2010 Annual Performance Report

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2010 ANNUAL PERFORMANCE REPORT

WA MUNICIPA HEALTH SERVICE
PREFACE This is 2010 performance review report of the Wa Municipal Health Service. It is an account of activities and achievements (inputs/outputs) for the reporting period. The Municipal Health Service is the key service provider with the responsibility for public service delivery in the municipality; plays a key role in the process by ensuring complete and accurate reporting on the performance of sub-municipals and private providers in the delivery of services. This is in line with the Ghana Health Service Five Year Programme of Work which demands the organization of performance hearing sessions by Budget and Management Centers which eventually culminates in annual reports by regions and national divisions. The annual review process started at the sub-municipal level. This involved an internal review of Sub-municipals performance based on their annual plans and targets and achievement over the period as well as the private providers. The Municipal Health Administration then collated the reports from the Sub district, the District Health Administration, and private providers. The reports include various activities undertaken in collaboration with the District Assemblies and other decentralized agencies. A Municipal performance hearing session was then held which included all stakeholders in health at the Municipal level. This forum provided the opportunity for each stakeholder, including the private providers to present an account of their performance and to highlight key challenges for discussions. A way forward for the New Year was carved out taking care of the identified gaps for bridging during the year. Comparisons are made with the previous three years same period wherever possible. The report is divided into six chapters. Chapter one is the introduction, which captures a brief profile of the municipality and the district health system. Chapter two looks at healthy lifestyles and environment. Chapter three takes care of health, reproduction and nutrition services. General health system strengthening makes up Chapter four. Chapter five covers governance, partnerships and sustainable financing. The sixth chapter is innovations / best practices and the annexes. Madam Beatrice Kunfah (MDHS)
Compiled by Municipal Health Information Unit
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TABLE OF CONTENT
PREFACE TABLE OF CONTENT LIST OF TABLES LIST OF FIGURES CHAPTER ONE: INTRODUCTION 1.1 BACKGROUND INFORMATION ABOUT THE DISTRICT 1.2 KEY ACTIVITIES DURING THE YEAR 1.3 MAJOR CHALLENGES 1.3 NON ACHIEVEMENTS CHAPTER TWO: PUBLIC HEALTH SERVICES 2.0 DISEASE CONTROL 2.1 ADOLESCENT HEALTH AND REPRODUCTIVE SERVICES 2.2 SAFE MOTHERHOOD 2.3 EXPANDED PROGRAMME ON IMMUNIZATION (EPI) 2.4 NUTRITION CHAPTER THREE: CLINICAL SERVICES/INSTITUTIONAL CARE 3.1 IMPROVE QUALITY OF CLINICAL CARE 3.2 SPECIAL INITIATIVES TO INCREASE ACCESS CHAPTER FOUR: SUPPORT SERVICES 4.1 HUMAN RESOURCE DEVELOPMENT 4.2 HEALTH INFORMATION MANAGEMENT 4.3 ESTATES AND EQUIPMENT 4.4 STORES 4.5 TRANSPORT 4.6 FINANCIAL MANAGEMENT 4.7 CHALLENGES 4.8 WAY FORWARD ANNEX A: PERFORMANCE INDICATORS 1 2 3 4 5 5 8 9 10 11 11 19 27 36 37 43 43 46 57 57 58 60 64 66 71 80 81 82
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LIST OF TABLES
Table 1: Projected Health Target Populations 2010 Table 2: Meningitis Case Fatality Rates, 2008-2010 Table 3: Investigations on Reported Meningitis cases Table 4: Incidence of Measles, 2008-2010 Table 5: AFP Rate, 2008-2010 Table 6: Pandemic Influenza H1N1 Vaccination Coverage Table 7: Sub- Municipality National Immunization Days Coverage against Poliomyelitis in 2009 and 2010 Table 8: STIs/Adolescent Health Services & other high risk cases Table 9: Trend in Teenage Pregnancy Early Teens (10-14 Yrs) Table 10: Trend in Teenage Pregnancy late Teens (15-19 Yrs) Table 11: Number of Adolescents Counseled Table 12: Number of Adolescents receiving Family Planning services Table 13: Adolescents Counseled and Treated On STIs Table 14: Vaginal discharges treated. (Females only) Table 15: Urethral Discharges Treated (Males Only) Table 16: Genital Ulcers Table 17: Genital Warts Table 18: Prevalence of wasting, stunting and underweight of Children 0-5yrs, 2010 Table 19: Trend of Inpatient Rehabilitation of malnourished children Table 20: Coverage of children and mothers of SFP Table 21: Market Salt Survey results, 2007-2009 Table 22: Top Ten Causes of OPD Attendance 2008-2010 Table 23: Admissions, Deaths and Death Rates at Regional Hospital, 2008-2010 Table 24: Bed Occupancy Rate and Average Length of Stay at the Regional Hospital) Table 25: Summary Human Resource capacity by Sub Municipals, 2010 Table 26: Donations Table 27: Summary of Vehicles Inventory Table 28: Summary of Motor bikes Inventory Table 29: Sub Municipals Motor Bikes Fleet Status Table 30: Vehicles Statistics Compared Table 31: Analysis of Motor bikes KPIs Table 32: Analysis of Vehicles KPIs Table 33: Total Inflows and Expenditures Table 34: Income and Expenditure on GOG and Donor Pool Funds (DPF) for 2008 - 2010 Table 35: Analysis of Expenditure on GOG Administration for the year under review Table 36: Analysis of expenditure on the GOG service for the year under review Table 37: Expenditure on DPF Table 38: Program Funds - Inflow Table 39: Expenditure On Program Funds Table 40: Analysis of IGF Revenue Table 41: Revenue Analysis by Facility - 2010 Table 42: Expenditure Categories For The Past three Years Table 43: Investment figures for the Sub Districts 6 11 11 12 13 14 17 21 21 21 22 23 24 24 25 25 26 38 39 40 42 43 45 45 57 65 66 67 67 68 70 71 72 72 73 73 74 74 74 77 77 78 79
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LIST OF FIGURES
Figure 1: Map of Wa Municipal 5 Figure 2: Filariasis MDA Coverage by Sub Municipals 16 Figure 3: NID Coverage by Sub Municipals 18 Figure 4: Reported cases of Hypertension 2005-2010 18 Figure 5: Reported Cases of Diabetes from 2008-2010 19 Figure 6: Antenatal Coverage by Sub Municipalities, 2008-2010 27 Figure 7: 3rd Trimester Registration, Average visits per Registrant and proportion making four visits, 2007-2010 28 Figure 8: Trend of ANC, Skilled Delivery and PNC coverage (2008-2010) 29 Figure 9: Percentage Coverage of Skilled Deliveries by Sub Municipals, 2008-2010 29 Figure 10: Number of TBA Delivery by Sub Municipalities, 2008-2010 30 Figure 11: Trend of Caesarian Section at Regional Hospital, 2003-2010 31 Figure 12: Institutional Maternal deaths and ratios, 2003-2010 32 Figure 13: Still births at the regional hospital, 2003-2010 33 Figure 14: Neonatal Deaths for 2010 33 Figure 15: Coverage of PNC by Sub Municipals, 2008-2010 35 Figure 16: Family Planning Acceptors 35 Figure 17: Coverage for Penta, 2010 36 Figure 18: BCG and Measles Coverage by Sub Municipals 37 Figure 19: Annual Malnutrition rates among Children under-five years 39 Figure 20: Total OPD Attendance and Attendance per Capita, 2009-2010 44 Figure 21: Trend in Per capita OPD Attendance by Sub Municipals, 2008-2010 44 Figure 22: Contribution of CHPS to some Service Indicators, 2010 48
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CHAPTER ONE: INTRODUCTION

1.1 Background information about the district The Wa Municipal is one of the nine districts in the UWR and its capital is also the regional capital. It attained its municipal status with effect from August 2004, when the then Wa District was split into three districts; Wa East, Wa Municipal and Wa West.
It is located in the northern savannah part of the country between Latitudes 8o 30" - 10o N and Longitude 0o 30" - 2o 30" W. The municipality shares common boundaries with Wa East district to the east, Wa West District to the south and west, and Nadowli district to the North
Figure 1: Map of Wa Municipal
Nadowli District
Wa East District
Wa West District
Wa West District
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1.1 Demographic characteristics The 2000 population census gave Wa Municipal a total population of 98,576 and Wa town has 51,302 i.e. 52.84% with a population growth rate of 4%. (Source: Ghana Statistic Service). The Municipal has a population of 116, 460 for the year 2009 (given by the region), projected from the 2000 population census, using a growth rate of 2.7%. It has 132 communities with one paramouncy, 4 area councils and 1 urban council.
Table 1: Projected Health Target Populations 2010

2010 Projected Population 0 - 11 Months (4% popn) 0 - 23 Months (8% popn) 0 - 59 Months (20% popn) Expected pregnanci es (4% popn) WIFA (24% popn) 6-11 Months (2% popn)
SUB-MUNICIPAL
BAMAHU BUSA CHARIA CHARINGU KAMBALI WA CENTRAL TOTAL
10,154 9,136 9,468 11,113 15,724 62,609 118,205
406 365 379 445 629 2,504 4,728
812 731 757 889 1,258 5,009 9,456
2,031 1,827 1,894 2,223 3,145 12,522 23,641
406 365 379 445 629 2,504 4,728
2,437 2,193 2,272 2,667 3,774 15,026 28,369
203 183 189 222 314 1,252 2,364
The major ethnic groups in the municipality are the Walas and Dagaabas, and other tribes in the minority. It is a male dominated community with polygamy and discrimination against women in lifes choices including health, education and engagement in economic activities.
1.1.2 Geo-climatic Conditions The municipality lays in the savannah high plains with a rather short rainy season that is from May to September each year. The erratic nature of the rainfall impacts poorly on crop production. Temperatures are lowest in the early parts of the dry season (December/January and highest in the latter part of the dry season (March/April) with average monthly maximum of 38.5C and a daily highest temperature of 43C in March. Vegetation is the guinea savannah grassland type, made up of short trees and shrubs of varying heights and luxuriance, with grass ground cover in the wet season. Commonly occurring trees are Shea-trees, Baobab, Cashew, Mangos and Dawadawa.
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1.1.3 Socio-Economic Environment With the exception of Wa, the remaining settlements are predominantly rural, 80% of the people are engaged in subsistent farming and little scale livestock and poultry rearing. Agricultural production is mainly rain fed during a short spell of rainy season (May October) followed by a prolonged dry season. Commercial activities like Shea butter extracting, local soap manufacturing, pito brewing, weaving, dress/smock making, carpentry, masonry etc. are on small scale and mainly done around Wa. The formal sector offers employment for public/civil servants, teachers, nurses etc. Construction and hostel/hotel services are other source of economic activities for a few. The unemployment rate especially among the youth is unacceptably high and this accounts for a lot of out migration to the commercial towns in the south. There is high poverty rate in the municipality, at the individual, household and community levels. There is empirical evidence that the Upper West Region has a high incidence of poverty (86% of the population fall below the U.N accepted poverty line) Source Municipal Assembly. There is low job market, employable skills, and income ventures Wa and some of the communities are connected to the National Electricity grid. Telephone facility is very good including four mobile network systems. On transportation, the Municipality has good road network and virtually all the Wa town roads have been tarred. There is a central transport station in the Wa Town but the vehicles that convey goods and services are old. Internal circulation is mainly by motorbikes, bicycles, private saloon cars and a few commercial taxis.
The Municipality has three FM radio stations that broadcast in English and two local languages (Dagaare and Sissali); one serves mainly the university population.
1.1.4 Socio-Cultural Characteristics 1.1.4.1 Education It is estimated that only about 15% of the adult population of the municipal are literate. There are a total of 110 primary, junior and secondary/technical schools and 2 higher institutions; integrated development studies faculty of the University for Development
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Studies (UDS) and the Wa Polytechnic. These impacts on the burden of health service delivery when they are on campus. 1.1.4 Political Governance The highest political authority is the Municipal Assembly headed by the Municipal Chief Executive (MCE) who is appointed by the president. The Municipal Assembly has the responsibility of formulating and executing Programmes and projects. It is also entrusted with the responsibility of formulating strategies for effective and sustainable development of the people within its jurisdiction. 1.2 Key Activities during the year Held 4 procurement committee meetings to plan medicines and logistics and review procurement of
Held one audit committee meeting to discuss and respond to audit queries Held two Iodated Salt committee meetings to plan and monitor iodated salt consumption in the municipality. Monthly staff meetings held in all sub municipalities to review activities, strategies and performance. Quarterly SDHMT meetings with opinion leaders, community representatives to discuss health activities and plan service delivery. Community meetings with TBAs, Volunteers and traditional authorities Held 8 CHPS review meetings to provide feedback on facilitative supervision and share experience on CHPS implementation Review meetings with stakeholders TB/HIV/AIDS, malaria Facilitative Supervision Quarterly FSV and feedback to Sub municipalities- 100% Monthly FSV to CHPS zones by SDHT- 65%coverage Night Videos Conducted night videos covering 20 communities to create awareness on HIV/AIDS,TB, CAC, and maternal Health issues Surveys
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Conducted nutrition surveillance to determine the nutritional status of the people Iodated Salt survey in the households and markets House hold visits Municipality zoned for surveillance and data validation monthly Used radio programs to sensitize the general on various health issues Durbars and Campaigns Quarterly durbars are held at CHPS zones and sub municipalities to provide feedback and plan for activities. Furnished and commissioned five health facilities(Market, Dobile, Kambali, Adolescent Health center and Busa health centers.) for integrated services Refurbished two facilities for PMTCT services (Busa and Bamahu health centers) Renovated Charingu Health center and Staff quarters Carried out Know Your Status Campaign for HIV over 6,000 people Conducted National campaigns for Polio, HINI, and Measles SIA, IMCH campaign, CSM immunization, CHPW activities and mass drug administration against lymphatic filariasis. Furnished and Launched one CHPS zone at Piisi Outreach Programmes
1.3 Major Challenges Improving the Quality of services- ANC, Immunization High maternal, neonatal and Stillbirths Increasing burden of communicable and non-communicable diseases Poor data management and utilization
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Staff attitude and indiscipline High attendance and overcrowding in some health facilities High mobility and poor community mobilization especially in Town Drug management in Health facilities 1.3 Non Achievements Medical screening of health staff Staff attitude Quality of services dropout rates Client and staff satisfaction surveys
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CHAPTER TWO: PUBLIC HEALTH SERVICES 2.0 Disease Control

2.01 Communicable Diseases
2.012 Meningitis
A total of 65 cases with 21 deaths (CFR of 32.8%) were recorded during the year 2010 as compared to 21 cases with 7 deaths in 2009, and 30 in 2008 with 3 deaths of the same period. Twenty six (26) cases and 9 deaths (CF of 34.6%) of the total cases reported from the reg. hosp. were from Wa Municipal. Table 2: Meningitis Case Fatality Rates, 2008-2010 2008 Cases Bamahu Busa Charia Charingu Kambali Wa sub Reg Hosp 2 2 2 0 6 18 0 Deaths 0 0 0 0 1 2 0 C/F 0 0 0 0 16.7 11.1 0 Cases 4 0 1 1 5 10 0 2009 Deaths 2 0 0 1 1 3 0 C/F 50.0 0 0 100.0 20.0 30.0 0 Cases 2 1 5 1 3 14 39 2010 Deaths 0 1 1 1 2 4 12 C/F 0.0 100.0 20.0 100.0 66.6 28.6 30.8
Total 30 3 10.0 21 7 33.3 65 21 32.3 About 56.9% (37) of all the suspected cases reported were investigated in the laboratory (table 15). Health education with emphasis on early report was the primary activity given to affected communities. All facilities were also monitoring their Meningitis thresholds and reporting to the next levels for action. Table 3: Investigations on Reported Meningitis cases Indicator Total cases Total Deaths LP/CSF examined Neisseria Meningitides N. Meningitis W135 2009 21 7 11 0 0 2010 65 21 37 3 5
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Strep Pneumonae Negative No organism seen No Results CSM CFR Other Meningitis CFR
2.013 Measles
4 3 4 0 33.3 0
8 21 0 0 32.3 0
During the half year of 2010, 13 cases of suspected Measles were reported as against 1 case and 20 case reported in 2009 and 2008 respectively. The target is at least one suspected case of measles with blood specimen collected during the year. Blood samples were taken on 11 cases in 2010. The MHD only received feedback from the Department of Surveillance that two (2) cases were confirmed Rubella positive. Table 4: Incidence of Measles, 2008-2010 Sub municipal Bamahu Busa Charia Charingu Kambali Wa-Sub Reg. Hospital Total
2.014 AFP Surveillance
2008 0 0 0 0 0 0 0 0
2009 0 0 0 0 0 5 0 5
2010 0 1 0 0 2 7 4 14
For the first half of the year, AFP surveillance has been intensified both at the facility and community levels. Two active case searches were carried out by volunteers during the NIDs activities in February and March respectively. Despite all these efforts, no case of AFP was detected. We would still continue to sensitized Health staffs, community members and volunteers so that we can detect at least two (2) cases of A F P before the year end since we are mandated to meet the minimum target of at least 2 AFP case per 100,000 populations in children less than 15 years. Table 17 below shows the AFP surveillance performance of the Municipality in 2008, 2009 and 2010.
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Table 5: AFP Rate, 2008-2010 AFP rate (per 100,000 % AFP Cases with stool Population of Children <15 specimen within 14 days of years onset of Paralysis 2008 Bamahu Busa Charia Charingu Kambali Wa-Sub Municipal Total 0 0 0 0 0 1 1 2009 0 0 0 1 1 0 2 2010 0 0 0 0 1 0 1 2008 0 0 0 0 0 100 100 2009 0 0 0 100 100 0 100 2010 0 0 0 0 100 0 100
Sub municipal
2.015 Cholera
There has been on reported cases of Cholera within the Municipality in the past including the period under review. Despite this, the MHD still intensify surveillance on the disease as we effectively monitor and investigate the incidence of diarrhoea diseases weekly and more especially during the rainy season.
2.016 Yellow Fever
For the period under review, no Yellow Fever case was detected within the Municipal despite the intensified surveillance activities that have been going on at all facilities. Measures are being put in place to suspect all jaundice cases as yellow fever so that samples can be taken for further laboratory investigations.
2.017 Pandemic Influenza A (H1N1)
Since the confirmation of the Pandemic Influenza A H1N1 2009 in June 2009 by the Director General of the WHO, the Wa Municipal Health Directorate inconsonance with GHS call to step-up surveillance on the disease also marshal efforts to detect all suspected case of influenza and investigate them.
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During the period under review a total of one hundred and six (106) cases were suspected and specimen take and sent to NOGUCHI Medical Memorial Research Institute for investigation and confirmation. Four (4) of these cases were confirmed positive for the disease. All the cases and contacts were treated with Tamiflu capsules. The MHD also received 11,430 doses of Pandemic Influenza Vaccine from the Regional Health Directorate to vaccine 10% of Municipal total population (11,821). The main targets of for the vaccination were; Health Workers, Pregnant Women, Security Officers, Chronic Disease and International Travellers. The vaccination was extended to other populations mostly students within the Municipality. A total of 10,561 people were vaccinated, a coverage 89.3%. Only one person reported with a swollen arm as well as local reaction at the site vaccination and it was managed. Table 18 below shows the performance of the exercise by Sub-Municipalities
Table 6: Pandemic Influenza H1N1 Vaccination Coverage

Sub-Mun Total Pop Target Pop Bamahu Busa Charia Charingu Kambali Wa Central Reg. Hosp. Total 10154 9136 9468 11113 15724 62609 0 118205 1015 914 947 1111 1572 6261 0 11821 41 41 70 35 73 47 328 635 0 0 0 3 0 287 0 290 Health Workers Security officers Preg Women 176 86 77 95 326 269 29 1058 90 9 19 25 92 187 116 538 1 0 0 0 0 3 0 4 305 538 1154 24 1144 4560 311 8036 Chronic Disease Int. Travellers Others Total Vacc 613 674 1320 182 1635 5353 784 10561 Cov (%) 60.4 73.8 139.4 16.4 104.0 85.5 12.5 89.3
2.02 Diseases Targeted for elimination and eradication

2.021 Guinea Worm eradication
Wa Municipal as part of measures to break the chain of transmission of Guinea Worm (GW) disease, has intensified surveillance in all communities in the Municipality so as to detect any case of the disease in the lesion (Blister) state adequately contain it.
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In the light of the above the MHD trained heath workers in the MHD and Sub-Municipalities and CBSVs in all communities on Integrating GW surveillance into the IDSR system. A total of 45 health workers, 127 CBSVs were trained. Community Based Surveillance registers were also distributed to all CBSVs. Registers to summarize monthly records captured by the volunteers was also distributed to all SubMunicipalities to capture CBSVs monthly data and transmit the MHD. All the above activities were funded by the GHS/WHO/GW Surveillance Project that has the mandate of ensuring that GW disease is eradicated in the Ghana in 2010 and to prepare the country for GW free certification by 2014. Active case search has been carried in thirty six (36) communities and one thousand five hundred and eighty four people were physically examined and health educated on the mode of transmission and prevention of GWD with emphasis on prompt reporting of all suspected boil to any health facility or health personnel. During the period under review three (3) suspected GW diseases were detected, investigated and reported to next level. They were all unconfirmed cases.
2.022 Filariasis and Onchocerciasis
The Lymphatic Filariasis Elimination and Onchocerciasis Control Programmes were merged in 2003 and have since been undertaking joint programme activities where possible. The Ghana Filariasis Elimination Programme completed 6 rounds of programme implementation in 2007, having started annual Mass Drug Administration in 2001. The main aim of Filariasis Elimination Programme is to control lymphatic Filariasis as a public health problem. The strategies employed by the programme are mass drug administration and morbidity control. The MHMT organized one day training on Neglected Tropical Diseases (with special focus on Filariasis Mass Drug administration on 13th January, 2010. Participants were taken through a brief overview on the Neglected Tropical Diseases Programme and told that several control programmes in Ghana covering major diseases such as Trachoma, Filariasis, Schistosomiasis and intestinal worms overlap geographically. It was emphasized that three programmes use the same drugs for treatment of some patients, for example, albendazole is use for both lymphatic Filariasis as well as schistosomiasis control programmes. These programmes also use the same strategy i.e. mas drug distribution by health workers and community based volunteers.
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In view of the existence of these common factors, there is the need to integrate these related activities in order to maximize the use of the available resources. The disease Filariasis is vector borne and mainly transmitted by mosquitoes. It is characterized by fever, swollen and painful lymph nodes and the lymphatic vessels. The DCD therefore has as an aim to eliminate lymphatic Filariasis as a Public health problem in the Upper West Region and for that matter Wa Municipal. As part of the objective of the Filariasis Elimination Programme of reducing the morbidity and mortality, the administration organised training for some selected volunteers and health workers to carry out one of the specific strategies of Mass Drug Distribution. 95.0 90.0 85.0 80.0 75.2 75.0 70.0 65.0 Kambali Charingu Charia Bamahu Wa Central Busa Municipal 77.9 85.0 87.2 89.1 89.9 84.7
Figure 2: Filariasis MDA Coverage by Sub Municipals

2.023 Leprosy
The goals of leprosy elimination programme in Ghana is to reduce the prevalence rate of leprosy from 1-15 and the global elimination target of less than 1-0 per 10,000 population within a fully integrated programme. The municipal objective for 2010 is to intensify disease surveillance and active case search so as to reduce the proportion of new cases presenting with disability grade 2 to less than 5%. Key activities under taken were: Routine disease surveillance /monitoring within all Health Facilities in the Municipality Integration of active case search endemic communities with other routine health interventions Awareness creation in communities Encouraged all registered cases to take their treatment regularly and completely within the given period. Decentralization of treatment of all Leprosy cases at the Sub-Municipal level
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For the period under review, 7 new cases of leprosy were detected compared to 6 and 5 in 2009 and 2008 same period respectively as indicated on table 13 below. All these case are put on treatment at the respective Sub-Municipalities and are being monitored by the Municipal Leprosy Technical Officer. For the rest of the months, integrated case search and health education activities will be intensified. Sub Municipal staff and CBAs will be supported on case detection and early reporting in their communities Table 13: Incidence of Leprosy, 2008-2010 Sub municipal Bamahu Busa Charia Charingu Kambali Wa-Sub Total
2.024 National Immunization Days against Poliomyelitis
2008
2009
2010
The GHS in the final raise to eradicate Poliomyelitis carried out two rounds of mass campaign (National Immunization Days) against the disease in February and March 2010 as the same period in 2009. Wa Municipal Health Directorate also joined this crusade with the participation of all Submunicipalities and partners. The three days exercise for each round was successfully carried out with the following achievements on the table 19 below.
Table 7: Sub- Municipality National Immunization Days Coverage against Poliomyelitis in 2009 and 2010
SubMunicipality BAMAHU BUSA CHARIA CHARINGU KAMBALI WA CENTRAL TOTAL
2009 Rd1 (Feb) No. Vacc 2622 1306 2031 2085 4708 10399 23151
Cov 97.3 99.7 97.2 99.9 100.0 101.0 99.9
Rd2 (March) No. Vacc Cov 2938 100.0 1387 100.0 2684 99.2 2406 100.0 6360 98.1 14170 99.0 29945 99.0
2010 Rd1 (Feb) No. Vacc 2452 1352 2769 1604 5836 15236 29249
Cov 86.8 91.0 103.7 83.2 112.1 101.8 100.6
Rd2 (March) No. Vacc Cov 2468 87.4 1340 90.2 2424 90.8 1463 75.9 6789 130.4 14096 94.2 98.3 28580
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The bar chart below shows the performance of Sub-municipalities during the round one and two of the 2010 NIDs. Kambali-Sub constantly increases in their coverage during all the rounds while only Charingu-Sub and Bamahu-Sub fell below the minimum coverage of 90%. 140 120 100 80 60 40 20 0
NID R1'10 NID R2'10
NIDs ROUNDS 1 & 2 - 2010
Percentage
Bamahu 87 87
Busa 91 90
Charia 104 91
Charingu 83 76
Kambali 112 130
Wa Central 102 94
Municipa l 101 98
Figure 3: NID Coverage by Sub Municipals
2.03 Non-Communicable Diseases

2.031 Hypertension
1200 1000 No of cases 800 600 400 200 0 MALE FEMALE TOTAL 2005 32 68 100 2006 231 367 598 2007 124 266 390 2008 173 308 481 2009 419 692 1111 2010 209 673 882 R = 0.6759
Figure 4: Reported cases of Hypertension 2005-2010
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2010 ANNUAL PERFORMANCE REPORT 2.032 Diabetes Mellitus
160 140 120 100 80 60 40 20 0 MALE FEMALE TOTAL
No of cases
R = 0.0954
2008 15 10 25
2009 118 21 139
2010 26 35 61
Figure 5: Reported Cases of Diabetes from 2008-2010 2.1 Adolescent Health and Reproductive Services Adolescent Health and Development Programme (ADHD) is an integral part of the Reproductive and Child Health programme .The ADHD aims at promoting the health of the youth by preventing and responding to their health problems from Sexual Transmitted Infections(STIs), Alcohol &Drug abuse, unwanted pregnancies, Violence &injuries, etc. Adolescent health key interventions includes providing accurate information, counseling and provision of youth friendly health services, building life and livelihood skills , creating safe and friendly health facilities, etc. Adolescence is a transitional period between childhood and adulthood. It is a period of rapid physical, psychological and social changes. Adolescence is also a period of excitement, questioning and difficult decisions making. Adolescent Health is thus the positive concept which comprises of physical mental and social well-being and not absence of disease or infirmity during the period of adolescence.
2.11 objectives
To increase adolescents access to general health services including sexual and reproductive health care without fear. To change or modify the behavior/attitude of health care providers within the municipality towards adolescents health issues. To involve and build competencies of all key stake holders e.g parents, teachers, chiefs etc. in the concept of adolescents health services.
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To truck, document and analyze all data generated by sub municipals from adolescent friendly health services. To integrate adolescent health service key indicators into municipal FSV monitoring tool
2.12 Key Strategies
Provision of adequate and accurate information on adolescent health issues Counseling and testing on control of sexual Transmitted Infections Treatment of sexual transmitted infections Provision of adolescents friendly health services Formation of adolescents clubs in communities and schools Documentation of all adolescent friendly health services Monitoring and supervision of adolescent health activities
2.13 Key Activities in Adolescent Health Services
1. Integrated durbars on adolescents health services 2. Counseling on general health issues with emphasis on reproductive health and sexual transmitted infections(STIs) 3. Formed adolescents clubs in 3 communities 4. Held monthly meetings with the Adolescents/STIs youth clubs 5. Identified and treated some adolescents with STIs and other diseases 6. Held meetings and discussions with Commercial Sex Workers (CSW) and Roamers in the municipality.
2.14 Activities with the Support of Plan Parenthood Association of Ghana (PPAG)
Trained 75 Peer educators in 35 communities Identified 4 health facilities(Busa, Bamahu, Dobile& STIs Clinic)to establish for adolescent friendly health services Identified and trained 8 health staff from the above health facilities on the provision of adolescents friendly health services Weekly airtime on adolescent reproductive health issues and STIs control Trained some teachers on how to encourage adolescents learn in schools without fear Sampled and trained some parents from the 35 communities on the developmental changes and behavior of adolescents in their homes.
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Table 8: STIs/Adolescent Health Services & other high risk cases ACTIVITIES Number of STI clients/adolescents seen. Number of referrals from outreach services Number of C.S. W. and other At risk cases seen for Counseling & services Number of C.S.W./Roamers counseled & Rendered services Number of adolescents counseled & tested for HIV/AIDS Number of adolescents HIV positive Number of HIV positive cases referred for ART ANC Adolescents aged (10-14 years) ANC Adolescents aged(15-19yrs) 2008 474 760 23 100 108 7 7 2 102 2009 540 342 100 84 82 2 2 1 248 2010 946 447 82 45 79 2 2 6 383
2.15 Teenage Pregnancy
Table 9: Trend in Teenage Pregnancy Early Teens (10-14 Yrs)

SUB-MUNICIPALS BAMAAHU BUSA CHARIA CHARINGU WA-CENTRAL Regional HOSPITAL KAMBALI MUNICIPAL TOTAL NO. 1 0 0 0 0 1 0 2 2008 % 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 NO. 1 0 1 0 0 2 0 4 2009 % 0 0 0 0 0 0.1 0 0.03 NO. 0 0 2 0 1 0 3 6 2010 % 0 0 1.4 0 0 0 0 0.07
Table 10: Trend in Teenage Pregnancy late Teens (15-19 Yrs) SUB-MUNICIPALS BAMAAHU BUSA CHARIA CHARINGU WA-CENTRAL WA-HOSPITAL KAMBALI MUNICIPALTOTAL 2008 NO. 8 7 5 0 42 33 7 102 % 5.1 4.1 6.1 0 6.4 4.6 1.5 4.4 NO. 25 54 27 35 80 163 72 456 2009 % 10.1 13.1 12 13.8 11.2 5.1 12.2 9.8 NO. 25 29 25 21 55 138 90 383 2010 % 5.6 10 9.8 6.5 8.9 4.2 9.8 7.5
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Except Charingu all health facilities recorded high cases of teenage pregnancies and should account for the cases accordingly. Wa central should further segregate their figures to enable site clinic staff and midwives account for cases seen. All teenage pregnancies identified by health care providers must be monitored till delivery and also seen through postpartum with continuous care. Regional Hospital public health unit to support Maternity wing link teenage mothers to their specific sub municipalities to ensure continuity of care. Formations of both in school and out school adolescents clubs in communities and schools can support reduce this unpleasant trend.
2.16 Adolescent counseling sessions
Table 11: Number of Adolescents Counseled

H/F Bamahu Busa Charia Charingu Kambali Wa Central TOTAL 2008 1014 45 90 223 123 148 548 1,177 1519 145 134 200 167 172 610 1,428 2024 113 143 202 192 213 978 1,811 TOT 323 367 625 482 533 2136 4,466 2009 1014 98 90 213 206 200 838 1,645 1519 189 102 578 276 234 992 2,371 2024 299 177 900 299 678 1586 3,939 TOT 586 369 1691 781 1412 3416 8,255 2010 1014 111 128 645 285 259 1592 3,020 1519 388 148 1079 298 291 1933 4,137 2024 460 168 1180 323 785 3137 6053 TOT 959 444 2904 906 1335 6662 13,210
It is realized that there has been improvement in the number of adolescents counseled by health staff in the year under review and this could mean that, health staff are now committed and also improve in documentation of adolescent health activities .This could also be due to the support offered the municipality by PPAG. The specific counseling topics include: HIV/AIDS and STIs Teenage pregnancy Drug Abuse and Sexual Abuse Rape and Defilement. Carrier achievement Mental Health etc.
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Bamahu, STIs/Adolescents clinic& Busa referred five (5) adolescents with pregnancies to the Regional hospital for comprehensive Abortion Care (CAC) Two defiled cases reported to the Adolescents /STIs clinic were also referred to the regional hospital for further investigations and management.
2.17 Adolescents Family Planning
Family planning (F/P) patronage among adolescents is paramount and so, health care providers should encourage them to practice F/P to prevent unwanted pregnancies and death from unsafe abortions. Table 12: Number of Adolescents receiving Family Planning services
H/F 2008
1 014yrs 1519yrs 2024yrs TOT
2009
1014yrs 1519yrs 2024yrs TOT
2010
1014yrs 1519yrs 2024yrs
TOT 329 225 82 126 258 386 1406
Bamahu Busa Charia Charigu Kambali Wa Central TOTAL
0 0 0 0 2 0 2
7 2 23 17 34 158 241
78 24 24 45 78 130 379
85 26 47 62 114 288 622
1 3 1 0 4 2 11
57 65 19 23 53 34 251
98 88 40 67 99 92 484
156 6 156 60 90 156 128 5 0 1 6 10
130 88 23 53 59 88 441
193 132 59 72 193 288 937
746 28
There is an increase in the number of adolescents seeking Family Planning services in the year under review. Series of trainings and meetings were conducted for health care providers on adolescents Friendly Services and attitudinal change towards adolescents. Health providers are now realizing the importance of adolescents care. As l also mentioned earlier on, there is improvement in the documentation of adolescent health activities. With the support of PPAG, there is also weekly radio airtime on adolescent health issues and where they can obtain services. Though there is an increasing trend in adolescents practicing F/P, health providers still have to encourage them to improve on their health seeking behaviour.
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Table 13: Adolescents Counseled and Treated On STIs H/F

10-14 15-19
2008
20-24 10-14 15-19 TOT
2009
20-24 10-14 15-19 TOT
2010
20-24
TOT 108 126 28 30 213 441 946
Bamahu Busa Charia Charingu Kambali Wa Central TOTAL
0 0 0 0 2 6 8
8 10 9 8 46 111 192
10 15 10 10 54 175 274
18 25 19 18 102 292 474
0 1 1 0 1 8 11
12 14 12 10 51 118 217
15 20 14 13 62 178 302
27 35 37 23 114 304 540
0 0 2 1 2 12 15
37 34 10 10 64 192 347
71 92 16 20 147 237 583
The number of adolescents reporting with STIs for management has improved drastically in the year under review and this could be due to the increased number of peer educators that refer cases to the health facilities for treatment. The weekly radio airtime on the causes and signs and symptoms of the various STIs could also encourage adolescents to report with conditions they were suffering from. The series of trainings and information on health providers attitude towards adolescents could also contribute to this achievement. Table 14: Vaginal discharges treated. (Females only) H/F 2008 10-14 15-19 20-24 10-14 15-19 TOT 2009 20-24 10-14 15-19 TOT 2010 20-24 TOT
Bamahu 0 1 4 5 0 2 7 9 0 3 11 14 Busa 0 1 0 1 0 0 0 0 0 0 0 0 Charia 0 0 1 1 1 0 0 1 I 0 0 1 Charingu 0 0 0 0 0 0 10 10 0 10 17 27 Kambali 2 1 0 3 2 8 10 20 2 13 33 48 Wa Central 5 15 30 50 14 50 78 142 24 20 245 189 TOTAL 5 18 35 60 17 60 105 182 27 46 306 279 This improvement could be due to the periodic radio discussions on the signs & symptoms of the different types of STIs and where they could be managed. Health care providers are now adolescent friendly and most adolescents are also changing their health seeking behaviors.
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Table 15: Urethral Discharges Treated (Males Only) H/F 1 0-14 15-19 2008 20-24 10-14 15-19 TOT 2009 20-24 10-14 15-19 TOT 2010 20-24 2010 10-14 15-19 20-24 0 0 0 0 0 6 6 TOT TOT 0 0 0 0 0 30 30
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Bamahu 0 0 1 1 0 1 2 3 0 6 12 18 Busa 0 0 0 0 0 0 0 0 0 0 0 0 Charia 0 1 1 2 0 0 2 2 1 0 0 1 Charigu 0 0 0 0 0 0 0 0 0 0 2 2 Kambali 0 2 2 4 0 0 2 2 0 3 2 5 Wa 0 2 5 7 1 8 9 18 18 21 26 65 Central TOTAL 0 5 9 14 1 9 15 25 19 30 42 91 Generally, male adolescents health seeking behaviors is lower than females. Though there is an increased trend of males treated with urethral discharges in the year under review, but it is observed that the number of males reported with STIs is not encouraging. Health providers are therefore challenged to integrate the importance of male involvement in health issues in their activities. Males should also be encouraged and given special services at the health facilities as a way of motivation to improve on their health seeking behaviors. Table 16: Genital Ulcers H/F 10-14 15-19 2008 20-24 10-14 15-19 TOT 2009 20-24
Bamahu Busa Charia Charigu Kambali Wa Central TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 2 2
0 0 0 0 0 4 4
0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 4 4
0 0 0 0 0 11 11
0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 3 3
Genital Ulcer cases are usually reported at the Adolescent /STIs clinic situated in the center of the municipality. Most sub municipals do not submit report on such conditions.
TOT
The rest of the sub municipals should encourage the adolescents through durbars, stake holders fora home visits and meetings to also report with their health issues to the health facilities. Because l believe strongly there are numerous of such cases in the communities but taking to herbal medications. The continuous radio airtime could support change this trend of issues. Genital ulcers are of great significance and if untreated early, could lead to permanent complications in life.
Table 17: Genital Warts H/F 2008 1510- 19 14 0 0 0 0 0 0 0 0 0 0 0 1 2024 TOT 0 0 0 0 0 0 2009 101514 19 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2024 0 0 0 0 0 4 4 TOT 0 0 0 0 0 0 2010 101514 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2024 0 0 0 0 0 4 4 TOT 0 0 0 0 0 14 14
Bamahu 0 Busa 0 Charia 0 Charigu 0 Kambali 0 Wa 3 Central TOTAL 0 1 3 The same problem as above.
Very infectious, If untreated can render a male or female infertile.

2.18 Challenges
Unfriendly attitude by all key stake holders e.g. Health care providers, parents, teachers etc. towards adolescents Inadequate knowledge on health issues by adolescents thus very poor health seeking practices. Poor Provision and documentation of adolescent health activities at all levels Low priority accorded to adolescent health services at all levels due to inadequate funding. Periodic changes of adolescent data capturing format from regional level which leads most peripheral level providers into total confusion Negative responses to sexual urges and other negative attractions in adolescence Make the environment of health facilities ,adolescent friendly Encourage all sub municipals to form adolescents clubs in schools and communities
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2.19 Way Forward
To continue with the weekly radio airtime on adolescents health issues and where to seek for treatment with the support of PPAG Continue to encourage health providers to render adolescent friendly services Form adolescent health advisory committees at the municipal and Sub municipal level s with implementing agencies. Conduct stakeholders fora on the need for their involvement in adolescent health activities Solicit for funds from partners and NGOS for adolescent health activities Integrate adolescent health service key indicators into municipal FSV monitoring tool
2.2 Safe motherhood

2.21 ANC Services The main objective for ANC services was to improve and maintain quality services to reduce maternal/infant morbidity and mortality rate in the Municipality. Conscious efforts were made to re-organize Reproductive Health Services including Adolescent Health to ensure that all pregnant mothers within the Municipality are reached with quality services. Integrated ANC services were been provided at both static and outreach points, during durbars, and defaulter tracing with the aid of the community pregnancy outcome registers which captured all information with regard to pregnant women and is updated monthly.
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0
BUSA 2008 2009 2010 118.1 131.7 104.0 KAMBALI 125.7 116.7 97.8 BAMAHU 91.0 102.0 79.5 CHARIA 56.7 73.2 73.4 CHARINGU 62.2 65.3 68.4 REG. HOSPITAL 60.8 54.3 63.2 WA CENTRAL 53.5 58.5 62.3 MUNICIPAL 104.6 106.2 106.6
90% Target
Figure 6: Antenatal Coverage by Sub Municipalities, 2008-2010 In order for a particular woman to derive maximum benefit from antenatal care, it is essential for her to start utilizing the service early in pregnancy and to attain a minimum number of Contacts with the service. For instance to benefit fully from malaria prevention
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through Intermittent Preventive Treatment, a pregnant woman must make at least three contacts with services between 20 and 36 weeks of gestation. The figure below indicates that the average number of visits has been increasing steadily plateauing from 2008 to 2010 ranging between 3.2 and 4.0. After plateauing from 35.2% in 2007 to 48.2% in 2008, the percentage of women making at least 4 visits has sharply shot up to 73.1% in 2009 and further increased to 79.1% in 2010. The proportion of pregnant women who seek care during the third trimester has been reducing steadily over the four year period. All these are indications that in spite of the high antenatal coverage some registrants may not be deriving maximum benefits from the service.
3rd Trim 100 80 60 40 20 0 2007 2008 2009 2010 3.9 3.2 4.0 3.9 %4 visits Av. Visits 5 4 3 2 1 0
Figure 7: 3rd Trimester Registration, Average visits per Registrant and proportion making four visits, 2007-2010 Pregnancy is particularly risky to certain groups of women - very young women, older women, women who have had more than four deliveries, and women with existing health problems. Very young, adolescent women who become pregnant face serious health risks because their bodies may not be physically matured enough to handle the stress of pregnancy and childbirth. Women aged 15-19 have up to three times the maternal death rate as those aged 20-24. They are especially likely to suffer from pre-eclampsia and eclampsia, obstructed labour, and iron deficiency anaemia. The risks of childbearing also are greater in older women as their bodies may be less able to deal with the physical stresses of pregnancy and childbirth. The risk of giving birth to babies with low birth weight or disabilities also increases in older women. 2.22 Skilled Deliveries Skilled delivery comprises of deliveries from both private and public health institutions by trained health professionals like Midwives and Doctors. Coverage in this area have consistently risen in the past three years from 68.9% in 2008 to 78.9% in 2010.
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120.0 100.0 80.0
60.0 40.0 20.0 0.0

2008 104.6 68.9 85.5 2009 106.2 69.9 86.3 2010 106.6 78.9 90.2
ANC SKILLED DEL. PNC
Figure 8: Trend of ANC, Skilled Delivery and PNC coverage (2008-2010) It is generally acknowledged that unskilled attendants such as TBAs cannot make any significant contribution to maternal mortality reduction. Analysis shows that deliveries conducted by skilled personnel only (midwives, general medical practitioners and obstetricians) also consistently increased during the last three years. Figure 9: Percentage Coverage of Skilled Deliveries by Sub Municipals, 2008-2010
140.0 120.0
100.0
80% Target
80.0 60.0 40.0 20.0 0.0

2008 2009 2010 Reg. Hospital 111.4 107.7 120.6 Busa 21.7 35.8 35.0 Wa Central 10.9 15.5 19.6 Charia 21.5 18.2 19.5 Charingu 7.4 4.1 4.0 Bamahu 0.0 0.0 0.2 Kambali 0.0 0.0 0.0 MUNICIPAL 68.9 69.9 78.9
The slight increase in the skilled delivery coverage in 2010 could be due to sub-municipals implementing special initiatives like domiciliary midwifery and giving of hot water and tea to mothers at the health facilities as some of the change packages being employed through
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Project Fives Alive interventions. The breaking of Cultural and social barriers through intensive education has been of immense contribution to the increased skilled delivery for the reporting period. Despite these achievements, the absence of a resident Midwife in the Charingu Sub Municipal has greatly affected skilled delivery in the Sub Municipal. The Charingu Sub Municipal now has a midwife and the hope is that skilled delivery services will soon be on the rise. 2.23 TBA Deliveries Analysis of deliveries conducted by TBAs indicates a reduction from 460 TBA deliveries in 2009 t0 389 in 2010. This reduction could partly be attributed to the fact that, TBAs are being encouraged by Sub Municipal Staff to bring mothers to health facilities for skilled attendance which has reflected in the increase in skilled attendance during delivery as discussed earlier in the chapter.
500
No. Pregnant
400 300 200 100 0

2008 2009 2010 WA CENTRAL 125 165 139 REG. HOSPITAL 70 73 90 KAMBALI 41 81 58 BUSA 46 54 29 CHARIA 23 27 27 BAMAHU 35 25 25 CHARINGU 19 35 21 MUNICIPAL 359 460 389
Figure 10: Number of TBA Delivery by Sub Municipalities, 2008-2010 The reduction of maternal morbidity and mortality depends on womens access to Essential Obstetric Care. Basic Essential Obstetric Care is the minimum package of services provided at the health center level without the need for an operating theatre, to manage complications during pregnancy, labour and delivery and post-delivery. This package of services includes IV or IM administration of antibiotic and anticonvulsants, manual removal of placenta, assisted vaginal delivery and removal of retained products. Comprehensive Essential Obstetric Care includes all Basic Essential Obstetric care package in addition to the availability of caesarean section and safe blood transfusion. The percentage of births by caesarean section is an indicator of access and utilization of health care during child birth. It is estimated that between 5% and 10% of all births in a population will involve a complication that requires an intervention such as caesarean section. Without this service many pregnant women with such complications will die or
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develop disabilities. For the reporting period, 356 caesarean sections were performed which represents 10.0% of skilled deliveries in the municipality. The Figure below compares caesarian sections conduction from 2003 to 2010 for the reporting period
450 400 350 300 250 200 150 100 50 0 12 10
% C/S Conducted
No of C/S
8 6 4 2
2003 223 7.2
2004 254 7.5
2005 292 8.2
2006 326 8.6
2007 190 4.9
2008 415 9.0
2009 341 7.8
2010 356 10.0
No. of C/S % of Del. C/S
Figure 11: Trend of Caesarian Section at Regional Hospital, 2003-2010
2.24 Maternal Mortality, still births and audits Complications during pregnancy and child birth are leading causes of death and disability among women of reproductive age in many developing countries. Only the Regional Hospital accounts for institutional maternal deaths in the Municipality. Fifteen (15) maternal deaths were reported at the Regional hospital for the year 2010, out of which 7 were from the Wa municipality. Following audits of all these deaths across the Municipality, the following activities were carried out towards the reduction of maternal mortality in the Municipality; Mother support groups have started holding meetings with the pregnant women and have also composed songs on danger signs of pregnancy and labour. The ambulance driver and staffs phone numbers was given to mothers, volunteers and some husbands who have mobile phones to call in case of emergency. Interaction with some mothers/observations and reports indicates that some husbands now support their wives by accompanying them to health facilities for ANC, delivery and PNC services. Some even remind their wives when they are due for their next F/p visit. Some community members have started contributing towards the emergency transport system.
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Implementation of community pregnancy outcome registers have been put in place and monitored by staff/volunteers. TBAs/volunteers accompany mothers to the health facilities for safe delivery.
10 9 No. of Maternal Deaths 8 7 6 5 4 3 2 1 0
9 297
9 8 272 7 205
333
9 8 6 182 130 6 168
350 300 250 200 150 100 50 0
219
2003
2004
2005
2006
2007
2008
2009
2010
Maternal Deaths
MMR
Figure 12: Institutional Maternal deaths and ratios, 2003-2010 The still birth rate is an indirect measure of the management of pregnancy, labour and delivery. A total of 165 still births were recorded giving a still birth rate of 4.4%. Thirtynine (31%) of these were fresh still births. It is possible that fresh stillbirths are under reported as it may be more convenient to label many still births as macerated as this absolves the facilities of any blame. As part of the strategy to reduce neonatal and peri-natal deaths, all such deaths occurring in institutions should be audited.
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MMR/100000 LBs
250 200
60 50
No. of Still Births
150 100 50 0 2003 2004 2005 2006 2007 2008 2009 2010
30 20 10 0
Still Births
Still Births Rate
Figure 13: Still births at the regional hospital, 2003-2010 Cord round neck, 2 Anaemia, 4 Asphyxia, 16 Congenital abnormality, 5 Sepsis, 2
Prematurity, 11
Figure 14: Neonatal Deaths for 2010 All still births in the Municipality were audited the findings were as below; 17 mothers with traceable addresses were visited. Four(4) of them did not feel foetal movement and therefore reported to the hospital and scanning done which indicated that their babies were dead. Two mothers said after delivery their children did not cry and the staff showed the children to them and explained that they were dead. 5 mothers had premature deliveries.
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Still Births/1000 lBs
40
One teenager (18yrs) took concoctions to terminate a pregnancy that was about 28 weeks. She was rushed to the hospital where she delivered a baby girl who lived for some few minutes before it passed away. One of the mothers from Charia with breech presentation refused to report the facility till the baby came out and was hanging. The mother in-law attempted to remove but failed so she was sent to the hospital where the dead foetus was removed. Another was referred from Charia with delayed second stage. They did vacuum and removed a dead baby. One mother said she delivered a baby whose stomach was not normal. She could see the intestines through some transparent covering, (Exampholus) Two mothers at Dondoli complained that the nurses did not pay much attention to them when they were in second stage and were calling for help. They feel that if they were attended to early their children would have been born early and would not have died. Recommendations after the audit were as follows; To train staff on record keeping To ensure the use of a pathograph to monitor the progress of labor of all mothers who come during first stage. To intensify IE&C on signs and symptoms of IUD and the effects/complications. Regular still births audit
2.25 Post Natal Care (PNC) The objectives of post natal care are to maintain the physical and psychological wellbeing of the baby and mother; perform comprehensive screening for the detection and management of complications in both the mother and the baby; and provide education on nutrition (including breastfeeding), infant immunization and family planning. The big difference between antenatal care coverage on the one hand and skilled delivery and postnatal care coverage on the other is a cause for concern. The high drop-out rate is probably an indication that people who make contact with service providers are unwilling to continue for reasons which might possibly include dissatisfaction with the service. Operational research is necessary to find the contributory causes of this high drop-out rate.
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140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0

KAMBALI 2008 2009 2010 137.7 131.8 102.9 BAMAHU 85.1 87.7 83.2 REG. HOSPITAL 30.3 27.2 66.8 CHARINGU 59.9 44.8 56.2 CHARIA 79.6 55.2 54.4 BUSA 43.5 48.3 52.0
90% Target
WA CENTRAL 53.7 65.0 38.4
MUNICIPAL 85.5 86.3 90.2
Figure 15: Coverage of PNC by Sub Municipals, 2008-2010 To further stress the importance of Post natal care services the Ghana Health Service have come out with a revised policy on PNC that will ensure that the mother and child after delivery are seen not less than three times within One week to ensure and guarantee their health status. 2.26 Family Planning Family planning services forms an integral part of maternal and child health. Parents are encouraged to think about their family life and reproductive health because family spacing is really life planning as women are less burdened with too much work and too many children.
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
KAMBALI 2008 2009 2010 87.8 87.2 74.4
80% Target
WA CENTRAL 62.2 78.4 62.4
CHARIA 51.4 65.4 61.3
BAMAHU 47.9 56.1 42.5
BUSA 52.3 79.5 41.4
CHARINGU 45.1 28.4 33.1
REG. HOSPITAL 7.3 14.1 11.2
MUNICIPAL 65.0 79.4 63.8
Figure 16: Family Planning Acceptors
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Acceptor rate for Family Planning has decreased drastically for the year 2010 as compared to 2009. All the sub municipals had very low coverage except Charingu. The region ran short of Depo Provera which is the most preferred method in the Municipality. Combined pill remains the second most preferred method followed by Norigynon. Mothers have therefore resorted to visit private practitioners for services. Some NGOs also now distribute male condoms free or at prices that are lower than the health facilities to the youth, thus the low patronage of condoms at the health facilities. It is hoped that efforts will be made by the Regional Health directorate to procure more family planning devices (Depo Provera) to relief our clients from the burden of visiting private practitioners whose services might not be to the best of their interest. All midwives within the Municipality were trained on Jadelle insertion. This will go a long way to ease the burden of clients travelling from far distances to Wa Regional Hospital for services.
2.3 Expanded Programme on Immunization (EPI)

Infant immunizations have plateau over the years with some decrease in 2010 for all antigens. Apart from Bamahu, Charia and Kambali, the other sub municipalities could not meet the minimum annual coverage target of 90% as can be seen in the graph below.
COVERAGE IN PENTAVALENT VACCINE - 2010

140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 -20.0 -40.0 -60.0 Bamahu Penta 1 Penta 3 Drop out rate 107.8 106.6 1.2 Busa 50.9 55.8 -4.9 Charia 53.6 91.1 -37.5 Charingu Kambali 58.9 53.8 5.2 120.5 123.9 -3.3
Coverage
Wa Central 71.4 84.7 -13.3
Reg. Hospital 32.0 12.1 19.9
Municip al 93.8 93.5 0.3
Figure 17: Coverage for Penta, 2010 Busa and Charingu Sub-Municipalities have been identified as the least performing SubMunicipalities in all the antigens during the year of 2010. The MHD has to employ appropriate strategies to support them meet their targets in the ensuing year.
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The drop-out rate for Penta1/ Penta3 immunization has improved for the year to 0.3% for the municipality although some sub municipalities recorded extremely high negative dropout rates. The Municipal has embarked on Community Registers for under-fives and pregnant women to check immunization and IPT defaulter tracing to further reduce high dropout rates. The MHD has also put in place an effective vaccine and cold chain management system to ensure effective running of the cold chain in all facilities with cold chain and also reduce vaccine wastage. BCG & MEASLES/ YELLOW FEVER COVERAGE
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 -20.0 -40.0 -60.0 Charia BCG MEASLES/YF DROP OUT RATE 33.5 82.9 -49.4
BCG 90% Target
MEASLES/YF
80% Target
Coverage
Wa Central 88.3 131.2 -42.8
Kambali 101.8 130.5 -28.8
Bamahu 85.4 114.0 -28.6
Charingu 46.8 54.9 -8.1
Busa 62.7 50.6 12.0
Reg. Municipa Hospital l 111.7 8.6 103.1 138.7 116.9 21.8
Figure 18: BCG and Measles Coverage by Sub Municipals
2.4 Nutrition
Childrens nutritional status is a good reflection of their overall health. Children who have access to an adequate food supply and are not exposed to repeated illness often reach their growth potential. Malnutrition plays a significant role in morbidity and mortality from common childhood conditions such as malaria, diarrhoea and acute respiratory infections. Three indicators are commonly used to assess the nutritional status of children. These are Weight for Age (W/A), Height for Age (H/A) and Weight for Height (W/H). Weight for age measures both acute and chronic malnutrition. Height for age is a measure of linear growth.
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During routine service delivery the data collected is based on weight for age. Children whose weight for age is more than 2 standard deviations below the median for a reference population are considered underweight while those below 3-standard deviations from the median are classified as severely malnourished.
2.41 Nutrition Surveillance
Nutrition surveillance is a bi-annual study to determine the nutritional status of the general population. Though not every community in the Municipality was studied yet the selection of the action communities were done in a more scientific process (i.e. random sampling method) which becomes representative of the entire Municipal population. The assessment is carried out mostly in May and November each year. The main purpose is to collect essential data that can help guide policy and re-strategize in programme implementation. Unlike growth monitoring which was mainly conducted in health facilities, nutrition surveillance was carried out at the community level and children of all ages and adults were covered. All six sub-municipal carried the exercises in three communities each. The anthropometric indicators used in assessing the nutritional status in the population were as follows: Height-for-age: HAZ (referred to as stunting chronic malnutrition). Weight-for-height: WHZ (referred to as wasting acute malnutrition). Weight-for-age: WAZ (referred to as underweight composite of HAZ & WHZ). By WHO (1995) standard, less than 10-19% prevalence of stunting in any given population or sub-group of children can be described as medium.
Table 18: Prevalence of wasting, stunting and underweight of Children 0-5yrs, 2010 SUB-MUN Bamahu Busa Charia Charingu Kambali Wa Central Total NO EXAMINED 153 156 136 146 104 98 793 WASTING 13.1 4.2 5.9 11.9 12.5 10.2 9.5 STUNTING 18.7 14.8 13.9 23.6 11.1 11.8 16.2 UNDERWEIGHT 12.8 5.1 7 5.9 16.9 8.2 8.4
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Malnutrition rates for the year under review slightly reduced with underweights reducing drastically from 18.9% in 2009 to 8.4% in 2010, stunting also reduced among children under. Wasting among children under five still remains a major problem as there has been a marginal increase in wasting from 9.4% to 9.5% in 2009 and 2010 respectively. The Figure below shows a a two-year trend of malnutrition rates in the Municipality
25 % Malnourished 20 15 10 5 0 2009 2010 WASTING 9.4 9.5 STUNTING 19.1 16.2 UNDERWEIGHT 18.9 8.4
Figure 19: Annual Malnutrition rates among Children under-five years

2.42 Rehabilitation of malnourished Children
Several factors culminate in leading to malnutrition among children less than five years. The most among them is household food security. Majority of the people also do not adhere to the advice by health officials on facts on nutrition. Some mothers/caregivers do not take counseling on exclusive breastfeeding serious and this partly could form the basis of most malnutrition condition. Table 19: Trend of Inpatient Rehabilitation of malnourished children Indicator Old cases New cases No. Kwashiorkor No. Marasmus Marasmus/Kwashiorkor No. Discharged No of deaths Rehabilitation Rate Case Fatality Rate No of Defaulters No. Absconded Absconding Rate 2008 71 52 13 86 24 43 3 35 2.4 0 0 0 2009 203 6 184 13 95 0 46.8 0 7 7 6.4 2010
2 34 4 36 0 47.4 0 1 0 0
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Management of malnourished children at the Rehabilitation Centre has been improving over the years. There was no death during the year. This has also affected the discharges. Most mothers now understand the importance of the center and the assistance they derive from the services given to them. This explains why many kwashiorkor and marasmic/kwashoikor cases have increased in 2009 over the years. It also suggests that nutrition education from the outreach points is having an impact hence the prompt response of mothers to bring the malnourished children to the center. Also the plumpy-nut is also serving as bait in encouraging mothers to come for the assistance. Most of the cases were not resident cases but mobile ones i.e. they return to the center daily for the services.
2.43 Impact of the Supplementary Feeding Programme (SFP) The Ghana Health Service with support from the World Food Programme (WFP) targets deprived and disadvantage population groups to improve household food availability, food safety, and other food-based approaches to address malnutrition including micronutrient deficiencies. The package includes take home ration for pregnant and lactating mothers and on site feeding of under-five children where monthly growth monitoring and nutrition education activities are also conducted during outreach days. Table 20: Coverage of children and mothers of SFP SubNo. of No. of municipal Communities feeding centres Busa Charia Charingu Kambali total 13 13 16 19 61 1 1 3 1 6 Beneficiaries Children 6 23 mths 2 5 years Boys Girls Boys Girls 40 38 68 61 28 30 40 36 56 53 58 42 67 54 64 53 191 175 230 192 Mothers Pregnant Lactating 20 15 15 18 68 122 67 105 98 392
During the year a number of planned visits were made to the feeding centers. The common thing that kept arising was the frequency and quantum of food received from WFP. Children according to some attendants only appear when food arrives and cooking was
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going on at the center. This made the management of the programme very stressful at both the community/sub and the municipal level. A center was forced to move from Kperisi to Guli less than a kilometer from Kperisi because the attendants were not leaving up to expectation. Others however have to be commended e.g. Sagu, and Gbegru who contributed their own food to run the centers when food was out of stock. In 2009 food supply to the programme has not been encouraging. The usual items which include rice, CSB, sugar, edible oil, and sometimes maize meal all have been reduced by more than half and also the frequency in lifting this food to the communities has not been consistent. This has lowered the interest of mothers and for that matter communities involved to participate fully. 2.44 Micro-Nutrient Deficiency Disorders: Vitamin A Deficiency In line with the ultimate goal of eliminating vitamin A deficiency in the municipality, the following Strategic Objectives were pursued during the period under review Provide high dose vitamin A capsules to all children aged 6 to 59 months Provide high dose vitamin A capsules to at least 60% of all post-partum women within 8 weeks after delivery Control of micronutrient deficiencies remain significant in efforts towards the reduction of child mortality and improved survival of children. The control of iron, vitamin A and iodine deficiencies are being tackled through supplementation and targeted food fortification. The purpose of capturing postpartum vitamin A is to appreciate how many of mothers usually are covered during this period. In most cases low coverage is recorded for routine services as can be seen in the table above. This could partly be due to the mass campaigns which captures most of the children during such periods. However some sub-municipal may have to work harder to improve their CWC coverage so as to increase routine coverage.
2.44.1 Control of Iodine Deficiency Disorders Iodine Deficiency Disorders (IDD) are the worlds leading cause of preventable mental retardation and impaired psychological development in young children. In the extreme form it results in cretinism and intellectual impairment of school children. IDD increases the risk of still births and miscarriages in pregnant women. It is a common cause of goiter. The control of IDD involves the promotion of the consumption of iodated salt, monitoring the consumption of iodated salt through periodic household and market surveys
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Ghana joined the salt iodated countries and passed a bill seven years ago which prohibit non-iodized salt to be used for both animal and human consumption. By law anyone producing or selling salt that is not iodized can be prosecuted in law courts. As a result, the monitoring of salt in our markets is to ensure that all salt sold to the general public are having a level of iodine not less than a unit measure of 15 pass per milligram (PPM). However monitoring reports indicate that majority of the salt sold are either without iodine or very little levels found. The following recordings have been made over a three year trend. Table 21: Market Salt Survey results, 2007-2009 No salt sellers TEST RESULT Tested <15PPM >15PPM 2007 76 51(67.1%) 25(32.9%) 2008 94 73(77.7%) 21(22.3%) 2009 228 143(62.7%) 85(37.3%) The target to increase salt consumption with iodine from 25% to 31% was set in 2007 but it is only in 2009 year that the target is achieved and even exceeded by a very significant margin. This however did not happen without any effort. The Municipal Salt Committee had to meet and roles and tasks were assigned to members. The committee agreed that every salt consignment entering the Municipality would have to undergo test and certified before it could be sold to the general public. The committee impounded a number of consignments where some were tested and certified and released to their owners while some are locked up to ensure that they are iodized according to the required standard before it could be released for public consumption. 2.45 Nutrition and Malaria Control for Child Survival project (NMCCSP) The Municipality was part of a workshop on Nutrition and Malaria Control for Child Survival Project (NMCCSP) organized for managers in the region at Bolgatanga in the Upper East Region. After the training an implementation plan and a budget was developed to execute the programme which has been submitted to national level for approval. Consequently, a baseline survey has been carried out in the selected communities in preparation for the project. Feedbacks on results of the survey are yet to be received. Also as pre-elude to the project execution, a 4X4 Nissan pick-up and motorbikes has been allocated to the municipality for the project. YEAR
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CHAPTER THREE: CLINICAL SERVICES/INSTITUTIONAL CARE

3.1 Improve Quality of Clinical Care
3.11 Institutional Care
The top ten causes of OPD attendance during the year 2010 include malaria, acute respiratory infections, diarrhoea, skin diseases and ulcers, dental carries and gynaecological conditions. Others are Acute Ear infection, Vaginal Discharge and PUO (not Malaria). This is virtually the same picture for the past three years. Malaria accounted for over 54.9% of total new cases at the OPD level which is an increase compared to 46.4% in 2009. Table 22: Top Ten Causes of OPD Attendance 2008-2010
RANK 1
Acute Eye Infection 7545 2225 1978 9.3 2.8 2.4 2:Other ARI 3:Acute Eye infection 4:Diarrhoea Diseases 5:Skin Diseases & Ulcers 6:Dental Caries 7:Gynaecological conditions 8:Road Trafic Accidents 9:Typhoid/Enteric Fever(Typhoid) 10:Acute Ear infection Others TOTAL OPD NEW CASES 10692 5680 3141 8.9 4.8 2.6 2:Other ARI 3:Acute Eye infection 4:Diarrhoea Diseases 5:Skin Diseases & Ulcers 6:Dental Caries 7:Gynaecological conditions 14815 5536 5300 12.4 4.6 4.4
CONDITION
Malaria
2008 %
44.7
CONDITION
1:Malaria
2009 %
46.4
CONDITION
1:Malaria
2010 %
65653 54.9
36089
55455
2
Dental caries
3
Other(ARI)
4
Road Traffic Accidents 1911 1888 2.4 2.3 3062 1981 2.6 1.7 4331 1703 3.6 1.4
5
Skin Diseases & Ulcers
6
Gynaecological Conditions 1569 1.9 1803 1.5 1674 1.4
7
Diarrhoeal diseases 895 1.1 1791 1.5 8:Acute Ear infection 1625 1.4
8
Hypertension 648 577 25488 0.8 0.7 31.5 100. 0 1701 1260 32944 11951 0 1.4 1.1 27.6 9:Vaginal Discharge 10:PUO (not Malaria) Others TOTAL OPD NEW CASES 1559 1470 32595 1.3 1.2 27.3
9
Malaria in pregnancy
10
All Other Diseases
TOTAL OPD NEW CASES
80813
100.0
136261
114.0
3.12 Utilization of OPD Services Utilization of health services is one of the measures of both geographical and financial access to these services. During the past three years the utilization of OPD services has been increasing as shown by the total OPD attendance as well as the
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attendance per capita (Figure 20). Total OPD attendance has been increasing steadily over the period under review maintaining a per capita of 0.07 for 2010.
160000 140000 120000 100000 80000 60000 40000 20000 0 0.08 0.07 0.06 0.05 0.04 0.03 0.02 0.01 0
No. of clients
2008 69313 14995
2009 105292 12324
2010 143011 7200
Insured Clients Non-Insured Clients Per capita
0.05
0.07
0.07
Figure 20: Total OPD Attendance and Attendance per Capita, 2009-2010 It would be observed that the attendance by insured clients keep increasing while the noninsured reduces. This trend could be attributed to the fact that the coverage for insurance schemes has increased tremendously over the years. This has however increased the indebtedness of health facilities since the re-imbursement process by the National Health Insurance Authority is too slow and irregular.
1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Bamahu 2008 2009 2010 0.2 0.2 0.4 Busa 0.3 0.3 0.4 Charia 0.5 0.6 0.9 Charingu 0.3 0.2 0.3 Kambali 0.4 0.5 0.8 Wa Central 0.2 0.3 0.4 Attendance/capita
Regional Hospital 0.8 1.2 1.2
Figure 21: Trend in Per capita OPD Attendance by Sub Municipals, 2008-2010 Analysis of Sub Municipal performance shows contant gradual increases in OPD per capita across all Sub Municipalities. There are still significant barriers to utilization of health services especially in the Charingu Sub Municipal due to lack of accessible road network to
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the facility. Some communities like Yibile would prefer accessing services in Wa than going to the Charingu Health Facility. This situation is not helped by the poor road network within the Sub Municipal. Whiles the Municipal Health Services intensifies the scaling up of the Community-Based Health Planning and Services (CHPS) to address the issue of inadequate geographical access, other sectors including the District Assemblies should put measures in place to address the challenges facing the implementation of the Health Insurance scheme and improvement in the road network. 3.13 Utilization of In-patient Services The total number of admissions has increased from 14383 in 2009 to 16514 in 2010. The death rate, which is the probability of any person who goes on admission dying, remained almost the same between 2008 and 2009 while decreasing slightly to 2.8 in the year under review. Table 23: Admissions, Deaths and Death Rates at Regional Hospital, 2008-2010 2008 Admissions Admissions Death Rate Deaths Facility 2009 Admissions Death Rate Deaths 2010 Death Rate 2.8 Deaths 469
UWR Regional Hospital 15318
515
3.4 14383
485
3.4 16514
The Bed Occupancy Rate (BOR) in any hospital, within a specified time frame, represents the proportion of the beds available in the facility that were occupied by patients during that period. It is a measure of efficiency of the hospitals operations. The Average Length of Stay (ALOS) on the other hand is affected by the disease pattern as well as the quality of interventions. A bed occupancy rate of below 80% is an indication that the available beds are being under-utilized. Table 24: Bed Occupancy Rate and Average Length of Stay at the Regional Hospital) Facility Reg. Hospital BOR 76.7 2008 ALOS 2.98 BOR 60.3 2009 ALOS 2.9 BOR 95.6 2010 ALOS 3.2
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3.2 Special Initiatives to increase access

3.21 Specialist outreach services on CHPS CHPS is a strategy that intends to empower community members to be responsible for the production and promotion of their own health. It is the mobilization of community leadership, decision making system and resources in a defined catchment area (Zone), re-deployment of re-oriented health staff (Community Health Officer-CHO), with logistic support and community volunteer system to provide services according to the principles of primary health care. It is also a public health service initiative to deliver community level services closer to the community members.
The main objectives of the CHPS strategy include;
Improve access and equity in the provision of basic, essential health information and package of services to all especially in the deprived and hard-to-reach areas To improve partnership with community leaders and social groups in the communities through planning and delivery of services To provide cost-effective services to individuals and households in the communities To carry out health care services to the door step of every individual in the municipality
Key activities in the area of CHPS that was carried out throughout 2010 include the following
Held CHOs and their supervisors review meetings Conducted FSV to all sub municipals and CHPS zones Launched Piisi CHPS zone Organized community durbars and CHC /CBSVs meetings Kperisi CHPS established CHAPS and reviewed their activities Jonga, Boli &Kperisi conducted emergency deliveries Boli CHPS organized meeting and a health forum with the Fulani herd men within the catchment area. Finished registration of 8 more CHPS zones(sing,konjiehi,mangu/sombo,Dandafuuro/kagu,kpaguri,konta,Dokpong & Yibile) Some concerns with regards to CHPS activities for the year under review also include the following Inadequate FSV to CHOs by their supervisors Poor resource mobilization by communities Most communities reluctant towards CHPS activities eg Instituting CHAPS, Clean up campaigns, CETS, Meetings etc. Some trained CHOs left for further studies
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IMPLEMENTATION STATUS OF CHPS WITHIN THE MUNICIPALITY The Municipal has mapped out 28 zones of which 13 are operational namely; Boli, Dobile, Dondoli, Jonga Kunbiehi Kperisi, Tampaalpaani, Bamahu, Piisi, Biihee, Nachanta, Gbegru, Kpongu and an additional 2 would be operational by the beginning of 2011 that is Sing & Mangu /Sombo . The zones have carried out averagely 14 of the implementation steps of the CHPS process. Biihee, Jonga & Kunbiehi operate from their mother Sub Municipals, the CHOs reside outside the community and reach out to the CHPS zones on daily bases. SUMMARY OF CHPS IMPLEMENTATION STATUS BY SUB MUNICIPALITIES SUBMUNICIPALITY Bamahu Busa Charia Charingu Wa central Kambali Municipal TARGETED ZONES 5 4 5 5 4 5 28 CHPS NO.FUNCTIONAL 3 2 2 1 3 2 13 NO.OF CHPS COMPOUNDS 3(one under construction) 0 2 1 1 1(one under construction) 8(2 under construction)
ACHIEVEMENT. Mapped the municipal into 21 CHPS zones Thirteen(13) zones are fully implementing CHPS, 4 urban and 9 rural are functioning JICA trained 12 supervisors and 21 CHOs for the Municipal to take up the CHPS mantle. Carried out refresher training for supervisors and CHOs on revised safe motherhood protocol. Held 13 durbars in the Sub Municipals to strengthen community and stakeholder participation and involvement in health promotion and disease prevention.
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Held 10 review meetings with CHOs and Supervisors Conducted quarterly facilitative supervision to all the functional CHPS zones Municipal Assembly constructing 2 compounds at Dondoli& Sing. JICA donated delivery equipment and other medical instruments for CHPS activities Instituted CHAPS in 2 CHPS zones(Kperisi& Gbegru) SERVICE DELIVERY ACHIEVEMENT
CHPS ZONE
NO.CHC /CBSVs MEETINGS Bamahu 2 Boli 2 Piisi 3 Biihee 1 Jonga 2 Kperisi 2 Dobile 2 Gbegrru 3 Kpongu 2 Nachanta 2 Dondoli 1 Kunbiehi 3 Tampaalipaani 3 TOTALS 28
NO.DURBARS NO.CLEAN UP CAMPAIGNS 2 1 2 1 2 1 2 2 2 2 2 1 2 1 2 0 1 0 1 0 1 1 2 0 1 0 22 10
NO.H,SE HOLDS 382 366 392 210 315 460 1237 137 258 310 911 968 762 6708
NO.H,SE HOLDS VISITED 771 708 904 745 2987 512 2454 274 618 928 2667 3745 953 17521
140 120 100 80 60 40 20 0
% Coverage
MUNICIPAL CHPS
ANC 107 18
PNC 90 21
BCG 139 11
MEASLES 117 21
PENTA3 94 27
TT+2 78 19
Figure 22: Contribution of CHPS to some Service Indicators, 2010
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3.22 National Health Insurance The Government of Ghana as part of its poverty reduction strategy for the past decade worked towards providing easy access to health care services to its people. However, in order to make it more affordable for all Ghanaians the National Health Insurance Scheme (NHIS) as a propoor programme was introduced in 2003 through the National Health Insurance Act (Act 650 of 2003) and the Legislative Instrument (LI 1809 of 2004). For efficient and improved healthcare provision, the National Health Insurance Council identified strategic initiatives in 2007 to guide the schemes in their operations. These initiatives were; Accelerate the pace of registration and issuance of ID Cards Transform NHIS into a solution based organization Ensure financial sustainability of the scheme Develop and implement effective communication strategy and Improve portability and ensure quality of service.
In meeting the above guide/initiatives, the Wa Municipal scheme was established as mandated to register, mobilize revenue, allocate the revenue collected and ensure provision of prescribed benefit package. Other responsibilities of the scheme includes public education, coding houses, training agents and Community Health Insurance Committees and Collectors, creating database for printing and issuing of identification cards, claims management and adjudication. The operation of the scheme however, is faced with some challenges. To overcome the challenges and stay focus to provide effective, efficient, equitable and sustainable health services for its clients, SNV, Netherlands Development Organization, a Dutch technical support Non-Governmental Organization and the Wa Municipal Health Insurance Scheme agreed to work together towards drawing a Five
Year Strategic Plan to guide its operations.
In October 2004, a new management team took over the running of the then Wa District Wide Scheme that was being managed by a Focal person on health insurance. The Scheme then covered three (3) distinct districts namely Wa East, Wa West and Wa Municipality. However, by the end of 2006, Wa East and Wa West had evolved into fully fledged schemes leaving Wa Municipal Scheme standing as one automous one. The then Wa District Wide Scheme was among 45 pilot ones that were established in 2001 nation wide. It ensures the provision of both OPD and inpatient health care to its members starting from 2005 as a Mutual Health Insurance Scheme in the same year in compliance with NHI Act (Act 650, 2003) and the Legislative Instrument (LI 1809 of 2004). From that period up to 2010, the scheme has operated a vision-led strategic plan and covered about 231,900 clients (active and non-active members) and 126,112 active clients, constituting 92. % of the population. Currently the scheme is been governed by a Caretaker Committee (4) (IMC) and has staff strength of twelve. It has also constituted 70 Community Health Insurance Collectors (CHICs) and engaged 12 revenue agents in Wa town.
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ACHIEVEMENTS 1. The Scheme has registered 29,763 members (fresh) and renewed 32,227 expired IDs within the year under review- 2010. This brought the Scheme total active membership to 121,713 covering 88.75% of the Municipality population, after we had made a significant improvement on our last years figures. 2. We mobilized revenue to the tune of GH146,004.00 as processing fee and GH154,261.72 as premium within this year under review- 2010. 3. Conducted public education on NHIS concept in 48 communities within the Municipality as a result of effective Public Relations Programmes . 4. Trained 70 agents on community entry and mobilization strategies on two different occasions. 5. The backlog of data at MIS Unit was cleared before the end of the year under review2010. 6. Able to handle about 99% of all complaints brought to the Scheme. 7. Team work amongst staff 8. Good working relationship between clients and service providers 9. The ability of staff to speak almost all the local languages 10. Early payment of claims bills 11. Detection of fraud MEMBERSHIP 3.01. REGISTRATION FIGURES BY CATEGORIES
REGISTRATION CATEGORIES EXEMPT INFORMAL QUARTER B/F 2009 SC SP <18 PW 70(+) IND TOTAL
21,010 5,835 5,673 10,431 2,659 45,608
4,453 1,318 1,133 2,599 899 10,402
1,764 408 127 170 148 2,617
28,758 9,333 6,251 5,999 7,619 57,960
543 128 97 101 162 1,031
3,253 512 482 411 624 5,282
1,864 184 326 252 586 3,212
61,645 17,718 14,089 19,963 12,697 126,112
1ST 2ND 3RD 4TH

TOTAL
The Scheme has registered 29,763 members (fresh) and renewed 32,227 expired IDs within the year under review- 2010.
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This brought the Scheme total active membership to 121,713 covering 88.75% of the Municipality population (137,139) estimated for 2010 (Reg. Statistical Service) . ID CARDS MANAGEMENT The early part of the year was very challenging because of late delivery of ID cards, but with the intervention of the CEO and other Directors, the situation has improved drastically. The table below indicates the submission and receivable flow of ID cards ID CARDS MANEGEMENT 1st Total number data sent for 29,117 production Total number of ID card 10,198 received Total number of distributed Total number distributed Total of ID renewed Total of old ID renewed Expired cards Total of valid ID cards 10,345 82,093 5,543 114,730 7,813 135,426 7,452 126,112 of 10,008 2nd 52,976 12131 12,251 5,036 7,337 3rd 11,867 6,040 6231 7,920 6,543 4th 22,402 28,029 26,499 2,518 6271 Total 116,362 51,198 54,989 18,019 30,091 5,543 34,153 121,713
not 2,545 9,940
MONITORING OF HEALTH CENTERS The monitoring was in response to my additional role of exercising an oversight responsibility over the health centers, specifically, to assess the operational issues that are affecting the ICT platform at the centers in the municipality. This normal helps us in accessing the general performance of the system. STATUS OF ICT PERFORMANCE IN THE MUNICIPALITY AND USAGE OF VARIOUS MODULES
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Installation for the nationwide ICT network commenced and was completed in Dec 2008 on thirteen (14) Health Centres and the Scheme. 10 Health Facilities, Clinics and Hospitals with Electricity connection were hooked to the network in Dec 2009. (An additional 2 facilities have currently been installed). Migration of data from the old systems onto the new system also begun in Jan 2009. There were challenges with the loading of the pictures from the old system but that has been resolved and now have our data and photos loaded onto the new platform. Following that, Kick-off for the region took place in Jan 2009 and the Roll out of the new ICT platform was successfully completed for the scheme. Training was also organised for all core staff (i.e. MIS staff, Claims staff and Marketing Officer) as part of the roll out in the Scheme. Refresher Training for selected provider staff was organised in 2010 for all facilities where the equipment were installed. However, there is the need for more training for providers and plans are underway to collaborate with the Regional Office to train more staff at various provider sites. The MIS officer has also been given training on the usage at Accra: (troubleshooting and maintenance of the new ICT platform) to enable him extend support to both their scheme and provider sites within our catchment area. All five modules of the new software (Membership, Claims, Complaints, Member Verification and Internal Help Desk Modules) are currently operational in all Centres and the Scheme. The scheme is using the Membership and the Internal Help Desk Modules. The scheme is also using the Claims Module on limited bases (i.e. Some Claims forms are entered into the system but payment is done only after manual vetting of all the claims) due to volume of work as against staffing constraints. We strongly recommend that the Claims Module in the ICT sould be upgraded and refresher training given to claims officers to meet this challenge. Utilization of various modules of the software by both scheme and providers in the Municipality are summarized in the tables below: TOTAL INSTALLED 14 NO. OPERATIONAL 10
SCHEME Wa Municipal
INITIAL 12
SUPPLIMENTARY 2
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FINANCIAL INFLOW
IGF TOTAL PREMIUM COLLECTED (GH) PROCESSING FEES COLLECTED (GH) NHIA SUPPORT OTHER INCOME (GH) SUBSIDY (GH) ADMINISTR ATIVE SUPPORT (GH)
MONTH
YEAR
SUB TOTAL (GH)
Total
2010
154,261.72
146,004.00
45,720.64
1,418,020.82
52,280.86
1,816,288.04
FINANCIAL OUTFLOW ADMINISTRATIVE EXPENDITURE SALARIES OTHERS TOTAL CLAIMS EXPENDITURE
TOTAL
TOTAL
(GH) 1,014.02
(GH) 86,295.04
(GH)
(GH) 1,892,849.58
(GH) 2,140,158.64
3.02. FINANCIAL INFLOW SUMMARY Wa Municipal Premium collected Processing fees collected Subsidies received(NHIA) Reinsurance received ADMIN SUPPORT(NHIA) CLAIMS MANAGEMENT TOTAL VOLUMES OF CLAIMS RECEIVED OPD 158,127 IPD 5,114 TOTAL 163,241 2008 GH 111,154.00 49,544.20 830,515.04 133,138.56 48,477.14 2009 GH 161,439.20 164,929.40 1,219,199.60 617,393.40 47,317.78 2010 GH 154,261.72 146,004.00 1,418,020.82 0.00 98,001.50 TOTAL GH 426,854.92 360,477.60 3,467,735.46 750,531.96 193,796.42
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TOTAL CLAIMS BILL RECEIVED OPD GH 1,647,873.85 IPD GH 690,462.90 TOTAL GH 2,338,736.75
TOTAL AMOUNT OF CLAIMS PAID OPD GH 1,599,412.64 IPD GH 293,436.94 TOTAL GH 1,892,849.58
INDEBTEDNESS (AS AT END OF YEAR)

NAME OF PROVIDER SEPT OCT NOV DEC AMOUNT(GHC)
ISLAMIC CLINIC
36,394.37
93,971.64 4,361.41 1,236.50 1,016.90 2,814.41 1,376.50 4,929.69 3,293.32 2,283.30 2,606.01 4,482.49 7,221.18 3,982.42
83,626.31 5,779.42 1,055.24 969.52 2,055.67 1,384.32 2,671.25 2,104.86 1,822.02 2,705.79 4,071.26 8,120.99 3,675.49
0 3,559.05 720.83 1,142.05 1,582.96 1,048.19 2,926.34 0 2,145.88 0 3,053.97 5,771.31 3,791.77
213,992.32 13,699.88 3,012.57 3,128.47 6,453.04 3,809.01 10,527.28 5398.18 6,251.20 5311.8 11607.72 21,113.48 11,449.68
GOOD SHEPHERD MATERNITY 0 HOME/CLINIC WEST END PHARMACY CHARINGU HEALTH CENTRE KONTA CENTRE NORTH 0 0
HEALTH 0 0 0
KPERISI CHPS DOBILE CHPS
ARCH BISHOP DERYS 0 REMEMBRANCE CLINIC BUSA HEALTH CENTRE IBRAHIM ADAM PHARMACY BAMAHU HEALTH CENTRE STI/CT HEALTH CENTRE CHARIA HEALTH CENTRE 0 0 0 0 0
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KAMBALI CLINIC WA SUB HEALTH CENTRE MARKET CLINIC EYE CLINIC GREEN BEAM CHEMISTS BIL CLINICAL SERVICES
TOTAL
0 0 0 0 0 0
36,394.37
14,228.02 13,017.39 10,648.18 292.30 0 0

171,761.66
13,416.96 10,242.40 8,111.86 436.50 7,545.25 16,623.63

176,418.74
0 6,468.65 7,042.52 589.05 5,690.44 15,779.39

61,312.24
27,644.98 29,728.44 25,802.56 1,317.85 13,235.69 32,403.02

445,887.17
CHALLENGES Inadequate staff strength e.g. no assistants for the following departmental heads; MIS, PRO and Claims Manageress. Inadequate logistics e.g. cameras, motorbikes, cars, computers, printers among others Inadequate office space. Inadequate motivation for staff and agents. Inadequate staff development training programmes Unclear job progression Unable to use the oracle system for paying claims thus manual vetting is still use to process and pay claims returns hence claims backlog. Political interference in the management of schemes Irregular review of drugs and medicines list Abuse of the system by clients and service providers RECOMMENDATION Procurement of logistics notable cameras, motorbikes, cars, computers among others Employment of assistance for the line managers
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Enlargement of the office space Initiate monthly allowances for agents We strongly recommend that the Claims Module in the ICT Platform should be upgraded and refresher training given to claims officers to meet this challenge. Refresher training be organized for health providers on the ICT Platform. The equipment should be labeled for easy identification. Training programmes should be organized for staff to enhance our work
A major concern of the scheme management is the critical issue of sustainability, accessibility and quality healthcare delivery. Various measures will be put in place to ensure the achievement of this goal. Some of these measures are as follows: 1. Promoting the culture of cost consciousness in order to ensure that, the limited financial resources available are judiciously applied to accomplish the goals and objectives of the Scheme. 2. Liaised with the Municipal Assembly to increase the office space of the Scheme 3. Increased internally generated funds through the issuance and renewal of ID cards. 4. Lobbying NHIA and Municipal Assembly to increase funding support to activities of the scheme 5. Proactively sourcing and lobbying Civil Society Organizations and International Non-Governmental Organizations (SNV, UNICEF, CARE, JICA, DANIDA, PLAN GH. etc) to support the funding of activities of the scheme. 6. Organized refresher training for staff and providers.
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CHAPTER FOUR: SUPPORT SERVICES 4.1 Human Resource Development

For an organization to achieve its mission and vision it needs skillful, dedicated and qualified human resource. This has become paramount to the Ghana Health Service since it works towards delivering health care to human beings, and without them too the laboratory equipments, X-Ray machines, Ambulances and the Hospital will be of no use.
This has therefore necessitated the need for the Wa Municipal Health Administration to attract and retain qualified Human Resource to ensure effective and efficient Health Care Delivery. The Human Resource situation in the Municipality was not very bad during the year. The main challenges were uneven mix which saw huge numbers of some categories and in others very few or even none at all. The staff strength of the Wa Municipal Health Administration stood at 164 as at 31st December 2010 as can be seen in the Table below. Table 25: Summary Human Resource capacity by Sub Municipals, 2010
Profession Bamahu Busa Charia charingu Kambali MHA Wa Central Grand Total
Accountant Accounts Asst. Clinic Attendant Driver Field Technician Finance Officer Health Aide MDHS Medical Assistant Midwife Nurse Technical Officer II Grand Total
1 1 1 2 2 1 1 1 1 2 7 10 1 9 12 2 11 14 1 6 8 1 14 17 1 11 52 78 2
1 1 3 2 5 1 2 1 1 18 102 5 164
3 5 25
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The following categories of critical staff are completely absent in the Municipality:1. Dispensing Technician 2. Laboratory Technician 3. Medical Officer 4. Medical Assistant 5. Technical officer (DC) 6. Technical Officer (Nut)
4.2 Health Information Management

In its bit to improve data and information management through the use of ICT, a Wireless Network with Internet Connectivity has been installed at the Municipal health administration to enhance information sharing and data security through regular servicing of computers with latest anti-virus software The Health information Unit is also functioning very well with very vibrant workers highly motivated with modern equipment to enhance its work. Provision of technical support to others units and Sub municipalities to develop themselves technologically has also become a core duty of the health information unit of the municipal health administration and also serves as a key source of health information to researchers and students in the Municipality On the area of data management, the District Health Information Management System (dhims) software is being used exclusively although some other reporting formats which cannot be captures by the software are being managed using Microsoft excel templates.
4.21 Timeliness and Completeness of Data
For the period under review, all Sub municipals were able to meet the deadline for submission of returns to the Municipal Health Directorate and must be commended for that.
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Timeliness of Data Reporting - Jan-Dec 2010 Wa Municipal goal <=5

6 5 4 3 2 1 0 BAMAHU BUSA CHARIA CHARINGU KAMBALI WA CENTRAL REG. HOSPITAL Days of Submission
Data Completeness for the period was also very good and facilities are encouraged to continue the good work Data Completeness by Facility - Wa Municipal Jan-Dec 2010
100% 80% 60% 40% 20% 0% BAMAHU
BUSA
CHARIA
CHARINGU
KAMBALI
% Summary Sheets submitted
WA REG. CENTRAL HOSPITAL % Data Elements completed
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4.3 Estates and Equipment

4.31 Estates FACILITY Bamahu
PROBLEM 1. No official accommodation for the in charge 2.No pipe borne water at the facility 3.No lights
ACTION Negotiating with municipal assembly/NGOs Supported by the Municipal to install lights. 1. Roof repaired 2. Facing board replaced. 3.H/C repainted, 4.Public Urinal Constructed 1.Cracks mended 2.Gates replaced 3. Locks replaced 4. Roof mended and plywood replaced 5. Bathroom drained 6. Molding raised 7. Quarters repainted
REMARKS 1. Negotiating with municipal assembly/NGOS for support. 2.Work is in progress to connect to National Grid Funded by Wa Central Member of Parliament.
Busa
1. Leaking roof 2.Rotten ceiling and facing board 3.faded paint 4.Weak Public urinal 5. Dilapidated Urinal
Charia
1.Cracks on walls 2,Weak main gates 3. Damage locks 4.Roating ceiling 5.Chocked bath room 6. Moldings too low 7. Faded paint.
Funded by Wa Central Member of Parliament.
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Dobile C H P S
No public urinal
Contract awarded for the construction of urinal
Funded by Wa Central Member of Parliament
Charingu Staffs Quarters
1.Weak Verandah moldings 2.Weak building base 3.Cracks on floors 4. Leaking Roofs 5.No Parapet wall to buildings, 6.No Plat form for tank 7. Faded Paint 8.Open Veranda
1. Moldings repaired 2. Base reconstructed 3. Cracks Mended. 4. Roofs mended and Ply wood replaced 5. Parapet walls constructed 6. Platform constructed. 7. Facility Repainted. Veranda Fenced
Funded by Wa Central Member of Parliament.
Health Center
9. Leaking Roof
10. Dilapidated Public 8. Roof repaired Urinal 9. Urinal Constructed. Kperisi No Water at facility No lights Connected to National Grid MHA
RENOVATIONS /CONSTRUCTIONS AND ACHEIVEMENTS
Major renovation of MDHS bungalow. Renovation of Charingu in charge and staff quarters. Renovation of Charingu health Centre
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Installation of air conditioner at six facilities (Dobile, Market, Busa, Bamahu, Kambali, STI, and officers. Repairs of office and conference Hall broken and weak chairs. Replacement of locks to the toilet and Nutrition office Feeling of Dobile CHPS frontage with gravel. Feeling of Kambali Clinic with gravel. Renovation and extension of STI clinic. Construction of market clinic, Dobile CHPS, Piisi CHPS and Bussa CT centr A Urinal Pit at Charingu H/C A Urinal Pit at Fadama Live Stock Market A Urinal Pit under construction at Dobile CHPS Compound. A Urinal Pit at Busa H/C A Urinal Pit at Wa Urban Health A shed at Wa-Sub A Shed under construction at Konta North Tanpalpani C H P S connected to pipe borne water S T I center connected to pipe borne water 20 .Market clinics connected to pipe borne water Kambali clinic connected to pipe borne water Bamahu work in progress to be connected to the National Grid.
FACILITIES UNDER CONSTRUCTION 1. Sing CHPS compound. 2. Dondoli CHPS compound. 3. Kunbiehi CHPS compound
4.32 Equipment
The MHA had donor support from UNICEF to CHPS compounds in the form of furniture, fixtures and medical equipment BENCO HOSPITEX GH LTD. Donated medical equipment to the Municipal Health Administration which was distributed as indicated on the table below.
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SUD AND CHPS DISTRICTS DOPPLER5 500A GLUCOM.T ONETOUCH FEOTALSTE THOSCOPE DRESSING SET DIGITAL THERMOMETE R WEIGHINGS CALE ADULT SPHYG PB FULL AUTOMAT IC SPHYG BP.MERCU RE
QUNTITY BUSA CHARINGU KPERISI DOBILE CHARIA KAMBALI NACHANTA GBERU CHPS BAMAHU PIISI CHPS KONTA NORTH
S T I ADOLESCENT
6 1
20
10
10 1
10 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 6
0 0 1 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 5
1 1 2 0 2 0 1 2 1 2 2 0 1 1 0 0 1 1 0 0 1 1 0 0 0 1 1 0 2O 1 1 0 0 1 0 9 0 1 0 0 1 1 1 0 1 1 1 1 0 0 0 1 0 10
1 0 1 2
0 0 1 1 0 0 0 1 1 0 1 0 10
WA.U/C WA,UB/MCH KUNBIEHI TANPALPANI CHPS BOLI CHPS MARKET CLINIC MHA TOTAL
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CONSTRAINTS 1. Capital project of MHA office accommodation is still pending. 2. No access road to Bamahu clinic 3. No lights and water in some of the clinics and CHPS Compounds 4. Defects at kpongu and Boli CHPS not yet rectified. 5. Constant fusing of bulbs at Urban Health and Busa. 6. Inadequate working tools and protected clothing for sundry staff.
RECOMMENDATIONS 1. It is our hope that all remarks for minor renovation and the connection of light and water to facilities needing them would be done by the end of 2010, to facilitate the smooth running of services. 2. It is also our hope that access road would be demarcated to Bamaahu clinic and CHPS compound for easy access. 3. Office of the MHMT building should be seen as a priority among other capital projects in the region efficient service delivery.
4.4 Stores
The stores unit in accordance with the stores regulation, financial administrative regulation and departmental instruction of the Ministry of Health and Ghana Health Services ensures that medical supplies, stationery, fuel and other medical logistics needed by the sub-municipals and the Municipal Health Administration are provided at the right time, right place, right quantities at the right cost, right condition for a Better Health Service Delivery. The stores and supplies management class advices management on the procurement needs of the Municipal Health Administration and Sub-Municipals. It takes delivery of stores for the Municipal Health Management team and effects issues based on approved stores requisition. In addition stock taking in general, inventory and ledger data are carried out by the class.
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The store unit also in conjunction with a accounts department carries out monitoring and support visit to the sub-municipalities and CHPS zones.
Table 26: Donations

EQUIPMENT Haemoglobin Starter Haemoglobin Refill Vacuum Extractor Ambu Bag Infant SPHYG BP Apparatus Mucus Extractor Treated Glogs Googgise Kidney Dish Artery Forcep Knoker Forcep 29 TV Set DVD Player Air Conditioners CSB 25K Bags Vegetable Oil Sugar 50K Salt 25K DONORS UNICEF NACP WFP QUANTITY 27pcs 56 pcs 2 pcs 12 pcs 13 pcs 750 pcs 2 pcs 2 pcs 2 pcs 2 pcs 2 pcs 6 6 6 2,828 Bags 390 Ctns 107 Bags 65 Bags
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4.5 Transport
Transport Management is a system that is made up of five major components; Transport policy, Operational management, Fleet management, Management of information and Human resources that seeks to; Improve access to basic health services through the development of appropriate transport management system and to Improve livelihoods by building transport and logistics sector capacity to operate effectively, efficiently and safely. Its sometimes best describe as a motorcycle that runs on two wheels (Fleet management& Operational management), that is powered by its engine (Information management), operated by its rider (Human resources) and directing the motorcycle through its handlebars (Policy). The Situation of Wa Municipal Transport System The period under review, Municipal Health Directorate bought (funded by Wa Central Sub Municipal) a hire purchase Great wall Wingle Pick -up bringing the total number of Vehicles to four (4), thus Toyota Hilux, Nissan, Madza and Wingle Pick-ups. The above mentioned Vehicles are all roadworthy and are manned by Two (2) drivers. Table 27: Summary of Vehicles Inventory Year Year Make Model Received Manufactured Age Condition Pick Road MHA Gv304u Madza Up 2003 1998 13 Yrs Worthy Pick Road MHA Gv487y Toyota Up 2007 2007 4 Yrs Worthy Gv Pick Road MHA 169z Nissan Up 2008 2008 3yr Worthy Gv231Pick Road MHA 10 Wingle Up 2010 2010 1yr Worthy The Health Directorate `has fifty four (54) Motorbikes; out of this number 16 are AG100, AG200 five (5), DT125 one (1), Nanfan125 twenty one (21), Jailing eight (8) and FYM three (3). Reg. Location No
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Table 28: Summary of Motor bikes Inventory Serial No. 1 2 3 4 5 6 7 Make AG100 AG200 DT125 Nanfan125 Jailing FYM TOTAL No. 16 5 1 21 8 3 54 off-road 0 0 0 0 1 0 1 4 0 0 0 4 3 11 Condition Very Weak Weak 0 0 1 0 0 0 1 Roadworthy 12 5 0 21 3 0 41
Analysis of the Motorbikes Inventory clearly shows that Twelve (12) motorbikes need to be replaced, or the effect would be continues high cost of maintenance, since they are weak and would frequently breakdown. However the year under review saw a lot of the Nanfan motorbikes constantly breaking down with the common problem being; hub cover, chain etc. which is a source of worry to every rider. Table 29: Sub Municipals Motor Bikes Fleet Status Sub MAKE Total SUB NO. MUNICIPAL AG100 AG200 DT125 Nanfan125 Jailing FYM 36 1 Bamahu 2 1 0 2 0 0 5 2 Busa 2 1 0 1 0 0 4 3 Charia 1 1 0 2 0 0 4 4 Charingu 3 0 0 1 0 0 4 5 Kambali 1 2 0 2 0 0 5 6 Wa Central 1 0 0 11 2 0 14 7 MHA 6 0 1 2 6 3 18 TOTAL 54 16 5 1 21 8 3 54 Sub Municipals Motor Bikes Fleet Status stands at 36, which Wa Central has received the greatest number of Bikes. Averagely every Sub Municipal has not less than 4 Motor Bikes,
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an indication that Health Administration has catered for the motor bikes needs of Sub Municipals. On the other hand, the whole of 2010 Municipal Health Directorate did not receive any donations for Transport, neither Vehicles nor Motors bikes as compared to last year. Table 30: Vehicles Statistics Compared N0. 1 2 3 4 5 6 7 8 Indicator Proportion of vehicles road worthy Proportion of vehicles from 0-5 years Proportion of vehicles from 6-10 years Proportion of vehicles more than 10 years Proportion of motorbikes road worthy Proportion of motorbikes 0-3 years old Proportion of motorbikes 4-5 years old Proportion of motorbikes more than 5 years old 2008 4 1 0 2 2009 3 2 0 0 18 21 6 6 2010 4 3 0 1 41 41 9 4
Activities Carried out Servicing A Mechanic has been contracted by the Municipal Health Administration to carryout monthly servicing of both the Sub Municipals and Administration motorbikes for service delivery. The period under review, the Municipal Health Administration procured lubricants ( 209 gallons each of two stoke and engine oil) for routine servicing and also paid an amount of Two thousand, Two hundred and Fourteen Ghana Cedis Ten pesewas GH(
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2,214.10) for servicing and maintenance of motorbikes. In all fifteen (15) sessions of serving of motorbikes was carried out, routine servicing accounted for twelve (12) of these sessions and three (3) was as a result of National Programmes (NID round 1 & 2 and Measles SIA Campaign). In the case of Vehicles, Servicing were done in Kumasi or Tamale, with the exception of the Madza Pickup that is serviced at Mechanic and Technology Centre, Wa. In-service Training A three day refresher training Workshop was organized in November, 2010 by Regional Health Directorate for Municipal, Districts Transport Officers and Directors of Health Service. The Workshop was intended to strengthen Transport Management system at the various Health Directorates. Key among the facilitators was the Deputy Director Transport, Mr. E. Hamond. Parading of Vehicles for Inspection Municipal Health Administration has instituted a system where monthly vehicles are paraded for inspection to ensure road worthiness of the Vehicles. The inspection team is constituted by Municipal Health Management Team (MHMT) actions to who be provides taken after their every recommendations to MHMT for suitable inspection. The year under review, there were twelve (12) planned Vehicles Inspection Parades which nine were honoured. Conflicting Programmes account for the three (3) that werent honoured.
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Reporting Since the implementation of log books and log sheets use in the Municipality in 2009, both Drivers and Riders alike has been reporting to Municipal Transport officer at the end of every month. However some riders have not been reporting as result of malfunctioning of their motor bikes odometers. Another issue of concern is the inability of some riders to take reading of odometer, upon several corrections of past mistakes. The idea behind the introduction of these log books is to monitor the availability, utilization, maintenance and proper handling of vehicles, especially motor bikes in the Municipality. Data collected were collated, analyzed and submitted quarterly to the Regional Transport Unit. Accident The Municipal Health Directorate has not recorded any major accident under the period of review. Analysis of Vehicles Key Performance Indicators Table 31: Analysis of Motor bikes KPIs INDICATOR Km Travelled Running Cost (GH) Maintence Cost (GH) 3,268.00 2008 2009 47,817 2010 63,3372 13,936.90 2,214.10
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Table 32: Analysis of Vehicles KPIs INDICATOR Km Travelled Running Cost (GH) Maintence Cost (GH) Availability (%) Utilization (%) 2,239.17 94% 24% 2008 21,869 2009 94,793 8,448.16 1,938 98% 91% 2010 79,527 11,127.85 4,373.65 97% 95%
Challenges 1. Insufficient number of Drivers. 2. Unplanned request of vehicles. 3. Frequent breakdown of Nanfan motorbikes. 4. Lack of spare parts for servicing of motor bikes. 5. Improper filling of motorbikes Log sheets. Way Forward 1. Liaise with Regional Health Directorate for a Driver. 2. Municipal Health Administration to ensure that unplanned request of Vehicles is not for entertained. 3. Municipal Health Administration should source funds to procure motor spare parts for the servicing of motorbikes. 4. To train and acquire Motor Drivers Linence for new staff. 5. To ensure regular maintenance of vehicles and motor bikes.
4.6 Financial Management

The vision of financial management is to provide relevant and timely financial information for effective management and decision making on Quality Health Delivery. The key achievement for this reporting period includes the following:
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All ledgers were up to date Financial reports and statements prepared up to date. Expenditure was incurred on priority analysis. All outstanding liabilities on Drugs has been paid Sources of funding are the Central Government Funding (GOG), Donor Pool Funds Internally Generated Funds (IGF) from the Sub Districts and program based funding. Special program funds are sometimes sent specifically for the programs activities. For the period under review, the summary planned budget, approved budget and expenditure is shown below: Table 33: Total Inflows and Expenditures Indicator Planned Budget (MTEF) *Total Inflows 2008 566,367.39 566,367.39 2009 745,926.38 745,926.38 2010 1,093,705.73 1,093,705.73
Table 34: Income and Expenditure on GOG and Donor Pool Funds (DPF) for 2008 2010 PERIOD 2008 GH income GOG service % GOG Admi. % DPF 5,682.50 expenditure 6,503.76 2009 GH income 7,663.30 expenditure 3,801.00 2010 GH income 8,676.11 53.09 12,411.34 39.93 6,934.90 expenditure 12,699.36 12411.34 6,788.90
16,530.00 16,530.00 0 0
57.42 18,663.72 18,663.72 53.30 1,617.80 2,011.90
4.61 GOG ADMINISTRATION There was a reduction of 13.37% of the total inflow of GOG administration in 2010 as against 2009. Warrants for the lass four month of the year were not received.
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Table 35: Analysis of Expenditure on GOG Administration for the year under review NO ACTIVITY 1 Purchase of publication news papers 2 3 4 5 6 Renovation of residential accommodation Payment of transfer grants Insurance of official vehicles Accommodation Allowance Car maintenance allowance Total AMOUNT 1,392.40 3,526.20 504.00 1,799.42 4,545.32 644.00 12,411.34
4.62 GOG SERVICE There was a beginning balance of 4,092.52 for GOG item 3 which resulted in the a higher expenditure as against the total inflow for the period. Even though there was a little increase in the 2010 as against 2009, the inflow was far less than the required budgeted amount. Especial considering the rate of increase in the number of health facilities in the Municipality. Also considering the rate of increase in the population as a result of the UDS; which has led to the emergence of new settlements, service delivery has to be stretched with the little available funds. Table 36: Analysis of expenditure on the GOG service for the year under review No 1 2 3 4 5 6 ACTIVITY Training and Conferences Stationery Refreshments Non drugs consumables Night Allowance Fuel and Lubricants Total AMOUNT 3,629.57 1,539.01 3,569.68 1,490.10 844.00 1,627.00 12,669.36
4.63 DONOR POOL FUNDS DPF
For the year under review, there was a significant increase in the inflow of DPF as compared to the pass three years. Upon receipt of the funds, 20% of the amount was apportioned among the Sub Districts to undertake Campaigns on Maternal and Child Health
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in the Municipality. Similarly, 24% was used for routine serving of motor bikes and official vehicles whiles 18% was used to procure fuel for administrative and service delivery activities. There were other expenditure on the fund; such as training of health staff, night allowances, refreshment and bank charges. Below is the detailed analysis of expenditure on the DPF for the year under review. Table 37: Expenditure on DPF No Activity Fuel and running cost Maintenance & repairs of office Vehicles Training and Conferences Health promotion & campaign Refreshment Night allowances Bank Charges total Table 38: Program Funds - Inflow Indicator HIRD UNICEF AIDS CONTROL MALARIA NUTRITION MALARIA TUBERCLOSIS Other Program Fund 2008 77,766.85 147,333.27 2009 40,092.93 49,300.00 234,809.30 11900.00 4,858.80 232,826.35 2010 30,080.85 24,613.10 3,750.00 20,114.49 6,228.00 66,492.26 Amount 1,217.30 1796.5 1,845.10 1,380.00 446.00 32.00 72.00 6,788.90
Table 39: Expenditure On Program Funds Indicator HIRD UNICEF HIV/AIDS Other Program Fund 147,333.00 261,517.17 2008 64,746.28 2009 45,823.00 33,420.00.00 233,723.11 70,293.38 2010 21,964.37 22,061.6 4,836.20 65,643.64
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4.64 High Impact Rapid Delivery (HIRD) Fund Half of the total inflow of 30,080.85 was received at the beginning of the year whiles the other half was received at the end of the year. There was a beginning balance of 6,845.85. Total expenditure as at the end of the year amounted to 21964.34 leaving a closing balance of 14,961.60 4.65 National AIDS Control Program Over the pass two years, the Municipal Health Directorate benefited a lot from the support of the National Aids Control Program. (NACP) on infrastructural improvement, medical equipments and also on training of health staff on PMTCT activities in the Wa Municipality. The total amount received for the year represents an allocation from the Regional Health Directorate for monitoring on HIV/AIDS activities and Know Your Status Campaign in the Wa Municipality. UNICEF In 2009 total amount of 49,300.29 was received from UNICEF for the construction and furnishing of a CHPS compound at Piisi and for the extension of Busa and Bamahu Health Centres for PMTCT activities. As at December, 2010, a total amount of 24,613.10 was receive for activities such as training of health workers on lactation management, training of Community Base Agents (CBAs) on CCM & ZINC on diarrhoea and training of volunteers and monitoring on CMAM activities in the Municipality.
4.66 TUBERCULOSIS - TB
More funds were received in 2010 than the previous years. With the total amount of 6,228.00 that was received, the following activities were carried out. Review meeting with Health workers, Chemical sellers, Traditional Healers and Private Health Facilities Operators, provision of enablers package for TB clients, Sensitization of Schools, Radio Discussions and Quiz competition for Junior High Schools on TB activities. Also, there was monitoring on TB activities 4.67 Malaria For the year under review there was specific program funds ear mach for Malaria Nutrition activities in the Municipality.
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4.68 Nutrition
An amount of 3,002.00 was received from World Food Program to support in the distribution of food items to the various feeding centres in the Municipality. Also, a total amount of 2,815.00 was received from the Regional Health Directorate Nutrition activities. 4.69 DISTRICT ASSEMBLY SUPPORT A total amount of 4,835.00 was received from the Wa Municipal Assembly for connection of water and electricity to Bamahu H/C, Market Clinic, Kambali H/C, Dobile CHPS and Adolescent H/C. The Municipal Assembly also did support in the National Immunization campaigns. 4.610 SPECIAL SUPPORT FUNDS For the year under review, a total amount of 10,554.96 was received from Pathfinder International for training of Health Workers and volunteers on comprehensive abortion care in the Municipality. Similarly, an amount of 4,200.00 was received for extension, partitioning and furnishing of some rooms at the Adolescent H/C for comprehensive abortion care services. Through the member of parliament of Wa central, an amount of 50,000.00 was received from the NHIA for renovation and furnishing of Health Facilities in the Municipality. 4.611 Other Programs Funds Other programs consist of National Immunisation on Polio and Measles - NID, Guinea worm eradication, Family Planning services, sale of ITN, EYE CARE, etc Funding for National Immunisation activities amounted to 44,912.00; also an amount of 13,409.96 was received from the Regional Health Directorate for fillariasis control program. The opening balance for ITNs Revenue was 1,712.79 Total inflows from the sale of bed nets amounted to 1,892.50 with 2,292.00.00 being remitted to the Regional Health Directorate. Opening balance for family planning revenue was 801.50. Sale of family planning devices yielded 4,914.40 with 4,466.28 being remitted to the Regional Health Directorate. Eye care services was also supported by Swiss Red Cross with an amount of 563.40
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4.612 Internally Generated Fund (IGF) Table 40: Analysis of IGF Revenue YEAR CATEGORY DRUGS SERVICE TOTAL GRAND TOTAL % 2008 CASH NHIS 13,175.00 75,583.00 6,538.00 69,760.00 19,713.00 145,343.00 165,056.00 16.3 2009 CASH NHIS 7,952.44 168,768.43 8,114.63 124,007.32 16,067.07 292,775.75 308,842.82 30.44 2010 CASH NHIS 11,274.55 349,932.29 8,551.21 170,848.32 19,825.76 520,750.61 540,606.37 53.29
Table 41: Revenue Analysis by Facility - 2010 FACILITY BAMAHU H/C BUSA H/C CHARIA H/C CHARINGU H/C KAMBALI H/C WA URBAN H/C KPERISI CHPS MARKET CLINIC ADOLESCENT H/C KONTA NORTH H/C DOBILE CHPS EYE CLINIC TOTAL CASH REVENUE DRUG SERVICE 1,124.48 2,542.48 2,342.73 510.78 1,552.95 557.35 313.02 1,139.79 803.28 254.2 133.49 11,274.55 707.25 1535.7 1,545.37 454.03 857.05 677.95 341.43 800.01 1,256.38 268.80 107.24 8,551.21 NHIS REVENUE DRUG SERVICE 20,613.16 12,234.21 23,633.82 3,847.40 74,530.30 67,625.89 6,360.90 54,022.88 55,099.15 13,977.40 16,030.78 1956.40 170,848.32 11,224.23 9,523.55 11,191.61 4,321.05 30,812.88 42,319.43 5,255.29 24,931.19 15,720.77 6,552.36 7,709.61 1,286.35 349,932.29
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Table 42: Expenditure Categories For The Past three Years Description HIRED LABOUR PRINTIING MATERIALS AND STATIERY PHOTOCOPY RENT- OFFICE ACCOMODATION RUNNING COST OFF. VEHECLES MINOR REPAIRS OFFICE BUILDINGS MAINTENANCE OF MACHINES/EQUIP TELECOMUNICATION BANK CHARGES TRAINING REFRESHMENT FEEDING REHAB NON DRUGS CONSUMABLE NIGHT ALLOWANCE RUNNING COST FUEL & LUBRICANTS DRUGS 2008 5,056.47 1,782.10 1,296.48 3,760.00 471.90 2,987.57 1,176.50 0 449.73 4,816.00 0 0 12,358.04 0 0 54,129.28 2009 6,217.00 5,228.30 4,754.00 4,400 8,10.00 2,601.54 4,957.70 767.91 138.00 14,659.00 10,798.70 876.30 18,498.61 308.00 12,066.67 90,093.40 2010 19,152.00 21635.98 1170.50 0 18,538.25 11,720.58 6,291.85 644.00 875.00 29,122.25 21,552.56 39,117.37 856.00 18538.25 216,884.06
4.613 National Health Insurance (NHIS) Out of the total amount of 540,606.37 being generated through NHIS, an amount of 191,004.27 is outstanding claims, which is in respect of October to December. Out of the amount, 121,396.67 are for drugs whiles the balance of 69,607.60 is for non drugs revenue. Management of claims at the various facilities remains the biggers challenge facing the finance division.
4.614 IGF Expenditure
A total amount of 308,487.24 was incurred on both drugs and non drugs consumable. A monthly standing order of 1,500.00 which sums up to 10,500.00 was taken from the Wa Sub Accounts towards a hire purchase of a Wingle Pick up for the Sub Districts. In addition, fixed deposit investment was made in November, 2010, from the various Sub Districts Drugs Accounts after a full settlement of all third quarter drugs bill were made. Even though there has not being outstanding liabilities on drugs, management of drugs has not been the best at the facility level.
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2010 ANNUAL PERFORMANCE REPORT 4.615 Investments
Table 43: Investment figures for the Sub Districts BMC PRINCIPAL RATE % WA SUB 50,000.00 10.25 BUSA 3,000.00 6.75 CHARINGU 6,000.00 8.75 CHARIA 9,000.00 8.75 KPERISI 3,000.00 9.00 BAMAHU 2,500.00 9.00 KAMBALI 30,000.00 11.75
4.616 Internal Audit
INETEREST 5,125.00 202.50 525.00 787.50 270.00 225.00 3,525.00
AMOUNT 55,125.00 3202.50 6,525.00 9,787.50 3,270.00 2,725.00 33,525.00
The internal audit was introduced in may 2010 to complement the administrative functions of management on checks and balances. The unit is tasked to ensure management on efficiency and effectiveness of the various controls, evaluate compliance and report on any weaknesses identified and suggest corrective measures to be taken. It is also tasked to assess periodically the operational systems at the various units/centres and make suggestions to management for improvement. However, the overall objectives of the unit is to add value to the Bomb's operations. For the period under review the following observations were made Daily cash collected were being deposited monthly instead of weekly There was an improvement in stores management. Some collections were not recorded resulting in some revenue unaccounted for. Some collections were not recorded resulting in some revenue unaccounted for. Some centers entrusted cash collections to Non-established staff resulting in revenue lost. Inadequate segregation of responsibilities at the centers. Post audit conducted on the centers expenditures indicated some unreturned payments. Improvement on controls environment in areas of communications between MHA
Some achievement for the period under review includes the following; The unit has helped the various centres/units strengthened stores management and financial controls on IGF and other funds. The unit has directly participated in most of the interventions such as mass measles campaign, CHPS periodic training, facilitative supervision etc.
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The unit through sound team work has identified weaknesses in revenue collections at some centers involving Non-established staff and controls have been put in place to avert future occurrence.
Some challenges inlcude; Inadequate information on revenue not routed through GCRs example Family Planning proceeds. Inability to verify revenue generated from CHPS Zones due to audit staff constraint. Inadequate information for audit trail purposes at the centres. Segregation of duties as a Control Mechanism was not adequate to aid smooth auditing.
To maintain or improve on our current performance at both the Municipal Health Administration and the various centres on judicious use of resources for health care delivery, the unit wishes to propose the following; Periodic in-service or on-the-job training for the various units or centres on basic financial and logistic management and other operational systems should be organized. The current communication between the Municipal Health Administration and the various centres be maintained and improved upon. The unit shall endeavour to visit the centres at least once in every quarter The control environment employed by the management for the smooth operation in areas of staff attitude towards clients for quality health care delivery should be strengthened.
4.7 Challenges
Improving the Quality of services- ANC, Immunization High maternal, neonatal and Stillbirths Increasing burden of communicable and non communicable diseases Poor data management and utilization Staff attitude and indiscipline High attendance and overcrowding in some health facilities High mobility and poor community mobilization especially in Town Drug management in Health facilities
Page 80
4.8 Way Forward

Hold a durbar of chiefs, Assembly men, women and Volunteers to discuss maternal and child survival Conduct regenerative and nutrition activities Expand screening services to cover all areas in the municipality Conduct Night Videos, C4D activities in communities Form and conduct regular data validation in Health facilities and communities Regular support for health facilities Zone health facilities for MHD staff
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ANNEX A: PERFORMANCE INDICATORS

INDICATORS 2008 Performance 2009 Performance 2010 Target 2010 Performance
Total Population Expected pregnancies / children under 1 WIFA HO1 Bridge equity gaps in access to health care and nutrition services and ensure sustainable financing arrangements that protect the poor No. of functional CHPS zones No. of CHPS compounds Total population living within functional CHPS zones Number of doctors Population to doctor ratio Number of medical assistants Number of nurses (all categories) Population to nurse ratio Number of midwives Number of Community resident Nurses (CHOs) Number of Under five years who are under weight presenting at facility & Outreach Total number of outpatient visits Number of OPD visits by insured clients Outpatient visits per capita Number of cases seen and treated by the CHOs. HO2: improve governance and strengthen efficiency in health service delivery, including medical emergencies Revenue Mobilization IGF Insured clients Non- Insured Clients Drugs
114513 4581 27483
116229 4649 27895
118205
4728 28369
11
3
12
6
13 8 38271 12 9850 2 231 51171 54 22 440 150211 143011 1.27 14070
31,189
10 11451 2 154 74359 44 18 632 84308 69313 0.74 4764
35778
13 8941 2 204 56975 59 22 565 117616 105292 1.01 6422
145343 19713 88758
292755.75 16067.07 176720.87
361206.84 179399.53 361206.84
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Non-Drugs District Assembly Common Fund Other Sources Receipts Item 1: Personnel Emolument Item 2: Administration Expenses Item 3: Service Expenses Item 4: Investment Expenses Sector Budget Support (SBS) Global Fund(Malaria/TB/HIV) Expenditure Drugs Non-Drugs District Assembly Common Fund Other Sources Item 1: Personal Emoluments Item 2: Administration Expenses Item 3: Service Expenses Item 4: Investment Expenses Sector Budget Support (SBS) Global Fund(Malaria/TB/HIV) Proportion of vehicles road worthy Number of vehicles from 0-5 years Number of vehicles from 6-10 years Number of vehicles more than 10 years Proportion of motorbikes road worthy Number of motorbikes 0-3 years old Number of motorbikes 4-5 years old Number of motorbikes more than 5 years old HO3: Improve access to quality maternal, neonatal, child and adolescent health services. Number of ANC registrants Number of clients making 4+ visits Average number of ANC visits per registrant ANC Registrants receiving IPT1 ANC Registrants receiving IPT2 ANC Registrants receiving IPT3
76298
132121.95
179399.53 4835.00 245357.29
474049.47
348441.7
16530 6503.76
0 0 147333.27 54,129.28 12,358.04 261517.17 0 16530 6503.76 0 0 147333
18663.72 3801
0 1617.8 239668.10 90,093.40 18,498.61 70293.38 0 18663.72 3801.00 0 2011.9 233723.11 0
12411.34 8676.11
114160.00 6934.90 9978.00 216,884.06 39,117.37 65643.64 0 12411.34 12699.36 0 6788.9 4836.2 3 1 0 41 41 9 4
1 2 2 18 18 4 6
2 1 0 34 42 6 6
4790 2217
3.7
4893 3579
3.9
5042 4089 3.9 3074 2712 2242
5373 4218 3323
4035 3411 2860
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Number of pregnant women receiving Tetanus toxoid (T2+) Total Deliveries Number of deliveries by skilled attendants (by doctors and nurses only) Number of deliveries by TBAs Number of maternal deaths (institutional) Institutional maternal mortality ratio ( per 100,000) Number of institutional maternal deaths audited Total number of still births Total number of fresh still births Number of PNC registrants Number of Family Planning Acceptors %WIFA accepting family planning Total Couple Years of Protection (CYP) Number of Institutional infants deaths Number of Infants admissions Number of under five admissions Number of institutional under five deaths Total number of admissions due to malaria (under 5 years) Total number of deaths due to malaria (under 5 years) Number of children immunized BCG Number of children immunized Penta 1 Number of children immunized Penta 3 Number of children immunized OPV1 Number of children immunized OPV 3 Number of children immunized Measles Number of children immunized Yellow Fever Number of children under 5 years receiving at least 1 dose of Vitamin A Number of clients(15-24years) who accepted FP service Number of children under 5 using ITN Number of pregnant women sleeping under ITNs
3254
3555
3720 4142 3566 576 7 196 7 165 39 4265 18086 63.8 4854.2 69 814 2715 110 1576 40 6560 4436 4423 4436 4423 5527 5527
4615 3155 1437 6

130 6
4395 3254 1141 8

182 8
165 43 3916 17862

65.0
196 63 4021 22204

79.6
4583.36 57 559 1939 125 1205 64 6638 4364 4290 4364 4290 4707
6299.8 90 635 2491 166 1408 75 7212 5072 5039 5072 5039 5567 5567 17521
4705
15560
68% 5894
71% 6044
75% 5537
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HO4: Intensify prevention and control of communicable and noncommunicable diseases and promote healthy lifestyles Number of cases of Hypertension seen at OPD in District/Region Number of cases of Diabetes seen at OPD in District/Region. Number of cases of Sickle Cell Disease seen at OPD in District/Region
481 25 22
1111 139 25
882 61 36
No. of guinea worm cases seen Number of guinea worm cases contained No. of AFP cases seen Total number of lab confirmed malaria cases at OPD Microscopy+RDTs) Total number of admissions due to lab confirmed malaria (all ages) Total number of deaths due to lab confirmed malaria (all ages) No. of new HIV positive cases diagnosed Number of HIV+ cases receiving ARV therapy (cumulative) HIV Prevalence among pregnant women 15-24years(Sentinel sites) Total Number of infants born to HIV infected mothers Total number of HIV infected infants born to HIV infected mothers. Number of cases of STI diagnosed in population 15-24years. No. of TB patients Detected TB case detection rate Total number of TB cases on treatment who were cured Total number of TB cases that successfully completed treatment. HO5. : Improve Institutional Care Including Mental Health Service Delivery. Total admissions Hospital Admission rate(per 1000 population per year)
0 0 1 36089 4103 123 20
0 0 2 55455 3749 135 177 2201
0 0 1 33579 4671 94 108 353
80 23.6 15 13
75 17.3 23 8
84
27
15318 134
15944 137
16209 137
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Total number of beds Total number of discharges Total number of deaths Number of patient days Average length of stay % Bed Occupancy Bed Turnover Rate Major operations performed Minor operations performed Number of Beds in District/Region allocated to Mental Health clients Proportion of Hospital beds in District/Region allocated to Mental Health clients Number of professional mental health staff in the District
189
189
197 15498 469 44444 2.8 61.8 82.3 979 1319
14560 515 44933

2.9 76.7 81.0
1556 513 41601

2.6 60.3 84.4
1012 552
838 1459
Page 86

2010 Annual Performance Report - Wa Municipal

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2010 Annual Performance Report - Wa Municipal

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2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

CHAPTER ONE: INTRODUCTION

Figure 1: Map of Wa Municipal

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Table 1: Projected Health Target Populations 2010

BAMAHU BUSA CHARIA CHARINGU KAMBALI WA CENTRAL TOTAL

10,154 9,136 9,468 11,113 15,724 62,609 118,205

406 365 379 445 629 2,504 4,728

812 731 757 889 1,258 5,009 9,456

2,031 1,827 1,894 2,223 3,145 12,522 23,641

406 365 379 445 629 2,504 4,728

2,437 2,193 2,272 2,667 3,774 15,026 28,369

203 183 189 222 314 1,252 2,364

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

CHAPTER TWO: PUBLIC HEALTH SERVICES 2.0 Disease Control

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

2.016 Yellow Fever

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Table 6: Pandemic Influenza H1N1 Vaccination Coverage

2.02 Diseases Targeted for elimination and eradication

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

Figure 2: Filariasis MDA Coverage by Sub Municipals

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

SubMunicipality BAMAHU BUSA CHARIA CHARINGU KAMBALI WA CENTRAL TOTAL

Cov 97.3 99.7 97.2 99.9 100.0 101.0 99.9

Cov 86.8 91.0 103.7 83.2 112.1 101.8 100.6

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT

NIDs ROUNDS 1 & 2 - 2010

Kambali 112 130

Figure 3: NID Coverage by Sub Municipals

2.03 Non-Communicable Diseases

Figure 4: Reported cases of Hypertension 2005-2010

Compiled by Municipal Health Information Unit

2010 ANNUAL PERFORMANCE REPORT 2.032 Diabetes Mellitus

160 140 120 100 80 60 40 20 0 MALE FEMALE TOTAL