2021 ANNUAL HEALTH REPORT

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KADJEBI DISTRICT HEALTH DIRECTORATE

2021 ANNUAL REPORT

Executive Summary

HO1: Bridging equity gaps in access to health care and ensure sustainable financing arrangements that protect the poor

To increase accessibility to health services, all efforts were put in place to make all the demarcated 36 CHPS Zones in the district remain functional. The district has thirty-six (36) CHPS Zones, all of which are functional. Out of thirty-six (36) CHPS Zones, fourteen (14) CHPS zones have compounds and the remaining Twenty-Two (22) zones are without compound.  Provision of sheds was started in some of the CHPS zones by World Bank through Community Performance Based Financing (cPBF) project in Kadjebi District. The uncompleted sheds are being financed into completion by Korea Foundation for International Healthcare (KOFIH).

Outpatient visits (OPD) per capita recorded from 2019 to 2021 were 1, 0.89 & 0.99 respectively. There proportion of NHIS insured clients reporting at the OPDs from 2019 to 2021 were 90.3%, 88.6% and 88.6% respectively.

HO2: Improve access to quality maternal, neonatal, child and adolescent health services

In order to improve upon child health indicators, routine vaccination activities were carried out throughout the district with the available vaccine. The district achieved increases in coverage when compared to 2020 and also there was improvement in all drop-out rates as they were all kept below 10%.

There was an increase in IPT 3 coverage from 33.6% to 53.6% from 2020 to 2021.

HO3: Intensify prevention and control of communicable and non-communicable diseases and promote healthy lifestyles

Institutional Malaria Case Fatality increased from 0% in 2018 to 0.5% in 2019 due to late reporting to health facilities for treatment of severe malaria cases in the district. Surprisingly, non-communicable diseases were becoming significant causes of OPD morbidity. Anaemia recorded Nine (9) deaths as top ten causes of deaths in 2019.

HO4:   Improve institutional care, including mental health service delivery

The intermittent breakdown of the old pick up mounted pressure on the new pick up. In addition to the twenty-five (25) motorbikes provide by Community Performance Base Financing (CPBF) are five new motorbikes donated by KOFIH to the district to enhance service delivery. Construction of sheds for all CHPS zones without compounds is on-going.

TABLE OF CONTENTS                                                                       

Contents

Executive Summary. 2

1.7 Activities carried out 2019. 10

4.0.2. Strategies. 35

4.0.3. Activities Carried Out 35

4.0.4. Disease Surveillance. 36

4.0.5. Tuberculosis Control Programme. 37

Table 16: Gender Classification of HIV Positive Cases, 2017-2019. 39

4.0.6. Expanded Program On Immunization. 39

4.0.7. Malaria Vaccine Introduction Programme (MVIP) 39

4.0.8. Routine Immunization. 40

4.0.9. Neglected Tropical Diseases Control Program Oncho Control 42

4.0.10. School Based Deworming Exercise. 42

4.0.11. Achievements. 43

9.0.1. Human Resource Development 58

Conclusion……………………………………………………………………………………….62

LIST OF TABLES

Table 1:  SUB-DISTRICT POPULATION BREAKDOWN, 2019. 7

Table 2:  DISTRIBUTION OF HEALTH FACILITIES BY SUB-DISTRICT, 2019. 8

Table 3: OPD ATTENDANCE, 2017-2019. 11

TABLE4: OPD ATTENDANCE BY FACILITY TYPE, 2017-2019……………………….11-12

TABLE 5: OPD ATTENDANCE BY OWNERSHIP, 2017-2019……………………………………….12

TABLE 6: UNDER FIVE OPD ATTENDANCE, ADMISSION & DEATHS, 2017-2019…12-13

TABLE 7: OPD ATTENDANCE BY FACILITY, 2017-2019……………………………… ….13

TABLE 8: TOP TEN CAUSES OF OPD MORBIDITY, 2018-2019…………………. ….……14

TABLE 9: TOP TEN CAUSES OF ADMISSION, 2017-2019………………………………….15

TABLE 10: CAUSES OF MATERNAL DEATHS, 2017-2019…………………………………16

TABLE 11: TOP TEN CAUSES OF DEATHS, 2017-2019…….………………………………17

TABLE 12: CONDITION OF PHC SUSPECTED & INVESTIGATED, 2017-2019…………….36

TABLE 13: TB CASE NOTIFICATION & TREATMENT OUTCOMES, 2017-2019……….37

TABLE 14: CLASSIFICATION OF CASES REGISTRATIONS BY GENDER, 2017-2019…37

TABLE 15: TB/HIV COLLABORATION, 2017-2019…………………………………………38

TABLE 16: GENDER CLASSIFICATION OF HIV POSITIVE CASES, 2017-2019………….38

TABLE 17: RTSS VACCINATION (MAY-DECEMBER), 2019……………………………….39

TABLE 18: ROUTINE IMMUNIZATION COVERAGE, 2017-2019….……….…………….40

TABLE 19: IMMUNIZATION DROP-OUT RATES, 2017-2019………………………….….40

TABLE 20: IVERMECTIN THERAPEUTIC COVERAGE BY SUB-DISTRICT, 2019…….41

TABLE 21: TREATMENT OUTCOMES ON SCHOOL DEWORMING BY CIRCUIT,2019.42

TABLE 22: GROWTH MONITORING REGISTRANTS, 2016-2019………………………..…43

TABLE 23: UNDERWEIGT STATUS OF SCHOOL CHILDREN 0-59 MONTHS, 2019……44

TABLE 24:  STUNTING STATUS OF CHILDREN UNDER FIVE YEARS, 2019….…. ….44

TABLE 25: MARKET IODIZED SALT SURVEY, 2019…………………………….……….46

TABLE 26: HOUSEHOLD IODIZED SALT SURVEY, 2019………….……………….……47

TABLE 27: BREAST FEEDING & COMPLEMENTORY FEEDING PRACTICE, 2019….47

TABLE 28: ANAEMIA AMONG PREGNANT WOMEN, 2016-2019……………………….48

TABLE 29: CHPS STATUS, 2017-2019………………………………………….…………….50

TABLE 30: HOME VISIT CONDUCTED, 2017-2019……………………………………………50

TABLE 31: CHANNEL USED DURING HEALTH PROMOTION ACTIVITIES, 2019.53

TABLE 32: TYPE OF SESSIONS HELD, 2018-2019………………………….………….54

TABLE 33: TYPEOF SBCC MATERIAL USED, 2018-2019…………………………….54

TABLE 34: CATEGORIES OF STAFF IN THE DISTRICT. 2019……………………57-58

TABLE 35: VEHICLES AVAILABLE & CONDITION, 2019…………….…….……….58

TABLE 36: LOCATION OF MOTOR BIKES PER SUB-DISTRICT, 2019………………….59

LIST OF FIGURES

FIG 1: HEALTH FACILITIES IN KADJEBI DISTRICT 2019…………………………….9

FIG 2: MALARIA MORBIDITY AND MORTALITY, 2017-2019……..…..……….….16

FIG 3: ANC COVERAGE, 2015-2019………………………………………………..…..20

FIG 4: TD2+ VACCINATION COVERAGE, 2015-2019………….…………………….21

FIG 5: ANC COVERAGE BY TRIMESTERS, 2015-2019……..………………………..22

FIG 6: IPTps COVERAGE, 2015-2019………………………………………….….……23

FIG 7: ANC COVERAGE BY 4+ VISIT, 2015-2019…………………………………….24

FIG 8: ANAEMIA IN PREGNANCY, 2025-2019………………….…………………….25

FIG 9: ADOLESCENT PREGNANCY RATE, 2015-2019………………………………27

FIG 10: COVERAGE FOR SKILLED DELIVERY, 2015-2019…………………….…….28

FIG 11: POST-NATAL COVERAGE, 2015-2019………….………….…………..…….29

FIG 12: MATERNAL MORTALITY RATIO, 2015-2019……………………………….30

FIG 13: NEONATAL MORTALITY RATE, 2015-2019……………………………..….31

FIG 14: FAMILY PLANNING ACCEPTOR RATE & CYP, 2015-2019………………..32

FIG 15: SCHOOL HEALTH SERVICES, 2015-2019…………………………………….33

FIG 16:HEALTH STAFF TRAINING &CHILD RECEIVING RTSS 1, ……………..…39

FIG 17: VITAMIN A COVERAGE AMONG CHILDREN UNDER FIVE, 2017-2019…45

FIG 18: COVERAGE OF 2ND DOSE VAS FOR CHILDREN12-59 MONTHS………….46

FIG 19: COMPLETED SHEDS AT KADJEBI ZONGO & FREE TOWN CHPS……..…56

FIG 20: ON-GOING SHEDS CONSTRUCTION AT ATTA-KOFI & DOA SOUTH …..56

FIG 21: RENOVATION AT AMPEYO CHPS COMPOUND……………………………57

CHAPTER ONE

1.0 BACKGROUND INFORMATION    

1.1     Introduction

The Kadjebi District was one of the twenty-six established districts of the Volta Region and became part of the Eight (8) administrative districts in the new Oti Region in the later part of 2019. The legislative instrument establishing the district was enacted in 1988 but became fully functional as an autonomous district in the year 1992. Subsequently the Kadjebi District Health Directorate was created and located on the compound of the Kadjebi Health Centre. The district is located in the Northern sector of the Volta Region of Ghana and it occupies an approximate land space of 675sqkm. It shares boundaries with Nkwanta South District in north, Jasikan District in the south, Biakoye and Krachi East Districts in the west and the Republic of the Togo in the east.

The District has a population of 73,959 people based on the projection from the 2021 Population and Housing census with annual growth rate of 2.5%.

Table 1 : Sub-District Population Breakdown, 2021

Sub-DistrictPopulation0-11 Months (4%)12-59 Months (16%)WIFA Pop. (24.4%)Exp. Preg. (4%)
Kadjebi-Asato2072482933165057829
Dodi2061982532995031825
Dodo1515560624253698606
Ahamansu1068742717102608427
Pampawie677427110841653271
District73959295811833180462958

For the purpose of health programmes planning and implementation at the local level, the district was demarcated into five sub-districts namely:

  • Kadjebi- Asato
  • Dodo
  • Dodi
  • Ahamansu
  • Pampawie

1.2     Health Facilities

There are twenty one health facilities in the district, consisting of one hospital (CHAG)), five Health Centres, 14 CHPS zones with compounds and one private maternity home. There are however, 23 CHPS zones without compounds. There is no government owned hospital in the district. The Mission Hospital owned by the Roman Catholic Church, Mary Theresa Hospital, located at Dodi Papase serves as the District Hospital. The Health Centres   provide curative, preventive and primitive services. Due to increase in staff, the Kadjebi Health Centre, Poase Cement Health Centre and the Ahamansu Health Centre now offer 24hrs services. Serious cases are referred to the next level of care.

Table 2: Distribution of Health Facilities by Sub-Districts, 2021

Sub-DistrictHospitalHealth CentreClinicCHPS with CompoundCHPS without compoundTotal Facilities
Ahamansu010236
Dodi1103712
Dodo010449
Kadjebi-Asato0122813
Pampawie010214
District152132244

*Serves also as a CHPS compound in Dzindziso CHPS zone.

Figure 1: Health Facilities in Kadjebi District, 2021

1.3     Vision

People living in Kadjebi district become healthier, wealthier and happier through the provision of the highest quality health services.

1.4       Mission for the District

To implement approved national health policies; increase access to improved health service and manage prudently resources available for provision of efficient health services.

1.5     Major Concerns at the beginning of the year

  • To maintain <10% Drop-Out Rate for Penta1/3, BCG/MR, MR1/YF, MR 2/Men A by end of December 2021.
  • To increase supervised delivery rate
  • To reduce the high rate of anemia  among women attending ANC
  • Manage all cases of malnutrition reported among children under five years
  • To achieve at least 95% immunization coverage for all antigens by end of December 2021
  • To detect and investigate at least one case each of Measles, Yellow Fever, and AFP by end of December 2021
  • To reduce teenage pregnancy rate
  • To increase testing rate of malaria cases suspected before treatment
  • Infrastructural improvement in health facilities in the district

1.6 Activities carried out 2021

  • Organized quarterly Performance Reviews in all the 5 sub-districts
  • Conducted 2021 Annual performance review in all the five sub-districts
  • Promoting of infant and child health activities through regular growth monitoring sessions
  • Covid-19 case identification, investigation, contact tracing, isolation, case management and discharge
  • Organized quarterly durbars to engaged community member on KOFIH project in the district

CHAPTER TWO

2.0.0.  CLINICAL SERVICES / INSTITUTIONAL CARE

2.0.1. Out Patient Department Services

Utilization of health services is one of the measures used to determine both geographical and financial access to Primary Health Care (PHC). Total OPD attendance increased from 66,920 in 2020 to 73,604 in 2021.  During this same period, insured clients increased from 88.6% in 2020 to 88.9% in 2021.

Table 3: OPD Attendance, 2019-2021

YEAROPD ATTENDANCEINSUREDNON-INSURED% INSURED% NON-INSURED
201975,28167,9607,32190.39.7
202066,92059300762088.611.4
202173,60465,4048,20088.911.1

.

Table 4: OPD Attendance by Facility Type and Ownership, 2019-2021

LEVEL2019%2020%2021%% INC/DEC 2021
HOSPITAL30,01139.928,07141.925,36134.5-10.7
HEALTH CENTRES34,61445.729,79344.531,81043.26.3
CHPS9,31012.47,83411.715,33720.848.9
CLINIC (PRIVATE)1,52621,2221.810961.5-11
OPD TOTAL75,28110066,92010073,604100 
OWNERSHIP2019%2020%2021%% INC/DEC 2021
GOVERNMENT43,92458.137,62756.247,14764.120.2
CHAG30,01139.928,07141.925,36134.5-10.7
PRIVATE1,52621,2221.810961.5-11
OPD TOTAL75,28110066,92010073,604100 

Total OPD attendance by facility type has showed slight variation of client seeking health care at the hospital, health centres, functional CHPS compounds and Private clinic in the district. OPD attendance at hospital declined from 41.9% in 2020 to 34.5% in 2021; health centres OPD attendance has also decreased from 44.5% in 2020 to 43.2% in 2021. OPD attendance of functional CHPS zones increased tremendously from 11.7% in 2020 to 20.8% in 2021. Meanwhile the total number of clients who accessed health care delivery at private clinic declined from 1.8% in 2020 to 1.5% in the year under year review.

Table 5: Under Five OPD Attendance, Admission and Deaths, 2019-2021

AGE GROUPSOPD ATTENDANCEADMISSIONSDEATHS (AFR)
201920202021201920202021201920202021
0-28 days42141142314112214214 (9.9)10 (8.1)15 (10.6)
1-11 Months3,44729223203164137962 (1.2)4 (2.9)3 (3.1)
1-4 Years13,2531036691346565534038 (0.9)15 (2.7)8 (2.0)
Grand Total17,12113,66912,75096181264124 (0.2)29 (3.5)26 (4.1)
% Inc./Dec. Over. Prev. Yrs. 2019 -25.1-7.2 -18.3-26.7 3.30.6

OPD attendances among children less than five years showed slight decrease as indicated in Table 6; admission decreased from 812 in 2020 to 641 in 2021 but unfortunately there was an increase of admission fatality rate from 3.5% in 2020 to 4.1% in 2021.

Table 6: OPD Attendance by Facility, 2019-2021

HEALTH FACILITY201920202021% OF 2021 OPD ATTENDANCE% INC/DEC 2021
ST. MARY THERESA HOSPITAL30,01128,0172536134.5-10.5
AHAMANSU HEALTH CENTRE4,1623,78260088.28.8
POASE CEMENT HEALTH CENTRE4,4985,01853387.31.3
DODO AMANFROM HEALTH CENTRE5,5365,09949776.8-0.5
PAMPAWIE HEALTH CENTRE1,6771,19213601.80.7
KADJEBI HEALTH CENTRE18,56114,7021412719.2-2.3
DAPAA CHPS1,4951,46515702.10.4
KPONKPA CHPS6433513110.4-0.2
BETHEL CHPS3072521220.2-0.5
YADZO CHPS6555194960.7-0.1
AMPEYO CHPS6143815560.80.7
MEMPEASEM CHPS1,49639913021.83.6
PEPESU CHPS7195058741.21.5
DZAMLOME  CHPS1,3001,05110531.40.0
ASATO CHPS1,15182420762.84.9
WAWASU CHPS5273848841.22.0
KORU CHPS2144233580.5-0.3
KOTO-NKWANTA CHPS122582490.30.8
AKUM CHPS67763340.51.0
DODOFIE CHPSN/AN/A15702.1N/A
FAITH MATERNITY HOME (PRIVATE)1,5261,22210961.5-0.5
OPD  ATTENDANCE  TOTAL75,28166,92073,6041009.1

Total OPD attendance in all health facilities reporting during the year increased marginally from 66,920 in 2020 to 73,604 in 2021. All health facilities OPD attendance increased, St. Mary Theresa Hospital, Dodo Amanfrom Health Centre, Kadjebi Health Centre, Kponkpa CHPS, Yadzo CHPS, Koru CHPS, Bethel CHPS and Faith Maternity Clinic has marginally declined.

Table 7: Top Ten Causes of OPD Morbidity, 2019-2021

20202021
DISEASE/ CONDITIONNO. OF CASES% OVER TOTALDISEASE/ CONDITIONNO. OF CASES% OVER TOTAL
Malaria24,55542.8Malaria1726621.7
URTI11,15619.4URTI1140914.3
Rheumatism & Other Joint Pains51128.9Rheumatism / Other Joint Pains / Arthritis51046.4
Diarrhoea Diseases44907.8Intestinal Worms50256.3
Anaemia43657.6Anaemia47786.0
Intestinal Worms41947.3Diarrhoea Diseases33064.2
Skin Diseases24904.3Skin Diseases18702.3
Acute Urinary Tract Infection11512Acute Urinary Tract Infection11391.4
Pregnancy Related Complicated10031.7Hypertension11061.4
Acute Eye Infection8641.5Acute Eye Infection6410.8
All other Diseases22,54539.3All other Diseases2794935.1
Total Cases57,370100Total Cases79,593100

Table 7 shows the top ten conditions reported to the various health facilities in the district.

The top ten diseases reported for the year under review showed malaria leading followed by Upper Respiratory Tract Infection, Intestinal Worms, Rheumatism & Other Joint Pains, Diarrhoea Diseases with the last being Acute Eye Infection

Whiles Malaria remains the top cause of OPD attendance for the year 2021, it has declined as compare with 2020. Anaemia however increased from 4365 in 2020 to 4778 in 2021 and remain the 5th cause of OPD attendance.

Figure 2: Causes of Maternal Deaths, 2003- 2021

Figure 3: Trend of Infant Death Rate, 2003-2021

Table 9: Top Ten Causes of Deaths, 2019- 2021

201920202021
Anaemia9Anaemia14Anaemia10
Neonatal sepsis8Hypertension10Pneumonia8
Heat Failure7Birth Asphysia7Sepsis8
Hypertension6Septic Shock7Head injury6
CCF5Malaria6Left Ventricular failure5
Malaria4Hypoglyceamia5Septicaemia4
CVA4Head Injury 2RTA5Birth Asphyxia4
Pneumonia3Cerebrovascular accident5Diabetics4
RTA3Alcoholic Intoxicfication4Hepatic Encephalopathy4
Septicaemia3Acute LVF2HHD4Septic Shock3
All Other Diseases62All Other Diseases60All Other Diseases66
Total114 129 122

2.1.3. Accident and Emergency Services

All health facilities in the district i.e. Hospital, Health Centres, Clinic, CHPS Compounds, provided 24hour services to the population. Accidents and other emergency cases were immediately attended to.

CHAPTER THREE

 

PUBLIC HEALTH UNIT

3.0.0. Specific Objective for year 2021

To increase:

To reduce:

3.0.1. Strategies/Key Activities Performed

3.0.2. Safe Motherhood

Figure 3: ANC Coverage, 2019-2021

ANC coverage under review this year has seen some slight decreased as compared to 2020 year. This is because fuel support for contracted midwives has decline within the period, therefore reducing the frequency of such visits.

During the period under review, early registration of our pregnant women has declined from 61.6% to 58.1% whiles ANC 4+ has increased from 57.3% in 2020 to 70.2% in 2021. CHNs were motivated to increased their home visits activities in order to trace defaulting pregnant women which was the main contributing factor leading to increase of ANC 4+ visit.

3.0.3. Tetanus Diphtheria (Td2+) Vaccination Coverage

Tetanus vaccination is initiated at first contact with the antenatal clinic. The aim is to reduce neonatal tetanus as well as the incidence of maternal tetanus in the postnatal period.

Figure 4: TD2+ Vaccination Coverage, 2019-2021

Td2+ has seen a decline of 3.1% as compared to last year. This could be due to data capture error of all pregnant mothers who were vaccinated with Td2+ in the ANC registers.

3.0.4. Gestational Age at Registration

Early booking at ANC aids to establish the correct gestational age and enables early identification of problems for prompt management. This enables women to get the information they need during pregnancy. Besides the first ANC visits should be early in the first trimester

GESTATIONAL AGE AT REGISTRATION

Early booking at ANC aids to establish the correct gestational age and enables early identification of problems for prompt management. This enables women to get the information they need during pregnancy. Besides the first ANC visits should be early in the first trimester whiles the last visits should be at around 37 weeks or near to the expected day of delivery to ensure that appropriate advice and care is provided to prevent and manage problems.

INTERMITTENT PREVENTIVE TREATMENT

Intermittent Preventive Treatment (IPTp) for prevention of malaria during pregnancy is a recommended strategy by WHO. Sulfadoxine Pyrimethamine is administered at 16 weeks of gestation when mother feels the quickening of the foetus in the uterus and it is repeated every four weeks until the 38th weeks of gestation regardless of whether or not the clients are known to be infected.

Year% of pregnant women taking IPT-1% of pregnant women taking IPT-2% of pregnant women taking IPT-3% of pregnant women taking IPT-4% of pregnant women taking IPT-5IPT1/IPT3 dropout rate
201963.249.636.318.38.242.6
202069.452.533.618.38.251.5
202178.869.653.630.912.832

 Under the period of review, women taking at least third dose of IPTp prophylaxis for the prevention of, malaria has increased from 33.6% in 2020 to 53.6% in 2021. This is attributed to continuous tracking of pregnant women in their second and third trimester. All concerned staff, especially the midwives were informed to ensure that the number of women receiving SP to prevent malaria increases. They were also encouraged to increase awareness creation on the benefits of taking SP during any of their social gatherings and also provided with motorbikes for ANC outreach.

HAEMOGLOBIN CHECKED AT REGISTRATION AND AT 36 WEEKS OF GES.

Per the reproductive health policy and standards, the haemoglobin (Hb) of pregnant women is checked at registration and 36 weeks to detect anaemia. This sorely relies on the availablity of laboratory services at all facilities offering ANC services

            FIG: ANAEMIA IN PREGNANCY, 2019-2021

Anaemia at registration and at 36 weeks of gestation has been on the ascendency over the period of review. The nutrition officer was alerted to support the RCH unit increase educating mothers to eat from the four star diets locally available in their community, thus starting right and eating right. Also, all staff were notified to intensify health education and promotion on variety of eating local diets that are nutritious to boost the Hb of women who are pregnant and moreover, refer women with moderate to severe anaemia for medical management. Staff were again reminded to check and encourage pregnant women to take their iron folic and fersolate tablets during home visits activities

PMTCT TESTING AND COUSELING SERVICES, JAN TO JUNE 2019-2021

Mother to child transmission of HIV during pregnancy, labour and breastfeeding is the main cause of HIV in the children under the age of 12 years. PMTCT services offered at antenatal clinics are routine testing and counselling of all pregnant women and administration of antiretroviral drugs for those who test positive. Prophylactic treatment is given to exposed new-borns until six weeks.                 

ADOLESCENT PREGNANCY

 Age of mother at delivery is an important risk factor as it influences pregnancy outcomes. Pregnancies in women below 19 years carry greater risk. Of the coverage of 88.1% ANC coverage, 26.9% accounted for teenage pregnancy. The table below again, depicts the high incidence of teenage pregnancy in the district. CHNs were informed to intensify education on ASRH in the communities, schools, social gatherings and on radio programmes to curtail the rate of adolescent pregnancy. They were reminded to collaborate with school authorities to regularly meet parents/guardians during P.T.A. meeting and advise these parents to show more concern for the needs of their wards during their adolescent period.

TABLE: 9

                       ADOLESCENT PREGNANCY, 2019-2021
YEARANC COVERAGE
201931.6
202033
202126.9

SKILLED DELIVERY

Childbirth is one of the most critical moment in the continuum of care from pregnancy to postnatal period

FIG: 4

Skilled delivery as compared to last year has increased by 6.8%.This was due to  the continuous education of the pregnant women.

ESSENTIAL OBSTETRIC CARE

This includes basic and comprehensive essential obstetric care interventions that are provided to women in pregnancy, delivery, and post-delivery. All the facilities conducting delivery in the district provide BEOC services except assisted vaginal delivery which is performed by Mary Theresa Catholic hospital.

Caesarean Section rate is improving as records of gradual decline noticed over the past two years. Many women who delivered during the period under review were so inclined to their religious beliefs of giving birth without the use of the ‘knife.’

            FIG: 5

STILL BIRTHS & NEONATAL DEATHS

Still birth rate is an indirect measure of the effectiveness in the management of pregnancy, labour, and delivery.

TABLE: 11

Data/Period201920202021
Total Deliveries177316911874
Still Birth312825
Neonatal Death1369

Whiles still birth has decreased in 2021, neonatal death has increased.

 Some of these babies were delivered with medical condition such as asphyxia due to premature delivery and were referred to Mary Theresa Hospital for further management where they expired.

Besides intervention such as institution of proper referral system and prompt referral, Proper monitoring of labour using the partograph, CHNs assigned to intensify home visit and supervision of pregnant women in their homes, Community Volunteers also were trained to supervise and encourage pregnant women to attend ANC.

 MATERNAL MORTALITY

TABLE:12

Data/Period201920202021
Total Maternal Death111
% Maternal Death Audited100100100
Maternal Mortality Ratio56.658.553.1

Maternal death under the period of review recorded ONE. Despite the conscious effort made by all and sundry to ensure that no woman died during delivery one has been recorded Some best practices that will be adopted to curtail such subsequent event are: 

BABY FRIENDLY HEALTH FACILITIES INITIATIVE

Baby friendly services were rendered in the district. Nine of the facilities conducting delivery in the district promote breastfeeding practices. Breastfeeding practices are being promoted through advocacy and educational programmes as well.

TABLE:13

  Year  Live Births  Initiating at breastfeedingExclusive breastfeeding @ discharge
2019179817141754
2020173216391697

Under the period of review, baby friendly initiation to breastfeeding within thirty minutes has decreased from 848 in 2018 to 812 in 2019 respectively, whiles exclusively breastfed has increased from 726 in 2018 to 784 in 2019.

 FAMILY PLANNING SERVICES

Family Planning services include the provision of education, methods and practices to space births, limit family size and prevent unintended pregnancies and reduce maternal mortality. Pregnancy by choice and not by chance is a basic requirement for women’s health. Family planning services serve as a link to other reproductive health services such as prevention and management of RIT including STI/HIV/AIDS. These services were provided during home visits, outreaches markets places and health facilities.

TABLE: 15

The year under review has seen some level of increased of family planning acceptor rate as compared to last year. This was because of the purchase of these devices from the chemical shops and the regular re-registration of women on long and permanent term appropriately

FIG:6

.

SCHOOL HEALTH SERVICE

 Coverage of school enrolled during the year under review has declined as compared to the previous year, 2019: However no of school visited, no referred and no receiving 3+ health has in declined significantly, because of the covid-19 pandemic resulting to closure of schools. Besides, findings during examinations for the first two month of school activities revealed Poor oral hygiene, Skin infections, UTI, ear and eye infections, other conditions referred for management were fevers and diarrheal diseases. A referral system has been put in place to enhance feedback and follow-up, and some of the topics treated during health education in the schools include the following:

ADOLESCENT HEALTH SERVICES

Adolescent Health programme has not been encouraging in the municipality due to lack of interest, inadequate capacity of some service providers and also most of the service providers not living in their communities to render services when the adolescents them. This is impacting on teenage pregnancy rates in the municipality.

4.0.0. DISEASE CONTROL ACTIVITIES

4.0.1. Objective for year 2021

  • To achieve at least 95% immunization coverage for all antigens by end of December 2021
  • To maintain <10% Drop-Out Rate for Penta1/Penta3 and BCG/Measles-Rubella; zero Drop-Out Rate for Measles-Rubella1/Yellow Fever and Measles-Rubella2/Men A by end of December 2021
  • To detect and investigate at least one case each of Measles, Yellow Fever, and AFP by end of December 2021.
  • To promptly investigate and apply appropriate control measures to any other condition of public health concern detected in 2021.
  • To detect 134 cases of all forms of TB by end of December 2021 and initiate all on treatment

4.0.2. Strategies

4.0.3. Activities Carried Out

4.0.4. Disease Surveillance

With regards to disease surveillance, the following activities were undertaken:

NO.Epidemic Prone Diseases/ Other Conditions of Public Health Importance YEAR
201920202021
1Cholera010
3Epidemic Meningococcal Disease000
4Measles7513
5Yellow Fever664(1+ve)
6Viral Haemorrhagic Fever000
7Acute Flaccid Paralysis (AFP)234
8Neonatal Tetanus000
9Rabies040
10AEFI8648

Table 12: Conditions of Public Health Concern Suspected and Investigated, 2019-2021

All suspected cases from the facilities that were reported to the unit were duly investigated and region was appropriately informed. All the suspected cases were negative.

4.0.5. Tuberculosis Control Programme

Until recently, the district has two [2] heath facilities that do TB diagnosis, namely:

  • St. Mary Theresah Hospital
  • Kadjebi Health Centre

However, with the implementation of the new algorithm on TB diagnosis using the GeneXpert, only St. Mary Theresah Hospital now do diagnosis of cases. Follow-up examinations are however done at both Kadjebi Health Centre and St. Mary Theresah Hospital.

Management of cases is however through the community-based approach. However, all facilities do the systematic screening for care seekers. Presumed clients were referred to St. Mary Theresa Hospital for diagnosis.

The main activities carried out in the period included:

Table 13: TB Case Notification and Treatment Outcomes, 2019-2021

Indicator201920202021
Expected number of cases134114117
Cases Notified312736
%  Case detection23.1%22.8%30.8%
Smear Positive161827
Smear Negative1498
Extra Pulmonary101
Number cured1615117
Number Completing Treatment159N/A
Died02N/A
Defaulted01N/A
Transferred Out00N/A
Treatment Success Rate100%88.8%N/A

Only Thirty-six (36) cases were registered in 2020 as compared to 27 in 2019.

Table 14: Classification of Cases Registrations by Gender, 2019

Indicator201920202021
Males3(50%)1(33.0%)3 (75%)
Females3(50%)2(66.6%)1 (25%)
Total634

Table 15: TB/HIV Collaboration, 2019-2021

Indicator201920202021
Number of TB Cases312636
Number Tested for HIV30(96.8%)22 (84.6%)31 (86.1%)
Number HIV Positive6(30.8%)3(13.6%)4 (12.9%)
Number TB Cases among PLHIV100

All but one TB clients were counseled and tested for HIV. HIV positivity increased among the tested TB clients as compared to previous years.

Table 16: Gender Classification of HIV Positive Cases, 2019-2021

Indicator201920202021
Males3(50%)1(33.0%)3 (75%)
Females3(50%)2(66.6%)1 (25%)
Total634

There were equal number of HIV positive TB clients in terms of gender for the period in perspective.

4.0.6. Expanded Program On Immunization

4.0.7. Malaria Vaccine Introduction Programme (MVIP)

As part of efforts to further reduce Malaria morbidity and mortality especially in children under 5years, the malaria vaccine, (RTS,S) was developed. The district started the pilot of the vaccine in May 2019 alongside selected districts in the country. The target was 6 and 7 months old children.

Figure 16: Health Staff Training & A child Receiving the Malaria vaccine.

4.0.8. Routine Immunization

Scheduled weekly and monthly static and outreach vaccination sessions were carried out by all 36 CHPS Zones in the district. A major challenge was the shortage of Men A vaccine in the later part of the third quarter to the end of the year.

ANTIGEN2019 (TARGET=2,919)2020 (TARGET=2,986)2021 (TARGET=2,959)
ACHIEVED%ACHIEVED%ACHIEVED%
BCG 265090.8222474.3234579.4
OPV/ 0 240881.4210071.0214972.6
OPV/ 1 282996.9235378.2250784.7
OPV/ 2 280295.9247082.2257786.8
OPV/ 3 290799.5257085.5267690.4
Penta 1 283297.0236278.5253685.7
Penta 2 279595.7246782.1257787.1
Penta 3 290299.2257485.7272292.3
PCV 1 284897.5236278.5253485.7
PCV 2 280295.9247982.5258587.4
PCV 3 290099.3258385.9271791.7
IPV 290099.3256785.4272991.9

Table 18: Routine Immunization Coverage, 2017-2019

There were improvements in almost all antigens when compared to 2019 figures and also improvement in all Drop-Out Rates and were kept below 10%.

Table 19: Immunization Drop-Out Rates, 2019-2021

 ANTIGENS201920202021
Penta 1/Penta3 drop out rate-2.5-9-7.8
Penta1/MR1 Dropout rate-0.3-4.71.3
RTSS 1/ RTSS 339.1-1.91.3
Rota1/Rota3 drop out rate10083.7-6.5
BCG /Measles-Rubella1 drop out rate-8.1-12.1-8.5
PCV 1/PCV 3 drop out rate-1.8-9.4-7.2
OPV 1/OPV 3 drop out rate-2.8-9.2-6.7
Measles-Rubella1/Measles-Rubella 25.76.610.1

There was improvement in all Drop-Out Rates and were kept below 10%.

4.0.9. Neglected Tropical Diseases Control Program Oncho Control

One round of Mass Drug Administration of Ivermectin was carried out throughout the district in August. Sixty-Nine Thousand and Ninety-One (69,091) people were treated in the exercise giving the district a therapeutic coverage of 84.6%. Below in Table 20 is the sub-district coverage.  

Table 20: Ivermectin Therapeutic Coverage by Sub-district, 2019

Sub-districtPopulation by GenderTotal populationTreatment by GenderNumber treated Coverage (%)
MFMF
Ahamansu6,7626,61613,3785,7975,45311,250              84.1
Dodi11,30912,95324,2629,92011,55921,479              88.5
Dodo7,5137,32214,8356,6656,31112,976              87.5
Kadjebi-Asato10,30710,32420,6317,9767,98415,960              77.4
Pampawie4,0884,4438,5313,5443,8827,426              87.0
Total39,97941,65881,63733,90235,18969,09184.6

Apart from Kadjebi-Asato sub-district which had 77.4%, all four sub-districts achieved between 84.1% and 88.5%.

4.0.10. School Based Deworming Exercise

There was one round of school-based deworming exercise in November 2019 aimed at controlling soil transmitted helminths and schistosomiasis using albendazole and praziquantel. The target group were pupils from KG1 to JHS3. Eighteen Thousand Eight Hundred and Fourteen (18,814) pupils were treated (93.1%) out of the 20,134 registered pupils. Eight Hundred and Eleven (811) Out -of-School children were also treated. Captured in Table 12 is the coverage by circuit.

Table 21: Treatment Outcome on School Deworming by Circuit, 2019

CircuitNo. of SchoolsIn-School Target (From Register)Out-of-SchoolTotal RegisteredNumber Treated% Treated
MaleFemaleTotalTotalMaleFemaleTotalMaleFemaleTotalMaleFemaleTotal
Ahamansu151,3391,1462,485241,3491,1602,5091,3311,1092,44098.795.697.2
Asato86505861,23616515861,2376145591,17394.395.494.8
Kadjebi192,2052,1374,342442,2182,1684,3861,9951,9723,96789.991.090.4
Dodi Papase151,1139412,054791,1589752,1331,0759262,00192.895.093.8
D Amanfrom121,2421,1742,4163211,4561,2812,7371,4141,2392,65397.196.796.9
Dzindzi101,1629472,1091501,2441,0152,2591,1319162,04790.990.290.6
Pampawie121,2991,1262,425301,3201,1352,4551,2281,0352,26393.091.292.2
Poase Cment141,1261,1302,2561621,2001,2182,4181,1351,135227094.693.293.9
District10510,1369,18719,32381110,5969,53820,1349,9238,89118,81493.693.293.4

Treatment coverage across the 8 circuits ranged from 92% to 97%.

4.0.11. Achievements

5.0.0. NUTRITIONUNIT

5.0.1. Major concerns at the beginning of the year, 2021

The main concern was the lack of a designated motorbike for the operations of the unit. However, the unit was allocated one TVS motorbike through the CPBF project. This has aided the movement of officers to health facilities for supportive supervision.

5.0.2. Objectives for the Year, 2021

The following objectives were set at the beginning of the year.

  • To increase under one growth monitoring registration coverage from 70% to 75%
  • To increase routine vitamin A supplementation for children 12-59 months from 58% to 65% for each semester
  • To offer prompt and appropriate nutritional support to all malnourished children identified
5.0.3. Growth Monitoring

Growth of children 0-59 months were monitored throughout the district at health facilities and communities. The nutritional status of children was assessed using underweight (weight-for-age).

5.0.4. Registrants for Growth Monitoring
Table 22: Growth Monitoring Registrants, 2018-2021
AGE (MNTHS)2018201920202021
%%%ACH%
0-11130.0135.2136.33249111%
12-2375.278.985.6221575.9%
24-5938.442.131.7278931.8%
0-5957.260.763.4825356.6%

Table 22 shows that overall, the registrants for growth monitoring for children 0-59 months decreased from 57.2% in 2016 to 56.6% in 2019.  However, the number of 0-11-month-old children registered for growth monitoring was above 100% for the three years and the numbers decreased as the children got older i.e. from 12-23 and 24-59 months.

5.0.5. Nutritional status of RegistrantsUnderweight
Table 23: Underweight Status of children 0-59 months, 2019
AgeNormalModerateSevereTotal
0-1132093823249
12-2321605142215
24-5927295912789
0-598098 (98.1%)148 (1.79%)7 (0.08%)8253

Table 23 shows that overall, 1.8% of the children 6-59 months were moderately underweight in the district whereas 0.1% were severely underweight. Underweight uses weight-for-age to compare the growth of children with a WHO standard population.

Table 24: Stunting Status of Children Under Five Years, 2019

AgeNormalModerateSevereTotal
0-11823110834
12-2383490843
24-5972530728
0-592382 (99.0%)23 (1%)02405

Length/Height-for-Age assessments are done for children under five years to ascertain how well they are growing compared to WHO reference populations. The data shows that almost all children assessed at child welfare clinics have no problems when it comes to stunting.  Stunting was found among only 1% of the children assessed as indicated in table 24.

5.0.6. Vitamin A supplementation

Vitamin A supplements were given to children 6-59 months. Figure 1 below presents the coverage for Vitamin A supplementation for under-fives. In general, coverage of Vitamin A was a downward trend over the past three years. Among children aged 12-59 months, coverage decreased from 106.4% in 2017 to 92.7% in 2019.

Figue17: Vitamin A Coverage Among Children under-fives, 2017-2019

Among children 12-59 months, 44% took the second dose of Vitamin A. There was an increase of 5% over the previous year’s coverage of 39%.  Children in this age need two doses of Vitamin A within a cyclical year to be protected. Figure two is a graphical presentation of the data from 2017 to 2019.

Figure. 18: Coverage for 2ndDose of Vitamin A among children aged 12-59 Months

5.0.7. Iodine Deficiency Disorders

The unit carried out market survey and household survey to know the iodine content of the salt sold in the market and used in household cooking. Tables 25& 26 below present the results of the salt surveys.

Table 25: Market Iodized Salt Survey, 2019
Iodine Level2018201920202021
00ppm (%)15.027.330.425
<15ppm (%)47.518.215.620
>15ppm (%)37.550.054.055
Table 26: Household Iodized Salt Survey, 2019
Iodine Level2018 201920202021
00ppm (%)40.433.325.2 17
<15ppm (%)34.933.340.5 36
>15ppm (%)24.829.434.3 47

Availability of iodized salt (salt with iodine level >15ppm) in the market has been increasing for the four-year trend (Table 25). During the year under review, more than half (55%) of the salt assessed had the right level of iodine. Again, the household survey revealed that close to half (47%) of the households consumed iodized salt in 2019. 

5.0.8. Infant and Young Child Feeding Practices
Table 27: Breastfeeding and Complementary Feeding Practices
 INDICATORS201920202021
mothers who delivered at health facility163016941773
Mothers initiating BF within 30 minutes156714931714
% of initiating BF within 30 minutes96.188.196.7%
EBF  at discharge150715301754
Exclusive breastfeeding rate at discharge92.590.398.9%
EBF at three months1565(96.0%)1781(97.1%)1544 (96.9%)
Appropriate complementary feeding1286(75.2%)1787(84.7%)1371 (92.9%)
# Continued breastfeeding at 1 year305639911382
% Coverage Breastfeeding at 1 year2489(81.4%)3962(99.3%)1369 (99.1%)

Health facilities are expected to assist mothers initiate breastfeeding during the first thirty minutes of delivery and implement steps to successful breastfeeding. During the year under review, 96. 7% of the mothers who gave birth at health facilities in the district, initiated breastfeeding within 30 minutes of live, an increase from 88.1% the previous year. Table 27 above presents various indicators on baby friendly hospital initiative activities in Kadjebi district.

5.0.9. Anaemia among Pregnant women

Table 6 presents anaemia among pregnant women in the district. Anaemia is a shortfall in blood. Anaemia among pregnant women at registration increased over the period, thus, 54.8% in 2016 to 56.3% in 2019. Anaemia has implications on pregnancy and pregnancy outcomes. Counselling at all health facilities must be intensified to reduce the rates of anaemia in the district.

Table 28: Anaemia Among Pregnant Women, 2019-2021
Haemoglobin Checked201920202021
ANC registrants251122292567
Hb checked at registration1847 (73.6%)1419 (63.7%)2077 (80.9%)
Anaemic983 (53.2%)776  (54.7%)1169 (56.3%)
Hb checked at 36 weeks of pregnancy.672 (36.4%)606 (27.2%)697 (27.2%)
Anaemic147 (21.9%)249 (41.1)371 (53.2%)
5.0.10. Girls Iron and Folate Tablets Supplementation (GIFTS) Programme

Ghana Health Service and Ghana Education service with funding partner (UNICEF) are implementing the Girls Iron Folate Tablets Supplementation (GIFTS) programme for adolescents 10-19 years. The following are the targeted Beneficiaries

  • 10-19 years old adolescents in JHS, TVET and SHS
  • 10-19 Out-of-school adolescents at facilities
  • Menstruating women 20 years and above (SBCC)

In 2019, 3187 girls were taking the supplements. Two rounds of supportive supervision were conducted in schools in February and September 2019. Some of the challenges identified are

  • Rumours of tablet being family planning drugs
  • Poor documentation by teachers
  • Non-adherence by the girls
5.0.11. Community Durbars

Community durbars served as means of giving nutrition education to communities, individuals and families. In 2019, Seven durbars were held in Ahamansu, Dodofie, Dzamlome and Todome. Participants were screened for obesity and hypertension. Appropriate nutritional counselling was given to all participants and those who needed further management were referred to the health facilities. Over 600 people were reached in total.

5.0.12. Achievements
  • We were able to hold seven durbars and served community members with nutrition and preventive health service activities
  • Support was successfully mobilized for the child born to a mentally challenged woman
  • Stunting assessment commenced in 2019 and most facilities are doing it monthly

6.0.0. Community Health Planning Services (CHPS)

 Community-based Health Planning and Services (CHPS) is a strategy from the government of Ghana with the aim of bringing health care closer to the door step of the community members, and it aim at establishing sustainable system for improving the health of community by involving individual and household in planning health care delivery.

 CHPS is the process of strategic planning and implementation of Primary Health Care (PHC) activities within a community with the full involvement and participation of the community members (CHPS, 1999).

Community-based Health Planning and Services (CHPS) was introduced as one of the objectives of Ghana Poverty Reduction Strategy and the second year programme of work of bridging health inequalities in deprived communities.

Its aim is to improve geographical access and comprehensive health care.

As such, the entire district has been demarcated into 36 CHPS Zones according to their electoral zones with each zone assigned to CHNs/CHOs.

During the year, through the help of the Kintampo research institute, 120 volunteers were trained on data collection on infant mortality in accordance of the implementation of the malaria vaccine and information relayed to the CHPS coordinator to go and conduct verbal autopsy.

Table 29: CHPS Status, 2019-2021

Indicator201920202021
No. of demarcated CHPS zones363636
No. functional CHPS zones111136
No.CHPS compound111112
Population living in functional CHPS72,9607624673715

Table 30: Home Visit Conducted, 2019-2021

 No. of Active CHVNo. of Functional CHPS with CHAPNo. of home visits doneNo. of Durbars heldNo. of CHMC meeting heldNo. of meetings with social groups
2019277965303323
2020271436061103411
202197164875513030

6.0.1. Verbal Autopsy

Verbal autopsy is a survey the research mounted by the Navrongo research institute sponsored by WHO in accordance with the implementation of the malaria vaccine, to ascertain the mortality aspect of the implementation. To train district officers to go and train all volunteers to identify any deaths in children aged under 5 years in the various communities in the district and 120 CHVs were trained in the district to do the following;

  • Report any death in children aged under 5 years to CHO and District VA coordinator: CHVs will report deaths using the Mortality Case Report Form
  • Report adverse events following immunization: to safety CHO
  • To take every opportunity (e.g. one on one, public gatherings, door-to-door etc.)  to sensitize communities on the need to;

Notify CHVs and CHOs of any under 5 deaths and Cooperate with Mortality Surveillance activities (especially verbal autopsies). 

6.0.2. Verbal Autopsy Cases Reported, 2021

Since May 2019 50 cases were identified through CHVs but 42 have been captured in the App. the administration of the VPM., the rest are yet to be conducted.

6.0.3. Achievements

  • Annual home visits have increased
  • Brand new motor bike received from Kintampo research institute for verbal autopsy activities
  • The District Assembly have started constructing a new CHPS Compound at Menuso
  • Mempeasem CHPS renovated by Systems for Health.
  • Home visiting Bags, Delivery sets and Bicycles deployed to all 36 CHPS in the District by CBPF.
  • 80 % of the Structures that are being put up at various CHP zones that don’t have buildings by CBPF that were not completed have been completed and the rest 20% will be completed by March 2020.

7.0.0.HEALTH PROMOTION UNIT

Health Promotion as a unit gives adequate information to people on health for them to change their risky behavior, make informed choice or decisions, prevent, protect and maintain their health status by using the available resources in their settings.

Health promotion as an entity worked in collaboration with both governmental and Non-governmental organizations in carrying out health activities to improve on the health and social well-being of individuals, groups and communities.

7.0. 1. Objectives for 2021

  • To conduct school health services in (24) schools in the district from January to December 2019.
  • To form four (4) adolescent reproductive health club in Junior High school in the district from January to December 2019.
  • To carryout intensive and massive integrated supportive supervision once in the six facilities.
  • To increase the awareness on facility delivery to reduce the incidence rate of maternal morbidity in the district.
  • To create and increases the awareness of the use of household latrines in the communities

7.0.2. Activities Carried Out

  • IE&C materials distribution for behaviour change
  • Regular monitoring and supervision at all levels
  • Conduction of monthly and quarterly data validation
  • Social/Community Mobilization, participation and Advocacy Meetings
  • Carried out Public Education / Sensitization activities (health talk’s durbars, Group meetings, community dialogue meetings.

7.0.3. Category of Health Topics

  • Nutrition
  • Disease control (Non-communicable and communicable)
  • Reproductive health services
  • Adolescent Health
  • Child Health
  • Personal| Environmental Hygiene
  • Mental Health

7.0.4. Collaborators

Some of the organizations we worked with are Ghana Education Service, Savanna Signatures, Population Services International (PSI), Environmental Health and sanitation and JICA.

Table 31: Channels Used During Health Promotion Activities, 2020-2021

CHANNELSNUMBER OF TIMESNUMBER OF TIMES
20202021
Group Meetings12351278
Radio 21 
One-on-One1430626076
Drama2 0
Community Information Centre (CIC)6235
Video Show29109
Television (TV)00 
Social Media2 0

There was rapid increase in all the channels used during health promotion activities in 2019 as compared to 2018.

Table 32: Type of Sessions Held, 2018-2019

YEAR20202021
TYPE OF SESSION HELDNUMBERNUMBER
ADVOCACY68140
EDUCATION11204935
COLLABORATIVE ACTIVITIES45152

4,935 Educational sessions were conducted in 2019 compared with 2018 tare he same as applies to other indicators as indicated in the table 25

Table 33: Type of SBCC Material Used, 2018-2019

SBCC MATERIAL USED20202021
PRINTS7101217
AUDIO18657
AUDIO-VISUAL99148
GAMES24

7.0.5. Achievements

  • Intensive and massive education on the importance of facility delivery, family planning and others were given at durbars, CWC, CHC meetings and other community gatherings.
  • The district came out successfully with just ended school screening exercises.
  • The district observed the child health promotion and other health week during the first and second quarters.

8.0.0. COMMUNITY PERFORMANCE BASED FINANCING

The Community Performance Based Financing (cPBF) is a sub-component of the Maternal Child Health and Nutrition Improvement Project (MCHNP) which has the goal of establishing an evidence-based approach to improve health outcomes at the community level.

The objective of the cPBF is to explore whether providing performance-based incentives to the CHPS zones could motivate Community Health Teams (CHOs/midwives or other GHS staff operating at the CHPS zone level, along with the community volunteers), to deliver quality services and enable them access resources needed to operate/perform with ease resulting in improved access, utilization and quality of health services.

The project is being piloted in eight districts in four regions namely Northern (West Gonja and North Gonja), Upper East (Talensi and Bawku West), Upper West (Lawra and Nandom) and Volta (Agotime-Ziope, and Kadjebi) Regions.

8.0.1. Activities Undertaken/Achievements

  • Equalization grant for procurement of logistics, renovation of facilities and building of sheds. (Total GHC369,760)
  • Distributed one (1) Vehicle, Twenty-five (25) Motorbikes and two (2) Laptops from Ghana Health Service headquarters for cPBF activities
  • Procurement and distribution of logistics (36 home delivery kits, 36 home visit bags, 36 HB test kits, 36 bicycles, 36 stethoscopes, 72 urine test kits)
  • Reorientation trainings for CHOs/CHNs
  • Renovation of thirteen (13) CHPS compounds (on-going)
  • Building of twenty-three (23) sheds for CHPS zones without compounds (on-going)
  • Business Plans and Contracts for 1st to 4th quarters done.
  • Invoices for 1st to 4th quarters completed and submitted to national.
  • Data validation for 1st to 4th quarter by District Assembly completed.
  • Qualitative assessment for 1st to 4th quarter by DHD completed.
  • Payment of incentives for 1st quarter 2019. Processing for payment of 2nd and 3rd quarter on-going.
  • Payment of MCHNP base funds for 1st and 2nd quarter 2019.
  • Monitoring, coaching and supervision visits to CHPS zones by the DHD and DA.
  • Successful implementation of the 100-day challenge.

Figure 19: Completed shed at Kadjebi Zongo CHPS zone & Freetown CHPS zone

Figure 20: On-going shed construction at Atta Kofi & Dodo Amanfrom South CHPS Zones

Figure 21: Renovation at Ampeyo CHPS compound

9.0.0. SUPPORT SERVICE

9.0.1.Human Resource Development

The inadequate and shortage of critical staffs in the Kadjebi District still remains a major setback in service delivery in the district.   The table below gives the breakdown of the various categories of staff.

Table 34: Categories of Staff in the District, 2019

CategoryStaff StrengthNumber at Post
District Director11
District Public Health Nurse11
Administrative Manager11
Accountant / Accounts Officer33
Medical Assistant53
Staff Nurse77
Midwife1818
Enrolled Nurse2520
Community Health Nurse6035
Technical Officers44
Mental Health Officers33
Nutrition Officer11
Others3023
Total Staff Strength159120

9.0.2. Staff Posted in and out

  • During the year under review four (4) staff were posted outwhile Two (2) were posted in.

9.0.3. TRANSPORT SYSTEM IN KADJEBI DISTRICT

The DHD has four pick-ups of which two were functional most of the year. The other vehicles have been off the road for many years now.

Table 35: Vehicles Available and Condition, 2019

STATIONREGISTRATION NUMBERTYPE OF VEHICLEAGEMOVABLE
DHDGV392TNISSAN17YEARSYES
DHDGV348-10GREAT WALL7 YEARSNO
DHDGV589-14FORD RANGER6 YEARSNo
DHDGV14/2-639-18TOYATO HELLIUS1 YEARYES

9.0.4. MOTOR BIKES

There are 29 motor bikes in the district and are allocated to various health facilities. Most of these bikes are functional. Out of these; twenty-five (25) of them are TVS whichwas donated by World Bank for Community Performance Base Financing (cPBF) project and other three (4) donated by Ghana Health Services (GHS).

Table 36: Location of Motor bikes per Sub-District, 2019

  DHD4
KADJEBI /ASATO8
DODI5
AHAMANSU4
PAMPAWIE3
DODO5
Total29

10.0.0. FINANCING IN THE YEAR 2019

A total of Seven Hundred and Ten Thousand, Three Hundred and Seven Ghana Cedis, Fifty-One Ghana pesewas [GH¢710,307.21] was generated as total revenue in the year 2020. This is comprised of collected revenue [Cash and carry] and notional health insurance revenue [NHIS].

Total NHIS generation for the year 2019 stands at Five Hundred and Thirty-Four Thousand and Twenty-Six Ghana Cedis and Twenty-Nine Pesewas [GH¢534,026.29] for both medicines and non-medicines, representing 75.18% of total revenue generated.

A total of One Hundred and Seventy-One Thousand, One Hundred and Seventy Ghana Cedis, Ninety-Two Pesewas [GH¢171,170.92] for medicines and non-medicines was generated as cash and carry, representing 24.82% of total revenue.

A total of Six Hundred and Thirty-Five Thousand, Five Hundred and Sixteen Ghana Cedis, Ninety Pesewas [GH¢635,516.90] was received as NHIS refund in respect of previous years i.e. 2016 ,2017 and 2018.

An amount of Seven Hundred and Forty-Nine Thousand, One Hundred and Sixty-Two Ghana Cedis and Seventy-Eight Pesewas [GH¢749,162.78] is outstanding as unpaid claims.

10.0.1. Summary of Revenue Generation – I.G.F

1. Cash and carry

Medicine                                              GH¢93,556.58

Non medicine                                      GH¢77,614.34

Total                                                   GH¢171,170.92

2. NHIS Generation

Medicine                                              GH¢214,658.37

Non medicine                                      GH¢319,367.92

Total                                                    GH¢534,026.29

3. NHIS REFUND IN THE YEAR 2019

Medicine                                             GH¢299,227.35

Non Medicine                                     GH¢336,289.55

Total                                                   GH¢635,516.90

4. Outstanding NHIS Claims Unpaid.

Medicine                                 GH¢331,878.74

Non medicine                                      GH¢417,284.04

Total                           GH¢749,162.78

5. Total IGF Expenditure

Medicine                                             GH¢276,489.83

Non-Medicine                                     GH¢432,903.44

Total                                                   GH¢719,393.27

10.0.2. PROGRAMME FUNDS RECEIVED IN THE YEAR 2021

  1. Malaria                                                            GH¢35,571.36
  2. MCHNP                                                          GH¢115,434.84
  3. UNICEF                                                         GH¢2,283.00
  4. TB                                                                   GH¢2,441.00
  5. HIV/AIDS                                                      GH¢1,577.00
  6. SAVANA                                                       GH¢15,385.00
  7. ONCHO                                                         GH¢22,898.90
  8. MPSF                                                              GH¢65,000.00
  9. CPBF                                                              GH¢56,904.38
  10. NTD                                                                GH¢15,950.00

TOTAL                                                    GH¢357,892.43

11.0.0. Conclusion

There wereincreases in most of the indicators especially with the EPI indicators in 2019 as compared to 2018 due largely to quarterly data verification and validation at all health facilities by District officers. However, there was marginal increase in adolescent pregnancy rate in the district. Community Performance Based Financingproject via World Bank contributed immensely towards the improvement of maternal and child health indicators.

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