Availability of health professionals is a general problem countrywide and the situation in Ahafo Ano North District is no exception.The district can boast of one hospital and four health centres. The availability of health professionals to operate the health centres is also nothing to write home about. All the four health centres are supposed to at least, have one Medical Assistant with the District Hospital, having two. Currently, only two of the health centres have Medical Assistants. In all the district supposed to have 26 staff nurses but only 11 is at post. There is one permanent doctor.
It is sad to note that Field Technicians and Ward Assistants are currently operating the rest of the health centres. There is only one midwife in the four health centres. In the light of this, deliveries are not allowed at the health centres and this poses a great threat to pregnant women and nursing mothers. Infrastructure wise, the least can be said about the District. For instance, the district does not have a District Health Management Team Block. The DHMT staff are currently perching in an old information block, which belongs to the Assembly with few office accommodations. The health staff are living in a deplorable office condition.
There are not enough residential accommodations to house the staff at post and this discourages many others who get transfers to the district. For easy access of client to health facilities for service delivery in all the sub-districts, Six (6) CHIPS Compounds are badly needed. The problem of good road net work worsens the already bad situation. The majority of the populace who reside in the small towns and villages always have difficulty accessing health services from the facilities. Community Health Nurses have serious difficulty reaching out to the communities for their out reach programmes especially during the rainy season Incidence of Guinea worm.
The incidence of Guinea Worm is a concern to the nation since Ghana ranks second in the world as far as Guinea Worm is concerned. But the disease has it‘s prone areas in the country and fortunately Ahafo Ano North has not yet identified any case these years.Incidence of HIV/AIDS
The trend of the diseases in the district is such that it increases on a yearly basis from 2003 to 2005 for example, it has increased from 37, 48 and 54 respectively. Data available shows that the most affected age groups are between 20 to 40 years. It is noticed that this age group represents the active labour force. The cause of this can be attributed to;
- Low educational background of the populace.
- Lack of funds for intensive public education on the disease in the district.
- Migration of labour into the area especially in the cocoa season, and recently the mining activities in the near by town (Kenyase) attract many people into the area.
- General lack of parental control.
The impact of this on the district is great. This is because the affected age group constitute the active labour force and this in turn has effect on productivity. Also people with HIV/AIDS are likely to be affected with other diseases like Tuberculosis which is equally a problem in the district. This is because; the immune system of the HIV/AIDS patients becomes weak.
Though programmes are carried out to sensitize people and educate them about the disease, funds are always not adequate to make this intensive and frequent.Malaria
Malaria always comes top among the top ten OPD cases in the district. The most vulnerable are children under five years and pregnant women. It is one disease, which attacks almost all, and its effect or impact is equally bad. Productivity is affected; socio economic activities slow down, poverty set, in pupils and students absent themselves from school leading to low performance .The problem of malaria can be attributed largely to the generally bad environmental situation, heaps of refuse, choked gutters, bushy surroundings, and lack of places of convenience, refusal to patronise and sleep in treated bed nets with some complaining of heat.
Even though roll back malaria programme was launched three years ago, lack of funds to constantly carry out intensive health education is a major set back. Global Fund, NGO has come out with some support through the supply of bednets, IPT (Intermittent Preventive treatment and ITNs. Government has also come out with a new anti malaria drug, which is highly subsidized so that everybody can afford to buy, but because of perceived side effects, many people are not patronising it. Even after treatment at the hospitals, many do not make use of them. This has also made it positive for the prevalence of the disease.
To improve the situation all health service workers, Chemical Sellers, CBSVs & TBAs have been trained to sensitize people on the new anti malaria drug. It is a programme, which is currently ongoing. So far, the district has sold 3500 bednets and retreated 840 bednets.Mortality Rate
The National Health Insurance Scheme took off in the district in December 2005 and even though it is too short a period to assess its impact, it has been realised that there has been some improvement in OPD attendance and admission. People have realised the need for reporting early when they are sick.
Looking at the numbers who have currently registered, it can be said that the scheme needs much time to gain root. Over 9,000 people registered in the year 2005 out of 85044 population in the district, which gives us over 10% coverage.
The problem of the slow pace at which the scheme is moving can be attributed to inadequate information and education about the scheme. Records from the OPD attendance indicate that out of 8784 patients who visited the facilities. 3100 are insured client’s whiles 5684 are non-insured, for the half year 2006. In spite of this situation, the infant mortality rate and the maternal mortality rate has gone down within the last three years.
The improvement in these three areas can be attributed to intensive education on malaria prevention, exclusive breastfeeding, immunization and the use of ITNs. On Maternal Mortality, mothers were sensitised on malaria in pregnancy, nutritious balance diet, Intermittent Preventive Treatment (IPT).Buruli-Ulcer
Buruli-Ulcer is a terrible skin disease caused by mycobacterium ulcerous. The disease is largely a neglected problem of the poor in the remote areas where there is limited access to modern medical care. The disease can affect everyone but most especially children.
Ahafo Ano North District is one of the endemic buruli ulcer districts in the country. It is one of the priority health problems of the Ghana Health Service. The disease is mostly endemic in Manfo Sub-District especially Asuhyiae zone.
At the moment, most of the patients seek treatment too late. Some of the reasons include the superstitious beliefs among the people that the disease is caused by witchcraft, which is probably inspired by terrible looks of deformities, the perceived lack of effective medical treatment, poor awareness about the early symptoms of the disease, poor accessibility to health services and general poverty in the district. Contributing to the late presentation of cases is the role of traditional healers who are often consulted initially by patients.
Because of the late presentation of cases, hospitalization is prolonged averaging two months or more. This seriously disrupts schooling for children and work for adults’ caregivers.
What the Ghana Health Service has done so far include:
No. of Diseases Grand total % of total
- Community Based Surveillance Volunteers and Traditional Birth Attendants (CBSV’s/TBA’s), Traditional Healers, Chemical Sellers and School Health Teachers have been trained on the identification of the disease at its early (nodular) stage.
- Weekly free surgical services at the district hospital.
- Free dressing of ulcers at the various health facilities.
Malaria 10,207 49.3
Cough or cold 1,128 5.5
Diarrhoea disease 1,117 5.4
Home occupational injuries 686 3.3
Skin disease and ulcers 537 2.6
Acute Urinary infections 483 2.3
Intestinal worms 451 2.2
Anaemia 379 1.8
Infectious yaws 276 1.3
Rheumatic and other joint conditions 270 1.3
All other disease 4,589 22.2Total 20,670 100.0 Implications for development Planning
- It is recommended that, the Assembly sponsors Medical Assistants, Midwives, Community Health Nurses, Ward Assistants, Field Technicians, Ward Aides, Heath Information Officers etc. to come back and serve the district after their period of training to help improve health care delivery in the district.
- As a matter off urgency, the Assembly needs to make efforts for the construction of DHMT Block and provide enough residential facilities to house the health staffs. The Assembly also need to put in place incentive packages to motivate the health staff to give off their best.
- The District Assembly needs to take the initiative of putting structures and mechanisms in place to help train teachers, religious groups, concerned groups, opinion leaders, chiefs and queen mothers, to help spread the message.
- The Assembly should also try to create opportunities for the youth to be gainfully employed. For example setting up a bakery, oil palm processing factory, farm cooperatives.
- The Assembly and health workers should reinforce VCT (Voluntary Counselling and Testing) to encourage people to know their HIV status.
- Intensive education on the behavioural and attitudinal change of the people should be carried out.
- It is also recommended that posters and billboards be put up at public places and in the communities with pictures and writings to depict the danger of the disease.
- The District Assembly should try to allocate part of its common fund to the health sector to specifically tackle the malaria problem in the district.
- Environmental Health Officers should be empowered to summon and give spot fines to help improve the sanitation in the district.
- Education should be intensified in the use of the treated bed nets and the re-treatment of bed nets.
- Education should also be highly intensified for the patronage and the use of the new anti malaria drug.
- There should be collaboration between the Assembly, the scheme managers and the health service providers to educate the public on the importance of the health insurance scheme.
- The Assembly should provide funds to purchase drugs and other logistics to help improve health delivery, in view of the delay in the payment of claims from the scheme.
- The District Assembly should furnish and equip the newly built clinic at Asuhyiae to take care of Buruli Ulcer cases in the area.
- Funds should also be provided to purchase drugs and other logistics to help improve health delivery.
- Improve knowledge among health workers at peripheral health facilities (Private/Public) to enhance case detection, manage simple cases and refer complicated ones to the hospital.
- Intensify sensitization exercise in the communities.
Refer to pdf file for tables.