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This report highlights some of the major health service activities and programmes carried
out in the Ashanti Region during the year under review.
The activities were largely determined by the priorities and action plans of the region in line
with the Ghana Health Service Strategic Objectives and New Paradigm of the Ministry of
Health. It also highlights the broad policy and operational direction of the Ashanti Regional
Health Directorate in 2010.
A detailed description of the key activities in the region has been expressed, though other
areas of service delivery have not been highlighted. It is hoped that the final report at the
end of 2010 would bring all into focus. Certain information has been added and other parts
have been documented in more detailed to make sure the report serves as a valuable
reference material.
We acknowledge with many thanks the contributions from all the Institutions,
Headquarters, Regional Coordinating Council, Health Partners, NGOs, DHMTs and units of
the Regional Health Directorate towards the overall service delivery in the region.
EXECUTIVE SUMMARY
The Regional Half Year Report 2010 reflects the major activities undertaken by the Regional
Health Directorate under the four health sector strategic objectives and its results as
measured by the key sector indicators. The Regional Health Directorate viewed the first six
months of the year 2010 as successful though challenging. The region appears to be on
course in achieving most of the set targets particularly in the areas of key priorities.
There was a conscious effort to sensitize the populace on healthy lifestyles and
environmental management and these were achieved through Radio shows, health
talks and durbars.
The District Health Information Management System (DHMIS) has been implemented
throughout the region though there are challenges with timelines and completeness
of reporting from the districts.
Though maternal deaths have reduced over the period, other indicators like postnatal,
TT2+, ANC coverage and Caesarean rate have reduced. Maximum effort would be put in
the second half of the year to ensure improvement in the maternal and child health
indicators as we push to achieve the MDGs 4 and 5.
There have been substantial improvements in the indicators of malaria leading to a
significant reduction in deaths in U-5. IPT coverage however deceased due to the erratic
supply of SP. The OPD per capita of 0.4 appears to be on course in line with that of 2009.
It is hoped that with increasing coverage of NHIS, OPD utilization would increase further.
However Hypertension is the third most reported disease at OPD and this call for more
efforts to address non communicable diseases in the region.
Routine EPI coverage has been impressive.The two NIDs during the half year also
recoreded coverage of more than 100% in both rounds. However the H1N1 vaccination has
received a lot of negative reports from the media with rumours of severe adverse reactions.
The region has officially recored 31 AEFIs and there are no reports of any severe reaction.
The region reported one outbreak of H1N1 in a secondary school and was well managed by
the District Epidemic Response Team with support from the Regional level.
The Leadership Development Programme has trained several key managers in the region
and it is hoped that the acquired leadership skills would impact greatly in the second half of
the year as the rest of the untrained manpower in the region are brought on board the
programme.
Financial support from central Government has continued to be below par and is greatly
affecting planned activities. Delayed payments to health facilities from the NHIA are also
impeding health service delivery at the hospitals and health centres. It is hoped that
financial inputs to health service would improve in the second half of the year to enhance
total health delivery.
INTRODUCTION
1.0 REGIONAL PROFILE
Ashanti Region lies approximately between longitude 0.15 to 2.25 west and latitude 5.50
to 7.40 north. It has common boundary with Brong Ahafo Region in the north, Central
Region in the south, Eastern Region in the east and Western Region in the west. The
Region has a land size of 24,390sq km representing about 10.2% of the land area of
Ghana.
Ashanti is the most heavily populated region in Ghana, with a population of 4,881,738 for
2009 (Projection from the 2000 Housing and Population Census, Ghana Statistical Service).
It has a population density of 169.3 per sq. km. The region has 27 districts and 132 subdistricts. Kumasi has the highest population of 1,559,807 (32.4%) of the regional total.
About 47% of the population are in the rural areas. The region has a large proportion of
hard to reach areas especially in the Afram Plains sections of Sekyere Afram Plains, Ejura
Sekyedumase, Sekyere Central and Asante Akim North districts.
There are five hundred and twenty-seven (527) health facilities in the region. The Ghana
Health Service operates about 33% of all health facilities in the region. Kumasi has the
highest number of facilities (29%) with Ejura-Sekyedumase having the least (2%). The
population hospital ratio is 48,276.
TABLE 1. 1HEALTH FACILITIES
TYPE
NUMBER
170
71
278
Quasi Government
Total
527
Improvement of Staff and Management capacity through leadership and regular inservice training
The activities carried out in respect of the above are well articulated in the respective
strategic objectives.
The Key Priorities for the year are:
Maternal Mortality
Stillbirth
Malaria
HIV
NTDs
School Health
Adolescent Health
CHAPTER ONE
1.1.1 Strategic Objective
Healthy Lifestyle and Healthy Environment
vaccination. The RHD is collaborating with local FM stations particularly Angel FM and Hello
FM to promote health.
During the year under review, Health talks were given on the local FM stations i.e. Hello
Fm, Nhyira Fm, Angel Fm etc, churches, mosques, outreach points, facilities and other
social organizations to increase awareness on the new paradigm shift of Regenerative
Health and Nutrition, importance of optimal exclusive breastfeeding and benefits of iodated
salt and fortified products usage.
The general populace were educated on the importance to eat healthy meals, drink a lot of
water, exercise three times a week, as well as make time for recreation and to rest for at
least 8 hours a day. Discussions were centered on eating plant based diet and to limit the
intake of animal based food products which are high in fat, salt and sugar. Environmental
and personal hygiene were also stressed so that people would maintain a hygienic and
sanitary environment as well as live sensible lifestyles. Babies are to be breastfed
exclusively for six months, continued along side the introduction of appropriate
complementary feeding.
No.
Organization
Location
Topic Treated
1.
Methodist mens
Group
Effiduase
2.
Aboabo Mosque
Aboabo 1Kumasi
3.
Hairdressers
Association
4.
Kumasi
Cultural
Centre
Boss-Adum,
Ashh-Stadium
& AngelAbrepo
junction
Iron Fortification
Programme & essence
of exclusively
breastfeeding babies
Regenerative Health &
Nutrition & importance
of iodated salt usage
Iodated Salt, Balance
diet and it importance
& Personal hygiene
Importance of
Exclusive
Breastfeeding for
children 0-6mths,
appropriate
complementary
feeding etc
Resource
Persons
Reg. &
Dist. Nut.
off
Date
April
2010
Reg. &
March
Metro Nut.
2010
Off
Reg. &
June
Metro Nut.
2010
Off
Reg. &
May 2010
Metro Nut.
Off
The Health directorate through the Health Learning Material unit (HLM) has also
organized health educational programmes on radio, in churches, communities and
schools.
Indicators
SEX
Jan- Dec
2009
20222221222
Jan- June
2010
422200
# Tested
33327
31,345
41879
46,049
310
326
792
757
33327
31,345
41879
46,049
75,206
77,394
# Positive
# Posttest
counselled
Total
1.1.3 Work with other stakeholders and communities to help members maintain
healthy lifestyle behaviours
Ghana Health Service in collaboration with other stake holders like Ministry of Agriculture,
Department of Social Welfare, Ghana Tourist Board, Food and Drugs Board, District
Assembles, Ghana Standard Board, Ghana Education Service, Womens Groups, Religious
Bodies etc., organized workshops, seminars, community durbars in March and May 2010
with the Regional Nutrition Officer, Regional Health Education Officer and Regional Tourist
Board as resource persons to educate food vendors, hoteliers, market women, school
children, health workers, teachers on the need to make the right choice of food, demand
for healthy environment, adopt healthy life styles to reduce the disease burden, be friendly
to water bodies that have become a major source of water borne and water related
diseases. Participants were made to understand the need not to take nutrition for granted
by eating all the wrong foods at the wrong times, at the wrong places, constipate heavily
and generate toxic waste in their bodies which also become the cause of many noncommunicable diseases.
Participants were informed to always make time for rest and recreation to refresh them for
the next production week and not to crowd their week ends with all kinds of unnecessary
activities. The three food groups were also discussed as well as their uses in the body,
food hygiene, food microbiology, oral hygiene were amongst the topics treated.
WORK WITH OTHER STAKEHOLDERS
Date
Programme
Resource Persons
March 10
Essence of
iodated salt
usage &
Regenerative
Health &
Nutrition
Iron
Fortification
Programme
May 10
National Coordinators
(3) & Reg. Nut. Off
Target
Audience
Food Vendors
Market Women
No. of
Participants
102
40
Traditional
Caterers
25
nurses, disease control and health promotion officers. It was well attended, patronized and
successful.
1.1.5 Promote food safety
The regional health directorate in collaboration with School Health Education Programme
(SHEP) Coordinators, Nutrition Officers and the Environmental Health department organized
workshops for heads of schools and food vendors. The objective was to promote food
safety in schools.
environmental hygiene, cooking practices and food storage among others. A certificate of
participation was given to all the food vendors who attended the workshop.
10
CHAPTER TWO
2.0 Strategic Objective 2- Health, Reproduction and Nutrition Services
REGIONAL
AVERAGE
4.2
95.0
35.0
35.0
100
WHO
STANDARDS
2
100
20
20
100
91.0
100
100
100
Facilitative supervision undertaken during year revealed that most of the facilities had
quality assurance teams in place. In 2009, client satisfaction survey was conducted by
most hospitals. About 96% of clients indicated their satisfaction with services provided.
There is a need to revamp the quality assurance systems in all health facilities in the period
ahead.
11
Govt, 170
Private, 278
Mission, 71
OPD/CAPITA:
Per Capita
0.6
0.5
0.4
0.4
0.3
0.2
0.1
0
2008
2009
2010 Half-Year
Year
12
OPD ATTENDANCE
Generally, OPD attendance has increased over the years. Districts with mission institutions
in the region contributed almost 60% of total OPD attendance See table 2.2 below.
FIGURE 2.1 OPD Attendance, 2008 2010 Half Year
OPD Attendance
Year
Out-Patients Visits
2010 Half-Year
2,046,993
2009
3,962,986
2008
3,140,880
MORBIDITY PATTERN
Table 2.3 shows the regional top 10 leading causes of OPD attendance for the past three
years. Malaria continues to be the leading cause of OPD attendance. Malaria alone
accounted for almost half (50%) of the total OPD attendance. Hypertension, URTI and
13
Rheumatism
have
also
featured
prominently
over
the
years.
2009
CASES
DISEASE
CASES
DISEASE
Malaria
814,998
Cough (IMCI)
119,490
Hypertension
CASES
DISEASE
1,449,260
80,429
Malaria
Acute Respiratory
Inf.
Hypertension
Malaria
797,629
259,701
148,366
125,453
Hypertension
66,098
Skin Disease
70,694
Diarrhoeal Disease
123,107
Diarrhoeal Disease
65,858
Diarrhoeal
Disease
57,252
Skin Disease
115,212
Skin Disease
62,839
Rheumatic
Conditions
42,617
Rheumatic Conditions
94,531
Rheumatic Conditions
51,229
33,900
58,324
Intestinal Worms
34,102
Intestinal Worms
28,258
Intestinal Worms
54,719
32,300
Home/Occup
Injuries
26,363
49,509
26,619
10
Chicken Pox
22,552
Home/Occup Injuries
43,820
Anaemia
21,574
District
2008
2009
2010
Half Year
Hypsion
Diabetes
Hypsion
Diabetes
Hypsion
Diabetes
38,388
6,118
36,605
8,200
15,721
3,677
2,092
559
2,855
899
7,581
4,101
20,614
5,310
26,750
6,087
7,121
1,691
Atwima Nwabiagya
3,363
930
7,555
2,217
4,564
448
Ejisu Juaben
3,588
581
5,304
1,247
4,101
1,144
Sekyere South
2,940
661
5,025
1,152
3,988
1,156
588
688
1,073
130
3,475
887
Sekyere East
3,672
960
4,389
920
2,734
465
2,339
467
4,728
587
2,221
227
Kumasi
Asante Akim North
Obuasi
Mampong Municipal
14
District
2008
2009
2010
Half Year
Hypsion
Diabetes
Hypsion
Diabetes
Hypsion
Diabetes
Adansi South
2,241
237
3,000
292
2,042
277
Afigya Kwabre
3,343
836
3,005
592
1,945
330
Mampong Municipal
2,003
688
2,210
899
1,540
571
Ejura Sekyedumase
1,320
234
1,181
65
951
46
Bekwai Municipal
3,315
600
2,759
422
903
216
Adansi North
1,380
189
1,818
152
898
86
1,678
111
801
60
1,257
326
1,081
258
752
177
Kwabre
1,159
60
1,711
99
671
62
Sekyere Central
District
2008
2009
2010
Half Year
Hypsion
Diabetes
Hypsion
Diabetes
Hypsion
Diabetes
Atwima Kwanwoma
1,431
62
1,794
40
618
11
2,348
660
5,015
1,214
594
62
Offinso Municipal
1,490
123
1,402
126
548
32
Amansie central
765
135
768
182
479
58
Bosome Freho
265
572
38
459
Amansie West
237
40
550
98
383
53
Offinso North
799
49
582
66
376
64
1,116
452
1,420
418
361
96
Atwima Mponua
261
21
216
62
136
23
15
Hypertension & Diabetes Mellitus cases Reported 2008 2010 Half Year
4.5
3.5
% of OPD Morbidity
2.5
1.5
0.5
2008
2009
Hy'sion
3.21
3.91
Diabe
0.64
0.83
0.99
Year
Hospital Admissions
Total Admissions 2008
107,743
2009
162,591
= 80%)
=
56.7%
=
59.4%
=
37.4%
15
16
Inpatients:
Hospital Admissions have been increasing over the years, but the half year apperas to be
just marginally high. The Average bed occupancy rate also appears to be marginally similar
to the figure in 2009.
TABLE 2.4 Hospital Admission
Causes of Admission
Malaria, Diarrhoea, Hypertension, Aneamia, Gastritis, Asthma, Pneumonia, Abortion, Hernia
and Enteric fever were the ten top causes of admissions in the year under review. Malaria
was the highest among the ten leading causes of admissions accounting for over
30.1%.See table 2.5 below.
TABLE 2.5
Top 10 Causes of Admissions, 2008 2010 Half Year
2009
No.
DISEASE
CASES
Malaria
Diarrhoea
815
Diarrhoea
3,203
Diarrhoea
1,635
Anaemia
663
Anaemia
2,148
Anaemia
1,075
Hypertension
503
Hypertension
1,535
Hypertension
831
Pneumonia
308
Enteric
Fev./Typhoid
994
Enteric
Fev./Typhoid
576
Hernia Inguinal
303
Hernia
Inguinal
911
Hernia
Inguinal
564
Asthma
277
Pneumonia
709
Gastritis
373
Gastritis
272
Gastritis
691
Asthma
345
Enteric
Fev./Typhoid
244
Abortion
683
Pneumonia
333
10
183
Asthma
643
8,914
DISEASE
Malaria
CASES
29,486
DISEASE
Malaria
Abortion
CASES
16,362
325
16
17
Causes of Death
The mortality profile shows Malaria, Anaemia, Hypertension, Pneumonia, Septicaemia,
Diarrhoea, HIV/AIDS, Diabetes, Bronchopneumonia and CVA as the ten leading causes of
deaths with Malaria accounting for over 30% cases. See table 2.6 below.
TABLE2.6
Top 10 Causes of Death, 2008 2010 Half Year
Diseases
2008
Diseases
2009
Malaria
2010
Half
Year
Malaria
67
Malaria
Anaemia
22
Anaemia
83
Anaemia
36
Hypertension
21
Hypertension
50
Diarrhoea Dis.
25
Diarrhoea
16
Septicemia
35
HIV/AIDS
22
Pneumonia
13
Pneumonia
34
Hypertension
20
HIV/AIDS
12
HIV/AIDS
34
Pneumonia
17
Diabetes Mellitus
Diarrhoea Dis.
33
C V A
16
Bronchopneumonia
Diabetes Mellitus
26
Diabetes Mellitus
12
C V A
Bronchopneumonia
25
Septicemia
Typhoid Fever
C V A
20
Cardiac Failure
10
226
Diseases
126
8
6
17
18
NHIS - Utilization
80
70
60
50
40
30
20
10
Out-Pat
In-pat
% Insured
% Non-Insured % Insured
% Non-Insured % Insured
% Non-Insured
2008
2008
2009
2009
61.34
38.66
69.58
30.42
75.92
24.08
57.2
42.8
68.46
31.54
70.78
29.22
2008
2009
2010
Ashanti
WHO
4.2
4.2
3.8
4.0
2.0
% Generic
88.0
67.8
77.3
95.0
100.0
% Antibiotic
41.8
43.0
46.0
35.0
26.0
% Injection
36.0
18.9
22.0
35.0
20.0
% EDL
100.0
87.5
85.0
100.0
100.0
% Diagnosis
100.0
100.0
100.0
100.0
100.0
19
Drug Availability
20
Case search on some selected communicable diseases like AFP, Buruli Ulcer, Guinea worm,
Leprosy and Yaws was conducted by CBSVs in all the communities in the district to enable
them detect early and report suspected conditions to health facilities for management.
The key activities carried out included:
Distribution of IDSR materials such as Fact Sheets, Reporting forms and Sample
Collection kits
% Complete (>90)
2008
94.4
100
2009
93
98.7
2010
100
Reports
No.
Timely No.
Lately %
Timely
Expected
Received
Received
Received
2008
324
138
186
42.6
2009
324
228
96
70.3
2010
324
109
53
21
FIGURE 2.3
Specimen Results
Disease
Specimen
2008
2009
No. Positive
2010
2008
2009
2010
Measles
219
103
76
11
Meningitis
92
21
137
83
YF
28
46
47
AFP
28
48
29
Cholera
11
22
Positive Cases
Case
District Detected
Measles
Meningitis
No. of cases
Amansie West
Atwima Nwabiagya
Ejura Sekyedumase
Total
23
New
Recurrent
Clinical Forms
Nodules
Ulcer
Others
2008
235
24
36
164
2009
177
15
22
129
46
251
72
180
47
250
251
238
200
177
new
recurrent
150
100
50
24
15
0
2008
2009
2010
24
Onchocerciasis
About 400,000 people at risk. Two hyperendemic districts, Offinso North and Asante Akim
South carried out CDTI activity with coverage of 81% and 79.3% respectively
COVERAGE(%)
2008
74.4
2009
74.5
2010
N/A
REMARKS
Leprosy Cases:
The region registered some few new cases in the year. See figure 2.5 below:
Trends on Leprosy cases 2008 - 2010
Year
No. of cases
2008
44
2009
50
2010(HY)
26
25
COVERAGE
67.4
66.6
56.4
65.5
49.9
70.3
56.3
50.9
22.3
42.7
46.1
68.2
52.9
56.5
69.3
WASTAGE
2.5
1.8
18.4
5.1
15.0
1.3
5.3
7.5
9.7
5.6
2.6
1.3
32.3
0.2
1.4
AEFI
0
7
0
6
0
0
2
2
0
2
0
0
0
5
0
COVERAGE
36.4
25.3
32.8
16.3
61.0
64.9
279.2
59.5
61.8
61.1
36.7
51.3
53.2
66.2
65.5
58.5
WASTAGE
0.7
9.2
0.3
0.9
0.3
0.5
0.3
0.9
6.2
6.7
8.5
0.5
21.4
5.4
0.5
4.4
AEFI
0
0
0
2
2
0
0
0
0
0
0
0
3
0
0
31
26
27
TB
Case
Detection
Indicator
2007
2008
2009
2010 Half
Regional Population
4,565,683
Expected # of Cases
12,830
9,583
9,910
10,219
2,011
2,101
2,106
1,101
16
22
21
11
1,181
1,269
1251
626
627
635
629
341
Relapses
71
70
74
42
Other RTR
28
58
37
21
104
69
74
43
41
28
Extra
Pulmonary
Others
4,720,916 4,881,738
5,033,938
28
TB TREATMENT OUTCOME
Indicator
2006
2007
2008
2009 HY1
Smear Positives
1,283
1,181
1269
650
504(78%)
Cured
Completed
Treatment Success Rate
Died
Failed
Default
Transferred Out
69
99
113
78
86%
90%
90%
90%
86 (7%)
83 (7%)
80 (6%)
42(6.5%)
49 (4%)
14 (1%)
24 (2%)
10(1.5%)
38
14
10
12
2008
2009
2010HY1
2101
2106
1101
# Counseled
1493
1616
900
1305
1437
775
293
314
159
# Starting CPT
159
128
99
112
171
77
# on ART
52
37
70
29
HIV/AIDS:
The table 2.10 below shows CT trend analysis of HIV/AIDS activities carried out in the Haly
Year 2010. See table below:
CT Trend Analysis,2008-2010HY
Indicators
2008
2009
2010HY
# Pretest
Counseled
16949
24794
8706
# Tested
16530
23631
8278
# Receiving
Positive Test
Results
2485
3718
2182
# Receiving
Posttest
Counselling
16530
23631
8278
PMTCT-Trend Analysis(2008-2010)
Indicators
Jan - Dec 08
Jan - Dec 09
Jan - Jun 10
# of ANC Registrants
78782
69919
42801
# Tested
62996
54031
33308
% Tested
80%
77%
90%
# Positive
1275
1141
850
# Given ARVs
1037
845
222
% Given ARVs
81%
74%
26%
30
MALARIA CASES:
Malaria control activities carried out in the year under review included training of health
staff on management of uncomplicated and complicated malaria as well as Malaria in
Pregnancy (MIP).
The policy on malaria is now on definitive diagnosis especially in persons above 5 years. As
a result Rapid Diagnostic Test (RDT) kits were provided to aid in diagnosis especially in
health facilities without microscopy.
Chemical sellers were also trained on home based care which included recognising
symptoms of malaria and knowing when to refer. There were also radio discussions on the
use of ITNs and recognising symptoms of malaria throughout the region.
With the support of Ghana Sustainable Change Project (GSCP), CBSVs, some districts were
able to train community leaders and religious leaders in communication skills to educate
community members on malaria, breastfeeding and on complementary feeding. The Figure
2.7 below shows 3-year trend of malaria cases recorded at Outpatient departments
throughout the region.
31
Total
Malaria(2008-2010HY)
1000000
900000
858822
923521
800000
700000
600000
2008
2009
2010
500000
400000
301019
300000
200000
100000
0
CASES
33649
33706
30000
25000
20000
15000
12143
10000
2008
2009
2010
5000
0
ADMISSIONS
32
180
160
140
120
100
80
60
40
66
2008
2009
2010
28
20
0
DEATHS
13348
12114
10000
8000
6000
4778
4000
2008
2009
2010
2000
0
ADMISSIONS
33
0.06
0.05
0.042
0.045
0.04
2008
2009
2010
0.03
0.02
0.01
0
%CFR
IPT
Trend(2008-2010HY)
90000
80000
70000
60000
50000
40000
30000
2008
2009
2010
20000
10000
0
IPT1
IPT2
IPT3
34
35
LABORATORY SURVEILLANCE
CSM
Surveillance
2006
2007
2008
2009
2010 HY1
# Tested
13
33
21
37
N. meningitidis A
S. pneumoniae
10
H. influenzae b
N. meningitidis C
Cholera Surveillance
# Tested
V/c Ogawa
V/c Inaba
2006
2007
2008
2009
2010 HY1
176
20
20
11
54
High consumption of alcohol and nutritionally deficient food that are also high in fat,
sugar, and salt
Obesity and
During the year under review diet related diseases clinic were set up in selected health
facilities to manage reported cases and to give counseling, Health and Nutrition talk to
clients visiting these facilities. In all 6,244 clients were seen and of these 3651 were
hypertensive, 1649 were diabetic, 682 had both conditions and 262 were obesed. After
analyzing their body mass index (BMI) 4140 females and 2004 males were seen.
70
64.7
58.86
% No. of Cases
60
58.49
50
Diabetes
40
Hypertension
30
28.4
Diab-Hypertension
26.47
25.58
Obesity
20
10
10.34
4.1
0
2008
2.8
5.22
2009
10.92
4.2
YEAR
37
Year
Type of Disease
2007
2010 1ST
Half Yr
2008
No.
No.
No.
Diabetes
3357
28.40
3051
25.58
1649
26.47
Hypertension
7646
64.70
7022
58.86
3651
58.49
Diabetes-hypertension
486
4.10
1233
10.34
682
10.92
Obesity
316
2.80
623
5.22
262
4.20
Total
11805
11929
6244
38
86.1
83
% COVERAGE
90
80
70
60
50
40
30
20
10
0
39.7
YEAR
2009
2008
2010
14
12
10.3
10
9.1
8
6
4
2
0
2008
2009
2010
39
9.6
10.6
8
8
6
4
2
0
2008
2009
2010
90
80
81.8
71.5
70
60
50
40
33
30
20
10
0
2008
2009
2010
40
26.3
27.5
2009
2010
22.8
22.6
22.4
22.2
22
2008
% COVERAGE
50
45
40
35
30
25
20
15
10
5
0
49.4
47.5
20.5
2008
2009
YEAR
2010
41
LBW
Still Birth
Macerated
Fresh
Total
2008
9200
1080
777
1857
2009
11143
1341
631
1972
2010
3291
488
242
730
2.1
2.1
2.05
2
1.95
1.9
1.85
1.8
1.8
1.75
1.7
1.65
2008
2009
2010
FIGURE2.9
Supervised Delivery
This is done by skilled staff to ensure safe delivery of babies to reduce infant and maternal
mortality. However TBAs also conduct deliveries because there are not enough midwives.
Activities carried out include:
Mothers were encouraged to practice exclusive breastfeeding after delivery for six
months and they were also given Vitamin A after delivery.
During the year a target of 60% was set .The region however achieved 49.4% which again
indicated a decrease of 5.9 % over the previous year. See the figure 2.10.
The low skilled delivery could be attributed to the low numbers of trained Midwives in the
facilities and in some cases the absence of Midwives in most of the rural clinics as a result
of diploma Midwives refusing posting to the rural areas.
Figure 2.10
Skilled Delivery, 2008 - 2010
% COVERAGE
50
45
40
35
30
25
20
15
10
5
0
49.4
47.5
20.5
2008
2009
YEAR
2010
43
2.1
2.1
2.05
2
1.95
1.9
1.85
1.8
1.8
1.75
1.7
1.65
2008
2009
2010
7
6
5
4
3
2
0.6
1
0
caesarian
vacuum
0
forceps
44
51.6
50
47.8
40
30
18.6
20
10
0
2008
2009
2010
15.7
2008
17.5
7.4
2009
2010
45
51.6
47.8
40
30
18.6
20
10
0
2008
2009
2010
46
9.6
10.6
8
8
6
4
2
0
2008
2009
2010
FAMILY PLANNING
Family planning services are carried out to prevent unwanted pregnancies and help in the
reduction of maternal deaths. The acceptor rate for the previous year was quite low and as
part of measures to improve the rate, durbars were held in a number of districts e.g.
Kumasi Metro, Ahafo Ano South, Atwima Kwanwoma and Bosomtwe.
In Kumasi Metro, satisfied trained with support from Engender Health were used to give
testimonies about various methods.
To scale up the use of Jadelle, some districts namely Bosomtwe, Ahafo Ano South, Amansie
West and Atwima Kwanwoma in collaboration with the Metro Director of Health Services
trained a number of service providers in Jadelle insertion.
collaboration with Marie Stoppes International.
Jadelle. However the acceptor rate apperas to be low at 7.4% compared with 2009 figure
of 17.5%.
However there has being a steady increase in the number of males accompanying their
spouses to access reproductive and child health services.
47
MATERNAL DEATHS
Maternal deaths recorded for the half year is 67 which compare favourably with 177 and
222 in 2009 and 2008 respectively.This represents a significant reduction of maternal
deaths in the region. The regional maternal committee was re activated though it met only
once for the half year. A region wide sensitization of Safe Motherhood protocol has been
undertaken and this would enable practitioners handle emergency situations.
Reported Maternal Mortality 2008 2010
Institution
Death
G H S Institutions
18
KATH
49
Total
67
Death
G H S Institutions
18
KATH
49
Total
67
No. Audited
56
Not Audited
11
% Audited
83.6
48
CHILD HEALTH
Child Welfare Average Visits
CWC PARAMETERS
Children 0- 23 months
Year
Total Registrants
W/A <80%
Target Population
% Coverage
% Malnourished
2008
2009
299693
319642
205914
7837
5432
3716
372952
384606
398065
80.4
83.1
51.7
2.6
1.7
1.8
CWC PARAMETERS
Children 24- 59months
Year
Total Registrants
W/A <80%
Total Population
% Coverage
% Malnourished
2008
2009
96607
108810
75969
2540
2111
1642
405999
418683
433336
23.8
26.0
17.5
2.6
1.9
2.2
49
BFP PARAMETERS
2008
2009
Expected
delivery
188837
194736
201552
41332
62386
31237
% Initiation
40
67.94
74.96
% M. Vitamin A
43
45.80
41.1
Year
50
BREASTFEEDING PROMOTION
Year
Total facilities
Designated
% BF
2008
2009
313 ( mat)
313 ( mat )
313 ( mat )
Nil
Nil
28
51
52
2008
2009
May
Nov.
May
Nov.
May
% Availability
72.1
66.4
62.3
76.8
77.2
% Use
66.8
70.5
59.9
75.1
77.6
Target
90%
90%
90%
90%
90%
Nov.
90%
53
2008
299693
7837
372952
80.4
2.6
2009
319642
5432
384606
83.1
1.7
96607
2009
108810
2540
2111
1642
405999
418683
433336
% Coverage
23.8
26.0
17.5
% Malnourished
2.6
1.9
2.2
Year
2008
Total Registrants
W/A <80%
Total Population
2008
396300
2009
428452
W/A <80%
11282
7543
5358
Total Population
778951
803289
831401
% Coverage
50.9
53.3
33.9
% Malnourished
2.8
1.8
1.9
60
53.3
50.9
50
40
33.9
30
% Malnourished
% Coverage
20
10
2.8
1.8
1.9
2008
2009
Year
54
District
1.
2.
No. of Mother
Support Groups
2
3
Offinso North
Amansie West
Sale and promotion of the use of iodated salt was also carried out in majority of the
communities in the districts, in addition to surveys carried out in market areas, households,
institutions, restaurants and chop bars to assertain the status of the districts.
Iodated Salt Survey (Market & Household)
Year
2008
2009
Months
May
Nov.
May
Nov.
May
% Availability
72.1
66.4
62.3
76.8
77.2
% Usage
66.8
70.5
59.9
75.1
77.6
Target
90%
90%
90%
90%
90%
Nov.
90%
Iodated Salt Survey-May & Nov/Dec (Food Vendors, Chop Bars & Rest. &
Institution)
Year
No. collected,
Tested & %
Passed
Months
2008
No. Tested
Food Vendors
M
104
8
N
123
5
Institutions
Chop Bars &
Restaurants
86
111
5
158
129
2
% Passed
M
74.
5
81.
4
73.
5
2009
N
63.9
81.6
71.6
No.
Tested
M
N
13
32 1621
26
2
174
16
59 1574
% Passed
M
72.
5
80.
9
69.
6
N
76.3
83.9
69.3
No.
Tested
M
160
0
249
172
6
% Passed
M
72.
8
81.
9
79.
1
55
Lactation Management workshops were also organized in some district at selected facilities
for all staff to make the facilities baby friendly.
District
No.
Facility Trained
Trained
Offinso
North
Amansie
West
Category of
Resource
Person
trained
Nkenkaasu Government
Nut. Off,
Hospital
Midwife I/C
people
Nut. Off,
the facility
DCO, Midwife
totaling 76
I/C
people
All trained facilities were assessed by the National assessors for designation. On the 27TH of
July 2010, twenty-eight trained facilities in lactation management in Ashanti Region were
designated as Baby Friendly at Prempeh Hall in Kumasi.
Maternal Vitamin A Supplementation was carried out in all delivery facilities to boost the
Vitamin A levels in breast milk especially for postnatal mothers within eight (8) weeks of
postpartum. This would cater for the vitamin A needs of children 0-5 months of age who
are being exclusively breastfed.
Maternal Vitamin A
2008
2009
Expected Delivery
188837
194736
201552
BF<1HR
41332
62386
31237
% Initiation
40
67.94
74.96
% Mat. Vit. A
43
45.80
41.1
Year
56
Two rounds of Vitamin A supplementation was carried out for children 6-59 months of age
during the National Immunization days to boost the vitamin A levels in their bodies and also
to fight against infection. Children under 2 years of age were also given dewormers as a
measure to prevent anaemia.
Vitamin A supplementation (6-59mths)
Year
2008
Month
May
Target
Nov.
May
822183
Children Dosed
% Coverage
2009
Nov.
Apr
May
(NID)
(CHPW)
843726
865269
175655
833968
68628
759353
832389
10339
21.4
101.4
8.1
90
96.2
1.19
57
Year
2008
2009
Yr
Total No. of Cases seen
7651
4347
2135
Kwashiorkor
642
484
273
Marasmus
4780
2598
1308
Kwash-Marasmus
354
396
235
Anemia
1875
869
319
Rehabilitation Rate
34.0
62.7
74.9
0.41
0.60
0.80
Nutrition surveillance was also carried out in selected day care centres to determine the
nutritional status of the children. Nutrition and health talks on Breastfeeding, importance
of good weaning practices among others were given to mothers and caregivers so they
could take good care of these children in terms of their Nutritional needs.
NUTRITION SURVEILLANCE
14
13.1
11.5
12
10
9.7
8.1
9.5
% Underweight
% Stunting
% Wasting
5.2
2
0
11.8
2008
11
2009
YEAR
The Regional Health Directorate in collaboration with the District Health Management
Teams supported the school feeding programme at all levels. Several workshops were
organized for caterers and other stakeholders in charge of the feeding programme on menu
preparation, basic Nutrition etc.
58
The National Commission on children organized several seminars and workshops on early
childhood Development for all stakeholders of which the Ghana Health Service and the
Department of social welfare were part. The programme sought to improve upon the skills
and performance of day care attendance at day care centres. Food demonstrations were
organized in Kumasi, Sekyere East, Ejura Sekyereduamse and Asante Akim North with the
support of world vision International to show case the various balanced diets that can be
fed to children to improve upon their nutritional status. Resource persons included District
Nutrition officer and DHMT members. Topics treated included the three food groups, how
to combine them and the need to give fruits and vegetables.
IMMUNIZATION COVERAGE:
Routine immunization and NIDS were intensified in the half year of 2010 in all Districts
with supervision from the Regional Health Directorate. Some of the activities included
House to house immunization, defaulter tracing and mop-up.
EPI Activities Half Year 2010
Routine Immunization
H1N1 Vaccination
There has been appreciable increase in EPI coverage in all the antigens. The main
improvement was from Kumasi Metro where various strategies were implemented to boost
the coverage.
On other hand the BCG/Measles drop out is way above the accepted value of 10%.
However the NIDs carried out throughout the year were successful and this goes on to
ensure the regions fruitful fight towards Polio eradication.
59
60
61
62
NIDS
NIDS
Target
Population
Total
Vaccinated
Coverage
ROUND 1
950,190
1,000,927
105.3%
ROUND 2
950190
977,507
102.9
63
CHAPTER THREE
3.0 Strategic Objective 3- General Health System Strengthening
64
A posting committee was set up to review and submit recommendations to the Regional
Director, all request for study leave.
HUMAN RESOURCE SITUATION
The total regional staff strength in 2009 was 4952 as against 4192 in 2008. See Table 3.1
below.
Manpower Situation
Total
staff
Retired
Death
June 2009
June 2010
4, 386
4,748
23
21
Resignation
Vacation of Post
65
No
District
Nurse
Kumasi , Mampong
Midwives
Accountant
Dispensing Assistant
Orderly
Amansie West
Security
Medical Assistant
Technical Officer
Storekeeper
Adansi South
Health Assistant
Offinso Municipal
Driver
Kumasi
Total
21
Regional
Quota
150
Total No of
Applicants
486
No Selected
Staff Nurse
Staff Nurses ( Mental)
90
9
188
21
92
9
Staff Midwives
Technical Officer (HI)
20
3
62
13
22
5
13
29
13
9
160
12
530
6
178
Field Technician
Medical Officer
Health Assistant Clinical
159
CHALLENGES
The constraints the Region faced in the management of Human Resource included the
following:
1. Inadequate clinicians (Doctors, Medical Assistants and Midwives)
2. Large number of staff applying for study leave
66
67
On-going
projects
Project
Location
Contractor
Consult
Works
done
Tafo
Konneh Ent
BIC
68%
Upgrading of Manhyia
Hospital - Construction
of OPD Block
Manhyia
Consar Ltd
ACP
68%
Construction of
Coldchain Room
Abrepo
Junction
Al-Raxmak
Ocads
40%
Staff Accommodation
The availability of residential and office accommodation in both the Regional and District
level is a factor that helps to attract qualified critical personnel to enhance improvement in
Service delivery. We did not make much progress in this area. An eight (8) flat residential
accommodation block at Bantama in Kumasi has not seen any additional works within the
last three (3) years due to lack of funding. The situation is similar in the Districts. There are
quite a number of abandoned projects in the region and it is hoped that capital investments
would be made available to complete them.
68
Suspended
Projects
Project
Location
Contractor
Consult
Works
done
Rehab/Expansion (Const of
Wards)
Kumasi
South
Konneh Ent
BIC
68%
Kumasi
South
Rafcofe Ent
BRRI
85%
Abrepo
Junction
Duocon
Services
Ocads
Consult
60%
Ejura
Gyaba Const
AESL
60%
Const of 2 storey
Adm/Pharm/Lab Blk
Ejura
Gyaba Const
AESL
75%
69
Planned
Projects
Projects
Location
Remarks
Regional Hospital
Sewua
Procurement in
Process
District Hospitals
Bekwai
Konongo
Tepa
Stakeholders levels
DHMT Blocks
70
EQUIPMENT
INSTALLATION
NO
INSTITUTION
EQUIPMENT
LOCATION
QUANTITY
ASONOMASO
UNIVERSAL
OPERATING
LAMP
DELIVERY
BED
THEATRE
MATERNITY
1
1
THEATRE
THEATRE
1
1
THEATRE
THEATRE
1
1
SURGEON
STOOL
MAYO
TABLE
THEATRE
THEATRE
2
1
PATIENT
TROLLEY
SUCTION
MACHINE
THEATRE
THEATRE
1
1
AUTOCLAVE
THEATRE
LAMP
THEATRE
THEATRE
1
1
NKAWIE
CYCLINDRICAL AUTOCLAVE
THEATRE
TAFO
NEBULIZER
WARD
71
2009
1
3
16
58
0
1
2
81
331
1
2010
0
3
20
89
0
1
2
115
531
1
72
Fleet
Situation
Ages
Vehicles
2009
2010
1-5 yrs
26
32
63
55
Green
6-9 yrs
47
58
37
32
Yellow
10 yrs +
10
15
13
Red
81
100
115
100
1- 3 yrs
221
67
392
74
Green
4 6 yrs
91
27
110
21
Yellow
6 yrs+
19
29
25
Red
Total
331
100
531
100
Total
Zone
M/Bikes
Ambulances
Five (5) of the Twelve (12) facility based ambulance in the Region were in good condition
while five (5) of the rest could be said to be in fair condition. The other two (2) were off
road. Ten (10) facilities are in urgent need of ambulances in the region.
Boat Service
The only natural lake in the Country is in the Ashanti Region. The only boat that is utilized
in support of service delivery is nine (9) years old. This boat like some of the vehicles in the
Region is in red zone and needs to be replaced with a fibre glass boat. There is also only
one coxswain on the boat. There is the need for the organisation of regular survival training
for staff in the area to cover new staff in the District.
Drivers
About 48% of the drivers in the service were between 50 and 60 years old. Only 14% of
the drivers were below 40 years old.
73
FIGURE.3.4
Drivers
Situation
2009
2010
39 & below
yrs
11
14
11
Green
40- 49 yrs
30
38
29
36
Yellow
50 60 yrs
39
48
42
53
Red
Total
80
100
80
100
Age Range
ZONES
Year
2009
2010
1:1.0
1: 1.5
74
NUMBER
No of sub districts
133
DHMTs trained
No of Demarcated Zones
341
No of CHPS Zones
171
No
of
functional
CHPS
compounds
36
75
Capacity of CHPS
76
Way
Forward
Appointment
of
District
CHPS
Focal
Persons
Formation
of
Community
Health
Management
Committees(CHMC)
Training
of
CHMC
CBRDP
districts- ASS,
OFM,
AAS,
AAN,
AMC,
ATN,
ATM
GHS/MOH
financing
of
2
CHPS
compounds
per
district
108
TBA
Volunteer
(s)
Chemical
Seller
Agric
Extension
Officer
Environmental
Health
Assistant
Assembly
Member
Womens
group
Leader
Other
opinion
leaders
109
77
Health
Promotion
Mabel
Kissiwah
Asafo
appointed
as
new
Regional
Health
Promotion
Officer
Review
a
draft
strategic
document
on
Health
Promotion
on
the
1st and
2nd March,
2010
Activities
1
Celebration
of
World
No
Tobacco
Day
May,
24th is
World
no
tobacco
day
Radio
talk
show
on
Nhyira
FM
on
tobacco
use
and
its
effect
on
the
users.
Time
was
allowed
for
phone
-in
where
people
raised
various
concerns
about
tobacco
and
were
addressed
accordingly
78
Activities
2
Production
of
Materials
on
Pandemic
Influenza
H1N1
Jingles
produced
and
aired
on
Nhyira
FM
&
Garden
City
FM.
Jingles
aired
for
two
months
Audio
CDs
produced
for
distribution
to
all
the
districts
for
continuous
education
at
the
OPDs
and
communities.
Activities
3
Tuberculosis
Training
The
unit
in
collaboration
with
Metro
TB
coordinator
trained
information
services
department
staff
on
TB.
All
district
representatives
of
the
service
were
present.
They
were
also
given
recorded
messages
on
TB
to
aid
their
public
education.
79
CHAPTER FOUR
4.0 Strategic Objective 4- Governance, Partnership and Sustainable Financing
80
Promote good linkage with NHIS to reduce delays in the payment of medical
bills to the health facilities
NEXT STEPS
1. Schedule for RHMT/SMC Meetings for 2010
2. Regional staff awards
3. Schedule for Regional Staff appraisal
4. Schedule for monitoring and support visit to facilities
5. Workshop on ATF rules
6. Orientation and induction for newly recruited staff
7. Submission of hard/soft copy of Annual Reports to National by the end of March
10. Refresher training on DHIMS for data managers
11. Refresher training course for motorbike riders
12. Ensuring that all facilities have Quality Assurance (QA) and Drug and Therapeutic
Committee (DTCs) in place
82
Indicators
Healthy
lifestyle
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
and
healthy
environment
Availability
of
communication
80
100
100
80
60
100
80
60
NA
NA
10
2660
2660
180
180
NA
of
schools
with
health
2550
programmes
# of health workers oriented in
50
ALL
RHN
#
H/Workers
of
community
volunteers
NA
NA
oriented on RHN
10
Objective
Indicators
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
83
Health,
222 (253)
180
177 (189)
67
86.9
90
162 (91.5)
56
Reproduction
and
Nutrition
Services
(83.6)
% of facilities with functional customer
NA
100
50
50
60
100
75
10
25
15
15
NA
100
85
90
0.79
1.2
1.4 (48)
0.7 (29)
95
100
80
90
95
100
100
90
18.5
81
80
6/27
4/27
8/27
2101(22)
2106(21)
1101(11)
90
90
COHORT
90
1290
1182
1286
30
19
29.6
care services
% of client satisfied with health care
services
increase
in
timeliness
and
completeness of reporting
% of hospital with functional public health
units
Proportion of districts with functional
facility-based ambulance
ambulance
% district with functional EPR teams
100
80
%ANC coverage
90
83
83
39.5
28
40.8
60
60
20.5
% PNC coverage
51.6
55
41.3
18.6
22.8
60
26.8
friendly
% of deliveries attended by trained health
workers
4 prenatal visits
84
% WIFA accepting FP
15.7
17
17.5
7.5
77
100
83.7
41.6
N/A
of
children
0-6months
exclusively
N/A
breastfed
% of facilities offering basic EOC
100
100
74
74
100
100
74
74
EOC
% of children 6-59months receiving VAC
101.4
90
97.3
NA
NA
NA
# of dentist
# of surgeries performed
17399
24361
14902
conducted
85
Objective
Indicators
2008
2009
2009
2010
Actual
Target
Actual
Half
Actual
General Health
NA
NA
NA
NA
System
hospital computerisation
46281/1
42450/1
31157/1
39153/1
3523/1
3315/1
3414/1
7215/1
0.7
0.8
0.8
0.4
100
100
88
60
100
80
80
36
36
98
100
86.8
NA
NA
NA
NA
in
NA
57
57
71
NA
100
40
40
NA
NA
NA
NA
NA
100
80
Strengthening
of health infrastructure
Governance,
of
managers
trained
Partnership
leadership programme
and
Sustainable
Financing
sub-district
that
have
BMCs
with
performance
NA
NA
NA
contracts
# of staff trained in gender
mainstreaming
Per capita expenditure on health
Proportion of NHIS claims settled
4.55
4.55
52
64
62
within 4 weeks
%non
wage
GOG
budgets
86
52
76
39
78
87
86
80
90
89
# of audit queries
NA
NA
NA
NA
NA
NA
10
allocated
budget
utilized
Indicators
Healthy
lifestyle
2007
2008
2009
2009
Actual
Actual
Target
Actual
and
healthy
environment
87
Availability
of
communication
80
80
100
100
50
60
100
80
NA
NA
NA
NA
10
1979
2550
of
schools
with
health
2660
programmes
# of health workers oriented in
50
ALL
RHN
#
180
H/Workers
of
community
volunteers
NA
NA
NA
NA
oriented on RHN
%
10
Objective
Indicators
2007
2008
2009
2009
Actual
Actual
Targe
Actual
t
Health,
179 (246)
222 (253)
180
177 (189)
84.4
86.9
90
162 (91.5)
NA
NA
100
50
Reproduction
and
Nutrition
Services
88
care services
% of client satisfied with health care
NA
60
100
75
25
10
25
15
NA
NA
100
85
0.79
0.79
1.2
1.4 (48)
95
95
100
80
95
95
100
100
18.5
18.5
81
11/21
6/27
4/27
2011(16)
2101(22)
2106(21)
86
90
90
COHORT
695
1290
18
62
30
100
80
%ANC coverage
76
86
90
83
17
28
40.8
47.5
50
49.4
% PNC coverage
50.6
51.6
55
41.3
22.7
22.8
60
26.8
% WIFA accepting FP
15.1
15.7
17
17.5
74.3
77
100
83.7
N/A
N/A
100
100
100
74
100
100
100
74
99.7
101.4
90
NA
NA
NA
services
of
facilities
with
adverse
incident
of reporting
% of hospital with functional public health
units
Proportion
of
districts
with
functional
facility-based ambulance
1182
0
2
19
ambulance
prenatal visits
of
children
0-6months
exclusively
N/A
breastfed
89
conducted
# of dentist
# of surgeries performed
11005
17399
24361
90
Objective
Indicators
2007
2008
2009
2009
Actual
Actual
Target
Actual
NA
NA
NA
NA
46589/1
46281/1
42450/1
48334/1
3349/1
3523/1
3315/1
2271/1
0.5
0.7
0.8
0.8
100
100
100
88
60
60
100
80
31
97
98
100
86.8
66
60
100
86
in
NA
NA
57
57
NA
NA
100
40
100
100
100
100
NA
NA
100
80
NA
NA
NA
482P
2.46
4.55
50
52
64
General
Health
hospital computerisation
System
Strengthening
of health infrastructure
Governance,
of
managers
trained
Partnership
leadership programme
and
Sustainable
Financing
BMCs
with
performance
contracts
#
of
staff
trained
in
gender
mainstreaming
within 4 weeks
%non
wage
GOG
budgets
91
52
76
61
78
87
84
80
90
# of audit queries
26
NA
utilized
NA
NA
NA
NA
NA
allocated
budget
NGOs/CBOs/FBOs/HPs
2007
Indicators
Actual
Number of Infants deaths
Institutional
2,602
Number of Infants admissions
Institutional
6,285
Number of under five deaths
Institutional
3,018
Number of under five admissions
Institutional
24,941
Maternal Mortality ratio
Institutional (per 100,000 LBs)
246/100,000
Number of Under five years who
are under weight presenting
under facility & Outreach
% Under five years who are
underweight Institutional
13.5
2008
2009
2009
2010 Half
Actual
Target
Actual
Actual
2,280
2,000
2,460
331
6,133
6,000
8,647
5012
3,202
3,000
2,700
908
19,656
19,000
25,160
18947
253/100,000
200/100,000
189/100,000
167/100,000
16,872
16,000
14,005
8930
11.8
11.7
7.0
11.0
2,809,681
3,140,880
3,900,000
3,500,286
2,041,603
0.5
0.7
0.8
0.8
0.4
117,326
138,484
140,000
140,557
85669
26
29
30
32
16.9
82
90
COHORT
COHORT
82
90
81
90
78
90
Number of admissions
Hospital Admission rate
Specialist Outreach
Number of specialist visits
received from the national level
Number of patients seen by
national team
Number of operations performed
by national team
Disease Surveillance
TB cure rate
TB Treatment Success Rate
92
3.2
2.9
2.55
18
17
27
30
48
29
797,748
964,545
950,000
900,000
773,389
160,478
15.1
171,988
15.7
180,000
17
166,131
16
72,706
7.5
139,082
76
25.9
92,397
50.6
162,607
86
41
97,351
51.6
175,742
90
41
102,305
55
150,461
83
67,158
89,070
40.4
78,792
39.5
37,592
37,130
18.6
74,507
89,753
98,999
17,961
40,786
40.8
60
60
60
20.5
100,241
113,453
120,666
83,924
40,923
40.8
60
60
60
20.5
10
36
36
77
72
72
78
81
77
77
79
85
80
80
82
84
83.6
83.7
87.1
44.4
41.6
41.6
43.5
10,914
13,348
14,000
21,160
16,194
151
193
180
162
56
179
222
200
177
67
84.4
86.9
90
91.5
83.6
139
121
100
146
35
0.05
0.06
0.06
0.04
0.05
97
98
100
98
965
COHORT
0.79
1.2
361
504
2.05
0.7
93
years
Revenue Mobilization
IGF (bn)
Cash & Carry
NHIS
GOG Subsidy ((bn))
Health Fund ((bn))
MOH Programmes (Earmark
Funds) (bn)
District Assembly Common
Fund(bn)
Other Sources e.g. Financial
Credits, HIPC (bn)
Expenditure by Item
Item 1: Personal Emoluments
(bn )
Item 2: Administration Expenses
(bn )
Item 3: Service Expenses (bn )
Item 4: Investment Expenses
(bn )
Number of doctors
Population to doctor ratio
Number of nurses
Population to nurse ratio
11,407,149
162,446
105,446
21,177,134
4,636,084
16,250,601
620,497
0
24,353,704
5,331,497
19,022,207
713,572
0
3,288,926
12,212,000
183,487
12,890,204.98
1,760,368.11
11,129,836.87
220,990.61
144,925.92
1,941,027
1,701,703
1,936,958
1,184,749
1,423,131.50
10,000
41,500
15,000
115,869
4,052,101
0
0
0
0
15,000
15,000
178,790
295,468
106,256,.94
70,314.80
0
98
32,344
102
37,196
115
143
0
129
46,589/1
46,286/1
42,450/1
31,157/1
39153/1
1,529
1,711
1,911
1,305
700
3,349/1
3,523/1
3,315/1
3,414/1
7215/1
94