ashanti 3.0 3.9 3.0

Brong Ahafo 2.0 2.9 2.6

Central 1.7 3.0 2.0

Eastern 3.2 4.2 4.5


Northern 0.7 2.0 1.1

Upper East 2.4 2.2 2.0

Upper West 1.7 3.1 1.6

Volta 1.8 2.6 1.7

Western 2.5 3.1 2.9

National 2.0 2.9 2.2

HIV Prevalence among pregnant women by Age Groups

Age Group 2010 2009 2008

15 – 19 Yrs 1.1 1.9 1.2

20 – 24 Yrs 1.7 2.2 2.3

25 – 29 Yrs 2.5 3.7 3.0

30 – 34 Yrs 2.8 3.4 2.8

35 – 39 Yrs 2.8 3.6 2.9

40 – 44 Yrs 2.1 4.0 1.8

45 – 49 Yrs 2.7 1.8 2.6

15 – 24 Yrs 1.5 2.1 1.9


Service

63

Guinea Worm Cases

Region 2010 2009 2008

Ashanti 0 2 5

Brong Ahafo 0 2 11

Central 0 0 1

Eastern 0 1 2

Greater Accra 0 0 0

Northern 8 237 479

Upper East 0 0 1

Upper West 0 0 1

Volta 0 0 1

Western 0 0 0

National 8 242 501


Service

64

Tuberculosis Cure Rate

Region 2009 2008 2007

Ashanti 77.4 81.4 82.3

Brong Ahafo 71.3 70.9 64.1

Central 86.3 87.1 81.8

Eastern 73.8 75.5 72.9


Northern 79.3 74.8 76.3

Upper East 88.3 72.2 75.0

Upper West 54.6 42.1 44.5

Volta 90.7 88.0 79.8

Western 77.6 73.5 74.2

National 79.1 77.9 77.5

Tuberculosis Success Rate

Region 2009 2008 2007

Ashanti 88.8 90.3 90

Brong Ahafo 78.9 82.3 77

Central 90.4 89.8 87

Eastern 80.5 82.0 79

Greater Accra 87.5 84.4 87

Northern 84.5 87.8 83

Upper East 89.1 76.9 79

Upper West 73.6 61.8 71

Volta 97.1 93.4 87

Western 90.9 86.5 86


Service

65

National 87.0 85.5 84

Expanded Program on Immunization

Measles Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 87.8 87.1 80.7

Brong Ahafo 95.5 93.9 96.6

Central 97.4 98.1 94.4

Eastern 96.0 94.0 95.1


Northern 107.1 119.7 109.2

Upper East 83.6 105.9 93.1

Upper West 82.0 90.5 90.0

Volta 78.4 78.3 78.8

Western 85.7 85.1 87.5

National 87.7 89.1 86.5

Penta 3 Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 86.5 83.7 76.8

Brong Ahafo 94.3 95.0 97.3

Central 94.3 96.6 92.2

Eastern 93.6 94.5 93.0


Northern 109.2 123.0 114.5

Upper East 83.1 106.0 94.8

Upper West 81.7 90.1 87.5


Service

66

Volta 81.4 82.9 83.8

Western 86.4 88.6 89.0

National 87.1 89.3 86.6

OPV 3 Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 86.3 83.6 76.7

Brong Ahafo 94.1 93.8 97.2

Central 92.9 93.7 90.9

Eastern 93.1 94.2 92.7


Northern 109.0 122.1 114.2

Upper East 82.8 105.4 89.2

Upper West 81.7 89.3 87.4

Volta 81.5 83.1 83.8

Western 86.0 88.0 88.4

National 86.8 88.7 86.1


Service

67

BCG Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 105.5 101.6 95.7

Brong Ahafo 111.6 111.1 111.6

Central 120.5 123.9 118.6

Eastern 114.3 114.2 111.7


Northern 126.8 139.5 131.0

Upper East 91.3 123.5 107.3

Upper West 92.3 104.6 105.2

Volta 94.1 94.5 98.1

Western 99.0 100.7 103.0

National 102.1 103.8 102.6

Tetanus Toxoid Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 78.0 83.1 80.2

Brong Ahafo 84.9 82.2 89.8

Central 94.3 89.6 93.2

Eastern 83.6 85.1 80.7


Northern 93.5 108.0 97.9

Upper East 63.8 85.5 66.2

Upper West 69.4 71.2 71.6

Volta 60.8 63.9 63.7


Service

68

Western 62.8 62.6 62.7

National 76.2 78.6 76.3

Yellow Fever Immunization Coverage Rate

REGION 2010 2009 2008

Ashanti 87.4 86.8 80.4

Brong Ahafo 95.1 94.0 94.8

Central 95.1 96.8 91.3

Eastern 95.9 94.2 95.4


Northern 106.0 118.7 107.6

Upper East 81.5 107.5 84.8

Upper West 82.6 89.5 88.0

Volta 78.5 78.2 79.0

Western 85.5 84.7 93.1

National 87.5 88.8 86.0

AFP Non - Polio Rate

REGION 2010 2009 2008

Ashanti 1.48 2.1 1.35

Brong Ahafo 2.40 3.6 4.22

Central 1.38 3.8 2.00

Eastern 1.60 4.0 2.70


Northern 2.20 2.4 3.40

Upper East 2.00 5.3 4.50

Upper West 4.00 4.0 3.33


Service

69

Volta 3.13 2.3 1.63

Western 2.18 1.5 2.10

National 1.82 2.5 2.24

Reproductive Health Services

ANTENATAL COVERAGE SUPERVISED DELIVERY

REGION 2010 2009 2008 2010 2009 2008

Ashanti 84.7 80.7 86.1 53.4 42.4 35.0

Brong Ahafo 82.3 97.9 102.1 54.0 53.7 49.8

Central 106.1 109.1 115.5 51.6 52.5 56.3

Eastern 84.8 93.4 98.2 48.2 52.1 48.0

Greater Accra 89.5 77.4 85.2 54.4 47.9 50.3

Northern 120.9 120.8 127.7 36.8 36.1 26.0

Upper East 92.5 100.1 102.1 59.7 52.6 40.4

Upper West 88.8 88.9 93.5 46.5 36.7 40.6

Volta 81.0 88.9 93.4 36.9 39.4 37.5

Western 109.8 93.5 98.8 49.6 42.6 39.1

National 93.3 92.1 97.8 49.5 45.6 42.2

REGION

POST NATAL CARE FAMILY PLANNING

2010 2009 2008 2010 2009 2008

Ashanti 52.6 38.4 51.6 17.6 17.5 15.7

Brong Ahafo 59.2 53.7 57.2 33.0 43.4 36.3

Central 66.8 71.4 77.6 25.1 33.1 33.0

Eastern 64.5 67.0 61.5 31.5 32.9 33.1

Greater Accra 57.7 51.7 48.7 31.6 32.6 63.9

Northern 88.9 84.9 80.7 21.5 28.9 26.0

Upper East 76.2 77.8 57.3 24.3 33.0 26.2


Service

70

Upper West 68.4 64.9 68.7 49.2 56.5 59.8

Volta 50.1 47.3 50.5 22.5 27.5 21.6

Western 54.4 49.5 45.6 13.0 18.9 19.6

National 61.6 56.4 57.5 24.9 31.1 33.8

Institutional Maternal Mortality Ratio

Region 2010 2009 2008

Maternal

Deaths

Maternal

Mortality

Ratio

Maternal

Deaths

Maternal

Mortality

Ratio

Maternal

Deaths

Maternal

Mortality

Ratio

Ashanti 165 149.6 177 215.1 222 252.6

Brong Ahafo 73 138.7 94 194.4 81 185.3

Central 82 149.0 69 129.4 92 223.2

Eastern 115 191.6 82 135.5 98 170.7

Greater Accra 169 181.5 166 197.1 167 194.3

Northern 84 137.2 96 147.4 91 175.9

Upper East 37 137.9 30 130.9 27 152.2

Upper West 26 157.7 41 266.7 22 120.6

Volta 82 209.6 55 146.0 52 144.7

Western 99 176.1 79 148.2 101 269.5

National 932 163.2 889 169.9 953 199.7


Service

71


Service

72

Trend of OPD attendance per Capita 2001-2010

0.49 0.49 0.50 0.52

0.54 0.55

0.69

0.77 0.81

0.98

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

NU

MB

ER

OF

OP

D V

ISIT

S P

ER

CA

PIT

A

TREND IN OPD ATTENDANCE PER CAPITA (Ghana, 2001 - 2010)

Trend of Hospital Admissions(per 1,000pop) 2001-2010

34.9 34.1

36.0 35.3

36.9

33.6

39.3

35.9

43.8

47.9

20

25

30

35

40

45

50

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

NU

MB

ER

(P

ER

10

00

PO

PU

LA

TIO

N)

TREND IN HOSPITAL ADMISSIONS (PER 1,000 POPULATION) 2001-2010


Service

73

DOCTOR POPULATION RATIO (2001-2010)

20,036 18,274

16,759 17,733 17,929

14,732

12,529 12,713 11,929

10,423

-

5,000

10,000

15,000

20,000

25,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Doctor Population Ratio, 2001-2010

NURSE POPULATION RATIO (2001-2010)

1,728 1,675 1,649 1,510 1,508 1,537

1,342

1,079 971

1,077

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Nurse Population Ratio, 2001-2010


Service

74

6.4

5.5

4.64.4

4.0

0.0

2.0

4.0

6.0

8.0

1988 1993 1998 2003 2008

Total Fertiltity Rate - Ghana1988 - 2008

Trend of Institutiona Maternal Mortality Ratio(2001-2010)

255.7

204.4 204.5 186.0

196.8 187.2

230.2

199.7

169.9 163.2

0.0

50.0

100.0

150.0

200.0

250.0

300.0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Institutional Maternal Mortality Ratio 2001-2010


Service

75

76.3 78.1

76.0 76.0

83.0 84.2

87.8 86.6

89.3

87.1

60.0

65.0

70.0

75.0

80.0

85.0

90.0

95.0

100.0

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

PE

RC

EN

TA

GE

CO

VE

RA

GE

PENTA 3 COVERAGE 2001 TO 2010

Trend of Supervised Delivery (2001-2010)

49.3 52.6 52.1 53.4

54.2

44.5

32.1

42.2 45.6

49.5

0

10

20

30

40

50

60

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

PE

RC

EN

TA

GE

CO

VE

RA

GE

COVERAGE OF SUPERVISED DELIVERY (2001-2010)

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