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PRESENTATION
Background of the National MICS Survey
Putting the National MICS results into the context of the HSMTDP
Key Findings:
Maternal Health
Child Health
Nutrition
NHIS
Water and Sanitation
Conclusions
BACKGROUND
The Ghana National MICS (with an enhanced Malaria module and biomarker) was conducted by the Ghana Statistical Service with financial and technical support from: National Malaria Control Programme/GHS
Navrongo Research Centre
USAID/CDC/ICF-MACRO
UNICEF
Government of Japan
UNFPA
A lot of technical support from other DPs, UN Agencies and MDAs
BACKGROUND
2010 Census Sampling Frame was used, and a total of
12,250 Households were sampled;
4 Regions (Upper East, Upper West, Northern and
Central) were oversampled to provide more precise data
4 Questionnaires were used: HH, Women 15-49 yrs,
Children 0-5 yrs, and Men 15-59 years;
Anthropometry, Malaria/Anaemia testing for children
under-5 yrs, and salt was tested (Rapid test kits, and
titration);
Survey methodology similar to that of Demographic and
Health Survey (DHS), therefore, data is comparable;
Presentation only captures a few core indicators, and
additional results will be available in the next one month.
OBJECTIVES OF THE MICS
Provide more current information for assessing the
situation of children and women, and reporting on country
progress on achieving the GSGDA goals/targets, the MDGs
and the reporting requirements of other local and
international development declarations and agenda;
Provide much-needed data on practices used to treat
malaria among children under-five and the use of specific
anti-malarial medications, bednet coverage and use,
coverage of IPTP for pregnant women, treatment practices
for childhood fever, and prevalence of malaria and anaemia
among children age 6-59 months;
Provide baseline data for the new United Nations
Development Framework (UNDAF) (2012-2016).
National MICS in the context of
HSMTDP
MICS 2011 provides a mid-term snapshot on
progress on key HSMTDP 2010-2013 strategic
objectives
HO1: Bridge equity gaps in access to health care and
ensure sustainable financing arrangements that protect the
poor
HO3: Improve access to quality maternal, neonatal, child
and adolescent health and nutrition services
MICS 2011 provides nationally representative data
that can inform development of next health sector
medium term plan.
MATERNAL HEALTH
In aggregate, positive trends in maternal care
indicators, although disparities exist……..
82
40
86
58.9
44
89
62.3
44
92
69.4
47
95
78.2
59
96.7
84.7
68.4
0
20
40
60
80
100
120
ANC from health
professional, at least one
visit
ANC from health
professional, 4 or more visits
Skilled assistance at delivery
Pe
r C
en
t
Maternal Care Indicators
GDHS 1988 GDHS 1993 GDHS 1998 GDHS 2003 GDHS 2008 MICS 2011
Target is
60% for
2013
Target is
80% for
2013
Skilled deliveries still a challenges to many
women in the northern region….
Northern
37%
Volta
64%
Ashanti
74%
Brong Ahafo
64%
Western
65%
Eastern
78%
Upper
West
60%
Central
63%
Upper East
67%
Greater Accra
90%
Northern
27%
Volta
54%
Ashanti
73%
Brong Ahafo
66%
Western
62%
Eastern
61%
Upper
West
46%
Central
54%
Upper East
47%
Greater Accra
84%
Key Below
50% 51-70% Above
70%
2008 2011
Ratio of highest to
lowest is 1:2.43
Target: 1:1.8 (2011)
Was: 1:3.1 (2008)
The richer, educated and urban residents
benefiting more from skilled deliveries…
53.9
88.2
54.5
66.2
79.4
98.1
40.2
55.0
70.2
86.0
98.3
68.4
.0 20.0 40.0 60.0 80.0 100.0 120.0
Rural
Urban
RESIDENCE
None
Primary
Middle/JSS
Secondary +
MOTHER EDUCATION
Poorest
Second
Middle
Fourth
Richest
WEALTH QUINTILE
NATIONAL
Assistance by TBAs during delivery
reducing, but still high in some regions…
11
44
2 2
30
8 3 13
54
1 1
16 12
3
0
10
20
30
40
50
60
Assistance during Delivery
2008 DHS 2011 MICS
Northern
33%
Volta
11%
Ashanti
12%
Brong Ahafo
11%
Western
25%
Eastern
12%
Upper
West
13%
Central
30%
Upper East
4%
Greater Accra
5%
Key Above 30% 20-30% Below20%
88 92
97
76
88 87
79 75
83 85 86
88 88
95
72
88 87
72
63
73 77
82
0
10
20
30
40
50
60
70
80
90
100
Western Central Greater
Accra
Volta Eastern Asante Brong
Ahafo
Northern Upper
East
Upper
West
Total
PNC for the newborn PNC for the mother
PNC for mother and child fairly high,
although not uniform across regions…
The richer, educated and urban residents
benefiting more from PNC…
0 10 20 30 40 50 60 70 80 90 100
Urban
Rural
RESIDENCE
None
Primary
Middle/JSS
Secondary +
MOTHER'S EDUCATION
Poorest
Second
Middle
Fourth
Richest
WEALTH QUINTILE
TOTAL
PNC for the mother PNC for the newborn
Progress seen over time in prevention
of malaria in pregnant women…
31.0
16.1
37.3
25.0
18.1 21.9
34.2
27.7
40.3 43.7
27.5
45.5 45.7
29.4
59.8
40.8
50.8
63.7
27.9 26
52.5
43.7
63.0
67.8
62.5
40.5
74.1 76.1
63.8
74.1
70.2 70.2 67.1
.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Western Central Greater
Accra
Volta Eastern Ashanti Brong
Ahafo
Northern Upper
East
Upper
West
National
% of pregnant women receiving at least 2 doses of
IPTp
MICS 2006 DHS 2008 MICS 2011
Use of modern contraceptives
increasing….
13
17
22 21
17 16
22
6
14
21
17
24
29 27
16
26 23
27
13
19
22 23
0
5
10
15
20
25
30
35
40
45
50
Use of modern methods
2008
2011
1 in 4 women in Ghana has unmet
need for Contraception
25.1 22.6
19.7
37.9
22.4
29.8 27.3
30.4 26.3 28.0
35.3
26.4
.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0 Unmet need for Contraception
CHILD HEALTH
Some gains made in immunization, but
nearly 1 in 4 children missing out on
vital immunization by age 1
94.2
80.1 81.4 77.7
64.4
93.0
75.5 79.9 76.5
59.9
97.8
90.7 92.1 88.5
77.3
0
20
40
60
80
100
120
BCG OPV 3 Penta3 Measles All
vaccinations
% of Children fully immunized by age 1
MICS 2006 DHS 2008 MICS 2011
Target for Penta by age 1yr
is 91% by 2013
Increased no. of children sleeping under
ITNs, but well below the national target of
70% by 2013
Western CentralGreater
AccraVolta Eastern Ashanti
Brong
AhafoNorthern
Upper
East
Upper
WestTotal
MICS 2006 11.5 19.8 16.3 21.5 24.9 21.8 25.7 21.9 39.3 37.1 21.8
DHS 2008 35.5 18.9 17.2 40.4 35.7 25.3 50 11.2 36.8 34 28.2
MICS 2011 32.7 27.7 22.1 70.7 60.2 31.2 41.3 41.8 45.0 46.9 39.0
0
10
20
30
40
50
60
70
80
90
100% of Children under-5 yrs who slept under an ITN
MICS 2006 DHS 2008 MICS 2011
LLIN Campaigns took
place in these Regions
NUTRITION
Concerted efforts required to promote
breastfeeding…..
52
35
46 46
0
10
20
30
40
50
60
70
80
90
100
2003 DHS 2006 MICS 2008 DHS 2011 MICS
Timely initiation of breastfeeding
(1hr)
7
31
53 54
63
46
0
10
20
30
40
50
60
70
80
90
100
1993 DHS 1998 DHS 2003 DHS 2006 MICS 2008 DHS 2011 MICS
Exclusive breastfeeding
Exclusive Breastfeeding Target is 70% by 2012
Some reduction in malnutrition rates, but still
more than 1 in 5 children in Ghana is stunted….
34
9
23
31
10
20
35
8
18
28
9
14
22.8
6.2
13.4
0
10
20
30
40
50
60
Stunting Wasting Underweight
Pe
r C
en
t
Nutritional Status of Children under-5 yrs
1988 1993 1998 2003 2008 2011
Target for
U/W is 8% for
2013
Key Above 30% 20-30% Below20%
Wide disparities in malnutrition across regions
and poverty quintiles - Stunting
Northern
32%
Volta
27%
Ashanti
27%
Brong Ahafo
25%
Western
27%
Eastern
38%
Upper
West
25%
Central
34%
Upper East
36%
Greater Accra
14%
Northern
37%
Volta
22%
Ashanti
22%
Brong Ahafo
19%
Western
23%
Eastern
21%
Upper
West
23%
Central
23%
Upper East
32%
Greater Accra
14%
2008 2011
UE and
Northern well
above
national
Target of 23%
NATIONAL HEALTH
INSURANCE
At least 60% of children have NHIS in
Ghana…
0
10
20
30
40
50
60
70
80
90
100
NHIS Membership for Children under-5 yrs
Yes, card seen Yes card not seen
NHIS for women 15-49 yrs…
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Yes, card seen Yes card not seen
NHIS for men 15-59 yrs…
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Yes, card seen Yes card not seen
WATER, SANITATION
AND HYGIENE
71.5
80.5
85.6
61.8
76.5
90.5
80.4
68.4
78.3
88.6 90.7
68.6
56.4
69.8
86.0
92.0 92.1
.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Percentage of population with Improved
Source of Drinking Water
National average is 80%,
also the Target for 2013 4 regions fall below the National
average
22
43
29
6
20
13
54
13
23
16
46
15
0
10
20
30
40
50
60
70
80
90
100
Open defecation Unimproved facilities Shared facilities Improved facilities
% of Population with access to improved sanitary facilities
1990 2008 2011
Access to improved sanitation still a challenge,
with wide disparities across regions…….
Sanitation
Target is 21%
by 2013
Northern
72%
Volta
25%
Ashanti
10%
Brong Ahafo
16%
Western
12%
Eastern
6%
Upper
West
71%
Central
15%
Upper East
87%
Greater Accra
9%
Key Above 25% 10-25% Below 10%
Population with NO sanitation facilities quite
high in the north…….
Majority of the unserved are the poorest, and
those living in rural areas…….
69
91
56
70
86
92 92
79
9
21
5 8 9
15
38
15
0
10
20
30
40
50
60
70
80
90
100
Rural Urban Poorest Second Middle Fourth Richest Total
Water Sanitation
Progress has been made overall, but worrying
geographic and socio-economic disparities persist.
Current increased focus on deprived regions should
continue while watching out for other regions that may
also be vulnerable.
MDG4
Coverage of key child survival interventions show
improvement-immunization, malaria prevention,
undernutrition
However more efforts are needed to enable equitable
attainment of MDG 4 for all children in Ghana
Conclusions
MDG5
Progress on coverage of key interventions- family planning and skilled
delivery
However MDG target unlikely to be achieved at current pace and without
strategic focus on structural bottlenecks
MAF-operational plan currently under development presents a huge
opportunity to address these bottlenecks.
NHIS
Important tool for MDG attainment that needs further scale -up in
coverage for all but particularly for the poorest populations.
‘All hands on deck’ needed for the last lap to MDG 4 and 5 goals
CONCLUSIONS (CONTD.)