2013 annual Review Presentation

1. 2013
Regional Annual Performance Review
26th February 2014
WA MUNICIPAL HEALTH SERVICE
Mrs. Beatrice Kunfah
Municipal Director of Health Services

2.  Background
 Priorities during 2013
 Key challenges
 Key achievements
 Performance in Key Service Indicators
 Problems faced during implementation & How they were resolved
 Innovations & Best Practices worth Sharing
 Key Recommendations and Way forward for 2014
Presentation Outline

3. Background Information
BAMAHU
9% BUSA
8%
CHARIA
8%
CHARINGU
9%
KAMBALI
13%
WA
CENTRA
L
53%
Projected population for 2014
from 2010 Census is 115,597

4.  Scaling Up Community –based Health Planning and Services
 Improving Reproductive and Child Health
 Promote Regenerative Health and Nutrition including medical screening
 Strengthen Disease Control and surveillance
 Create awareness on maternal and child survival issues through night Video,
C4D and Radio programs.
 Improve data collection and reporting from public and private health facilities
 Conduct staff and client satisfaction surveys
 Continue collaboration with LNGOs in community mobilization
 Regular Feedback and dialogue with stakeholders
Priorities during 2013

5.  Inadequate Critical Health Staff ( Medical Assistants,Midwives, Dispensary Technicians and
Medical Records Assistants )
 Lack of staff and office accommodation-MHA and SD
 High communicable disease burden of Malaria, TB, HIV/AIDS
 Malnutrition among children
 Increasing non-Communicable disease burden of Diabetes and Hypertension
 High infant, maternal and neonatal mortality
 Inadequate/poor funding of health activities
 Delayed reimbursement of claims from NHIS
 Lack of maternity blocks for services at Bamahu and Kambali HC
 Poor security of health centres due to lack of watchmen
 Collaboration with Private Service Providers
Key Challenges during 2013

6.  Achieved targets for almost all Sector wide performance indicators
 Launched CHPS in 1 community
 Launched Female condom
 Iodized salt surveys and meetings to promote the utilization of Iodized salt
 All facilities Monitored and supervised-FSV
 Organized mass vaccination campaigns –measles, POLIO
 Quarterly CHPS review meetings held
 Meetings with adolescents and formation of Youth clubs and pregnancy Classes
 Collaborated with MOFA to control Anthrax
Key Achievements (1)

7.  Screening of general public/organisations- Blood sugar,
B/Pressure & BMI
 Sensitization of health staff and communities on mental
health, maternal and Adolescent Health, through night
videos,durbars,meetingsetc
 Conducted Trachoma surveillance in two selected
communities
 Conducted Mass Drug Administration (MDA) against filariasis
and Onchocerciasis
Key Achievements (2)

8. Performance in key
Service Indicators &
General Overview

9.  36 out of the 52 weekly meetings held
 3 Procurement committee meetings held
 More than half of the Staff have been Appraised for the year 2013
 Thirteen (13) staff have been recommended for study leave to offer courses in
Midwifery, Public Health, etc. to strengthen the human resource of the municipality
 Disciplinary committee meetings to resolve problems at some of the facilities .
 Orientation of new staff before posting
 In- service training organized for staff to improve their performances on the job.
 Instituted Quarterly meetings with in-charges to discuss major management and
health issues
Leadership & Governance – General Mgt. issues

10. Leadership & Governance – Monitoring & Supervision
 No. of SDHT: 6
 No. of functional CHPS: 12
- Facilitative supervision (FSV) conducted from January to Dec
FSV target Achievement Implementation rate
DHMT to SDHT 24
(6 SDHTs x 4 visit)
24 100 %
SDHT to CHO 240
(20 CHPS zone x 12 visits)
160 66.7 %

11. Leadership & Governance – Internal Audit
 Annual stocktaking of medicines and non medicines
 Pre auditing of Payment vouchers before payment
 Post Audit carried out in some selected areas such as procurement,
Internal generated Funds and Program Funds
 Audit response and follow up of issues raised in audit reports
 Conducted Human Resource Audit

12. Month Claims Submitted Claims Received from NHIS Outstanding
January 73580.76 73273.52
February 81911.47 78368.4
March 75407.14 75266.85
April 86127.32 86424.87
May 94884.06 94818.8
June 88911.63 88093.86
July 92199.11 90784.48
August 118607.99 118608
September 127310.97 127311
October 144149.2 144149.2
November 125987.82 125987.8
December 89988.43 89988.43
Total 1,199,065.90 587,030.78 606,044.4
Health Financing – National Health Insurance

13. Facility
Collected CASH Revenue Notional/ NHIS Revenue Total TOTAL %
Amount % Amount % Revenue % OF TOTAL REVENUE
Bamahu 1,884.99 8 89,500.27 7 91,385.26 7
Busa 3,048.62 13 74,904.43 6 77,953.05 6
Charia 2,764.23 12 68,829.17 6 71,593.40 6
Charingu 2,301.67 10 36,101.85 3 38,403.52 3
Kambali 1,655.45 7 243,730.80 20 245,386.25 20
Wa Sub-district 5,440.84 24 256,244.55 21 261,685.39 21
Kperisi 411.24 2 19,578.43 2 19,989.67 2
Market Clinic 1,940.57 9 144,145.75 12 146,086.32 12
Adolescent H/C 1,182.93 5 64,727.92 5 65,910.85 5
Konta North Clinic 788.09 3 65,805.57 5 66,593.66 5
Dobile CHPS 613.26 3 64,030.20 5 64,643.46 5
EYE CLINIC 68.19 0 0.00 - 68.19 0
WASEC 598.59 3 70,965.30 6 71,563.89 6
Totals 22,698.67 100 1,198,564.24 100 1,221,262.91 100 /NHIS-98%
Health Financing – Internally generated Funds

14. 14206.38
15630.1
18663.73
12411.34
11098.71
11743
7898.04
2007 2008 2009 2010 2011 2012 2013
GOG ITEM 2
Health Financing – Financial performance
SOURCE OF
FUND
2007 2008 2009 2010 2011 2012 2013
GOG2 14,206.38 15,630.10 18,663.73 12,411.34 11,098.71 11,743.00 7,898.04
GOG3 8,414.63 5,862.50 7,663.30 8,676.11 4,515.00 - -
SBS 1,858.80 - 1,617.80 6,934.90 17,795.53 3,017.32 -

15. SUB. BMC SERVICES MEDICINE TOTAL
WA-SUB 13,253.60 369.95 13,623.55
BAMAHU 0.02 457.11 457.13
CHARIA 310.65 5101.66 5,412.31
BUSA 2,051.44 52.17 2,103.61
CHARINGU 3,012.94 -19.49 2,993.45
KAMBALI 929.66 6576.61 7,506.27
KPERISI 232.39 185.33 417.72
WA MUNICIPAL 16,542.23 1143.08 17,685.31
DOBILE 74.80 415.57 490.37
WA SHS 1,262.36 -53.33 1,209.03
ADOLESCENT 236.34 -231.6 4.74
KONTA 4,159.76 494.31 4,654.07
MARKET 779.80 1091.14 1,870.94
TOTAL 42,845.99 15,582.51 58,428.50
Health Financing – Liabilities/RMS

16. RANKS TOTAL NO. NO. AT POST REMARKS
MDHS 1 1
Nursing Officers (PH) 3 3
Nursing Officer (Eye) 1 1
Midwives 27 27
Medical Assistants 3 3
Community Health Nurses 122 71 51 On Course
Enrolled Nurses 38 33 5 On Course
Technical Officers(Nutrition)//Nutrition Officers 3 3
Technical Officers (DC) 3 3 1 On Course
Field Technicians 11 9 2 On Course
Technical Officers (HI) 3 3
Staff Nurses 4 4
Laboratory Assistants 1 1
Support Staff 32 32
Health Aides 3 3
Mental Health Officers 3 3
Total 260 201 59
Human Resource for Health – Available numbers

17. PROMOTIONS BY RANK Number of staff
Senior Community Health
Nurse
1
Principal Community Health
Nurse
1
Stenographer Secretary 1
Senior Enrolled Nurses 6
Principal Accounts Officer 1
Total 10
Human Resource for Health – Promotions & Appointments
PROMOTIONS APPOINTMENTS
APPOINTMENTS BY
RANK
Number of staff
DDNS 1
Administrative
Manager
1
Enrolled Nurses 6
Driver 1
Staff Nurses 2
Staff Midwife 1
Total 12

18.  Petty quarrels among staff during the year affected the working
relationships that existed among staff and that would need to be
addressed.
 Unacceptable attitude towards clients
 Turning clients away
 Absenteeism without permission
 Security in the office and health facilities is a worry because there are
no security men.
Human Resource for Health – Disciplinary Issues

19. Support Services – Health Infrastructure
PROBLEM FACILITIES
Staff accommodation Bamahu, MHA Staff,
Pipe borne water at the facility. Bamahu,Nachanta, Nyagli,Sing,Pissi CHPS,
No access road to the facility. Bamahu, Boli CHPS,
Office Accommodation Municipal Health Administration
Medical Equipment Kperesi, Boli, Busa, Mangu,
Inadequate space for delivery Serv. Bamahu, Kambali, Dobile, Kperesi, Boli and Kpongu
Security of Health Facilities All Facilities
Electricity at CHPS zones Nyagli, Nachanta, Boli

20. Sub-Municipals JICA NMCSP E-GOVERNNCE
PROJECT
Type of Equipment
Theater
Stools
Sanction Pump Infant Resuscitation
Bag
Laptops
Computers
Desktop
Computers
BAMAHU 1 1 1 1 0
BUSA 1 1 1 1 0
CHARIA 1 1 1 1 0
CHARINGU 1 1 1 1 0
KAMBALI 0 0 0 0 0
WA CENTRAL 1 1 1 1 0
MHA 0 0 0 0 5
Support Services – Health Equipment

21. Support Services – Transport
SUB-
MUNICIPAL
PETROL (QTY IN GALLONS)
DIESEL (QTY IN
GALLONS)
2010 2011 2012 2013 2013
BAMAHU 24 26 26 26 0
BUSA 19 19 21 21 0
CHARIA 24 26 28 28 0
CHARINGU 19 24 28 23 0
KAMBALI 30 30 32 35 0
WA
CENTRAL 35 44 44 61 0
DHA 80 80 100 100 0
DHA 0 0 0 0 150
TOTALS 231 249 279 294 150
Indicator 2010 2011 2012 2013
Km Travelled 76146 605276 612,141 597,541
Maintenance
Cost (GHȻ) 5641 7940.94 6710.65 6517.85
Running Cost
(GHȻ) 9022 13745.4 14857.8 13987.14
Availability (%) 96% 98% 97.9% 99.2%
Utilization (%) 93% 91% 93.1% 94.8%
Key Transport Indicators-vehiclesFuel Used for Service Delivery monthly

22. Summary of Vehicles & Motorbike Inventory
Reg. No Make Model
Year
Received
Year
Manufac
tured
Age Condition
Gv487y Toyota Pick Up 2007 2007 6Yrs
Road
Worthy
Gv 169z Nissan Pick Up 2008 2008 5yr
Road
Worthy
Gv231-10 Wingle Pick Up 2010 2010 3yr
Road
Worthy
Make No.
Condition
off-road Very Weak Weak Roadworthy
AG100 16 0 4 0 12
AG200 5 0 0 0 5
DT125 1 0 0 1 0
Nanfan125 21 0 0 0 21
Jailing 8 1 4 0 3
FYM 3 0 3 0 0
TOTAL 54 1 11 1 41
Vehicles Motors

23. Indicator 2010 2011 2012 2013
Total cases 65 24 48 14
Total Deaths 21 4 4 3
LP done/LP rate 37(57%) 18(75%) 47(98%) 10(71.4%)
N. Meningitides A 3 1 1 0
N. Meningitides W135 5 0 7 1
Strep Pneumonae 8 7 9 6
Other meningitis 0 1 1 1
No Organism seen 21 9 29 2
CFR 32.3 16.6 8.3% 21.4%
Disease Surveillance and Control Services– IDSR
Meningitis
Sub municipal 2010 2011 2012 2013
Bamahu 0 2 2 0
Busa 1 3 0 0
Charia 0 0 1 0
Charingu 0 0 0 0
Kambali 2 4 0 0
Wa Central 7 10 7 12
Reg. Hospital 4 0 13 0
Total 14 19 23 12
Suspected Measles Cases
Three (3 ) Cases of Non-Polio AFP were detected & 8 suspected Yellow
Fever cases

24.  No case had been reported since 2008 but surveillance on the disease is on-
going to track suspected cases and rumours. All rumours reported were
investigated and Guinea Worm ruled out.
 Administered questionnaire during NID (October 2013) campaign to access the
knowledge level of guinea worm cash reward (GH¢ 200.00) and the
certification as guinea worm free country.
 About 500 community members were interviewed and out of this number,
ninety – five percent (95%) were aware of the cash reward and certification.
Disease Surveillance & Response – Guinea Worm

25. Mass Measles Vaccination

26. Indicator 2010 2011 2012 2013
#of clients
assessing services 3908 1542 1269
# positive 25 132 88
% positive 0.6 8.5 6.9
Disease Surveillance and Control Services– HIV & AIDS
Indicators 2010 2011 2012 2013
ANC Registrants 5042 5110 5731 6149
# Counselled 2722 2421 5121 5354
% Counselled 54.0 47.4 89.4 87.1
# Tested 2622 2399 5035 5303
% Tested 96.3 99.1 98.3 99.0
# Positive 46 28 63 56
% Positive 1.75 1.16 1.25 1.1
Prevention of Mother-to-Child TransmissionTesting and Counseling
INDICATORS
Adult Paediatric
TOTALMale Female Male Female
# of new clients receiving HIV clinical care 21 94 1 1 117
# of new clients on co-trimoxazole prophylaxis 21 94 1 1 117
# of new clients started on ARVs 26 132 1 4 122
# of ART clients screened for TB 23 123 1 1 148
# of clients who stopped treatment due to death 2 2 0 0 8
# of clients who stopped treatment due to loss to follow-up 10 43 1 0 54
# of Clients on Second Line 2 2 0 0 4
Anti-Retroviral Therapy at the Regional Hospital, 2013

27. INDICATOR 2009 2010 2011 2012
#of cases 73 84 75 108
# cured 16 30 28 44
% cured 61.5 71.4 54.9 69
#completed 26 22 22 42
#of deaths 20 17 14 14
Case fatality rate 27.4 20.2 18.7 12.9
#treatment failure 0 4 2 3
# defaulted 9 11 9 5
Trans out 0 0 0 0
Disease Surveillance and Control Services - TB

28.  All community Surveillance volunteers reported no cases for the priority diseases on the various register for
the year. On the average, 130 volunteers reported during the year representing 98.4% of the total number of
surveillance volunteers.
Disease Surveillance and Control Services– Community-based Surveillance
ZONE
BIRTHS DEATHS IMMUNIZATION
Male
Female
Infant
Others
BCG
OPV3
DPT3-
HEP+HIB
Measles
YF
Bamahu 62 88 2 14 66 299 301 466 466
Busa 52 58 0 0 114 330 350 380 380
Charia 0 0 0 9 94 389 396 570 477
Charingu 78 71 12 14 148 301 304 293 294
Kambali 15 17 1 17 96 716 716 441 237
Wa Central 143 130 3 106 414 1176 1168 1113 1122
Total 350 364 16 160 932 3211 3235 3263 2976

29. 5042
3588
4249
5110
4148
4887
5731
4839
5133
6149
5379 5435
0
1000
2000
3000
4000
5000
6000
7000
ANC Skilled Del. PNC
2010 2011 2012 2013
Maternal & New born care – ANC, Delivery & PNC
Target = 90% (2757 Target = 90% (2757
Target = 80% (2450)

30. Sub Municipal ANC Skill Del PNC
Bamahu 433 2 38
Busa 337 109 108
Charia 404 93 96
Charingu 247 48 83
Kambali 699 0 12
Reg. Hospital 1647 4697 4577
Wa Central 2137 428 519
Islamic Clinic 245 2 2
Municipal 6149 5379 5435
Maternal & New born care – ANC, Delivery & PNC (2013)

31. Maternal Health – First Trimester Registration
Median
Goal
0
10
20
30
40
50
60
70
80
Jan'10
Feb'10
Mar'10
Apr'10
May'10
Jun'10
Jul'10
Aug'10
Sept'10
Oct'10
Nov'10
Dec'10
Jan'11
Feb'11
Mar'11
Apr'11
May'11
Jun'11
Jul'11
Aug'11
Sept'11
Oct'11
Nov'11
Dec'11
Jan'12
Feb'12
Mar'12
Apr'12
May'12
Jun'12
Jul'12
Aug'12
Sept'12
Oct'12
Nov'12
Dec'12
Jan'13
Feb'13
Mar'13
Apr'13
May'13
Jun'13
Jul'13
Aug'13
Sept'13
Oct'13
Nov'13
Dec'13
Months
Percentage(%)
Instituted Pregnancy
Classes in all Sub
Municipals
51.3 59.8 59.0 64.1
0.0
20.0
40.0
60.0
80.0
2010 2011 2012 2013

32. Antenatal care– Average Visit per client
3.7
3.9 3.9
3.6
3.5
3.6
3.2
3.4
3.6
3.8
4.0
2008 2009 2010 2011 2012 2013
Average Visit/Client

33. Teenage Pregnancies – Increasing Trends
Median
0
10
20
30
40
50
60
70
80
Jan'10
Feb'10
Mar'10
Apr'10
May'10
Jun'10
Jul'10
Aug'10
Sept'10
Oct'10
Nov'10
Dec'10
Jan'11
Feb'11
Mar'11
Apr'11
May'11
Jun'11
Jul'11
Aug'11
Sept'11
Oct'11
Nov'11
Dec'11
Jan'12
Feb'12
Mar'12
Apr'12
May'12
Jun'12
Jul'12
Aug'12
Sept'12
Oct'12
Nov'12
Dec'12
Jan'13
Feb'13
Mar'13
Apr'13
May'13
Jun'13
Jul'13
Aug'13
Sept'13
Oct'13
Nov'13
Dec'13
Wa Municipal Health Service: Total Teenagers Registered for ANC
Months
NumberofTeenagePregnancies
Average Teenage Pregnancies Recorded
32/Month in 2010 48/Month in 2013

34. Post Natal Care Services
4839
5379
5133
5435
4547
5436
2392 2536
0
1000
2000
3000
4000
5000
6000
2012 2013
Skilled Del PNC Registrants PNC on Day 1/2 PNC on Day 6/7
Target for Day 2nd
PNC= 90% of PNC
Registrants(4892)

35. Maternal & New born care – Maternal Mortality
9 9 7 8 6 6 7 8 6 5 8
297
272
205
333
159
132
159
224
147
105
150
38
0
10
20
30
40
50
60
0
50
100
150
200
250
300
350
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Maternal Deaths Mortality ratio/100,000 livebirths Still births rate/1000 lives birth

36. Drug Reaction
12%
Direct Causes
50%
Medical Conditions
38%
Causes of Maternal Deaths in 2013
Myocardial infarction
Meningitis
Sickle cell
Haemorrhagic Shock
Anaemia
CPD
sepsis

37.  Phone calls are made to clients to find out about their
conditions
 Volunteers/CBAs have started sending clients to the facilities
 FTFSG at Dobile are educating their colleagues on taking care
and supporting their wives and children
 CETs in some of the communities
 Formation of susu groups by women to support one another
 Early registration during pregnancy
 Pregnancy classes for mothers and mother -in-laws and
spouses
 forums for men on family planning and other health related
issues
 Sensitization meetings with Fulani settlements in the
municipality
Implementation of Audit Recommendations

38. Durbar On Maternal Health & Teenage
Pregnancy

39. Follow of Children who lost their mothers

40. Session With Men On Maternal & Newborn Care
– Charia

41. BCG PENTA 3 Measles TT2+
2010 6488 4351 5263 3720
2011 5195 4151 3907 3278
2012 5443 4332 4440 4523
2013 5676 4628 4361 3873
0
1000
2000
3000
4000
5000
6000
7000
Child Health – Expanded Program on Immunization
Target = 90% Under
1yr.(2757)

42. Period
BCG Measles
BCG-Measles
Dropout
Penta 1 Penta 3
Penta1-Penta3
Dropout
2010 6488 5263 18.88 4491 4351 3.12
2011 5195 3907 24.79 4216 4151 1.54
2012 5443 4440 18.43 4334 4332 0.05
2013 5676 4313 24.01 4755 4630 2.63
EPI – Drop-out Rates
DISTRICT SUMMARY 2010-2013
Sub Municipal BCG Measles BCG-Measles Dropout Penta 1 Penta 3
Penta1-Penta3
Dropout
Bamahu 100 413 -313.00 386 398 -3.11
Busa 138 402 -191.30 370 389 -5.14
Charia 85 395 -364.71 357 424 -18.77
Charingu 137 302 -120.44 273 292 -6.96
Kambali 20 768 -3740.00 627 729 -16.27
Reg. Hospital 4659 340 92.70 1259 603 52.10
Wa Central 537 1693 -215.27 1483 1795 -21.04
DISTRICT 5676 4313 24.01 4755 4630 2.63
SUB-MUNICIPAL BREAKDOWN - 2013

43.  Monthly visits to schools to educate pupils
on health issues
 Conducted physical examination of the
target school children
 Referred school children identified with
health problems for management
 Immunized school pupils that are usually due
for some antigens
 Video shows to tertiary schools on maternal
and child health issues, family planning and
causes and prevention of STIs/HIV &AIDs
 Organized meetings with school health clubs
School Health
S. NO. CONDITIONS 2011 2012 2013
1 Ear problems 3 8 51
2 Eye 21 11 41
3 Oral problems 49 40 105
4 Skin problems 92 211 275
5 undescended testis 0 4 0
6 Epistasis 10 0 0
7 Respiratory tract infection 4 0 0
8 Foreign bodies in nose/ear 7 0 0
9 Injuries 6 0 0
10 Severe Malaria 10 0 0
11 Others 0 18 32
12 TOTAL 202 292 504
NUMBER OF CHILDREN REFERRED

44.  Integrated durbars on adolescent health services
 Counseling on general health issues with
emphasis on reproductive health
 Health talks on nutrition, substance use, sexually
transmitted infections(STIs)including HIV/AIDS
and partner treatment
 Provision of family planning counseling and
services
 Provision of Voluntary counseling and testing (
VCT) services
 Clinical care including referrals
 Meetings with the Adolescents/STIs youth clubs
 Night video show in all second cycle institutions
 Health talks on breast cancer,
Adolescent Health
Meeting with Youth club

45. ADOLESCENT HEALTH SESSION

46. Family Planning – Acceptor Rate
57.2
73.8
65
79.4
63.8
67.2
71.1
74.8
0
10
20
30
40
50
60
70
80
90
2006 2007 2008 2009 2010 2011 2012 2013
PercentageCoverage
Target: 80%

47. Female Condom 2 Regional Launch

48. Nutrition – Malnutrition & CMAM
Stunting
(%)
Wasting
(%)
Underweight
(%)
Moderate
Malnutrition
11.4 9.3 10.3
Severe
Malnutrition
7.8 1.6 3.6
Total
Malnutrition
19.2 10.9 13.9

49. Sub Municipal
Vit. A ( Children 6-59mths) Vit. A ( Post-Partum Mothers)
2010 2011 2012 2013 2010 2011 2012 2013
Bamahu 2056 4120 871 1864 549 332 151 28
Busa 81 150 767 840 214 234 144 96
Charia 53 1359 1180 1676 198 166 146 142
Charingu 801 548 620 409 249 229 94 82
Kambali 8258 5977 1340 1721 405 257 93 22
Reg. Hospital 74 170 265 380 1286 1977 2744 4259
Wa Central 1736 3411 2973 4556 773 683 629 450
Municipal 13059 15735 8016 11446 3674 3878 4001 5079
Nutrition -Vitamin A Supplementation

50. Screening for Non-communicable Diseases
Indicator
2013 2012
screened total referred % referred screened total referred % referred
Blood presure 697 132 18.9 449 116 25.8
Blood Sugar
level 446 84 18.8 341 48 14.1
BMI 683 95 13.9 457 72 15.8

51. Clinical Care – OPD Per Capita
0.6 0.5
0.7
1.0
1.3
1.7
1.7
1.9
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2006 2007 2008 2009 2010 2011 2012 2013
OPD Per Capita

52. Proportion of suspected Malaria OPD Cases tested
Years Both Clinical
&Confirmed Cases
Total Tested Percentage Tested
2011 82861 41016 49.49%
2012 103256 43728 42.34%
2013 107127 48019 44.82%

53. Proportion of Malaria Cases Tested Positive

54. Under-five malaria case fatality rate
59
94
64 65
40
45
31
17
0.06
0.09
0.05
0.04
0.03 0.03
0.01 0.01
0.00
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0
20
40
60
80
100
2006 2007 2008 2009 2010 2011 2012 2013
U5 malaria deaths CFR

55. INTERMITENT PREVENTIVE TREATMENT
2010 2011 2012 2013
IPT1 3074 3739 4005 3759
IPT2 2712 3234 3411 3396
IPT3 2242 2349 2195 2558
IPT 1& IPT3 GAP 832 1390 1810 1201
832
1390
1810
1201
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0
500
1000
1500
2000
2500
3000
3500
4000
4500
IPT1 IPT2 IPT3 IPT 1& IPT3 GAP

56. Home based care by CBAs
Period
FEVER FAST BREATHING DIARRHOEA
Fever
Treated with
AA
Fast
Breathing
Treated with
Amoxycillin
Diarrhoea
Chn Given
ORS & Zinc
2012 215 226 244 257 544 562
2013 467 320 338 239 455 407

57. Community Based Services – CHPS Implementation
24
2
4
5
1 1
2
4
1
2
6
11
12
13
15
19
20
0
5
10
15
20
25
30
2006 2007 2008 2009 2010 2011 2012 2013
Demarcated Zones No. of Functional Zones Total Functional Zones
Target
47.56% of population is covered by CHPS zones

58. CHPS Contribution to Key Indicators -2013
19.8
23.0
34.4
36.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
0
1000
2000
3000
4000
5000
6000
7000
ANC 2nd PNC on DAY 6 or 7 PENTA3 MEASLES
Municipal CHPS % Contribution

59. Sub-Municipal No. of CHPS Zones Durbars Home Visits Meetings
Bamahu 4 14 638 27
Busa 2 6 1134 15
Charia 3 13 1365 12
Charingu 4 5 358 1
Kambali 4 11 559 9
Wa Central 3 9 5398 8
Municipal 20 58 9452 72
Community Mobilization Activities By CHPS Zones

60. Intersectoral Collaboration
Partner/Collaborator Contribution
Municipal
Assembly
• Construction of Nyagli CHPS Compound.
• Provision of Items to Bone setters clinic
• Construction of Health Assistant training school
• Clean up campaigns
• Provision of Water and electricity to CHPS compounds
• Meetings
MOFA • Control of Epidemics and Nutrition
GES • Mobilization of schools for Health Care services including Mass campaigns,
School health services
NCCE • Social Mobilization

61. Engagement of Development partners & NGOs
Partner/Collaborator Contribution
PLAN GHANA • Disease Control and Nutrition
Member Of Parliament NHIS Fund • Renovation of Health Centres and Staff Quarters
• Construction of Urinals and Sheds for Health Facilities
• Provision of Laptops to the Municipal Health Directorate
• Renting of accommodation for Service delivery at Konta
YARO • Community Mobilization in health
Coalition of NGOs in Health • Stakeholders meeting on MAF
Agamal • Malaria control
Malaria Care/Prompt
World Food Program
PPAG
Youth Alive
• Malaria control
• Nutrition
• Adolescent health-corners and furnishing
• Adolescent Health

62. Sub Municipal Actual Reports Expected Reports
% Report
submitted
NO. On Time % On Time
Bamahu 1043 1057 99.1 950 93.3
Busa 629 641 98.8 571 91.7
Charia 839 849 99.2 750 91.3
Charingu 1042 1057 99.2 928 91.7
Kambali 1037 1057 99.0 927 91.6
Wa Central 1802 1825 99.1 1527 87.2
Reg. Hospital 337 433 77.7 124 26.8
Municipal 6729 6919 96.0 5777 81.9
Health Management Information Systems

63.  Distribution of Laptops and training of Health Center Staff on
E-register project
 Computers were received from the RCC through the Regional
Health Directorate for the E-governance Project
 Trained health staff on Power point Presentation
Information Communication technology

64. Health Research – House Hold Salt Survey
0
5
10
15
20
25
30
35
40
45
50
NEUTRAL <15PPM >15PPM
Percentages
Neutral <15ppm >15ppm
May, 2011 27.3 34 38.3
May, 2012 30 37 33
June, 2013 26 25 49

65. FOOD DEMONSTRATION AT BILINTOYIRI

66. Food demonstration @ Zongo

67. Problems faced during implementation & How they were
resolved (1)
Problem Solution
High deductions of NHIS claims Formed committee to vet NHIS claims in the office before submission
Staff conflicts and indiscipline Encourage more staff meetings, serving of query letters, disciplinary committee
Inadequate funds Lobbied with Assembly to support activities, Use of IGF to finance service delivery.
Collaboration with NGOs, Integration of services
High reported malaria cases Continuous education on the use of ITNs, Collaboration with Agamal on malaria control and
No test No treatment approach for malaria diagnosis
High maternal Deaths Dialogue with traditional authorities, Assemblymen and women, Maternal Death Audits,
Implementation of audit recommendation, formation of FTFSG, Radio discussions, durbars,
night videos, Stakeholders meeting on MAF, Pregnancy classes
Poor quality of services Regular supervision and involvements of PA in the teams to build capacity of other staffs, on
the job training, Provision of basic equipment like BP apparatus, glucometres and Urine test
kits etc
Poor documentations and
record keeping
Joint report collation-CHPS , Sub Mun. Reactivation of data validation teams, daily and weekly
summaries, Procurement of Arch files
Weak motorbikes Regular servicing and replacements of parts, Orientate riders on plan preventive maintenance,
supporting facilities with vehicles

68. Problem Solution
Community mobilization Collaborated with Local NGOs and organizations
Use of social groups, churches, mosques
Naming ceremonies, night videos and radio programs
CHAPS
High Attendance of clients at CHPS
zones
Redistribution of Enrolled nurses to CHPS zones
Problems faced during implementation & How they
were resolved (2)

69.  Constituted a vetting Committee for NHIS claims
 Zoning of health facilities for Unit heads and other staff in the Office
 Instituted Quarterly in-charges meeting
 Internal study tours for volunteers and Mother to mother support groups
 Quarterly Newsletter
 Development of a software for managing medicines in the municipality
 Put in place a Taskforce for health screening for detection of non communicable
diseases. Eg Hypertension, Diabetes, obesity etc.
 Support staff on study leave Financially and those who are sick and are referred to
facilities outside the region
Innovations & Best Practices worth Sharing

70.  Intensify community education and dialogue on reproductive
health services and CHPS
 Expand some health facilities for delivery and other services-
Kambali, Bamahu ,Kpongu, Dobile, Boli and Kperesi.
 Orientate staffs on the Ghana health service code of ethics
 Strengthen CHPS –Training of volunteers, CHCs, create model
CHPS zones
• Acquisition of land to relocate Konta Clinic
• Lobby for the completion of the office complex
Way forward for 2014 (1)

71. • Conduct quarterly data validation at health facilities
• Continue vetting of claims forms before submission to NHIS
 Continue health screening for general public and health staff for Non-
communicable diseases
 Introduction of Medicine management software to enhance efficient
drug management
 Collaborate with Clinical care Division of RHA to regulate the services
and reporting of Private Health Services.
 Hold community durbars and engagement on teenage pregnancies
 Sensitize adolescent health clubs on family planning
Way forward for 2014 (2)

72.  MUNICIPAL ASSEMBLY
 DECENTRALISED DEPARTMENTS
 NATIONAL AMBULLANCE TEAM
 COALITION OF NGOS
 PLAN GHANA
 YARO
 HON. MEMBER OF PARLIAMENT
 MUNICIPAL PARENTS
 JICA
 Agamal
 RDHS
 Traditional Authorities, Assemblymen, Mothers and Children
ACKNOWLEDGEMENT

73. THANK YOU

74. 2013
Ensuring Continuity of Services Rendered
@ Regional Hospital
Bottleneck Analysis of Postnatal Care
WA MUNICIPAL HEALTH SERVICE

75.  Introduction
 Identification of Bottlenecks
 Casual Analysis
 Stakeholder Analysis
 Strategies to Address Bottlenecks
 Monitoring & Evaluation Plan
 Conclusion
Presentation Outline

76.  The Regional Is the Biggest Health Facility in the Municipality
 Over 50% of Health services provided in the Municipality are initiated at the
Regional
 Most of these services are supposed to continued at the various health Centers
CHPS Zones spread across the Municipality
 How well this continuity of care is established is paramount to successful
health outcomes in the Municipality
 Our emphasis on this area is to help and improved especially maternal and
child health care services that are initiated at the hospital are effectively
monitored and continued to to avoid the high drop outs and miss opportunities
Introduction

77. Proportions of Services Rendered @ Reg. Hospital
Reg. Hospital
87%
Health Centers
13%
PROPORTIONS OF SKILLED DELIVERIES IN
2013
Reg. Hospital
87%
Health Centers
13%
Proportions of BCG Vaccinations in 2013

78. Postnatal Care Services in 1st Week of Life
4547
5436
2392 2536
0
1000
2000
3000
4000
5000
6000
2012 2013
Skilled Del PNC Registrants PNC on Day 1/2 PNC on Day 6/7

79. SELECTION OF Intervention &
BOTTLENECKs Identified

80. (Basic Emergency Obstetric Care (for sub-district health facilities)
100%
90%
100 100.0
71.4
118.5 119.8
55.9
0
10
20
30
40
50
60
70
80
90
100
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Commodities Human Resource Access Initial Utilization Continuous
Utilization
Effective
coverage/Quality

81. Tracer Intervention Identified Bottleneck
Basic Emergency Obstetric
Care (for sub-district health
facilities)
Only 55.9% of pregnant women who delivered at Health
Facilities had the 2nd PNC visits at day 6 or 7 in the last one
year (2013)
Identified Bottleneck

82. Causality Analysis

83. Only 55.9% of pregnant
women who delivered
at Health Facilities had
the 2nd PNC visits at
day 6 or 7 in the last
one year (2013)
Referral Communication
Gap
Referring
facilities'
failure
communic
ate
referrals to
receiving
facilities
Failure by
CHNs to
follow-up
referred
mothers
Weak Referral System
Poor
Education of
mother on
the need to
continue PNC
at receiving
Facility at
community
level
Poor Documentation of
PNC Visits
Workload
High Staff
Attrition
Inadequate
knowledge
on PNC
register
Little
orientatio
n for new
staff on
document
ation
Inadequat
e supplies
of
materials
to
document
visits
Poor
planning
Failure to
document
Fist PNC
on
Antenatal
Cards by
Heath
Staff
Negligence and
forgetfulness on
the part of staff
to document
after providing
service
Cultural practices barring
mothers from coming out
before 10days after delivery
Negative
socio-
cultural
beliefs
Low
Literacy
Rate
Inadequate Support from
Volunteers
Volunteer
Fatigue
Poor
Supervision
of
Volunteers
by Health
Facility Staff
Little Motivation of Volunteers & poor
Supervision
Little
knowledge
of day 6/7
PNC visits
by
Volunteers
Immediate Causes
Underlying Causes
Structural Causes
Colour Key

84. Stakeholder Analysis
Stakeholders Roles interests Fears
Constraints/Barriers/We
aknesses
Potentials/
Strengths
Win-Win
Strategies
Clients Avail themselves, accept and
utilize services
Satisfaction and
quality service,
Not being attended
to.
poor support from
husbands
Mothers attend
meeting/durbars
reach consensus
on method
through dialogueconfidentiality Attitude of spouses unavailability of service
Opinion
leaders
Enactment of community by-
laws
Healthy
community
Non compliance of
by laws
poor collaboration
between staff and
opinion leaders
Meetings, Durbars,
Festivals
Ensure proper
community
entering process
Local NGOs Support in advocacy in
service provision an d
education
Not achieving the
set goals
Inadequate funds Stakeholders meeting,
Quaterly performance
reviews sessions
Feedback
District
Assembly
Infrastructural development
and support training of
critical staff
Healthy
population
Fear of losing
political power
Inadequate funds Stakeholders meetings Dialogue,
Collaborations
and feedback
Regional
Hospital
Referral of PNC mothers to
H/C for 2
nd
PNC
Continuity of
Care
Poor Referral practice
and documentation
Public Health Unit to
initiate linkages
Reduce dropouts
and ensure
mothers enjoy
full PNC care
Media Information dissemination Misinformation Inadequate knowledge
on health issues
Medium to reach the
populace
Collaboration
and networking
Decentralised
Departments
Information dessimination Inadequate
knowledge on
health issues
Inadequate funds and
logistics
Ability to reach the
populace
Collaboration
and networking

85. Strategies to address
Bottlenecks

86. 1. Strengthen community engagement
and education to minimize effect of
negative socio-cultural beliefs on PNC
visits
• Strengthen referral system
(Emergency preparedness,
communication, Transport and
documentation)
• Line listing of ANC, Delivery and
PNC Registrants for follow-up
• Assign each Antenatal registrant
to Specific CHN/CHO to follow
through to delivery and PNC
• Sensitize Volunteers and Opinion
Leaders on Post natal care policy
and other new services policies
• advocate for motivational packages
for volunteers in collaboration
Municipal Chief Executive, MP &
other donor agencies
Weak
Referral
System
Poor
Supervisions
and Linkage
between
Health Centers
& Community
Structures
Poor Health
Education
• Orientation of newly posted staff
on documentation and record
keeping
• Develop Postnatal stamps for staff
to use on Antenatal cards after
offering PNC service
• Engagement meetings with Reg.
Hospital Public Health Unit staff
Poor
recording
Services
Provided at
Health
Facilities

87. M&E Plan during Implementation (1)
OBJECTIVE : To increase PNC Visits on Day 6or 7 from 55.9% Coverage to 85%% by 31st December 2014
TRACER INTERVENTION: Antenatal Services
Outputs Strategies Activities
2014
Q1 Q2 Q3 Q4
PNC Visits
on Day 6or 7
Coverage
Increased
from 55.9%
to 85%
Strengthen referral system (Emergency
preparedness, communication,
Transport and documentation)
Organise community meetings on referrals in all communities in the
municipality
Orientate Community Volunteers on Referral service continuity
Line listing of ANC, Delivery and
PNC Registrants for follow-up
Create a computerized line list of ANC Registrants in the Municipality
for follow-ups
Assign Staff one staff from each Health center to make follow-ups to
Regional Hospital to track mothers delivering there from their
catchment area
Assign each Antenatal registrant to
Specific CHN/CHO to follow through
to delivery and PNC
Assign ANC registrants to Specific CHNs/CHOs to Monitor until
Delivery
Document traceable addresses of all pregnant mothers]
Orientation of newly posted staff of
documentation and record keeping
Organise Orientation on Registers and reporting templates for new staff

88. Outputs Strategies Activities
2014
Q1Q2Q3Q4
Develop easy ways of documenting PNC &
CWC services Antenatal/CWC cards after
offering PNC service
Procure Customised stamps for postnatal care and CWC sessions
Distribute stamps to all Health centers CHPS Zones
Engagement meetings with Reg. Hospital
Public Health Unit staff
Hold engagement meeting with Public Unit of Hospital to discuss
how to coordinate service referrals to Health Centers
Sensitize Volunteers and Opinion Leaders on
Post natal care policy and other new services
policies
Hold engagement meetings at Sub Municipal
advocate for motivational packages for
volunteers in collaboration Municipal Chief
Executive, MP & other donor agencies
Organise stakeholders forum on Volunteer motivation
Strengthen community engagement and
education to minimize effect of negative
socio-cultural beliefs on PNC visits
Organise night Video shows on maternal and New born care
M&E Plan during Implementation (2)

89. THANK YOU