2014 Half Year Performance review

Mrs. Beatrice Kunfah (MDHS)

OUTLINE OF PRESENTATION

Background

Priorities

Key challenges

Key achievements

Performance in Key Service Indicators

Innovations & Best Practices worth Sharing

Key Recommendations and Way forward for Second half of the year

BACKGROUND INFORMATION/PROFILE

Pop: 115,597

6 Sub-Municipals

33 reporting Health Facilities

PRIORITIES & CHALLENGES Scale Up Community –based Health

Planning and Services Improve quality of Reproductive and

Child Health Regenerative Health and Nutrition

including medical screening Disease Control and surveillance Regular community dialogue and

sensitization through night Videos and C4D activities

Improve data collection and reporting from private health facilities

Data Management Intersectoral Collaboration

Inadequate Critical Health Staff ( Medical assistants, pharmacist and record and Lab Assistants etc )

Inadequate official and residential accommodation

Medicines and records management(folders)

Delayed Reimbursement for NHIS claims

Staff Indiscipline Weak Continuum of care(Regional

hospital and Health facilities) High communicable disease burden of

Malaria, TB, HIV/AIDS High infant, maternal and neonatal

mortality Collaboration with Private Service

Providers

KEY ACHIEVEMENTS (1) More than half of the Staff have been Appraised for the year 2013

Newly appointed staff were also oriented before posting to their various facilities

In- service trainings were organized for staff to improve their performances on the job.

No major accident under the period of review.

Active case search for CMAM Cases

Successful sensitization on guinea worm identification and cash reward, & preparation for visit of certification team

Conducted 2 rounds Facilitative supervision to all Sub municipals

Conducted first round of OTSS to all the facilities including private facilities.

KEY ACHIEVEMENTS (2) Conducted Mass Drug Administration (MDA) against filariasis and Onchocerciasis

Organized refresher training for Community Based Surveillance volunteers

Trained 24 CHNs/CHOs on Implanon and Jadelle insertion

Organized fora for men on family planning and other RCH activities in all sub-municipals

Organized community durbars on maternal/child health activities and importance of family planning

Carried out maternal death audits in two communities on causes and prevention of maternal deaths

Trained fifty five staffs on costumer care

Organized midwives forum on MNH/family planning

Screening of Fire service women for breast cancer

Renovation of MHA Offices

Commitments TO RMS & NHIS Outstanding claims

FACILITY

RMS COMMITMENTSOUTSTADING CLAIMS FROM

NHISNET BALANCE

NON DRUGS DRUGS

WA SUB. 1,765.61 35,331.02 145,710.42 108,613.79KAMBALI 1,076.95 15,764.16 87,708.33 70,867.22CHARIA 49.5 4,108.23 24,100.32 19,942.59CHARINGU 1,248.49 2,593.94 12,054.60 8,212.17KONTA NORTH 826.21 6,899.25 30,726.65 23,001.19MARKET CLINIC -16.77 31,826.01 78,512.82 46,703.58DOBILE CHPS 215.88 9,692.06 27,674.25 17,766.31BUSA 754.73 6,034.29 28,730.06 21,941.04BAMAHU 503.36 11,263.03 36,750.83 24,984.44WA SHS 360.99 7,828.07 33,212.39 25,023.33KPERISI 340.14 3,797.93 14,511.02 10,372.95ADOLESCENT 277.92 10,313.33 23,565.90 12,974.65TOTAL 7,403.02 145,451.32 543,257.59 390,403.26

HUMAN RESOURCE - SUMMARYINDICATOR NUMBERTotal number of staff 260

Total number of staff on course 57

Total number of Staff at Post 203

Postings In 63

Promotions 11

Appointments 9

HIGHLIGHTS OF PERFORMANCE

Sensitization on guinea worm Identification & Cash reward

VISIT OF GUINEA WORM INT. CERTIFICATION TEAM

HIV & AIDS - PMTCTINDICATORS 2012 2013 2014

ANC registrants 1,854 1,998 2,249

 Number Counseled  1,692  1,915  2,187

 percentage counseled  91.3%  95.8  97.2

No. Tested 1,662 1,909 2,195

 Percentage Tested  89.6%  95.5  97.5

 Number positive  17 19  20

 percentage positive  0.05%  1.0  0.9

Number tested for syphilis   1,909 1,446

Number positive for syphilis    3  9

Number treated for syphilis    3  9

TUBERCULOSIS –NEW CASES @ Half Year INDICATOR 2012 2013 2014

New Smear Positive PTB  26  5  5

New Smear Negative PTB  

 10 0 0

Extra Pulmonary ETB 

 11  0 0

Smear Not Done  5  0 0

 Total  52  0 5

MATERNAL & NEW BORN CARE – ANC, DELIVERY & PNC

2012 2013 2014 2012 2013 2014

ANC 66.4 66.6 71.4

SKILLED DEL. 51.6730294183696 57.6685764654033 66.6089965397924

PNC 56.1 56.7 67.5

TARGET 45 45 45

5

15

25

35

45

55

65

75

% Cl

ients

MATERNAL HEALTH – FIRST TRIMESTER REGISTRATION

Jan

'10

Fe

b'1

0

Ma

r'10

Ap

r'10

Ma

y'1

0

Jun

'10

Jul'1

0

Au

g'1

0

Se

pt'1

0

Oct

'10

No

v'1

0

De

c'1

0

Jan

'11

Fe

b'1

1

Ma

r'11

Ap

r'11

Ma

y'1

1

Jun

'11

Jul'1

1

Au

g'1

1

Se

pt'1

1

Oct

'11

No

v'1

1

De

c'1

1

Jan

'12

Fe

b'1

2

Ma

r'12

Ap

r'12

Ma

y'1

2

Jun

'12

Jul'1

2

Au

g'1

2

Se

pt'1

2

Oct

'12

No

v'1

2

De

c'1

2

Jan

'13

Fe

b'1

3

Ma

r'13

Ap

r'13

Ma

y'1

3

Jun

'13

Jul'1

3

Au

g'1

3

Se

pt'1

3

Oct

'13

No

v'1

3

De

c'1

3

0

10

20

30

40

50

60

70

80

MedianGoal

Months

Pe

rce

nta

ge

(%)

MATERNAL HEALTH – AVERAGE VISIT PER CLIENT

Sub Municipal 2012 2013 2014

Bamahu 2.9 4 4

Busa 3.1 3.4 4

Charia 3.3 5 5.3

Charingu 3.3 4.3 4.3

Kambali 5.1 3.3 4

Upper West Regional Hospital 2.7 3.1 3.7

Wa Central 3.2 3.9 3.6

Wa Municipal 3.2 3.7 3.9

MIDWIVES FORUM

CUSTOMER CARE TRAINING

TEENAGE PREGNANCIES – INCREASING TRENDS

Bamahu Busa Charia Charingu Kambali Reg. Hospital

Wa Cen-tral

Wa

2012 6.4 11 10.7 13.5 6.7 5.6 8.3 7.8

2013 7.4 19.1 17 20.2 10.1 7.4 9.4 10.3

2014 12.7 14 16.8 16.4 11.9 4.7 9.3 9.8

2.5

7.5

12.5

17.5

22.5

% of Adolescent 10-19yrs attending ANC

Pe

rce

nta

ge

(%

) 0

f A

do

lesce

nts

MATERNAL & NEW BORN CARE – MATERNAL MORTALITY – Half year Trend (2008-2014)

2008 2009 2010 2011 2012 2013 2014

Maternal Deaths 4 7 3 4 3 6 3

MMR 278 429 190 218 132 224 98

Target 185 185 185 185 185 185 185

25

75

125

175

225

275

325

375

425

475

278

429

190218

132

224

98

MM

R/1

00,0

00 L

iveb

irth

s

MDG Target (185/100,00 live births

CAUSES OF MATERNAL DEATHS

CAUSES OF MATERNAL DEATHS -2012-2014 1/2 YEAR

CAUSE OF DEATH 2012 2013 2014

HAEMORRHAGE 0 1 0

ECLAMPSIA 1 0 0CEREBRAL MALARIA 1 0 0HEPATITIS 1 0 0

DRUG REACTION ( community death) 1 0 0

MYOCARDIAL INFARCTION 0 1 0MENIGITIS 0 1 0SICKLE CELL DISEASE 0 1 0UNSAFE ABORTION 0 1 2SEPSIS 0 1 1TOTAL 3 6 3

SCREENING FOR BREAST CANCER

MATERNAL & NEW BORN CARE – STILL BIRTH RATE

2008 2009 2010 2011 2012 2013 2014

Still Births 83 97 76 87 95 103 104

still Birth Rate 58 59 48 47 42 38 34

10

50

90 8397

7687 95 103 104

58 5948 47 42 38 34

No.

of

Sti

ll B

irth

s &

Sti

ll

Bir

th R

ate

/1,0

00live-

bir

ths

Neonatal Deaths, 2008-2014: Half Year

2008 2009 2010 2011 2012 2013 20140

5

10

15

20

25

30

35

40

45

50

156

114 4

9 8

7

7

20 28 3134 30

Post neonatal deaths Neonatal deaths (<1 m)

NO

. o

f N

eon

ata

l D

eath

s

CHILD HEALTH – EXPANDED PROGRAM ON IMMUNIZATION

BCG PENTA3 MEASLES RUBELLA YF BCG PENTA3 MEASLES RUBELLA YF

2012 61 49 49 46

2013 102 48 40 40

2014 70 54 52 52

Target 45 45 45 45

10

30

50

70

90

110

% of C

hn. V

accina

ted

EPI COVERAGE & DROP OUT RATES - 2014SUB MUNICIPAL

BCG MEASLES PENTA 3 BCG/MEASLES DROP OUT

PENTA 1 & 3 DROP

OUT

BAMAHU 10% 49% 38% -378.0 -0.7

BUSA 27% 59% 63% -116.5 -18.5

CHARIA 11% 61% 61% -462.5 -17.6

CHARINGU 19% 29% 39% -53.1 1.7

KAMBALI 1% 67% 70% -6733.3 -24.6

WA CENTRAL 14% 44% 41% -208.0 -62.1

REG. HOSPITAL 108% 7% 11% 93.9 65.9

MUNICIPAL 70% 52% 54% 26.1 0.2

FAMILY PLANNING ACCEPTORS

Bamahu Busa Charia Charingu Kambali Wa Cen-tral

Reg. Hos-pital

Municipal Bamahu Busa Charia Charingu Kambali Wa Cen-tral

Reg. Hos-pital

Municipal

2012

32 30.6 34.6 15.1 36.5 9.8 4.7 32.4

2013

41.4 29.7 42.8 8.4 25.9 31.2 3.3 31.8

2014

34.7 28.6 52.4 17.9 50.6 40.9 5.4 42.3

Target

40 40 40 40 40 40 40 40

5

15

25

35

45

55

% F

P A

ccepto

rs

NUTRITION – HOUSEHOLD SALT SURVEY

Neutral <15ppm >15ppm

May, 2011 27.3 34 38.3

May, 2012 30 37 33

June, 2013 26 25 49

June, 2014 10.3 31.8 57.9

5

15

25

35

45

55

65

PERC

ENTA

GES

Proportion of suspected Malaria OPD Cases tested

TOTAL TESTED (MICROSCOPY OR RDT)% TOTAL POSITIVE (CONFIRMED MALARIA CASES ONLY) %

2013 0.396000000000001 0.498

2014 0.843000000000001 0.634000000000001

5.00%

15.00%

25.00%

35.00%

45.00%

55.00%

65.00%

75.00%

85.00%

20132014

INTERMITENT PREVENTIVE TREATMENT

Sub Municipal2012 2013 2014

IPT1 IPT3 IPT1 IPT3 IPT1 IPT3

Bamahu 203 117 194 164 62 2

Busa 58 61 76 40 30 2

Charia 119 91 141 127 83 0

Charingu 149 71 92 35 18 5

Kambali 229 89 224 88 45 27

Reg. Hospital 566 298 620 359 294 151

Wa Central 836 349 1047 694 284 116

Wa Municipal 2160 1076 2394 1507 816 303

Home based care by CBAs – Jan-Jun, 2014

Sub Municipal

Children Checked

Children with

danger sign

Conditions Treatments with Recommended

Medicines

Referrals

Fast breathing Diarrhoea Fever AA Amoxicillin ORS Zinc

Bamahu 79 9 0 27 43 43 0 27 0 0

Busa 57 0 14 18 25 25 14 18 2 8

Charia 0 0 0 0 0 0 0 0 0 0

Charingu 53 0 22 12 19 19 22 10 2 25

Kambali 0 0 0 0 0 0 0 0 0 0

Wa Central

475 6 81 173 215 145 81 173 0 120

Community Based Services – CHPS Implementation

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

5

10

15

20

25

30

24 24

2 2 3

710 10

12 12 13 13

2 24

811

1315

2022 22

Demarcated Zones Zones with compounds Functional Zones

No.

of

Zon

es Target

CHPS ZONEHOUSEHOLD VISITS

DURBARS SOCIAL GROUP MEETINGS

CHC MEETINGS

TOTAL 15667 44 45 71

DISTRIBUTION OF CHPS ZONES

Intersectoral CollaborationPartner/Collaborator

Contribution

Municipal Assembly

• Health Infrastructure• Child Health

AGAMAL Ltd. • Indoor Residual Spraying for malaria control

PLAN GHANA • Disease control and child Health

World FOOD PROGRAMME

• Child Health

GES • School Health Services• Deworming and Immunization of school children

NCCE • Social MobilizationNational Ambulance • Referrals

Media collaboration

radio discussion on male involvement at w fm.

HMIS, RESEARCH & ICT

Networking of the Municipal Health DirectorateCreation of a Data bank and installing a server Using file sharing system (e.g, dropbox) to make key information available to desktop computers in the network

Preparation for an Integrated EPI Cluster survey are complete and will be conducted in the third quarter to assess immunization coverage for all sub municipal.

Innovations & Best Practices worth Sharing Development and hosting a website for the Wa Municipal Health Service (www.wamunicipalhealthservice.com )

Internal study tour among CHPS Zones in the municipal Formation of CHOs Association Using occasions in communities such as naming ceremonies to pass Health messages to community members

Compilation of social groups and their meeting dates within CHPS catchment areas in the Municipality

Printing of Identity Cards for Community Volunteers

RENOVATION - MDHS OFFICE

Conference Room

Way forward for Second part of the year Intensify community education and dialogue on reproductive health

services. Quarterly orientation on data management Organize a staff durbar in the 3rd qtr Functionalize demarcated CHPS Zones• Conduct EPI Cluster Survey• Conduct quarterly data validation at health facilities • Posting/redistribution of midwives, CHNs and CHOs Organize health screening for health staff in the third Qtr. Begin to audit all neonatal deaths from the municipality Conduct Stakeholders forum in all sub municipals Meeting with all private health providers Staff Awards

ACKNOWLEDGEMENT RHD

MUNICIPAL ASSEMBLY

DECENTRALISED DEPARTMENTS

PATH MALARIA CARE

COMMUNITY BASED VOLUNTEERS

COMMUNITY MEMBERS & TRADITIONAL LEADERS

NCCE

WFP

UNICEF

WHO

JICA

Local NGOs

THANK YOUvisit www.wamunicipalhealthservice.com for more

details

“Some is not a number, soon is not a time, hope is not a plan”

- Anonymous