The District health services are organized around one hospital, three maternity homes, four health centres and fifteen Community-based Health Planning and Services (CHPS) compound. There are also twenty-eight demarcated CHPS zones with each assigned a community health worker. Services offered include clinical care, prevention of disease and health promotion activities.
Key Health Partners and Areas of Support
The district health administration works with other partners and stakeholders. The collaborative efforts contributed to the general performance of the district. The key health partners and their areas of support are as below;
District Health Services / Administration
The District Health Administration provides technical and administrative support for health service provision in the district. These include resource mobilization and distribution, planning, training and research programmes. The District Health Administration ensures that services provided are in accordance with the national policies and regional priorities. Planned activities revolved around the 5 main objectives of the Ministry of Health, which are:
· To increase geographical and financial accessibility in health to all Ghanaians
· To provide better quality of care in all health facilities.
· To improve efficiency at all levels.
· To foster closer collaboration with communities and other partners
· To increase resources and to ensure equitable and efficient resource distribution.
The core DHMT comprises of the District Director of Health Services, two public health nurses, two Disease Control Officers, the District Accountant, Health Information Officer, Human Resource Officer, community health nurse and one driver.
The District Health Administration oversees health delivery activities by all health facilities.
These services include
· Public health services
· Clinical services
· Special initiatives to improve access
· Support services
Public Health Services
Public Health services provided include all health preventive and promotion activities. It is also concerned with management of some cases seen and referrals. The major components involved in public health services are
• Disease control
• Reproductive and child health
• Nutrition and Regenerative health
Disease control is concerned with carrying out activities associated with distribution and determinants of health related events and how to control the health problems. The vision of the disease control unit was to contribute to the overall improvement of the health status of all people living in the district, through collection of data that are relevant to the district and prioritize, plan intervention, allocate resources and predict or provide early detection of outbreaks.
The unit seeks to be vigilant for both communicable and non- communicable diseases as well as all other disease categories of public health importance and their determinants with the responsibility to take measures that will control and prevent diseases and thus improve or maintain the health status of the people.
The objective of the unit was to institute integrated Disease Surveillance systems and rapid response in the sub districts in order to prevent any impending outbreak and to determine the trend of diseases in the population. The district surveillance unit in collaboration with the Public Health units in the hospital and disease surveillance personnel in the periphery undertook routine surveillance activities in the district. The district has a composite report format that captures data on all priority diseases.
Integrated Disease Surveillance and Response
Surveillance activities were coordinated and streamlined, rather than maintaining separate vertical activities. Resources were combined to collect information from a single focal point at each level. For example, surveillance activities for Acute Flaccid Paralysis (AFP) can address surveillance needs for neonatal tetanus, measles and other diseases. Thus health staffs that routinely monitor AFP cases also review district and health facility records for information about other priority diseases. Surveillance focal points at the district and sub-district and community levels collaborate with epidemic response committees at each level to plan relevant public health response action.
In line with effectively monitoring the trends of epidemic prone disease, priority focus was however given to diseases of public health importance and all others that pose threat to public health including,
1. Diseases of Epidemic Potential
Viral Haemorrhagic Fever
2. Diseases targeted for Eradication
Diseases targeted for Elimination
Leprosy and Neonatal Tetanus
Diseases of Special Public Health Focus
5. Other Diseases of Public Health Importance
• Buruli Ulcer
• Diarrhoea <5 years
• Viral Hepatitis
• Lymphatic Filariasis
The National/Regional Targets for Integrated Disease Surveillance and Response (IDSR) adopted by the District Health Directorate are: -
• 95% Timeliness of weekly reporting of Communicable Diseases
• 95% Timeliness of monthly reporting of Communicable Diseases 100% AFP case detection and 60-day follow-up.
• 100% Guinea Worm Case Containment
• 100% feedback on reports to sub districts/facilities
• 90% immunization coverage in BCG, Measles, OPV3, Penta3, Yellow Fever and TT2+ in Pregnant women
• 50% immunization coverage in TT2+ in non-pregnant women
• 85% Cure rate of newly detected cases of sputum smear positive TB
• 70% detection of estimated incidence of sputum smear positive cases
• 10% or less in TB defaulters
Most of these national targets were not achieved except for a few such as TB defaulter rate which dropped from 9% to 7.14%. Several activities were carried out regarding IDSR. Among these included the following;
1. Collation and critical analysis of health data from peripheral health facilities as well as timely, complete and accurate returns submitted to the region
2. Periodical review of hospital consulting room and ward registers
3. Distribution and Monitoring of logistics such as solo-shots, Child Health Records Cards, Vaccines and Standard Reporting Formats to sub districts and facilities
4. Collection and transportation of specimen on suspected cases of cholera, measles, Buruli ulcer etc. to regional level for investigation and confirmation.
5. Epidemic management committee meetings
Bacillary Dysentery suspected cases increased from 5 in 2015 to13 in 2016. Cholera cases have not been recorded in 2015 and 2016 which is great.
Special Initiatives to Increase Access
Access to health services in the district is challenged by staff inadequacy, poor road network, and infrastructural problems among others. In the midst of these challenges however, it is expected that people in the district benefit from scientific health care delivery that is affordable as well. In view of this, strategies were mounted to improve access among which sensitization on the National Health Insurance (NHIS) and the CHPS concept were paramount. The maps below show accessibility to health service in various factions.
The first map depicts that, most communities lie outside 5km proximity to a health facility be it a CHPS, health centre or hospital. In the second map however, all communities can be accessed in 2km proximity within the reach of an outreach point. This informed the district in mounting strategies to improve CHPS and outreach sessions since it is through this system that everybody in the district can be reached. The third map also shows accessibility and distribution of midwives in the district.
Communities outside the inner pink buffer do not have access to a midwife in 2km radius. By expanding it to 5km radius, there still remain many other communities that lie outside. With this as the situation, the DHA met with partners and all other stakeholders to discuss how access of quality and holistic health care could be delivered. Opinion leaders and stakeholders readily supported the distant CHPS concept as a start up in improving access.
In the period under review a special initiative was adopted by the DHA which encourages communities interested in health services at their door steps to get a structure and accommodation for health staff and purchase basic health equipment and the district health administration will also assign a community health nurse to that community. With these initiative eight (8) new CHPS zones have made functional with CHOs stationed there to provide health services to the people boosting the district functional CHPS from 7 to 15 in 2016.
Fig 1.5 Access to Health
Alternative Health Service Delivery (Traditional System):
Additionally, there are many traditional healers who serve as the first point of contact for health-seeking residents of deprived areas. The Traditional Medical system is another system of health care in the district which helps them a lot. The system offers treatment in specialized areas for about 60% of the population especially those in the rural areas. Specialized areas of treatment include: bone setting, snake bites, stomach upsets, and general conditions of ill health.
Mode of treatment include: consultations of spirits to diagnose condition and identify appropriate herbs, administering of drugs prepared from herbs into decoctions, tea, paste and the use of talisman and herbs by practitioners to cure and drive away evil spirits that are suspected to be the cause of a particular ailment. The survey identified a limited number of traditional medical practitioners operating in the district as indicated below.
HIV and AIDS
HIV/AIDS has been a peculiar challenge to the Upper Manya Krobo district over the years. It has been the top cause of hospital mortality and always appears to be one of the top ten causes of admissions in the hospital. Total cases recorded at OPD over the years have also been significant. Most patients with the HIVAIDS diseases are superstitious and report very late which results in high mortality. The district carried out several interventions on HIV/AIDS during the period with support from the National and Regional level and other stakeholders. These include testing and counselling at static, prevention of mother to child transmission (PMTCT), health education and promotions and other campaigns.
Key Issues on HIV/AIDS
High incidence of HIV/AIDS among youth and pregnant women. (About 11% of positive cases are teenagers)
Inadequate and infrequent supply of materials and resources
High TB rate among HIV/AIDS clients
Testing and Counselling (TC)
Testing and counselling services over the past five years has been unstable. Clients are tested and counselled on their HIV status. The number testing positive are enrolled into care. Number of clients screened and tested for HIV/AIDS has been reducing over the years. In 2015, there was a major problem with test kits (Ora quick) supply partly leading to less testing in 2015. Testing dropped from 1080 in 2014 to 888 in 2015 and further dropped to 810 in 2016.
Prevention of Mother-To-Child-Transmission (PMTCT)
A major intervention strategy employed to reduce HIV/AIDS transmission is the Prevention of Mother-to-Child Transmission. It includes all measures to reduce the transmission from an infected mother to the unborn child. The trend of PMTCT services from 2009 to 2016 is as show in the table below. PMTCT – summary, 2009 -2016