2012 Holistic Assessment of Health Sector POW - Ministry of Health

Ministry of Health
Ghana
Holistic Assessment of the
Health Sector Programme of Work 2012
Ghana
Version 11 th June 2013
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Table of Contents
List of abbreviations and acronyms ................................................................................................................... 3
Acknowledgements ........................................................................................................................................... 4
Executive summary ........................................................................................................................................... 5
Introduction ..................................................................................................................................................... 13
1.0 Assessment of the Health Sector Performance in 2012 using the Holistic Assessment Tool ................ 13
2.0 Assessment of indicator trends .............................................................................................................. 16
3.0 Regions of excellence and regions requiring attention ......................................................................... 33
4.0 Implementation status of the POW 2012 .............................................................................................. 34
5.0 Agencies assessments and performance contracts ............................................................................... 39
6.0 Follow-up on Aide Memoire recommendations ................................................................................... 57
7.0 Conclusion ............................................................................................................................................. 58
Annex 1: Sector Wide Indicators and Targets – POW 2012 ............................................................................ 61
Annex 2: Sector wide indicator trends based on 3% proportion .................................................................... 63
Annex 3: Holistic Assessment Tool and Analysis ............................................................................................. 64
Annex 4: Indicator definitions and calculations .............................................................................................. 91
Annex 5: Analysis framework for POW 2012 implementation ....................................................................... 94
Annex 6: Capital Investment Update POW 2012 .......................................................................................... 107
Annex 7: Procurement plan ........................................................................................................................... 115
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List of abbreviations and acronyms
ART
Antiretroviral Therapy
CHAG
Christian Health Association of Ghana
CHPS
Community Health Planning and Service
CIP
Capital Investment Plan
DFID
UK Department for International Development
DHIMS
District Health Information Management System
DMHIS
District Mutual Health Insurance Scheme
EmOC
Emergency Obstetric Care
EmONC
Emergency Obstetric and Neonatal Care
EPI
Expanded Programme on Immunisation
FP
Family Planning
GHS
Ghana Health Services
GOG
Government of Ghana
HIRD
High Impact Rapid Delivery
HMIS
Health Management Information System
HR
Human Resources
HRD
Human Resource Directorate
IGF
Internally Generated Funds
IMR
Infant Mortality Rate
ITN
Insecticide Treated Net
KATH
Komfo Anokye Teaching Hospital
KBTH
Korle-Bu Teaching Hospital
MDG
Millennium Development Goal
M&E
Monitoring and Evaluation
MICS
Multiple Indicator Cluster Survey
MMR
Maternal Mortality Ratio
MoH
Ministry of Health
MTEF
Medium Term Expenditure Framework
NCD
Non-Communicable Disease
NDPC
National Development Planning Commission
NHIA
National Health Insurance Authority
NHIF
National Health Insurance Fund
NHIS
National Health Insurance Scheme
OPD
Out-Patient Department
POW
Programme of Work
PPME
Policy, Planning, Monitoring and Evaluation
SBS
Sector Budget Support
TBA
Traditional Birth Attendant
TH
Teaching Hospital
U5MR
Under-Five Mortality Rate
WHO
World Health Organisation
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Acknowledgements
The holistic assessment of the health sector 2012 Programme of Work was done internally by the Ministry
of Health. A team of five people from Ministry of Health and Ghana Health Service undertook the review
and holistic assessment. The members of the team were Dr. Afisah Zakariah, Daniel Degbotse, Dan Osei, Dr.
Anthony Ofosu and Dr. Andreas Bjerrum.
The team would like to thank all individuals who contributed to this review and who kindly gave their time
and support to the review process.
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Executive summary
The year 2012 represented the third year of the implementation of the current Health Sector Medium Term
Development Plan (2010-2013). The review has placed emphasis on the performance of the sector
according to identified health objectives as outlined in the Four-Year Sector Medium Term Development
Plan and the derived Annual Programme of Work for 2012. The review assessed the overall sector
performance for the year 2012 using the agreed Holistic Assessment tool. The Holistic Assessment tool was
adopted in 2008 and has been used to assess the sector performance since its inception. The report is
organized into six chapters and a conclusion.
1. Assessment of the Health Sector using the Holistic Assessment Tool
The purpose of the holistic assessment is to form a basis for a balanced discussion between the Ministry of
Health, its agencies and development partners to reach a common conclusion of the sector’s performance.
The outcome of the assessment is that the health sector in 2012 was a positive sector score of +3, which is
interpreted as a highly performing sector.
2. Assessment of indicator Trends
Health Objective 1: Bridge equity gaps in health care and ensure sustainable financing arrangements that
protect the poor
The equity index for supervised deliveries by region improved and reached the target of 1.7 comparing the
best to the worst performing region with regards to coverage. Performance improved among both the best
and worst off regions. Almost all regions’ performance were above 50% except Volta Region at 46.5% and
Northern Region at 49.9%. Coverage increased in all regions except for Ashanti Region, which experienced a
drop of 2.1%. The poorest staffed region with regards to nurses is the Northern Region Volta and Upper
West Regions stand out with critical reductions in midwife populations. The Doctor to population ratio did
not change much and with 11 times less doctors per population in Upper West Region compared to Greater
Accra Region equitable distribution of doctors remains a major challenge to the health sector with one
nurse to 1,601 population compared to the national average of one nurse to 1,251 population. The
National Health Insurance since its introduction has led to increase in utilization of OPD services across all
the regions. Ashanti region like all the regions showed an increase in OPD attendance till 2012 when it
experienced a drop in OPD per capita
Health Objective 2: Strengthen governance and improve efficiency and effectiveness of the health system
In 2012, the ministry introduced performance contracts with four agencies: the three Teaching hospitals
and Ghana Health Service. Government of Ghana contribution increased by 126.9% from GH¢771 million in
2011 to GH¢1,750 million in 2012. Internally Generated Fund (IGF) increased by 8.9% from GH¢392 million
in 2011 to GH¢427 million in 2012. Contribution from donors in 2012 was GH¢290.8 million whilst there
was GH¢259.2 million contribution in the same period of the previous year, an increase of 12.2% over the
same period of 2011.Total Gross Revenue, recorded by the Ministry was GH¢2,489.8 million. The Ministry
recorded a total expenditure of GH¢2,613.4 million for the period under review Debtors have decreased
from GH¢137.7 in December 2011 to GH¢115.9m in December 2012, a decrease of 15.8%.
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Health Objective 3: Improve access to quality maternal, neonatal, child and adolescent health and
nutrition services
The total fertility rate increased from 4.0 to 4.3. Meanwhile the contraceptive prevalence rate for the same
period has improved significantly, increasing to 23.4% from 16.6% in 2008. The proportion of pregnant
women attending four or more antenatal care visits increased slightly to 72.3%. For the 2011 MICS report,
the corresponding figure was 86.6%. Over the past 3 years, supervised delivery coverage has increased by
28.2%, and over the past 5 years by 66.5%. Coverage of supervised deliveries in 2012 was 58.5%, based on
the estimated expected delivery of 4% of the population and 77.9% based on 3% estimate The MICS gave
the country a skilled attendant at delivery coverage of 68.4%. The proportion of children below the age of
six months that are exclusively breastfed has significantly dropped since 2008, and the current performance
at 45.7% is below 2003 levels and far below the target of 70%The national Infant Mortality Rate (IMR)
increased by 6% over the DHS 2008 figure from 50 to 53. IMR is highest in Volta, Upper West, Northern and
Brong-Ahafo Regions. Northern Region and Upper West Region have since 2003 had relatively high U5MR.
Upper West Region has been able to bring down under-five mortality rate by 50%.
Health Objective 4: Intensify prevention and control of communicable and non-communicable diseases
and promote a healthy lifestyle
According to the MICS 2011, use of ITNs has improved by almost 50% since 2008 and the proportion of
children under five sleeping under ITN the previous night has also increased. The national prevalence of
malaria parasitaemia in children aged 6-59 months based on microscopy was 27.5% with the highest
prevalence in Upper West Region (51.2%) and Northern Region (48.3%). Lowest prevalence was recorded in
Greater Accra Region (4.1%). While the national number of expected malaria cases among children has not
dropped significantly, case-fatality of malaria for children under five years has improved, dropping from 1.2
in 2011 to 0.6 in 2012 deaths per 100 confirmed malaria cases.
In 2012 coverage of Penta 3 was 87.8%. The MICS gave the corresponding survey based coverage of 92.1%..
The country continues to maintain surveillance for guinea worm. While the proportion of the population
with access to improved sanitary facilities that are not shared increased, the access to all improved sanitary
facilities, shared and not shared, reduced. TB treatment success went up to 86.2% but the target of 89%
was not achieved. The adverse outcomes reduced from 16.7% to 13.8%.
Health Objective 5: Strengthen institutional care including mental health service delivery
The total number of mental health nurses in the three psychiatric institutions was 1,068. This comprises
both community psychiatric nurses and registered mental nurses. Total number of patients seen during the
year was 67,732. No formal training exists for training community psychiatric nurses. The current crop of
community psychiatric nurses amount to 400 who are registered nurses converted to practice as
community psychiatric nurses.
Institutional infant and under five mortality rates improved significantly in 2012 with more than 50%
reduction in both. Institutional Maternal Mortality (iMMR) dropped significantly from 211 maternal deaths
per 100,000 live births in 2011 to 193 in 2012. While iMMR at Komfo-Anokye Teaching Hospital continued
to be high with 1,252 deaths per 100,000 deliveries, Korle-Bu Teaching hospital reduced institutional
maternal mortality ratio significantly from 1,133 in 2011 to 841 in 2012. The continuous high maternal
mortality ratio at the teaching hospitals calls for stronger and more structured collaboration between the
teaching hospitals and the referring hospitals and clinics at all levels.
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3. Regions of excellence and regions requiring attention
In the review of POW 2011, the review team introduced a simplified holistic assessment based on regional
performance of selected indicators to identify the region of excellence and the region requiring attention.
The scoring of each indicator follows the rules of the holistic assessment adapted to regional analysis. It is
important to note that the regional performance assessment is only indicative since it is based on a limited
number of service delivery indicators
In the regional analysis of POW 2011, three regions came out with a score of zero or below. In the current
review all regions have a positive score, which indicates a relative improvement over 2011 for these
selected service delivery indicators. The two regions doing very well are Central and Upper East Region,
those not doing so well are the three Regions Volta, Ashanti and Brong-Ahafo.
4. Implementation status of the POW 2012
In the Programme Work for the year 2012, some activities were planned to be implemented under the five
strategic objectives. The extent to which these activities are carried out determines the performance of the
health sector. Reasons for non-performance in some instances range from non-availability of funds to lack
of a clear framework for implementing such planned activities.
The objective of the Ministry of Health is to improve coverage of PHC services at sub-district level through
strengthening community health systems. The Ministry planned to do this by expanding CHPS coverage to
achieve 500 new functional zones during the year. Although the target was exceeded some challenges
remain.
The development of the health care financing strategy could not be carried out. The capitation pilot was
undertaken in Ashanti Region. Though the leadership development programme training is progressing as
planned, an assessment of the relevance of the programme in enhancing performance of district and subdistrict
teams is necessary.
Although a performance contract was signed with the Ghana Health Service and the three teaching
hospitals, contract management in terms of supervision, reporting and evaluation was not adequate. A lot
of health bills have been passed into law, efforts aimed at operationalising the law through legal
instruments however needs to be facilitated. The Ministry of Health developed a private sector policy,
however it was not printed or disseminated. This policy will provide for cross-sectoral activities in the
mobilsation of resources for health and health care.
The implementation of the MAF action plan has delayed. Indeed part of the MAF plan is being implemented
at all levels. Although the community case management of malaria, diarrhoea and acute respiratory disease
is being implemented in some districts as planned it is facing challenges. Community health workers face
difficulties in recouping funds for the drugs they dispensed at the community level. I
The adolescent health strategic plan and policy was disseminated to all stakeholders during the year.
The emergency obstetric care equipment meant for the three remaining regions (Upper West, Greater
Accra and Volta Regions) has not been delivered according information provided during the review.
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The pneumococcal, meningococcal and rotavirus vaccines including second dose of measles vaccines were
successfully introduced.
It was planned to disseminate and implement the National Nutrition Policy. The draft of the policy has been
developed and is being prepared for submission to cabinet. Nutrition, Malaria and Child Survival Program
was implemented to improve the nutritional status of children using community based approaches in
districts in Upper West, Upper East, Volta and Central Region.
To reduce malaria case fatality for the vulnerable groups, ACTs for treatment were procured and
distributed through the AMFm programme. LLINs Hang Up campaign was organized in all the regions.
The plan for the year was to maintain the polio free status of the country and validate eradication of guinea
worm and polio. To achieve this, surveillance activities including case searches were intensified.
The plan for the year was to increased case detection for NTDs. To achieve this, the Ministry finalized the
NTD Master Plan for Ghana for the period 2011 to 2015 in collaboration with WHO. The plan was shared
with the relevant stakeholders. Mass drug administration was conducted for Onchocerciasis,
schistosomiasis and Lymphatic Filariasis in communities and schools
The scaling up of the detection and management of non-communicable diseases through the
implementation of the national strategy for cancer control and expansion of screening program for
hypertension, diabetes and sickle cell were also not done. Though the guidelines for the cancer programme
have been developed they are yet to be printed.
5. Agency assessments
Centre for scientific research into plant medicine
The Centre for Scientific Research into plant medicine was set up to conduct and promote scientific
research relating to the improvement of plant medicine. Total staff at post at the centre is 192. The centre
screened and selected 4plants each for diabetes, hypertension and malaria respectively and 2 plants for
prostate cancer. Preliminary analysis on 4 anti hypertensive plant extracts showed promise in decreasing
blood pressure over a four week period in laboratory rats. Safety and efficacy evaluations of three out of
four herbal products which not dose dependent showed considerable reduction in parasitemia. With
regards to Dissemination of research findings (4 research papers and 6 technical reports) on quality,
efficacy and safety of herbal medicines; Two (2) papers were published
Allied health profession
It also works with other relevant organizations to provide accreditation to qualified training institutions
providing allied health programmes. It regulates practice standards of professionals.
Planned activities include among others the development of guidelines for accrediting training institutions
and programs in collaboration with the National Accreditation Board. A total of 34 applications were
received from training institutions for accreditation. A workshop on curricula for allied health programs in
the West African sub-region was held. The allied health professions Bill was passed by parliament and is
awaiting presidential accent.
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Food and Drugs Authority
From the number of activities planned to be implemented for 2012, Food and Drugs Authority was belt to ;
Train One hundred and ten (110) food manufacturing industries in Food Safety Management Systems. Train
Street Food Vendors in 30 Food Service Establishments in Basic Food Safety and Hygiene practices. Three
Hundred and Seventy samples of antimalarial preparations on the market were sampled and screened with
Minilabs. The first round of Quality Surveillance of Uterotonic preparations namely Oxytocin Injections and
Ergometrine Maleate Preparations (Injections and Tablets) was carried out – 279 samples were analysed of
which 178 (63.7%) failed.
The Public Health Bill, 2012, (Act 851) (which includes the Tobacco Bill, FDA Bill and Clinical Trials) was
passed into law.
The challenges of the authority are Inadequate operational vehicles. Limited border post-activities.
For the coming year post-market surveillance functions will be enhanced to rid the market of fake,
substandard and unwholesome regulated products.
Ghana College Of Physicians And Surgeons
The Ghana College was established to promote specialist education in medicine, surgery and related
disciplines. It also promotes continuous professional development in medicine, surgery and related
disciplines including research.
The college in 2012 planned to publish a journal and a newsletter and install ICT infrastructure to aid in the
colleges training programme. The college has 24 faculties. Other key activities planned for the year include
accreditation of training sites and medical knowledge fiesta.
The college published one journal and 2 newsletters and organized 20 CPDs out of the expected 24. A
knowledge fiesta was also organized for English speaking West Africa to exchange knowledge on current
happenings in the medical field. An ICT infrastructure sponsored by MTN was installed and commissioned
during the year.
Some of the challenges of the college include Developing alternate funding arrangements for post graduate
medical education, maintenance of College building and accreditation for training for decentralized sites.
The College will continue with its core functions of producing specialists in medicine, surgery and related
disciplines and develop options for funding post graduate specialist training The college will also support
implementation of WAHO initiative towards harmonization of curricula and accreditation criteria with subregional
Colleges.
Ghana Health Service
The Ghana Health Service identified 8 main priority areas for improvement in 2012 under the five strategic
objectives
The major priority activity under this objective one was the scaling up of the Community-based Health
Planning and Services (CHPS) as a close-to client policy to increase access to basic health services. This
achievement was made possible by simplifying the community health community training manual and
trainer of training programmes for the regional teams. One of the major challenges of the Ghana Health
Service is the availability, distribution and appropriate mix of relevant health staff at the health facilities.
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The GHS introduced the leadership and management capacity development as a capacity building effort in
the Central region in 2010. Since then 161 health personnel have been trained.
The processes were started for the Implement the MAF country Action plan for improved maternal and
neonatal care. Activities were initiated to develop and implement the National Nutrition Policy and
strategy. All Districts (170) were also trained In Community Management Of Malaria (CMM) and and some
districts commenced implementation of CMM.
As part of effort to improve prevention and control of communicable diseases, the GHS planned to procure
and distribute ICT equipment to support district level surveillance activities, which was done in three
regions. The following guidelines, policies and strategies were developed or reviewed
• Laboratory accreditation guidelines for clinical labs in hospitals
• Laboratory Quality Control of Taylor & Taylor Analysers in selected Laboratories in Greater-Accra
Region
• Antimicrobial policy for Ghana
• Community Mental Health Strategy
The Ghana Health Service plans to re-prioritize the numerous activities in 2013, to ensure that the key ones
are implemented.
Komfo Anokye Teaching Hospital
A patient satisfaction survey conducted during the year indicated that 62% of hospital clients were satisfied
with the hospital’s services. Customer Care Service Training was organised for staff during the period under
review to improve services provided to clients.
A Magnetic resonance Imaging (MRI) Centre was completed during the year and handed over to the
hospital Services at the center commenced. Work on the uncompleted Maternity & Children’s Block was
reactivated whilst construction of Eye Centre is 95% complete
OPD attendance and services provided at the hospital either declined or remained stagnant over the
period. Sustain activities aimed at reducing mortality, (especially maternal mortality), and improving
general care outcomes were undertaken. The maternal mortality however did not reduce.
Daily clinical meetings and monthly maternal mortality meetings were held to audit all Maternal Deaths.
Continue to support Doctors & Nurses to pursue training programme in Emergency Medicine
5 Doctors and 20 nurses qualified as Emergency Physician and emergency nurses respectively.
The Hospital embarked on several outreach programmes in eye screening and surgeries, ENT, Cleft, Child
Health and Infectious Diseases during the period under review. The Hospital visited One Teaching Hospital
and Eight Districts.
Twenty-five (25) research activities initiated by directorates during the period are on-going. Two (2)
research reports were completed and disseminated:Some of the challenges of the Hospital
were,Congestion, especially at maternal & children’s wards, Delays in the payment of health insurance
claims and unrealistic tariff,Old & Non-functional Oxygen Plant and Rent Expenditure for House Officers &
Residents
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Korle-Bu Teaching Hospital
The hospital has a total staff strength of 4419 with clinical staff constituting 72% (3,184) and Non clinical
staff 28% (1,235).
To improve maternal health outcomes and general clinical outcomes, a number of projects and
programmes were initiated. A Blood bank established at the Maternity Block Laboratory and the renovation
of the Maternity OPD, 4 th and 6 th Floors which was started at the beginning of the year are 80 to 90%
complete. The hospital saw a reduction in maternal deaths.
The emergency department is being refurbished to improve emergency medicine services. Capacity
building in Client/Patient care aimed at addressing Staff attitudes was initiated. About 50% of staff have
undergone the training.
The challenges of facing the hospital are High cost of incentives to attract and retain critical staff.
Tamale Teaching Hospital
The objectives for the hospital in 2012 were among others to strengthen and improve governance and
efficiency of the TTH’s management systems, provide excellent quality Maternal and Child Health Service
and attract and retain health staff.
In an effort to improve general hospital management through informed decision-making, an ICT Firm was
commissioned to develop a Health Management Information System.
The hospital introduced measures aimed at improving maternal and neonatal outcomes.
Radiology/Endoscopy/Urology services including new and improved imaging services have been
introduced.
National Ambulance Service
The Service opened 97 new ambulance stations during the year bringing the total number of ambulance
stations in the country to 121. Thirty-five emergency medical technician basic (EMTB) were upgraded to
emergency medical technician advance (EMTA) during the year. Inadequate Budgetary Allocation and late
release of funds hampered the programme and activities of the service. Lack of dedicated training facility
leading to delays in training schedules
National Health Insurance Scheme
Some of the objectives of the scheme at the beginning of the year was to ; To increase efficiency in the
financial operations of the scheme, to increase active membership to 45% of population by December 2012
and to provide support to increase access to quality basic health care services in all districts
To strengthen premium collection scheme level, a consolidated premium account was established. The
World Bank is supporting the Health Insurance Project (HIP) whiles DANIDA is supporting the authority with
an M&E advisor.
Until recently, returns from investment formed a substantial part of the total funds of the scheme.
However due to recent financial difficulties, the authority had not been able to invest and have had to
plough back its savings to keep the scheme afloat. To reverse this trend, the authority developed an
investment policy and guidelines to provide guidance to the authority. The authority realised 6.5% real rate
of returns on investment exceeding its target of 4%. The NHIA intensified clinical audit of the district
schemes and providers. The authority also hoped to improve efficiency by diversifying provider payment
mechanism.
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Some of the challenges facing the scheme are Financial sustainability of the concerns,ICT Challenges Claims
Management, Renewal of membership by clients and Irrational Prescription of medicines by providers.
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Introduction
The year 2012 represented the third year of the implementation of the current Health Sector Medium Term
Development Plan (2010-2013). The review has placed emphasis on the performance of the sector
according to identified health objectives as outlined in the Four-Year Sector Medium Term Development
Plan and the derived Annual Programme of Work for 2012. The review assessed the overall sector
performance for the year 2012 using the agreed Holistic Assessment tool. The Holistic Assessment tool was
adopted in 2008 and has been used to assess the sector performance since its inception.
For the second year running, the review was performed by an internal team drawn from the Ministry of
Health and its agencies. For this year’s review, a section on agencies performance was added.
The new census data from 2010 was available for the year’s review. From the census report, the proportion
of children under one year as well as expected pregnancies was estimated to be 3% of the total population.
When this proportion is applied to the data several indicators exceeds 100% coverage. Since most of the
analysis in this report is based on trends over time, and the targets of the HSMTDP was based on 4% the
review team finds it technically sound to continue basing the analysis on the 4% as in the previous reviews.
However data based on the 3% is made available for comparison and official purposes.
The report is organized into six chapters. The first chapter deals with the health sector performance using
the holistic assessment tool. The second chapter discusses the trends of sector wide indicators. The third
chapter provides an assessment of regions of excellence and regions requiring attention. The fourth
chapter looks at the implementation status of the programme of work 2012. The fifth chapter is a brief
report of the agencies performance. The sixth chapter follows up on the recommendation of previous Aidememoire.
Annexes are provided with further details of the basis of the analysis.
1.0 Assessment of the Health Sector Performance in 2012 using the
Holistic Assessment Tool
1.1 Sector score
The purpose of the holistic assessment is to form a basis for a balanced discussion between the Ministry of
Health, its agencies and development partners to reach a common conclusion of the sector’s performance.
The outcome of the initial assessment is that the health sector in 2012 was a positive sector score of +3,
which is interpreted as a highly performing sector (For the detailed analysis of the indicators and the
holistic assessment calculations, please refer to Annex 3: Holistic Assessment Tool and Analysis).
Health Objective 1 0
Health Objective 2 0
Health Objective 3 +1
Health Objective 4 +1
Health Objective 5 +1
Sector score +3
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Table 1: Sector Score 2012
Table 1 shows the overall scores for the five Health Objectives in the HSMTDP 2010-2013. Table 2 provides
a detailed overview of the indicators and trends from 2007 to 2012. Annex 2: Sector wide indicator trends
based on 3% proportion provides a presentation of trends of sector wide indicators over time based on the
latest projections from Ghana Statistical Services.
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2012 POW
2007 2008 2009 2010 2011 Target Performance (4%) Performance (3%) Source
Health Objective 1: Bridge equity gaps in health care and nutrition services and ensure sustainable financing arrangements that protect the poor
1 % children 0-6 months exclusive breastfed - 62.8% - - - 70% 45.7% 45.7% MICS
2 Equity: Poverty (U5MR) - 1.72 - - - 1:1.5 2.04 2.04 MICS
3 Equity: Geography - Services (supervised deliveries) 2.47 2.17 1.49 1.89* 1.66* 1:1.70 1.48 1.48 GHS
4 Equity: Geography - Resources (nurse: population) 2.26 2.03 1.81 1.99* 1.73* 1:1.95 1.75 1.75 MOH
5 Equity: NHIS – Gender - 1.22 - - 1.38 - 1.23 1.23 MICS
6 Equity: NHIS – Poverty - 0.82 (F) - - - - 0.69 (F) 0.69 (F) MICS
7 Outpatients attendance per capita (OPD) 0.69 0.77 0.81 0.91* 1.04* 0.88 1.17 1.17 GHS /TH
8 % population living within 8 km of health infrastructure - - - - - N/A -
9 Doctor: population ratio 1:13,683 1:13,499 1:11,698 1:11,833* 1:10,217* 1:9,700 1:10,452 1:10,452 MOH
10 Nurse: population ratio 1:1,537 1:1,353 1:1,494* 1:1,516* 1:1,262* 1:900 1:1,251 1:1,251 MOH
Health Objective 2: Strengthen governance and improve efficiency and effectiveness in the health system
1 % total MTEF allocation on health 14.6% 14.9% 14.6% 15.1% 15.8% ≥15.0% 15.4% 15.4% MOH
2 % non-wage GOG recurrent budget to district level and below 49.0% 49.0% 62.0% 46.8% 55.3% 50.0% 38.5% 38.5% MOH
3 Per capita expenditure on health 23.0 23.2 25.6 28.6 35.0 30.0 50.7 50.7 MOH
4 Budget execution rate (Item 3 as proxy) 110.0% 115.0% 80.4% 94.0% 82.1% ≥95.0% 86.8% 86.8% MOH
5 % of annual budget allocations disbursed to BMC by end of year - 23.0% 39.0% 31.0% 89.8% 50.0% - - -
6 % of population with valid NHIS membership card - - - 33.7% 33.4% 70.3.0% 34.0% 34.0% NHIA
7 Proportion of claims settled within 12 weeks - - - - - 70.0% - - -
8 % IGF from NHIS N/A 66.5% 83.5% 79.4% 85.0% 75.0% - - -
Health Objective 3: Improve access to quality maternal, neonatal, child and adolescent health services
1 Maternal Mortality Ratio (MMR) per 100,000 live births - 451 - - - - -
2 Total Fertility Rate - 4.0 - - - 3.8 4.3 4.3 MICS
3 Contraceptive Prevalence Rate 16.6% - 23.4% 23.4% MICS
4 % of pregnant women attending at least 4 antenatal visits 62.8% 63.8% 81.6% 71.1% 71.3% 80.1% 72.3% 96.4% GHS
5 Infant Mortality Rate (IMR) per 1,000 live births - 50 - - -

2.0 Assessment of indicator trends
2.1 Health Objective 1: Bridge equity gaps in health care and ensure
sustainable financing arrangements that protect the poor
2.1.1 Equity: Under-five mortality
With twice as many under-fives dying per 1,000 live births in the poorest wealth quintile compared to the
richest, the under-five mortality inequality gap between richest and poorest children is widening. While
children of the richest quintile seem to be on track to meet the MDG target, children from other quintiles
and especially the poorest children are faring much worse. The same widening of inequity is observed for
infant and neonatal mortality rates. Since 2003, according to the DHS and MICS there have been no
observed reduction of infant mortality and only 5% reduction in neonatal mortality among the poorest
children. There have been 35% and 43% reduction of infant and neonatal mortality among the richest
quintile during the same period. Further analysis of these trends to isolate the determinants of high
mortality among children, e.g. urban/rural dwelling, socio-economic status, education status of parents,
child gender etc. is needed, in order to device strategies to ensure more equitable health development for
children in Ghana.
Wealth Quintile DHS 2003 MICS 2006 DHS 2008 MICS 2012
Poorest 128 118 103 106
Second 105 126 79 85
Middle 111 100 102 83
Fourth 108 101 68 86
Richest 88 100 60 52
Equity Ratio 1.45 1.18 1.72 2.04
Table 3: Under-five mortality rate 2003-2012, source DHS and MICS
2.1.2 Equity supervised deliveries
The equity index for supervised deliveries by region improved and reached the target of 1.7 comparing the
best to the worst performing region with regards to coverage. Performance improved among both the best
and worst off regions. Almost all regions’ performance was above 50% except Volta Region at 46.5% and
Northern Region at 49.9%. Coverage increased in all regions except for Ashanti Region, which experienced a
drop of 2.1%. Volta, Northern and Western Regions have worse midwife to WIFA (women in fertility age)
ratio compared to the other regions. This could be the reason for the lower performance in these three
regions. Upper East Region continues to improve its supervised delivery coverage over the years. It will be
of beneficial to look to Upper East Region for best practices in supervised delivery coverage.
Although Volta region is showing an improvement in supervised delivery, it has consistently been the
lowest performer with regards to supervised delivery for the past three years. There may be various
reasons for this performance which came up in the joint monitoring visit report to the Region in 2011,
among the issues may be inadequate infrastructure, ageing and inadequate numbers of midwives and the
fact that Volta Region is one of the regions with very few maternal and child health interventions outside
the regular budget provided by the Ministry of Health. The region should over the coming years receive
special attention and support to catch up with the other regions.
16

Figure 1: Supervised deliveries by region 2007-2012, source GHS
2.1.3 Equity HRH distribution
The indicator of nurse distribution did not improve over 2011 performance, but reached its target of being
below 1:1.95. The poorest staffed region is Northern Region with one nurse to 1,601 population compared
to the national average of one nurse to 1,251 population. Equity with regards to nurses has however
improved significantly overall since 2007. The improvement over the years has been due to the
establishment of new nursing training schools in all the regions. The recent stagnation is possibly due to the
high failure rate among the nursing students over the past two years that has reduced the number of
nurses who are passing out of the schools.
The decision of Upper East Region to strictly implement the policy of retaining nurses that train in their
region appears to be yielding good results. Other regions, especially Northern Region, should also adopt
this approach.
From 2011 to 2012, the numbers of midwives are reducing across all the regions with the exception of
Ashanti Region, which showed a marginal increase. There appear to be a lag time between the increase in
the intake of trainees to the midwifery training schools and the rate of retirement of midwives. There is the
still the need to get more nurses into training; this can be accelerated if the community health nurses are
given diplomas instead of certificates when they undertake the post-basic midwifery course. Most of them
are reluctant to enrol in the post-basic midwifery course because they are awarded certificates. Figure 2
shows the percentage change in midwife population by region since 2009. Volta and Upper West Regions
stand out with critical reductions in midwife populations. Despite these reductions, both regions have more
17

favourable midwife to WIFA ratios than the national average, and both managed to increase the number of
women delivering in facilities by 18.1% and 53.7% respectively in the same period.
Figure 2: Percentage change in midwife population by region 2009-2012, source Free Maternal Health Care Policy Review 2013
The doctor to population ratio did not change much and with 11 times less doctors per population in Upper
West Region compared to Greater Accra Region equitable distribution of doctors remains a major challenge
to the health sector. Greater Accra Region continues to be the region with the highest number of doctors
per capita with one doctor per 3,540 inhabitants. Fifty percent of all Ghana’s doctors are in Greater Accra
Region and another twenty percent are in Ashanti Region. The number of doctors in training in Greater
Accra and Ashanti Region might be accounting for these high numbers. The proportion of female doctors in
Greater Accra is higher than for the other Regions, indicating that some of these doctors are in Greater
Accra Region because of domestic reasons. Northern Region has consistently improved its doctor
population ratio over the past three years, however this increase has only benefitted the Teaching Hospital.
Twenty five government Hospitals in Ghana are without doctors. Eight of them are found in the Northern
Region. There is the need for establishment of clear staffing norms for facilities and the Ministry of Health
will need to address the inequitable distribution of doctors.
18

Figure 3: Doctor: population ratios (lower is better), 2009-2012, Source MOH
2.1.4 Equity NHIS
The gender ratio of NHIS cardholders remains stable with 23% (MICS 2011) more female cardholders (15-49
years) than male cardholders (15-49 years) compared with 27%(DHS 2008). Women aged 15-49 years have
higher need for health care services (including maternal care) than men of the same age group, and until
NHIS reaches universal coverage the ministry both expects and desires relatively higher female enrolment.
Inequity in terms of socioeconomic status of NHIS active members by DHS and MICS surveys has
significantly worsened since 2008. The indicator is calculated as the ratio of valid cardholders among
women 15-49 years from the poorest quintile compared to women 15-49 years in the general population.
The MICS survey demonstrates a modest increase in cardholders among the poorest women, but this
increase is largely overtaken by a relatively higher national increase in cardholders. Curiously, equity among
men of the same age group is significantly improving over the same period.
The observed trend indicates that there is a financial access barrier for women from the lowest wealth
quintile to enrol onto NHIS and/or renew their membership card.
Reports from the district hospitals suggest that the poorest citizens choose to register with NHIS only when
they anticipate a need for health services and subsequently discontinue their membership. This can lead to
adverse selection that potentially creates challenges for the financial sustainability of NHIS.
The recent evaluation of the Free Maternal Health Care Policy concludes that NHIS membership provided
to pregnant women under the policy favours the poor. The evaluation also reports an increase in equity in
the utilisation of health facilities for delivery. Analysis of survey-based coverage of supervised delivery
19

confirms this finding. Between 2008 and 2011 the surveys demonstrate a relative increase of 60%
supervised delivery coverage among women from the poorest quintile.
Figure 4: Supervised deliveries by wealth quintile, 2003-2011, Source DHS and MICS
2.1.5 Access to health services
The National Health Insurance since its introduction has led to increase in utilization of OPD services across
all the regions. The number of outpatients per capita continued previous years’ increase, and in 2012, the
relative increase was 11%. OPD per capita reached 1.17, more than doubling 2006 figure. In regions like
Upper East and Brong-Ahafo, which share borders with neighbouring countries, the high figure may be
partly explained by patients coming from the neighbouring countries. Over 60% of those attending
outpatient were females and overall women between the ages of 20-34 years were seen more often at the
OPD than any other age group for males or females (Figure 5).
With the backdrop of doubling OPD per capita rate, 80% of total outpatients insured and 34% of the
population being active NHIS members, important questions can be raised:
1. Could the high proportion of OPD services be a reflection of frivolous use of services by NHIS
members (moral hazard)?
2. Could it be a reflection of high NHIS membership among those in need of services, i.e. persons only
register when they fall sick and refrain from renewing membership the following year (adverse
selection)?
3. Has the NHIS led to increased equity in utilization of health services, i.e. equal access for equal
need?
4. Could it be due to data capture problems?
While the third question is a goal of establishing NHIS, a positive answer to question 1 and 2 provide a
financial risk to NHIS, and these issues should be further analysed and addressed.
20

Figure 5: OPD visits by gender and age-group 2012, source GHS
Ashanti region like all the regions showed an increase in OPD attendance till 2012 when it experienced a
drop in OPD per capita (Figure 6). It was the year that the capitation was piloted in the region. It is not clear
whether this reduction in OPD was due to reduction in inappropriate utilization by insured clients or
reduction in access on account of the capitation. Ashanti Region was also the only region where the
proportion of OPD clients with insurance fell (from 82.6% to 76.9%).
Figure 6: NHIS membership and OPD visits per capita in Ashanti Region, 2012, source GHS and NHIA
21

Northern Region’s low OPD per capita rate might be a reflection of poor geographical access in the Region.
Although financial access has been facilitated with the health insurance, their overall OPD per capita
remained low compared to the other regions.
With the increase in OPD visits across the regions, there has not been equally significant improvement in
infrastructure of most of the facilities to accommodate these increases. It is now more important than ever
to ensure good service and clinical quality. Strategies for quality assurance for clinical care services should
be developed for inclusion in new HSMTDP.
Figure 7: OPD per capita by region, 2006-2012, Source GHS
The National Ambulance Service expanded significantly opening 97 new stations in 2012. Total number of
stations is 121 covering 70% of the 172 districts that existed when the HSMTDP was developed and targets
were set.
2.2 Health Objective 2: Strengthen governance and improve efficiency
and effectiveness of the health system
2.2.1 Improving efficiency and accountability
In 2012, the ministry introduced performance contracts with four agencies; the three Teaching hospitals
and Ghana Health Service. The ministry will sign performance contracts for 2013 with all its agencies.
2.2.2 Financing (based on MOH financial report 2012)
In 2012, Government of Ghana contribution increased by 126.9% from GH¢771 million in 2011 to GH¢1,750
million in 2012. Internally Generated Fund (IGF) increased by 8.9% from GH¢392 million in 2011 to GH¢427
million in 2012. Contribution from donors in 2012 was GH¢290.8 million whilst there was GH¢259.2 million
contribution in the same period of the previous year, an increase of 12.2% over the same period of 2011.
In terms of percentage contributions by the various sources to the sector, GOG and IGF contributed 87.5%
as compared with 78.6% in the same period of 2011. Donor contribution was 11.7% of Gross Revenue as
against 17.5% of the previous year.
22

Total Gross Revenue, recorded by the Ministry was GH¢2,489.8 million, the sources of which have been
broken down in Table 4 and Figure 8.
Source of Funds 2012 (as at December 2012) 2011 (December)
Amount (GHC Mn) US Dollar (Mn) Percent Amount (GHC Mn) Percent
GOG 1,750.2 921.1 70.3% 771.3 52.1%
IGF 427.4 224.9 17.2% 392.4 26.5%
Program - Donor 181.6 95.6 7.3% 154.5 10.4%
Budget Support 109.2 57.5 4.4% 104.7 7.1%
NHIA 15.1 7.9 0.6% 23.2 1.6%
F/Credits 6.4 3.3 0.3% 35.5 2.4%
TOTAL 2,489.8 1,310.4 100.0% 1,481.66 100.0%
Table 4: Gross revenue distribution by source, source MOH Financial Report 2012
Figure 8: Percent gross revenue distribution by source, source MOH Financial Report 2012
The Ministry recorded a total expenditure of GH¢2,613.4 million for the period under review (Table 5). Out
of this amount, 63.4% was for Employee Compensation as against 53.9% for the same period of 2011.
23

Expenditure incurred on Goods and Services was 34.5% as compared to 38.0% in 2011 whilst that incurred
on Assets was 2.2% compared to 8.1% in 2011 for the same period.
For the Year Ended 31st December, 2012 (GH¢ 'million)
GOG IGF B/SPT MOH PROG NHIA F/CRED TOTAL Percent
Employee Compensations 1,613.4 42.2 0.0 0.0 0.0 1,655.7 63.4%
Goods and Services 104.7 407.0 156.6 220.1 12.1 0.0 900.5 34.5%
Assets 30.5 6.7 12.0 0.0 1.7 6.4 57.2 2.2%
TOTAL 1,748.6 455.88 168.55 220.1 13.9 6.4 2,613.4 100.0%
Table 5: Expenditure distribution by item, source MOH Financial Report 2012
Figure 9 below shows comparative pattern of expenditure between 2011 and 2012 in absolute terms.
Employee Compensation increased significantly from GH¢ 754.7million in 2011 to GH¢1,655.7millon as a
result of the movement from the Health Sector Salary Scale (HSS) to the Single Spine Salary Pay Policy
(SSSPP).
Figure 9: Comparative Expenditure Distribution 2011 and 2012, source MOH Financial Report 2012
At the end of 31st December 2012, total cash balances were GH¢173.5 million as against GH¢215.1 at the
end of 31st December 2011. These amounts represent balances standing in the books of the various health
facilities nationwide and MOH/GHS Headquarters.
Debtors have decreased from GH¢137.7 in December 2011 to GH¢115.9m in December 2012, a decrease of
15.8%. A large proportion of the debts are IGF related, emanating from non-payment of service bills by the
NHIA. Most of the debts are owed to the District Hospitals; institutions which are no more benefiting from
GOG and Sector Budget Support/Health Fund but are now depending solely on IGF for the operation of the
Goods and Services budgets.
24

2.2.3 National Health Insurance
Active membership of the scheme stood at 34% short of the target of 45% (Figure 10). The indigent definition
was revised and the common targeting developed. With these revisions, some categories of persons with
disability and mental health patients were covered under the exemption policy. The Common targeting
mechanism is being piloted in 90 districts. Fifty three thousand two hundred and seventeen out of 200,000
LEAP beneficiaries were covered.
The National Health insurance authority accessed only 48% of all receivable funds during 2012 and this had
implication for timely reimbursement to providers. An analysis by the NHIA showed that the scheme cannot
be sustained at the current level of operation. A policy paper including sustainability analysis was submitted
to the government for consideration. To strengthen premium collection scheme level, a consolidated
premium account was established.
About 46% of earmark funds for the ministry of health was released whiles 94% of expected funds was
released to members of parliament.
Until recently, returns from investment formed a substantial part of the total funds of the scheme.
However due to recent financial difficulties, the authority had not been able to invest and have had to
plough back its savings to keep the scheme afloat. To reverse this trend, the authority developed an
investment policy and guidelines to provide guidance to the authority. The authority realised 6.5% real rate
of returns on investment exceeding its target of 4%. Its investment income for the year was GHc27.67m as
against a target of GHc18m.
The NHIA intensified clinical audit of the district schemes and providers. During the year, 157 providers
were audited and 128 schemes visited. An amount of GHc20.1 was recommended for recovery for the
2010-2012 period with GHc7.5m recovered in 2012.
A uniform prescription form was piloted in the Greater Accra Region and systems for linking treatment to
diagnosis were developed. These were meant to increase technical efficiency.
The authority also hoped to improve efficiency by diversifying provider payment mechanism. As a result
Capitation was piloted in the Ashanti region for which a mid-term evaluation was conducted.
25

Figure 10: NHIS coverage (active members), 2010-2012, source NHIA
2.3 Health Objective 3: Improve access to quality maternal, neonatal,
child and adolescent health and nutrition services
2.3.1 Maternal health
The total fertility rate has worsened from 4.0 to 4.3 since the previous survey compared to target of 3.8.
Meanwhile the contraceptive prevalence rate for the same period has improved significantly, increasing to
23.4% from 16.6% in 2008. Unmet need for family planning reduced from 34.0% in 2003 to 26.4% in the
2011 MICS. These factors indicate that access to family planning is improving and raise concern that the
increase in fertility may be a statistical variation that is not a true reflection of performance, and there
might be the need to investigate this further.
The consistently increased use of modern family planning methods and reduced unmet need for family
planning presented in the surveys is consistent with routine figures from the public sector. While long-term
CYP saw minimal increase from 2011 to 2012, short-term CYP increased markedly, and total CYP increased
to 1,922,290 years in 2012. Analysis by GHS shows that an increasing proportion of family planning clients
are accessing the services from the private sector including pharmacy shops, since this is more convenient
for the clients. The non-collection of data from some private facilities, chemical sellers and pharmacy shops
can lead to underestimation of routine Family Planning utilisation figures. Some of the long-term methods
can only be administered by midwives and doctors. Since both midwives and doctors are likely to be
occupied with other activities, these methods cannot be administered to meet the demand. The ministry is
currently considering the possibility of shifting the task of administering these long-term family planning
methods to other health personnel. Moreover, the calculation and understanding of CYP at the service
delivery and data collection points also need to be investigated.
26

The proportion of pregnant women attending four or more antenatal care visits increased slightly to 72.3%.
For the 2011 MICS report, the corresponding figure was 86.6%. The definition of this indicator presents
challenges for some of the Regions with their figures being consistently above 100%. In the previous review
the figures from Ashanti, Brong-Ahafo Volta and Greater Accra were omitted from the Analysis because of
these errors. It is only in 2012 that all the regions have been able to get reasonable coverage for this
indicator. This shows an improvement in the data quality.
Figure 11: Antenatal care registrant and 4+ visits 2008-2012, source GHS
Over the past 3 years, supervised delivery coverage has increased by 28.2%, and over the past 5 years by
66.5%. Coverage of supervised deliveries in 2012 was 58.5%, based on the estimated expected delivery of
4% of the population and 77.9% based on 3% estimate. The 58.5% represents a relative increase of 6.7%
over 2011. The MICS gave the country a skilled attendant at delivery coverage of 68.4%. With improvement
in the data collection on skilled attendant delivery, the routine data will be aligning reasonably well to the
survey data from MICS and DHS. The good performance may be attributed to improved financial access
from the free maternal health care policy, and improvement in the data collection.
2.3.2 Infant and Child Health
The national Infant Mortality Rate (IMR) increased by 6% over the DHS 2008 figure from 50 to 53. This
national average does show some large regional variations. IMR is highest in Volta, Upper West, Northern
and Brong-Ahafo Regions. The reported trend in Volta and Brong-Ahafo Regions is worrying with significant
worsening of IMR. Since 2003, Upper West Region has made an impressive effort to bring IMR down from
105 to 67.
AR WR NR BAR CR VR UER UWR ER GAR Ghana
DHS 2003 80 66 69 58 50 75 33 105 64 45 64
MICS 2006 72 45 83 88 69 57 68 114 61 60 71
DHS 2008 54 51 70 37 73 37 46 97 53 36 50
MICS 2012 43 50 66 66 55 68 58 67 38 37 53
Table 6: Infant mortality rate 2003 – 2012, source DHS (2003 and 2008) and MICS (2006 and 2012)
The under-five mortality rate remained stagnant since 2008. Despite stagnation of national average of
under-five mortality rate, significant regional variations occurred. Northern Region and Upper West Region
27

have since 2003 had relatively high U5MR. While Upper West Region was able to bring down under-five
mortality rate by 50%, Northern Region achieved only limited improvement (Figure 12).
Figure 12: Under 5 mortality by region 2003-2012, source DHS (2003 and 2008) and MICS (2006 and 2012)
With the scale-up of CHPS, increased utilisation of ITNs, high EPI coverage and improving coverage of skilled
deliveries since 2008, the ministry did expect to see an improvement of both IMR and U5MR. The ministry
plans to analyse the underlying data thoroughly to identify reasons for the observed stagnation in child
mortality indicators.
2.3.3 Nutrition
The proportion of children below the age of six months that are exclusively breastfed has significantly
dropped since 2008, and the current performance at 45.7% is below 2003 levels and far below the target of
70%. At district level, health activities to promote good nutrition, including exclusive breastfeeding, have
received decreasing attention over the past years. Because of limited financial and human resources and
since these activities are less integrated into the routine district level activities than for example EPI, the
tendency has reportedly been to give preference to other activities. Moreover, the Ghana Health Service
head quarter’s monitoring and support to regions and districts in the area of nutrition has reduced. Factors
external to the health sector are also likely to have influenced the trend, e.g. increased number of women
engaged in the workforce and behavioural changes as a consequence of economic growth and attainment
of middle-income country status.
The under-five prevalence of low weight for age has reduced slightly to 13.4%. The slow reduction in the
under-five prevalence of low weight for age is a reflection of the low performance of the sector in nutrition
in general. The target of 8.0% is far from being achieved. The coverage of nutrition interventions in the
country is not high. Most of the interventions like community management of acute malnutrition and
community growth promotion cover only few districts and regions. The ministry is concerned about these
trends and will work with its agencies to strengthen nutrition activities and promote exclusive
28

eastfeeding. There will be the need to fully integrate nutritional interventions into the activities of all the
districts in Ghana.
Health Objective 4: Intensify prevention and control of communicable and noncommunicable
diseases and promote a health lifestyle
2.4.1 Malaria and ITNs
According to the MICS 2011, use of ITNs has improved by almost 50% since 2008 and the proportion of
children under five sleeping under ITN the previous night reached 41.5%. Only Volta and Eastern Regions
had completed their universal coverage campaigns prior to MICS 2011 data collection; seven other regions
carried out campaigns during or after the data collection. With the completion of the hang-up campaigns
for the whole country, 7,645,745 LLINs have been distributed and household ownership of ITNs stands at
above 95%. The post hang-up campaign undertaken by the School of Public Health found that 69.2%
individuals in the sampled households slept under ITN the previous night before the survey.
The national prevalence of malaria parasitaemia in children aged 6-59 months based on microscopy was
27.5% with the highest prevalence in Upper West Region (51.2%) and Northern Region (48.3%). Lowest
prevalence was recorded in Greater Accra Region (4.1%). Despite no clear evidence of causality, it is
possible to attribute the high under-five mortality rate in Upper West Region and Northern Region to high
prevalence of parasitaemia. There will be the need to intensify malaria control activities in these two
regions to address their high under-five mortality rate.
The MICS survey showed that only 15.9% of children under five with fever malaria test done to confirm
diagnosis. Treatment for malaria is often based on clinical diagnosis. The Ministry is concerned about the
access to and quality of diagnostic services related to malaria. While the national number of expected
malaria cases among children has not dropped significantly, case-fatality of malaria for children under five
years has improved, dropping from 1.2 in 2011 to 0.6 in 2012 deaths per 100 confirmed malaria cases.
2.4.2 Expanded Programme on Immunisation(EPI)
Since 2007, EPI coverage has steadily been close to 90% with only slight variations. In 2012 coverage of
Penta 3 was 87.8%. The MICS gave the corresponding survey based coverage of 92.1%. The high coverage is
a demonstration of the strength of the EPI programme. The effect of low and erratic flow of funds to the
district level appears not to have had much impact on delivering of immunization service. A lot more effort
and input however will be needed to move the coverage the last few percentage point up and beyond 90%.
Sustainability of the gains made in EPI and any improvement thereof will depend in improvement in CHPS
implementation.
The routine Penta 3 coverage in Upper West Region has been going down over the years but the MICS gave
a coverage of 97.4%, so possibly the observed reduction might be due to data management challenges. The
same situation pertains in Greater Accra Region with a low routine coverage for Penta 3 but relatively high
MICS coverage. There is the need to improve data collection especially from the private facilities in the
major metropolitan areas like Accra and Kumasi.
29

Figure 13: Penta 3 coverage by region 2006-2012, source GHS
2.4.3 HIV/AIDS
The number of HIV Clients receiving ARV therapy continues to increase. This increase is encouraging,
however with the uncertainty surrounding the continuous supply of ARVs there are concerns about the
interruption of treatment of clients. This development if not addressed promptly can result in development
of resistance of the HIV virus to the drugs that are currently being used by the programme. There is an
urgent need with the lost of the Global Fund funding to look at how the country is going to ensure
continuous supply of ARVs for the increasing number of clients.
2.4.4 Water and sanitation
Transmission of guinea worm has been interrupted and there has not been a single case in Ghana since
May 2010. The country continues to maintain surveillance for guinea worm. 875 rumours of cases were
investigated within 24 hours and Stop Guinea Worm Teams have been deployed in 16 previously endemic
districts in Brong-Ahafo, Northern and Volta Regions. WHO has requested that the surveillance system be
improved to ensure the country is certified as guinea worm free.
Coverage of sanitary facilities that are not shared increased to 15% of the population but access to
improved sources of drinking water worsened since 2008 and came slightly under the set target of 80%.
While the proportion of the population with access to improved sanitary facilities that are not shared
increased, the access to all improved sanitary facilities, shared and not shared, reduced. To improve upon
these indicators, there is the need for inter-ministerial collaboration.
2.4.5 Tuberculosis
TB treatment success rate continues to improve although at 86.2% the target of 89% was not achieved. The
adverse outcomes reduced from 16.7% to 13.8%. The fieldwork to determine the national prevalence of
tuberculosis was started.
30

2.5 Health Objective 5: Strengthen institutional care including mental
health service delivery
2.5.1 Mental health
The total number of mental health nurses in the three psychiatric institutions was 1,068. This comprises
both community psychiatric nurses and registered mental nurses. Total number of patients seen during the
year was 67,732. The expected number of persons living with mental disorders is however expected to be
significantly higher; international estimations indicate that 10% of the population lives with mental
disorder, which amount to 2.59 million persons in Ghana.
No formal training exists for training community psychiatric nurses. The current crop of community
psychiatric nurses amount to 400 who are registered nurses converted to practice as community psychiatric
nurses.
2.5.2 Institutional child and under-five mortality
Institutional IMR improved significantly in 2012 with more than 50% reduction. There are, however, issues
with the data quality and accuracy of this indicator, especially with regards to the capture of all deaths
occurring in children under one year in the health facilities. The consistently high immunization rate and
the drop in vaccine preventable diseases like measles may have contributed to the low Institutional infant
mortality that was observed. The country has not recorded any deaths due to measles since 2003.
Institutional under five mortality also improved significantly in 2012 with more than 50% reduction overall.
All the districts experienced reduction with Upper West having a reduction of 91%. Despite concerns about
data quality, the observed drop in the institutional under-five mortality rate might be a reflection of
improvement in access to care. Health Insurance and community management of malaria, diarrhoea and
acute respiratory infection are the main interventions that have improved access to care in the districts and
communities. These interventions address the major causes of deaths in children under five years. The
community interventions for these three diseases are being implemented nationwide, but in Upper West,
Northern and Upper East Regions almost all the districts are now implementing the community based
treatment programme.
The improvement can also be attributed to an increase in the live births being seen in all the regions.
31

Figure 14: Under-five deaths by region 2008-2012. Not adjusted for population sizes. Central and Northern Regions excluded
because of unreliable data.
Institutional maternal mortality
Institutional Maternal Mortality (iMMR) dropped significantly from 211 maternal deaths per 100,000 live
births in 2011 to 193 in 2012. While iMMR at Komfo-Anokye Teaching Hospital continued to be high with
1,252 deaths per 100,000 deliveries, Korle-Bu Teaching hospital reduced institutional maternal mortality
ratio significantly from 1,133 in 2011 to 841 in 2012. During the year, Korle-Bu initiated and strengthened
several interventions to improve maternal services, including education of hospital staff and general public
on unsafe abortion, renovation of maternity OPD, addressing staff attitude, training in basic life support
and establishment of blood bank at maternity lab. These initiatives appear to have had a positive impact on
maternal mortality in the hospital.
During 2012, Komfo-Anokye Teaching Hospital established a blood bank at the maternity area and all
maternal deaths were audited. Despite these initiatives to improve maternal services, the hospital
continued to have a high maternal mortality ratio and on average, every second day a pregnant woman
died at KATH. The top-causes of maternal death at KATH were conditions related to high blood pressure,
i.e. eclampsia and pre-eclampsia. Post partum haemorrhage was the second highest cause and abortion
was third.
The continuous high maternal mortality ratio at the teaching hospitals calls for stronger and more
structured collaboration between the teaching hospitals and the referring hospitals and clinics at all levels.
Recent investigations by Foods and Drugs Authority have revealed poor quality of the investigated
medicines, which are potentially life saving in case of maternal emergencies. Almost 70% of all 279 samples
of Oxytocin failed the quality test. Sub-standard medicines are likely to have a negative impact on maternal
mortality ratio at all levels of the health care system. It is critical for the sector to analyse and address
causes of sub-standard drugs in the health sector.
32

3.0 Regions of excellence and regions requiring attention
In the review of POW 2011, the review team introduced a simplified holistic assessment based on regional
performance of selected indicators to identify the region of excellence and the region requiring attention.
The scoring of each indicator follows the rules of the holistic assessment adapted to regional analysis.
It is important to note that the regional performance assessment is only indicative since it is based on a
limited number of service delivery indicators, which may not reflect the true performance of the individual
regions.
Region Score Penta 3 ANC 4+
Skilled
delivery FP acceptors OPD/capita iMMR
TB
treatment
Central 5 0 1 1 1 1 1 0
Upper East 5 0 1 1 1 1 1 0
Eastern 5 0 1 1 0 1 1 1
Western 4 1 0 1 0 1 1 0
Greater Accra 4 1 1 0 0 1 1 0
Upper West 3 -1 -1 1 1 1 1 1
Volta 3 0 0 1 0 1 1 0
Ahsanti 3 0 0 0 0 1 1 1
Brong Ahafo 2 1 0 1 -1 1 -1 1
Northern 1 1 0 1 -1 1 -1 0
Table 7: Holistic assessment of regional performance in 2012
Table 7 shows the result of the regional assessment.
In the regional analysis of POW 2011, three regions came out with a score of zero or below. In the current
review all regions have a positive score, which indicates a relative improvement over 2011 for these
selected service delivery indicators.
The two regions doing very well, Central and Upper East Region, had access to extra budgetary funding,
which they are obviously using very efficiently compared to Regions like Northern and Upper West Region
who although benefiting from similar extra budgetary funding are not performing equally well.
The three Regions Volta, Ashanti and Brong-Ahafo do not have any significant extra-budgetary support and
depend only on the dwindling GOG funding possibly accounting for their lower than average performance
on these specific indicators.
From the analysis above it is clear that there exist factors associated with regional performance besides
resource inputs. It will be of interest to the sector to examine how the two high performing regions manage
to achieve the observed results.
Despite the positive overall score of Northern Region, four of the seven indicators had a neutral or negative
trend. Worryingly, the deteriorating trend of iMMR and FP acceptors is a continuation of the previous years
trend, and stagnation of ANC 4+ in Northern Region also continued the trend from last year. This is despite
considerable extra-budgetary support received by the Region.
The analysis suggests that Northern Region may require special attention in 2013, and the review team
recommends technical support to this region in order to identify the causes of the worsening performance.
33

4.0 Implementation status of the POW 2012
The HSMTDP (2010-2013) has five objectives and under each objective key priorities and activities were
outlined. The extent to which these activities are carried out determines the performance of the health
sector. Clearly there were difficulties in implementing some of these activities. Reasons for nonperformance
in some instances range from non-availability of funds to lack of a clear framework for
implementing such planned activities. Some planned activities also depended on the extent to which
external agents responded to requests for support on time.
A robust system for sector wide planning and implementation of plans is critical for a coordinated
response, good performance and impact on health outcomes. The review of POW 2012 raises concern
about non-adherence by several agencies to the sector’s annual programme of work. Moreover, the review
suggests that the current capacity and framework within the sector to monitor and evaluate agencies’
performance is inadequate and must be strengthened.
4.1 Health Objective 1: Bridging Equity Gaps in Access to Health Care and
Nutrition Services, and Ensure Sustainable Financing Arrangement that Protect
the Poor
4.1.1 Strengthen district health system with a particular emphasis on primary health care
The objective of the Ministry of Health is to improve coverage of PHC services at sub-district level through
strengthening community health systems. The Ministry planned to do this by expanding CHPS coverage to
achieve 500 new functional zones during the year. Although the target was exceeded some challenges
remain.
Key among the challenges is the difficulty in deploying close to 9,000 CHOs into the zones or communities.
Some CHOs are based in the hospitals and health centres and this defeats the objective of providing
community based basic health services to deprived communities.
The CHPS operational policy prescribes a package of equipment and logistics to aid the CHO in executing
his/her mandate as required. Due to inadequate funding, districts are unable to provide the basic package
to facilitate the deployment of the CHOs. This is one of the reasons why despite the increase availability of
CHOs some have still not been deployed to CHPS zones. Weak consultative processes and poor supervision
undertaken by the district and sub-district teams have also contributed to the poor performance of the
CHPS programme. Weak consultative process results in poor community ownership and local government
support for CHPS.
4.1.2 Develop sustainable financing strategies that protect the poor and vulnerable
Under the Ministry’s leadership and guidance, four main activities were to be undertaken. These include:
• Develop a comprehensive Health Care Financing Strategy
• Update National Health Accounts and initiate institutionalisation
• Pilot capitation payment in Ashanti Region
• Pilot project on identification of the poor using the common targeting instrument
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The development of the health care financing strategy could not be carried out. This activity has not been
carried out for the second year running and effort should be made to find out what the challenges are. This
activity needs to be implemented to ensure the Ministry makes certain key decisions from an informed
position.
It is not clear what has been achieved under the plan to identify the poor using the common targeting
instrument. This is a cross cutting assignment which involves several ministries including the Ministry of
Health, which is being represented by the NHIA. There is the need to contact the repackaged Ministry of
gender, women and social protection to reinvigorate the process.
The NHIA however is piloting a common targeting mechanism in some 10 districts against the anticipated
30 districts.
The capitation pilot was undertaken in Ashanti Region. It has been evaluated and disseminated. There is
the need for more consensus building for decision to be made in scaling up.
4.1.3 Increase availability and efficiency of human resource
Key activities under human resource have been running for the past four years without any clear and
definite timelines for the process. The absence of staffing norms, deployment plans and a final HRH policy
is affecting the management of human resource in the sector resulting in inequity in the distribution of
critical staff in terms of numbers and mix.
4.2 Health objective 2: Improve governance of the health system
4.2.1 Develop capacity to enhance the performance of the National Health system
Though the leadership development programme training is progressing as planned, an assessment of the
relevance of the programme in enhancing performance of district and sub-district teams is necessary.
Currently there is no evidence to show any difference in performance with regards to core functions
between the districts who have undergone the training and those who have not been trained.
The technical assistance provided to support Monitoring and Evaluation and Budget has been beneficial.
The M&E framework that was developed came late after the health sector medium term development plan
was developed. It is recommended that it should further be adapted and aligned to the new HSMTDP under
development.
Although a performance contract was signed with the Ghana Health Service and the three teaching
hospitals, contract management in terms of supervision, reporting and evaluation was not adequate. The
agencies were expected to report regularly on progress but this was not done neither was there a proper
appraisal of work done. The performance of the Ministry with regards to its obligations under the
performance agreement was not monitored. To make this exercise meaningful, both the Ministry and its
agencies should have their performance under the agreement assessed using mutually agreed indicators
that can easily be objectively assessed.
Under the agenda of enforcing adherence to sound PFM practices, all agencies of the ministry are to be
made familiar with composite budgeting and programme based budgeting. The health directorates in most
cases did not participate in the composite budget and planning that took place at the district, metropolitan
35

and municipal assembly levels because the health sector has still not been fully devolved. Secondly there
were no clear guidelines on how the district health directorates were to participate in the development of
the composite plans and budgets. In most districts they were not invited to participate in the exercise.
With regards to implementation of programme budgeting, budgets have already been categorised based
on programmes and there is the need to provide guidance to BMCs on how to access funds based on the
programs.
4.2.2 Strengthen the regulatory framework
Although a lot of bills have been passed into law, efforts aimed at operationalising the law through legal
instruments seem slow. The Ministry of Health should lead the process of ensuring that the appropriate
stakeholders are brought together to facilitate the development of the various legal instruments on time.
4.2.3 Strengthen inter-sectoral collaboration and public-private partnership
A framework (cross-sectoral planning group on health) exists at the national level and is led by the National
Development Planning Commission (NDPC). Similarly, structures exist at the regional and district levels for
cross-sectoral activities. The challenge is that of participation. Most district directors of health services do
not participate in District Assembly activities neither do the assemblies take responsibility nor initiate a
process to get cross-sectoral activities on health going. The process of devolving the health sector to the
district assemblies is gathering momentum. This will address some of these challenges.
The private sector policy provides for cross-sectoral activities in the mobilsation of resources for health and
health care. The delay in printing and disseminating the policy does not augur well for the development and
promotion of private sector participation in health. There is an increased interest of the private sector to
engage the public sector in improving access and quality of health care, lack of clear guidelines for these
engagements is affecting progress in this area.
4.2.4 Strengthen systems for improving the evidence base for policy and operations research
The plan to introduce a structured in-service training for the senior personnel of the MOH and Agencies in
evidence-based policy making and programme monitoring has been on the drawing board for the second
year running. It looks like the implementation of this priority activity has challenges. A re-evaluation of the
need for this activity should be carried out and resources allocated to ensure that the necessary
arrangements are made to bring the plan to fruition if it is still deemed necessary.
4.3 Health objective 3: Improve access to quality maternal, neonatal,
child and adolescent services
4.3.1 Reduce the major causes contributing to maternal and neonatal deaths
The implementation of the MAF action plan has delayed. Delay in release of funds has been blamed for the
slow process in implementing the MAF. The content and processes of MAF are not new. Indeed part of the
MAF plan is being implemented at all levels. Whiles waiting for disbursement of the MAF money, the
Ministry of Health should provide guidance and supervision to ensure there is synergy with on-going
activities. Meanwhile, efforts aimed at minimising the delays should be made.
The target of providing appropriate equipment to at least 25% of hospital blood banks nationwide to make
them functional could not be met. However 34 health facilities were provided with cold chain equipment
36

such as deep-freezers, chest freezers, plasma freezers and cold boxes for storage and transport of blood
and blood products. The basis for determining the 25% target is not clear. There is the need to establish a
baseline for coverage to be estimated and efforts will be made in that direction.
The emergency obstetric care equipment meant for the three remaining regions (Upper West, Greater
Accra and Volta Regions) has not been delivered according information provided during the review process.
It is not clear what the reasons are but subsequently it will be convenient for the M&E unit of the Ghana
Health Service to monitor such important arrangements and report same at their management meetings
for follow-up action to be taken by appropriate officers.
4.3.2 Reduce the major causes contributing to child morbidity and deaths.
The pneumococcal, meningococcal and rotavirus vaccines including second dose of measles vaccines were
successfully introduced. The recent study of Access, Bottlenecks, Cost and Equity (ABCE) shows a high
capacity to treat Malaria at CHPS level but less than 25% of CHPS providers have the capacity to test for
Malaria by Rapid Diagnostic Testing. Moreover, the implementation of the planned community case
management of malaria, diarrhoea and acute respiratory disease is facing challenges. Community health
workers face difficulties in recouping funds for the drugs they dispensed at the community level. This is
because they are not recognized by the NHIS and thus are not reimbursed even when they treat insured
clients in the communities. It is important to support community level initiatives to reduce child morbidity
and mortality with adequate financial support. Discussions on how insured clients can benefit from close to
client services like this should be pursued. Community interventions have the potential to reduce costs to
NHIS due to the prompt treatment that prevents disease conditions from worsening to a state where
children will need to be admitted.
4.3.3 Improve the health of adolescents and youth
It was planned to implement standards for adolescent and youth friendly health services in Ghana. The
adolescent health strategic plan and policy was disseminated to all stakeholders during the year
4.3.4 Improve nutritional status of women and children
It was planned to disseminate and implement the National Nutrition Policy. Although action was started on
this, it could however not be completed. The Nutrition policy and strategy has been finalised. The Ministry
of Health is working with the NDPC to prepare the document for submission to cabinet for approval. Most
of the Scale Up Nutrition (SUN) activities are in the form of advocacy. There were interactions with media
and a communication plan was also drawn. Nutrition, Malaria and Child Survival Program to improve the
nutritional status of children using community based approaches is being implemented in districts in Upper
West, Upper East, Volta and Central Region. Evaluation of the programme is being conducted.
4.4 Health objective 4: Intensify prevention and control of communicable
and non-communicable diseases and promote healthy lifestyles
4.4.1 Improve upon prevention, detection and case management of communicable diseases
The implementation of strategic plans for HIV/AIDS, malaria and tuberculosis started during the year.
However the range of years the plans cover should be clear and arrangements should be made to align and
integrate all these plans into the new Health Sector Medium Term Plan (HSMTDP).
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4.4.1 Improve upon prevention, detection and case management of non-communicable diseases
In the 2012 POW, the Ministry was expected to facilitate or advocate for incorporation of healthy lifestyles
into basic school and teacher training curricula and support the alcohol/substance abuse facility at Pantang.
While healthy lifestyles were incorporated into the curricula, the ministry was not able to support the
alcohol/substance abuse facility at Pantang.
The scaling up of the detection and management of non-communicable diseases through the
implementation of the national strategy for cancer control and expansion of screening program for
hypertension, diabetes and sickle cell were also not done. Though the guidelines for the cancer programme
have been developed they are yet to be printed. Screening is going on in the regions for hypertension,
diabetes and sickle cell, but such routine screening is unstructured. The 2012 Programme of Work requires
that screening centres for NCD be set up. This objective has not been achieved.
4.4.2 Implement national strategic plan to increase TB case detection and cure rate
It was planned to increase the TB case detection and cure rate during the year. To achieve this, regional and
district teams were trained on identifying cases among vulnerable groups. Capacity of laboratory staff was
built in doing sputum microscopy. To improve outcome of treatment, Nutritional assessment, counselling,
and food were provided for TB and HIV clients.
4.4.3 Implement national strategic plan to reduce malaria case fatality among pregnant women
and children
To reduce malaria case fatality for the vulnerable groups, ACTs for treatment were procured and
distributed through the AMFm programme. LLINs Hang Up campaign was organized in all the regions.
Indoor residual spraying was carried out in Ashanti and Northern Regions with some limited larviciding in
Accra. Public education on malaria prevention was also continued
4.4.4 Prevention, detection and management of diseases of epidemic potential and those
targeted for eradication
The plan for the year was to maintain the polio free status of the country and validate eradication of guinea
worm and polio. To achieve this, surveillance activities including case searches were intensified; Public
education was continued with monetary reward being advertised for anyone reporting a case of Guinea
Worm. As at December 2012, no case of Polio or confirmed Guinea Worm was seen.
4.4.5 Increase coverage of community activities for Neglected Tropical Diseases (NTDs)
especially onchocerciasis, lymphatic filariasis, trachoma, yaws and leprosy.
The plan for the year was to increased case detection for NTDs. To achieve this, the Ministry finalized the
NTD Master Plan for Ghana for the period 2011 to 2015 in collaboration with WHO. The plan was shared
with the relevant stakeholders. Mass drug administration was conducted for Onchocerciasis,
schistosomiasis and Lymphatic Filariasis in communities and schools. An Intra-Country Coordinating
Committee (ICCC) for the NTD program was constituted and two meetings were held. Although some
activities aimed at reducing the prevalence of yaws by 50% were performed, poor contact tracing and
treatment still remain a major challenge for the yaws control programme.
4.4.6 Improve prevention, detection and management of non communicable diseases
The plan for the year was to Implement the national strategy for cancer control and expand screening
program for hypertension, diabetes and sickle cell in all regional hospitals. The cancer control strategic
38

plan was finalized and submitted to PPME (GHS) for printing and dissemination. Screening for the noncommunicable
diseases is on-going.
4.5 Health objective 5: Strengthen institutional care, including mental
health service delivery
4.5.1 Enforce standards, guidelines and protocols to improve the quality of institutional care
Under this priority the Ministry is to ensure the availability of equipment and infrastructure required for
adherence to standards, guidelines and protocols. Most infrastructure projects, with the exception of the
construction of the 5 polyclinics in the Upper West Region, are at various stages of completion. Most are
encountering various degrees of financial challenges, which need to be resolved for the construction to be
completed.
Reporting on some of the projects is not comprehensive enough. The ministry needs to set up a reporting
framework that clearly spells out information needed. This is to ensure consistency in reporting by various
agencies.
4.5.2 Strengthen the system capacity for emergency response
The Ambulance service exceeded its target of establishing 80 district functional ambulance stations by
establishing 97 new stations.
4.5.3 Ensure commodity security of health technologies for medical products including
traditional medicines
Though a 5-year master plan for Supply Chain Management was completed there are disagreements from
some sections regarding centralisation of procurement at the national level. Preparations are however
going to operationalise the master plan with the appointment of a head for the new supply chain
management Unit.
4.5.4 Increase access to mental health services
Refer to 2.5.1 above.
5.0 Agencies assessments and performance contracts
5.1 CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE
The Centre for Scientific Research into plant medicine was set up to conduct and promote scientific
research relating to the improvement of plant medicine. As part of its mandate, it is to ensure the purity of
drugs extracted from plants and collate, publish and disseminate the results of its research and other useful
technical information.
Total staff at post at the centre is 192 comprising a medical doctor, two (2) medical herbalists, three (3)l
nurses, 13 medical herbalist interns and twenty three (23) research officers. It also has forty five (45)
senior staff and One hundred and four junior staff.
PLANNED ACTIVITIES FOR 2012:
The centre planned to undertake among others the following activities in 2012
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• Develop at least one herbal medicine for the ff. diseases conditions: malaria, diabetes,
hypertension, HIV/AIDS: The centre screened and selected 4plants each for diabetes, hypertension
and malaria respectively and 2 plants for prostate cancer. Preliminary analysis on 4 anti
hypertensive plant extracts showed promise in decreasing blood pressure over a four week period
in laboratory rats. Safety and efficacy evaluations of three out of four herbal products which not
dose dependent showed considerable reduction in parasitemia.
• Disseminate research findings (4 research papers and 6 technical reports) on quality, efficacy and
safety of herbal medicines; Two (2) papers were published
• Improve and expand access to herbal medicines
• Intensify program for the conservation & cultivation of medicinal plants
• Provide technical support services to herbal medicine manufacturers and Traditional Medicine
Practitioners (TMPs)
• Collaborate with pharmaceutical industry in the manufacture of herbal medicines
• Collaborate with TMPs In the development of their products (aimed at building confidence
between researchers & TMPs
5.2 ALLIED HEALTH PROFESSION
The allied profession task force was set up as a stopgap to provide some regulatory functions whilst
preparatory work in setting up a regulatory body to regulate the professional activities of the allied health
professions are completed. Its mandate includes collaborating with relevant agencies to standardize
training of allied health professionals in the country. It also works with other relevant organizations to
provide accreditation to qualified training institutions providing allied health programmes. It regulates
practice standards of professionals.
Planned activities include among others the development of guidelines for accrediting training institutions
and programs in collaboration with the National Accreditation Board. It also planned to initiate and
institutionalise Continuous Professional Development activities, which will be a pre-requisite for renewal of
professional license when registered. Data collection on existing training institutions and evaluation of e
training programs including curricula, facilities and Faculty Members were major plans for the year.
ACHIEVEMENTS
A total of 34 applications were received from training institutions for accreditation. Twenty applications
were reviewed and nine institutions were inspected. The board of the taskforce will meet to consider and
grant accreditation to deserving institutions. A start up kit for training institutions was developed for new
schools during the year. A workshop on curricula for allied health programs in the West African sub-region
was held. Application of the curricula will start after it has been adopted by ECOWAS Ministers of Health..
The allied health professions Bill was passed by parliament and is awaiting presidential accent.
5.3 FOOD AND DRUGS AUTHORITY
PLANNED ACTIVITIES
The following activities were planned for 2012:
• Accreditation as per ISO 17025 requirement
• Public education on food and medicine safety issues
• Training of industry in Good Manufacturing Practices (GMP) and Food Safety Management Systems
40

• Organization of training program on the regulation of controlled substances for the relevant
importers
• Industrial Support for Street food vendors, Ghana School Feeding Program and local industries
ACHIEVEMENTS
One hundred and ten (110) food manufacturing industries were trained in Food Safety Management
Systems and Street Food Vendors in 30 Food Service Establishments were trained in Basic Food Safety and
Hygiene practices. Two hundred and ninety nine institutions were trained in drug safety monitoring and
pharmaco-vigilance.
The 4 th round of the United States Pharmacopeia quality monitoring (USP/FDA PQM) Anti-Malaria project
was completed in the third quarter of the year. Three Hundred and Seventy samples of antimalarial
preparations on the market were sampled and screened with Minilabs. One Hundred and Sixty-Five (165) of
these samples were subjected to full monograph analysis. The observed failure rate of antimalarial
preparations was 6.3%. The first phase of testing of Analgesics commonly prescribed during malaria was
also carried out - 111 samples were analysed of which 22 (19.8%) failed. The first round of Quality
Surveillance of Uterotonic preparations namely Oxytocin Injections and Ergometrine Maleate Preparations
(Injections and Tablets) was carried out – 279 samples were analysed of which 178 (63.7%) failed. The Final
Draft of the National Food Safety Policy was completed
The Public Health Bill, 2012, (Act 851) (which includes the Tobacco Bill, FDA Bill and Clinical Trials) was
passed into law.
CHALLENGES
Inadequate operational vehicles. Limited border post-activities. High cost of radio programmes and TV
advertisements, as well as adverts in the print media for consumer education, Increasing enforcement costs
of joint police swoops, destruction of fake, unwholesome and substandard regulated products, press
releases, and post market surveillance functions. High cost of reagents and equipment for the lab.
OUTLOOK FOR 2013
Post-market surveillance functions will be enhanced to rid the market of fake, substandard and
unwholesome regulated products. Dissemination of sections of the Public Health Act 851 which deals with
the FDA. Increase the fleet of operational vehicles. Commence construction of Tema Port office complex.
Increase presence at the Border Posts. Increase staff strength. Increase Consumer Education
5.4 GHANA COLLEGE OF PHYSICIANS AND SURGEONS
The Ghana College was established to promote specialist education in medicine, surgery and related
disciplines. It also promotes continuous professional development in medicine, surgery and related
disciplines including research.
The college in 2012 planned to publish a journal and a newsletter and install ICT infrastructure to aid in the
colleges training programme. It also planned to have at least two continuous professional development
programmes per faculty. The college has 24 faculties. Other key activities planned for the year include
accreditation of training sites and medical knowledge fiesta.
The college published one journal and 2 newsletters and organized 20 CPDs out of the expected 24. A
knowledge fiesta was also organized for English speaking West Africa to exchange knowledge on current
41

happenings in the medical field. An ICT infrastructure sponsored by MTN was installed and commissioned
during the year.
CHALLENGES
The major challenges of the college include;
1. Developing alternate funding arrangements for post graduate medical education.
2. Maintenance of College building
3. Accreditation for training. The colleges hopes to decentralize training sites but this is dependent on
the state of the health facilities and the availability of relevant supervisors
OUTLOOK FOR 2013
The College will continue with its core functions of producing specialists in medicine, surgery and related
disciplines and develop options for funding post graduate specialist training. It will work with the Ministry
to attract trainees into ‘deprived’ specialties. Efforts will be made to develop sub-specialty training
opportunities in all faculties and implement ICT based education and learning. The college will also support
implementation of WAHO initiative towards harmonization of curricula and accreditation criteria with subregional
Colleges.
5.5 GHANA HEALTH SERVICE
The Ghana Health Service identified 8 main priority areas for improvement in 2012 under the various
health sector objectives. The priorities are as follows:
Health Objective 1:
1. Accelerate scaling up of the Community-Based Health Planning and Services (CHPS) under the
‘close-to-client’ service delivery policy
Health Objective 2
2. Support the finalization the staffing norms and implementing the Human Resource for Health
(HRH) deployment plan in order to provide more skilled middle level health workers for deprived
areas;
3. Increase the strategic use of Information Communication and Technology (ICT) for improved health
outcomes, especially as it relates to deployment of DHIMS2
Health Objective 3:
4. Continue implementation of the MDG Acceleration Framework for achieving MDG5, and related
emergency services.
Health Objective 4:
5. Introduce three new vaccines (pneumococcal conjugate, meningitis group A conjugate and
rotavirus) and a second dose of measles into the routine immunization programme;
6. Step up disease control activities, particularly surveillance
Health Objective 5:
7. Support implementation of the Mental Health Bill
8. Improve quality of care in GHS facilities.
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ACHIEVEMENTS
HO1: Bridging the Equity gaps in access to health care and nutrition services and ensure sustainable
financing arrangements that protect the poor
The major priority activity under this objective is the scaling up of the Community-based Health Planning
and Services (CHPS) as a close-to client policy to increase access to basic health services. The GHS made 551
CHPS zones functional exceeding its target (500) by 51 zones. This achievement was made possible by
simplifying the community health community training manual and trainer of training programmes for the
regional teams. The table below depicts the regional distribution and status of CHPS in the country
CHPS IMPLEMENTATION STATUS BY REGION
REGION
Number of Demarcated
CHPS Zones
Functional CHPS Zones at
Beginning of 2012
TOTAL No. of Functional CHPS
at the End of 2012
ASHANTI 438 196 478
BRONG
334 102 190
AHAFO
CENTRAL 134 134 148
EASTERN 679 369 428
GAR 514 66 111
NORTHERN 334 182 182
UPPER EAST 203 120 161
UPPER WEST 207 105 114
VOLTA 469 225 229
WESTERN 321 176 185
TOTAL 3,499
(100%)
Table 8: CHPS implementation by Region
1675
(48%)
2226
(64%)
One of the major challenges of the Ghana Health Service is the availability, distribution and appropriate mix
of relevant health staff at the health facilities. Out of a total of 149 hospitals (including CHAG facilities), 84
(56.4%) of hospitals have between 1 and 3 doctors with 25 (16.8%) without a doctor. This may have
implication for availability and quality of service.
Objective: HO2: Strengthen governance & improve efficiency & effectiveness
Leadership and Management capacity development and strengthening HMIS using ICT to improve
effectiveness & efficiency in service delivery were the two key priorities under this objective. The GHS
introduced the leadership and management capacity development as a capacity building effort in the
Central region in 2010. Since then 161 health personnel have been trained. This comprises Greater Accra
(35), Western (35) ,Volta( 41), Upper east (60) Upper West (44) and Northern(46) have been trained. A
total of 150 personnel were trained in 2012.
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As part of efforts to consolidate the achievements made, the GHS undertook training on DHIMS 2 in all the
regions and held two high level meetings to address technical problems arising out of the implementation
of the DHIMS 2. The GHS is also workinh with the NHIS on the Health Improvement Project to develop and
deploy hospital software to improve data capture and claims. management. Other activities carried out
during the year include:
• Scaling up a community health information system- the community e-register
• Evaluation EWS and development of plan for rolling out nationwide
• Expansion of mobile midwife pilot to provide health information for pregnant women and improve
data collection,
• Piloting of Rapid Malaria Diagnostic Reader in some Districts in GAR.
HO 3: Improve access to quality maternal, neonatal, child and adolescent health services
Key priority activities under this objective include the following;
5. Implement the MAF country Action plan for improved maternal and neonatal care
6. Develop and implement National Nutrition Policy and strategy
7. Scaling up child and Adolescent Health
8. Advocacy and Capacity building for providing family planning and safe motherhood
Under the MAF, a national assessment report were completed and incorporated into the MAF action plan.
The regional MAF work and procurement plans have also been completed.
The draft Nutrition policy was completed. A stakeholder meeting is planned for the first quarter of 2013 to
collate views on the draft policy for finalisation and submission to cabinet for approval. The Adolescent
Health policies and strategies were disseminated through several fora in collaboration with the paediatric
society of Ghana.
Training of trainers Workshops were held on Contraceptive Updates and Counseling, JADELLE and
IMPLANON insertion training for Ten Regions. Regional training and orientation for the new maternal
death audit guidelines were also held for three regions– GAR CR WR
HO4: Intensify prevention and control of communicable & non-communicable diseases and promote
healthy lifestyles
The GHS planned to introduce three new vaccines (pneumococcal conjugate, meningitis group A conjugate
and rotavirus) and a second dose of measles into the routine immunization program and step up disease
control activities, particularly surveillance.
Two new New Vaccines – Rotarix & Penvar and measles 2 nd dose at 18 months were introduced. All
Districts (170) were also trained In Community Management Of Malaria (CMM)and & some districts
commenced implementation of CMM.
As part of effort to improve prevention and control of communicable diseases, the GHS planned to procure
and distribute ICT equipment to support district level surveillance activities. Districts in three regions
(UWR, BAR and CR) were supplied with ICT equipment.
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Under a programme to prevent, detect and manage of HIV/AIDS, TB & Malaria,
• 7,645,745 LLINs were distributed under the hang up campaign using volunteers. Household
ownership of at least one ITN has improved to 96.7% of total population.
• The national HIV/AIDS strategic plan was implemented in all the regions.
• The Kick TB Ghana Project, an advocacy communication and social mobilization project was
launched and TB Treatment success rate improved from 83.35% to 86.2%
During the year under review, no case of Guinea Worm or wild poliovirus was reported. STOP GW teams
were deployed to 16 districts in VR, NR and BAR as part of the surveillance efforts and preventive Yellow
Fever mass vaccination in 15 districts was organised. Coverage of the population in these districts was
90.4% .
SO5: Strengthen institutional care, including mental health service delivery
The areas of emphasis under this objective included the improvement in quality of care, improvement of
knowledge and skills of health personnel and development of guidelines for improved service provision.
The GHS conducted evidence-based summary for selected medicines (Caffeine, Artemether, Amoxicillin,
Artesunate, Zinc, Chlorhexidine, Rosiglitazone, insulin analogues) as part of efforts to improve quality of
care in the service. It also conducted an Internal Lab Quality Audit Training based on ISO 15189 to improve
the knowledge base of 15 lab based auditors.
The following guidelines, policies and strategies were developed or reviewed;
1. Laboratory accreditation guidelines for clinical labs in hospitals
2. Laboratory Quality Control of Taylor & Taylor Analyzers in selected Laboratories in Greater-Accra
Region
3. Antimicrobial policy for Ghana
4. Informed Consent Form
5. Community Mental Health Strategy
6. Guidelines for A and E units developed
CHALLENGES
The major challenge of the Ghana health Service, which tend to impede service provision and the
achievement of set targets was inadequate & unpredictable funding. Out of an approved budget of 17.6
million, 4.5 million representing 25% was disbursed. Inequitable distribution and productivity of staff
were also major constraints
MITIGATING MEASURES
The Ghana Health Service plans to re-prioritize the numerous activities, to ensure that the key ones are
implemented. It will also explore non- traditional sources of funding for the Service – e.g. responding to
calls for proposals from funding entities. The service will as a matter of urgency help to finalize the staffing
norms and use it to establish the basis for staff redistribution.
OUTLOOK FOR 2013
Priorities for 2012 are still relevant for 2013. Strategies for their successful implementation will be reviewed
and refined to ensure efficiency. Targets will also be reviewed to reflect existing capacities
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5.6 Komfo-Anokye Teaching Hospital
The Komfo-Anokye teaching Hospital in 2012 planned to undertake the following;
9. Continue with policies to widen the range of specialist services and improve quality of care
10. Sustain activities aimed at reducing mortality, (especially maternal mortality), and improving
general care outcomes
11. Continue to support Nurses and Doctors to pursue training programme in Emergency Medicine &
Nursing
12. Conduct operational research into emerging Diseases
13. Complete Maternity and Children block
14. Set up Blood Bank Unit within the Maternity Area
15. Complete construction of a new eye centre
16. Expansion of Radiotherapy & Nuclear Medicine services
17. Put in measures to improve supply of water and electricity
18. Provide infrastructure for clinical training of students from KNUST
19. Continue efforts in providing support to district and regional hospitals in the northern sector of
Ghana, by way of providing outreach services
1. Continue with policies to widen the range of specialist services and improve quality of care
The appointment systems in the various Directorates were reviewed and this ahs brought improvement in
services provided to clients. Standard protocols for all procedures and emergencies were developed for the
Surgery, Child Health and Obstetrics & Gynaecology Directorates. A patient satisfaction survey conducted
during the year indicated that 62% of hospital clients were statisfied with the hospital’s services. Customer
Care Service Training was organised for staff during the period under review to improve services provided
to clients.
A Magnetic resonance Imaging (MRI) Centre was completed during the year and handed over to the
hospital Services at the center commenced. Work on the uncompleted Maternity & Children’s Block was
reactivated whilst construction of Eye Centre is 95% complete. The hospital renovated and modified an
existing building to a guest house.
OPD attendance and services provided at the hospital either declined or remained stagnant over the
period. With the exception of and emergency services which showed a discernible increase in service
provision, OPD attendance declined by about …..% and diagnostics also declined by ….%
2. Sustain activities aimed at reducing mortality, (especially maternal mortality), and improving general
care outcomes
As part of efforts aimed at reducing mortality and general health outcomes, the hospital’s Quality
Assurance (QA) Committee as well as Directorates Quality Assurance Committees were strengthened and a
Blood Bank Unit was established at the maternity area. Daily clinical meetings and monthly maternal
mortality meetings were held to audit all Maternal Deaths. A total of 152 maternal deaths were recorded
with an estimated institutional maternal mortality ratio of 1,255.37/100,000.00 LB. All neonatal deaths
were also audited with Pre-maturity and Birth Asphyxia being the main causes of neonatal deaths
46

2010 N=160 2011 N=197 2012 N=165
1 Eclampsia/Pre-
29 Eclampsia /Pre- 41 HPT-Related diseases(Eclampsia/Pre- 45
Eclampsia
Eclampsia
Eclampsia)
2 Septicaemia/Septic 12 PPH/APH 17 Haemorrhage (PPH) 26
Abortion
3 Severe Anaemia 10 Septiceamia 5 Abortion Related Deaths 17
4 PPH 6 Malaria in
5 SCD Related 11
Pregnancy
5 HIV Infection 6 Anaemia 4 HIV Related 9
6 Ruptured Ectopic 5 Lobar Pneumonia 4 Hepatic Failure 9
Pregnancy
7 Lobar Pneumonia 3 Ruptured Uterus 4 Malaria in Pregnancy 6
8 Placenta Abruptio 3 HIV Infection 4 Puerperal Sepsis 5
9 Placenta Previa 2 Sickle Cell Crisis 3 Labour Pneumonia 5
10 Ruptured Uterus 2 Placenta Abruptio 2 Meningitis 5
Table 9: Top-ten causes of Maternal Deaths at Komfo-Anokye Teaching Hospital
3. Continue to support Doctors & Nurses to pursue training programme in Emergency Medicine
There is an ongoing training programme for staff in Emergency medicine. 5 Doctors and 20 nurses qualified
as Emergency Physician and emergency nurses respectively.
4. Continue efforts in providing support to district and regional hospitals in the northern sector of Ghana.
The Hospital embarked on several outreach programmes in eye screening and surgeries, ENT, Cleft, Child
Health and Infectious Diseases during the period under review. The Hospital visited One Teaching Hospital
and Eight Districts.
5. Conduct operational research into emerging Diseases
Twenty-five (25) research activities initiated by directorates during the period are on-going. Two (2)
research reports were completed and disseminated:
• Endoscopy findings in patient with upper GIT bleeding at KATH)
• Prevalence of diabetic nephropathy in patients attending the diabetic clinic at KATH
CHALLENGES
• Late referrals of patients from lower level institutions
• Congestion, especially at maternal & children’s wards (eg. Bed occup. Ranges b/n 120%-156%)
• Inadequate clinical staff, particularly Nurses
• Accommodation for House Officers & Residency Drs
• Delays in the payment of health insurance claims and unrealistic tariff.
• Old & Non-functional Oxygen Plant
• Rent Expenditure for House Officers & Residents
The hospital will continue to put in measures to improve qaulity of services to the general public.
5.7 KORLE-BU TEACHING HOSPITAL
The hospital has a total staff strength of 4419 with clinical staff constituting 72% (3,184) and Non clinical
staff 28% (1,235). The composition of the clinical staff is as follows:
47

• Doctors 597
• Consultants (KBTH) 8
• Consultants (UGMS) 96
• Doctors (Specialist, MO’s & HO’s) 278
• Residents 215
• Nurses/HCA 1,899
To improve maternal health outcomes and general clinical outcomes, a number of projects and
programmes were initiated. A Blood bank established at the Maternity Block Laboratory and the renovation
of the Maternity OPD, 4 th and 6 th Floors which was started at the beginning of the year are 80 to 90%
complete.
Outreach programmes were held to educate hospital locality staff and general public on dangers of unsafe
abortion. The emergency department is being refurbished to improve emergency medicine services.
Capacity building in Client/Patient care aimed at addressing Staff attitudes was initiated. About 50% of staff
have undergone the training. Training in Basic Life support skills for all staff was also started.
2012 Achieved 2011 Achieved
TOTAL PATIENTS SEEN 412,964 367,132
OUT PATIENTS 362,775 317,122
IN PATIENTS 50,189 50,010
DEATHS 3,800 5,069
BED CAPACITY 2000 1,912
TOTAL SURGERIES 11,570 19,889
MAJOR 5,003 (43.2 %) 11,419 (57%)
MINOR 6,567 8,470
Obstetric and Paediatric indicators
Total live births 10,103 10,455
Total Caesarean Sections 4,063 4,040
Total deliveries 10,278 10,503
Caesarian Section rate (%) 39.5 38.5
Maternal deaths 85 119
Maternal mortality ratio
841 1,138
(per 100,000 live births)
Under-5 deaths 847 900
Under-5 Mortality Ratio (per 1000 live births) 83 86
Table 10: Clinical indicators for Korle-Bu Teaching Hospital
48

2012 Achieved 2011 Achieved
Patient days 370,467 364,912
Crude mortality (%) 7.6 10.1
Occupancy rate (%) 66.1 71.0
Average length of stay 8.3 days 7.8
Bed Turnover rate (%) 31.5 31.4
Discharges 41,023 41,960
Table 11: Service Utilization indicators, Korle-Bu Teaching Hospital
Ranking Conditions No. Cases % of Total
1 Pregnancy 11,717 38
2 Diabetes Mellitus 3,650 12
3 Cerebrovascular Accidents 3,376 11
4 Hypertension 2,692 9
5 Congestive Heart Failure 2,555 8
6 Appendicitis 1,823 6
7 Pneumonia 1,323 4
8 Fractures 1,322 4
9 Inguinal Hernia 1,095 4
10 Intestinal Obstruction 958 3
Table 12: Top-ten causes of admission, Korle-Bu Teaching Hospital
Ranking Conditions No. Of Cases %
1 Cerebrovascular Accidents 386 25
2 Congestive Heart Failure 241 16
3 Diabetes 154 10
4 Hypertension 151 10
5 Pneumonias 136 9
6 Renal Failure 123 8
7 Intestinal Obstruction 112 7
8 Anaemias 88 6
9 Pregnancy 85 6
10 Meningitis 69 4
Table 13: Top-ten causes of death, Korle-Bu Teaching Hospital
CHALLENGES
• High level of indebtedness to our Creditors/ Suppliers and Staff. (GH₵ 4,243,171.31)
• High proportions of deductions & delay in payment of NHIS claims.
• High cost of incentives to attract and retain critical staff.
• High maternal and child mortality.
• Weak logistical and infrastructural support.
• Inadequate capacity and funds to support research work.
The major challenges of the hospital include unstable power supply, old cabling and wiring. Overcrowded
Clinics and Wards and lack of IT supported bed management.
49

5.8 Tamale Teaching Hospital
The objectives for the hospital in 2012 were;
• Strengthen and improve governance and efficiency of the TTH’s management systems.
• Provide excellent quality Maternal and Child Health Service.
• Provide excellent tertiary health care.
• Attract and retain health staff.
• Improve and coordinate the TTH’s research/M&E activities.
To improve governance and efficiency of the TTH’s management systems, a clinical governance team was
set up and Sub BMC managers were appointed and given orientation. A financial management
improvement plan was also developed and operationalized during the year. In an effort to improve general
hospital management through informed decision-making, an ICT Firm commissioned to develop a Health
Management Information System.
The hospital introduced measures aimed at improving maternal and neonatal outcomes. To ease the severe
congestion at the wards, improved logistics, new born services (PPP) new delivery equipments were
acquired. The programme aimed at attracting and retaining specialised staff and building capacity of
existing staff was intensified through the provision of financial and training incentives. Five Doctors are
currently in Specialist Training.
With the acquisition of improved clinical equipments, new sub specialties are being created.
Radiology/Endoscopy/Urology services including new and improved imaging services have been
introduced. There is regular availability of oxygen due to completion of new Oxygen Plants. Medical
Outreaches services have been enhanced
Staffing Trends 2008 - 2012
STAFF CATEGORIES 2008 2009 2010 2011 2012
Permanent Staff 544 980 1221 1447 1597
Casual/Temporary Workforce 157 78 64 59 55
NYEP 193 193 116 419 78
TOTAL 894 1241 1401 1925 1730
Table 14: Staffing trends, Tamale Teaching Hospital
5.9 NATIONAL AMBULANCE SERVICE
The Service opened 97 new ambulance stations during the year bringing the total number of ambulance
stations in the country to 121. This was made possible with the acquisition 161 ambulances earlier. The
distribution of the stations is indicated in the table below. Thirty-five emergency medical technician basic
(EMTB) were upgraded to emergency medical technician advance (EMTA) during the year. Although the
training schools are yet to receive any major refurbishment, the schools is about 30% functional.
DISTRIBUTION OF AMBULANCE STATIONS BY REGIONS
2011 New stations 2012
Greater Accra 6 6 12
50

Ashanti 5 11 16
Eastern 4 11 15
Central 2 7 9
Volta 2 14 16
Western 1 9 10
Brong Ahafo 1 10 11
Northern 1 16 17
Upper East 1 6 7
Upper West 1 7 8
TOTAL 24 97 121
Table 15: Distribution of ambulance stations by regions
CHALLENGES
Inadequate Budgetary Allocation and late release of funds hampered the programme and activities of the
service. Lack of dedicated training facility leading to delays in training schedules
• Pass and implement mental health bill
• Training of MAPs, CMOHs, CPNs
• Improve the Mental Health Information Systems
• Establish alcohol and drug rehabilitation centre
• Formalize community psychiatric nursing training to degree level
• Strengthen international collaboration with Essex, Hampshire and Kaduna
• Mental Health Act enacted
• Training of MAPs, CMOHs on course
• Epilepsy Initiative started with WHO
• 8 Physician Assistants in Psychiatry produced at Kintampo College of Health
• Collaboration with Yale University Global Health Leadership Institute, US, continued
• Collaboration with South Essex in UK continued
5.10 NHIS
Objectives of the scheme at the beginning of the year include:
1. To mobilize 100% of receivable funds by end of 2012
2. To increase efficiency in the financial operations of the scheme
3. To increase active membership to 45% of population by December 2012
4. To increase active membership of the poor and indigent to 50% of their population be December,
2012
5. To provide support to increase access to quality basic health care services in all districts
6. To strengthen governance system and improve human resource capacity
7. To improve the quality of service accessed by members in the NHIS
Resource mobilisation
The National Health insurance authority was able to access 48% of all receivable funds during the year and
this had implication for timely reimbursement to providers. An analysis by the NHIA showed that the
scheme cannot be sustained at the current level of operation. A policy paper including sustainability
analysis was submitted to the government for consideration. To strengthen premium collection scheme
level, a consolidated premium account was established. This initiative raked-in additional GHc28m. Efforts
aimed at reviewing the premium upwards to between GHc10 to GHc 50 received some resistance and had
51

to be abandoned. The authority however has received some support and is in talks with other development
partners for further support. The World Bank is supporting the Health Insurance Project (HIP) whiles
DANIDA is supporting the authority with an M&E advisor. Discussions are underway with the USAID and the
Royal Netherlands Embassy.
Efficient financial operations
Until recently, returns from investment formed a substantial part of the total funds of the scheme.
However due to recent financial difficulties, the authority had not been able to invest and have had to
plough back its savings to keep the scheme afloat. To reverse this trend, the authority developed an
investment policy and guidelines to provide guidance to the authority. The authority realised 6.5% real rate
of returns on investment exceeding its target of 4%. Its investment income for the year was GHc27.67m as
against a target of GHc18m. The NHIA intensified clinical audit of the district schemes and providers. During
the year, 157 providers were audited and 128 schemes visited. An amount of GHc20.1 was recommended
for recovery for the 2010-2012 period with GHc7.5m recovered in 2012. A uniform prescription form was
piloted in the Greater Accra Region and systems for linking treatment to diagnosis were developed. These
were meant to increase technical efficiency. The authority also hoped to improve efficiency by diversifying
provider payment mechanism. As a result Capitation was piloted in the Ashanti region for which a mid-term
evaluation was conducted. Preliminary findings of the evaluation was presented and discussed with
stakeholders.
Membership Drive
Active membership of the scheme stood at 34% short of the target of 45%. The indigent definition was
revised and the common targeting developed. With these revisions some categories of persons with
disability and mental health patients would be covered under the exemption policy for services within the
benefits package. The Common targeting mechanism is being piloted in 90 districts. Fifty three thousand
two hundred and seventeen out of 200,000 LEAP beneficiaries were covered
Support to public health
About 46% of earmark funds for the ministry of health was released whiles 94% of expected funds was
released to members of parliament.
As part of efforts to Implement electronic claims management system 46 providers have been selected for
pilot.
Challenges
INTERNAL
• Financial sustainability of the scheme
• Identification of the poor in the informal sector
• Delays in ID card management chain
• ICT Challenge
• Claims Management
EXTERNAL
• Moral hazard
• Ability to pay premium
• Renewal challenges
• Rights and responsibilities of subscribers
52

• Quality of care challenges
• Attitude towards subscribers
• Waiting times
Clinical Audit findings
• Wrong application of Tariffs
• Irrational Prescription of medicines
• Inflation of quantities of medicine supplied
• Unauthorized co-payment
• Provision of services above accreditation level
• No record of attendance
• Overbilling of medicines
5.11 NURSING AND MIDWIFERY COUNCIL
The nursing and midwifery Council, which is concerned with practice standards of nurses and midwives
established 3 new regional offices and researched into low performance of students in nursing and
midwifery. The research, which is aimed at identifying factors affecting performance of trainees and
finding solutions to them is yet to be disseminated.
During the year, the bill aimed at revising the law governing the operations of the council was passed into
law. This will it is hoped will sharpen the mandate of the council and improve on its regulatory activities to
ensure improved nursing and midwifery standards.
As part of its continuing professional development programme, training workshops were organized during
the year to upgrade the knowledge and skills of 210 Nurses and Midwives. Seminars and workshops on test
construction and practical assessment for examiners, clinicians, tutors and invigilators were organized for
785 nurses and midwives nationwide. Rules and regulations for the conduct of licensure examination were
also reviewed and disseminated to all training schools.
Challenges
The main challenges of the council include;
1. Inadequate office accommodation at the Head office
2. Inadequate staff: difficulty in securing financial clearance to employ
3. Inadequate conduct of support supervision
5.12 PHARMACY COUNCIL
Planned activities for the year were under the following broad headings
• Education & Training
• Licensing & Registration
• Inspections & Monitoring
• Enforcement
• Public Education
53

A total of 137 interns started 9 attachments to various hospital pharmacies throughout the country whilst
1262 pharmacists were trained as part of its continuing professional education. Similarly, 1500 licensed
chemical sellers (LCS) were trained. Pass rate for the year’s General Pharmacy Practice Qualifying Exams
(GPPQE) was 89% (130/146).
Approval was given for the establishment of 246 pharmacies out of a total application of 334. Similarly, the
council received 565 for the establishment of chemical shops out of which 421 were processed. A thousand
five hundred and forty three (1543) licenses were renewed representing 86.4% of target for the year and
7678 LCs renewed their licenses representing 83.4% of expected.
One hundred and twenty six (126) new pharmacists were registered and 188 licenses were issued to
pharmacies.
The council in collaboration with the national malaria control programme, is mmonitoring the sale of copaid
ACTs by pharmacies & LCS . It is also training LCS in the management of diarrhoea in children in
collaboration with USAID, SHOPS and Ghana Health Service. Over 6000 LCS have been trained.
Budget Execution
SOURCES OF FUNDING APPROVED BUDGET (GH₵) TOTAL RECEIPTS (GH₵) TOTAL EXPENDITURE (GH₵)
GOG
76,187.44 11,945.00 11,945.00
(Goods & Services)
IGF 1,836,000.00 1,770,500.00 1,695,000.00
SBS 59,118.51 45,773.00 45,773.00
TOTAL 1,971,305.95 1,828,218.00 1,752,718.00
Table 16: Budget Execution by Pharmacy Council 2012
Total expenditure for the year amounted to GHc 1,752,718.00 representing 95.9% of total receipt.
Internally generated funds constitute 96.7% of total expenditure.
CHALLENGES
• Inadequate funds & budgetary allocations to execute line-up programmes
• High cost of Rental accommodation for offices and staff
• Emerging channels of distribution of Medicines (Unregulated and clandestine)
• Inadequate information among consumers
• Limited and skewed distribution of facilities
• Limited and ageing fleet of vehicles
• Inadequate staff (both in numbers and specialties)
5.13 CHRISTIAN HEALTH ASSOCIATION OF GHANA (CHAG)
The Christian Health Association of Ghana is a Network of 19 Christian health services with 182 health
facilities. The facilities comprises 58 hospitals (31%), 77 clinics (42%), 19 health centers (10%), 15 PHC
programmes (8%), 10 training institutions (6%) and 3 specialist clinics (2%9. CHAG facilities accounts for
about 5.3% of all health infrastructures in the country and are spread all across all 10 regions.
CHAG Priorities for 2012 include
54

• The improvement in service outputs [outpatients, inpatients, deliveries, outpatient insured clients,
15 additional hospital emergency service units]
• The improvement in organizational capacity of CHAG secretariat and member institutions
• The improvement of service outcomes [reduction in institutional mortality, community morbidity
and increase in community wellness]
Outpatient attendance increased by almost 17% from 4,867,252 in 2011 to 5692640 in 2012. However,
inpatient attendance increased just marginally from 394,442 in 2011 to 397,240. CHAG’s contribution to
the total OPD and inpatient attendance was 29% and 19% respectively. Deliveries in CHAG institutions
increased by 25.8% from 93,855 in 2011 to 118,040 in 2012. About 88% of outpatients attended by CHAG
institutions were insured.
CHAG Service Outcome -2012
A total of 13 hospitals were trained to establish hospital emergency units bringing the total to 22 since
2011. Similarly, 55 CHAG staff were trained and certified in basic life support skills. Table 17 below shows
details of both trainings.
Training 2011 2012
Planned
Hospitals trained to establish Hospital Emergency
Units
2012
Actual
9 15 13 22
Staff trained and certified in Basic Life Support skills 24 30 55 79
Table 17: Training in emergency skills, source CHAG
Overall
Total
Challenges
55

The major challenge of the CHAG is Having to make changes to implementation design and content on
account of observed results of the interventions (both desirable and undesirable) .
56

6.0 Follow-up on Aide Memoire recommendations
The Aide memoir to a large extent was adequately implemented except for some few activities that were
either not implemented or progress not known. Table 18 below indicates some of the activities that are
outstanding.
Activity
Complete the nutrition policy
Finalise a detailed implementation plan
and costing of the nutrition policy
Launch the nutrition policy
Disseminate the nutrition policy
Finalise HRH policy
Finalise Norms
Zero draft of comprehensive health
financing policy and strategy to be
completed by end July 2012 for
presentation and discussion
Establish a small team including NHIS,
Teaching Hospitals, CHAG and private
sector to tease out all the issues and
define an implementation
plan.(Institutional and organisational
assessement)
Provide office accommodation to solve
the repository problem
(Public Financial Management, flow of
funds) MOH to contact MOFEP and agree
on how to take forward the study
recommendations
Table 18: Outstanding Aide Memoire Recommendation as of 31 st December 2012.
Progress/Remarks
Nutrition policy could not be completed on schedule. The road
map fro completion was reviewed. A new deadline for
completion was set for the end of the first quarter of 2013
These activities are dependent on the completion of the
nutrition policy
A draft policy was circulated. A stakeholder meeting was
scheduled for the first quarter of 2013.
Tools for determining staff requirement at the institutional
level have been developed. A norm that standardises staff
numbers and mix is yet to be developed.
The health financing policy has not been developed. Roadmap
for completion has been rescheduled to 2013.
The process to implement the recommendations of the
institutional and organisational assessment is on-going.
Committees and sub-committees have been formed to look at
various aspects of the recommendations. New developments
such as decentralisation process warranted the revision of the
TOR for the various sub-committees
The CHIM offices, which was earmarked as the centre for the
data repository has been awarded for refurbishment. The
refurbishment is progressing rather slowly. A temporary
repository has however been established at the rRSIM
directorate of the Ministry of Health
An agreement was reached with MoFEP to hold regular
meeting to track and ensure funds for the Ministry of health
are released on time. It has been difficult to organise this
meetings. The convenor of the meeting (MoFEP) has not been
able to organise the meetings. A suggestion for MOH to be
proactive in ensuring the meetings are held have been made.
The ministry of health hopes to carry the suggestion forward in
the new year.
57

7.0 Conclusion
MDG4
With twice as many under-fives dying per 1,000 live births in the poorest wealth quintile compared to the
richest, the under-five mortality inequality gap between richest and poorest children is widening.
Exclusively breastfed has significantly worsened since 2008, and the current performance at 45.7% is below
2003 levels and far below the target of 70%. Factors external to the health sector are also likely to have
influenced the trend, e.g. increased number of women engaged in the workforce and behavioural changes
as a consequence of economic growth and attainment of middle-income country status.
The under-five prevalence of low weight for age has reduced slightly to 13.4% and the target of 8.0% is far
from being achieved. The Ministry expected to disseminate and implement the National Nutrition Policy in
2012. The Nutrition Policy and Strategy has been finalised and being submitted to cabinet for approval.
The pneumococcal, meningococcal and rotavirus vaccines including second dose of measles vaccines were
successfully introduced.
Community health workers implementing the community case management of malaria, diarrhoea and
acute respiratory disease face difficulties in recouping funds for drugs. This is because they are not
recognized by the NHIS and thus are not reimbursed even when they treat insured clients in the
communities.
Hang-up campaigns were completed for the whole country, and with 7,645,745 distributed LLINs household
ownership of ITNs stands at above 95%. The MICS survey 2012 showed that only 15.9% of children under
five with fever were tested for malaria. The Ministry is concerned about the access to and quality of
diagnostic services related to malaria.
MDG5
The total fertility rate has worsened from 4.0 to 4.3, meanwhile, the contraceptive prevalence rate for the
same period has improved significantly, and unmet need for family planning reduced.
Over the past 3 years, supervised delivery coverage has increased by 28.2%, and over the past 5 years by
66.5%. Coverage of supervised deliveries in 2012 was 58.5% (based on expected delivery being of 4% of the
population) and 77.9% (based on the 3% estimate). All regions were above 50% except Volta Region at
46.5% and Northern Region at 49.9%. The good performance may be attributed to improved financial
access from the free maternal health care policy, and improvement in the data collection.
Institutional Maternal Mortality (iMMR) dropped significantly from 211 maternal deaths per 100,000 live
births in 2011 to 193 in 2012. While iMMR at Komfo-Anokye Teaching Hospital continued to be high, Korle-
Bu Teaching hospital reduced institutional maternal mortality ratio significantly from 1,133 in 2011 to 841
in 2012.
Investigations by Foods and Drugs Authority revealed that almost 70% of all 279 samples of Oxytocin failed
the quality test.
58

OPD
The number of outpatients per capita reached 1.17, more than doubling 2006 figure. Citizens may choose
to register with NHIS only when they anticipate a need for health services and subsequently discontinue
their membership. This can lead to adverse selection that potentially creates challenges for the financial
sustainability of NHIS.
With the increase in OPD visits across the regions, there has not been equally significant improvement in
infrastructure of most of the facilities to accommodate these increases. It is now more important than ever
to ensure good service and clinical quality.
Non-communicable diseases
Detection and management of non-communicable diseases continued to provide challenging to the sector.
Guidelines for the cancer programme have been developed they are yet to be printed. Screening is going
on in the regions for hypertension, diabetes and sickle cell, but such routine screening is unstructured.
The total number of mental health nurses in the three psychiatric institutions was 1,068. This comprises
both community psychiatric nurses and registered mental nurses. No formal training exists for training
community psychiatric nurses and the current crop are registered nurses converted to practice as
community psychiatric.
Financing
In 2012, Government of Ghana contribution increased by 126.9% from GH¢771 million in 2011 to GH¢1,750
million in 2012. The Ministry recorded a total expenditure of GH¢2,613.4 million for the period under
review. Out of this amount, 63.4% was for Employee Compensation as against 53.9% for the same period of
2011. Employee Compensation increased significantly from GH¢ 754.7million in 2011 to GH¢1,655.7 millon
as a result of the movement from the Health Sector Salary Scale (HSS) to the Single Spine Salary Pay Policy
(SSSPP).
HRH
The poorest staffed region is Northern Region with one nurse to 1,601 population compared to the national
average of one nurse to 1,251 population. Other regions, especially Northern Region, should also adopt the
approach of Upper East Region to strictly implement the policy of retaining nurses that train in the region.
Twenty-five government Hospitals in Ghana are without doctors. Eight of them are found in the Northern
Region. The doctor to population ratio did not change much and with 11 times less doctors per population
in Upper West Region compared to Greater Accra Region equitable distribution of doctors remains a major
challenge to the health sector.
The Ministry expanded CHPS coverage with over 500 new functional zones during the year. Deploying close
to 9,000 CHOs into the zones or communities is a challenge. Due to inadequate funding, districts are
unable to provide the basic package to facilitate the deployment of the CHOs.
The absence of staffing norms, deployment plans and a final HRH policy continues to affect the
management of human resource in the sector resulting in inequity in the distribution of critical staff in
terms of numbers and mix.
59

Leadership
Performance contracts were signed with the Ghana Health Service and the three teaching hospitals, but
contract management in terms of supervision, reporting and evaluation was not adequate.
Bills have been passed into law and require development of legal instruments. The Ministry of Health
should lead the process to facilitate the development of the various legal instruments on time.
Regions of Excellence
Central and Upper East Region performed excellent in 2012. The two regions had access to extra budgetary
funding, which they are obviously using very efficiently compared to Regions like Northern and Upper West
Region who although benefiting from similar extra budgetary funding are not performing equally well.
The three Regions Volta, Ashanti and Brong-Ahafo do not have any significant extra-budgetary support and
depend only on the dwindling GOG funding possibly accounting for their lower than average performance
on these specific indicators.
60

Annex 1: Sector Wide Indicators and Targets – POW 2012
Indicators Base-line Targets
2009 2010 2011 2012 2013
Health Objective 1 Bridge equity gaps in access to health care and nutrition services and ensure sustainable financing
arrangements that protect the poor
1 % children 0-6 months exclusively breastfed 62.8% N/A N/A 70.0% 70.0%
2 Equity Index: Poverty (U5MR by highest/lowest wealth quintile) 1:2.18 N/A N/A 1:1.5 1:1.5
3 Equity Index: Geography - Services (Supervised deliveries by 1:1.97 1:1.90 1:1.80 1:1.70 1:1.60
region)
4 Equity Index: Geography - Resources (Nurses:Population by 1:2.03 1:2.00 1:2.00 1:1.95 1:1.90
region)
5 Equity Index: NHIS Gender (Active members by gender) 1:0.92 - - - -
6 Equity Index: NHIS Poverty (Active members by lowest quintile
- N/A N/A N/A -
to whole pop)
7 Outpatients attendance per capita (OPD) 0.77 0.82 0.85 0.88 1.00
8 Access to Health facility N/A N/A N/A N/A N/A
9 Doctor:population ratio 1:13,400 1:11,500 1:10,500 1:9,700 1:9,500
10 Nurse:population ratio 1:1,353 1:1,100 1:1,000 1:900 1:800
Health Objective 2 strengthen governance and improve efficiency and effectiveness in the health system
1 % total MTEF allocation to health 14.9% 11.5% 15.0% ≥15.0% ≥15.0%
2 % non-wage GOG recurrent budget allocated to District level 49% 50% 50% 50% 50%
and below
3 Per capita expenditure on health 23 US$ 26 US$ 28 US$ 30 US$ 31 US$
4 Budget execution rate (Item 3 as proxy) 97% ≥95% ≥95% ≥95% ≥95%
5 % of annual budget allocations to items 2 and 3 (GOG and 23% 40% 42% 50% 50%
SBS) disbursed to BMCs by end of year
6 % of population with valid NHIS membership card 45.0% 60.2% 65.0% 70.3% 75.0%
7 Proportion of NHIS claims settled within 12 weeks N/A 40% 60% 70% 80%
8 % of IGF from NHIS 66.5% 70.0% 70.0% 75.0% 75.0%
Health Objective 3 Improve access to quality maternal, neonatal, child and adolescent health services
1 Maternal mortality rate per 100,000 live births 451 N/A N/A N/A 226
2 Total fertility rate 4.0 N/A N/A 3.8 3.8
3 Institutional Maternal Mortality rate per 1000 live births 196 185 170 160 150
4 % of pregnant women attending at least 4 Antenatal visits 62.4% 70.0% 74.6% 80.1% 85.7%
5 Infant Mortality Rate (IMR) per 1,000 50 N/A N/A

9 Institutional under five mortality rate 10.2 - - - -
10 Institutional Maternal Mortality rate per 1000 live births 196 185 170 160 150
62

Annex 2: Sector wide indicator trends based on 3% proportion
Table 19 below presents sector wide indicator trends recalculated for the previous years on basis of the 2010
census projections for expected pregnancies (3%), expected children under one year (3%) and WIFE (25.8%).
POW 2012
2008 2009 2010 2011 Performance Source
Health Objective 1: Bridge equity gaps in health care and nutrition services and ensure sustainable financing arrangements that protect the poor
1 % children 0-6 months exclusive breastfed 62.8% - - - 45.7% MICS
2 Equity: Poverty (U5MR) 1.72 - - - 2.04 MICS
3 Equity: Geography - Services (supervised deliveries) 2.17 1.49 1.89* 1.66* 1.48 GHS
4 Equity: Geography - Resources (nurse: population) 2.03 1.81 1.99* 1.73* 1.75 MOH
5 Equity: NHIS – Gender 1.27 - - 1.38 1.23 MICS
6 Equity: NHIS – Poverty 0.82 (F) - - - 0.69 (F) MICS
7 Outpatients attendance per capita (OPD) 0.77 0.81 0.91* 1.04* 1.17 GHS /TH
8 % population living within 8 km of health infrastructure - - - - - -
9 Doctor: population ratio 1:13,499 1:11,698 1:11,833* 1:10,217* 1:10,452 MOH
10 Nurse: population ratio 1:1,353 1:1,494* 1:1,516* 1:1,262* 1:1,251 MOH
Health Objective 2: Strengthen governance and improve efficiency and effectiveness in the health system
1 % total MTEF allocation on health 14.9% 14.6% 15.1% 15.8% 15.4% MOH
2 % non-wage GOG recurrent budget to district level and below 49.0% 62.0% 46.8% 55.3% 38.5% MOH
3 Per capita expenditure on health 23.2 25.6 28.6 35.0 50.7 MOH
4 Budget execution rate (Item 3 as proxy) 115.0% 80.4% 94.0% 82.1% 86.8% MOH
5 % of annual budget allocations disbursed to BMC by end of year 23.0% 39.0% 31.0% 89.8% - -
6 % of population with valid NHIS membership card - - 33.7% 33.4% 34.0% NHIA
7 Proportion of claims settled within 12 weeks - - - - - -
8 % IGF from NHIS 66.5% 83.5% 79.4% 85.0% - -
Health Objective 3: Improve access to quality maternal, neonatal, child and adolescent health services
1 Maternal Mortality Ratio (MMR) per 100,000 live births 451 - - - -
2 Total Fertility Rate 4.0 - - - 4.3 MICS
3 Contraceptive Prevalence Rate 16.6% - - - 23.4% MICS
4 % of pregnant women attending at least 4 antenatal visits 81.1% 81.6% 71.1% 71.3% 96.4% GHS
5 Infant Mortality Rate (IMR) per 1,000 live births 50 - - - 53 MICS
6 Under 5 Mortality Rate (U5MR) per 1,000 live births 80 - - - 82 MICS
7 % deliveries attended by a trained health worker 56.3% 60.8% 65.0% 73.0% 77.9% GHS/TH
8 Under 5 prevalence of low weight for age 13.9% - - - 13.4% MICS
Health Objective 4: Intensify and control of communicable and non-communicable diseases and promote a healthy lifestyle
1 HIV prevalence among pregnant women 15-24 years 1.9 2.1 1.5 1.7 - GHS
2 % of U5s sleeping under ITN 40.5% - - - 41.5% MICS
3 % of children fully immunized by age one - Penta 3 115.5% 119.1% 114.5% 115.3% 117.1% GHS
4 HIV+ clients ARV treatment 23,614 33,745 40,575 59,007 73.339 NACP
5 Incidence of Guinea Worm 501 242 8 0 0 GHS
6 % households with improved sanitary facilities 12.4% - - - 15.0% MICS
7 % households with access to improved source of drinking water 83.8% - - - 79.3% MICS
8 Obesity in population (women aged 15-49 years) 9.3% - - - - -
9 TB treatment success rate 84.6% 85.4% 87.0% 85.3% 86.2% NTP
Health Objective 5: Strengthen institutional care, including health service delivery
1 Psychiatric patient treatment and rehabilitation rate - - - - 84.8% Chief Psy.
2 Equity index: Ratio of mental health nurses to patient population - - - - 1:63 Chief Psy.
3 Number of community psychiatric nurses trained and deployed - - - - 400 Chief Psy.
4 % tracer psychotropic drug availability in hospitals - - - - 85.0% Chief Ph.
5 Institutional infant mortality rate 7.0 7.4 6.8 6.4 2.2 GHS
6 Basket equipment functioning in hospitals - - - - - -
7 % tracer drugs availability in hospitals - - - 94.1% 85.7% Chief Ph.
8 % of hospitals assessed for quality assurance and control - - - - - -
9 Institutional under-five mortality rate 9.0 10.2 9.7 9.7 4.0 GHS
10 Institutional MMR - - 190 211 193 GHS /TH
Table 19: Sector wide indicators 2007-2012 based on both 3% of children under 1-year/expected pregnancies, greyed out
indicators are not measured on annual basis.
63

Annex 3: Holistic Assessment Tool and Analysis
The holistic assessment tool was developed during the 5YPOW 2007-2011 to provide a brief but wellinformed,
balanced and transparent assessment of the sector’s performance and factors that are likely to
have influenced this performance. Most of the indicators from the 5YPOW have been carried over to the
HSMTP and used in the 2011 POW. The indicators have been clustered under Health Objectives 1 to 5.
The review team has performed the initial assessment based on the holistic assessment methodology. The
purpose of the initial assessment is to form a basis for a balanced discussion between the Ministry of
Health, its agencies and development partners to reach a common conclusion of the sector’s performance.
During this discussion, the final sector score can be modified if the initial assessment has either over- or
underestimated the performance.
Methods
The assessment is based on indicators and milestones specified in the operational annual POW. More
specifically, the analysis underlying the holistic assessment is based on the following elements:
1. Annual POW including budget
2. Annual Performance Review Reports and presentations from MoH and its Agencies
3. Annual MoH Financial Statement
4. National survey reports (Ghana DHS, MICS etc.)
5. Health Sector Medium Term Development Plan 2010-2013
As part of the annual health sector review process, the review team has conducted an initial assessment of
milestones’ realization and indicator trends. The assessment was guided by a predefined methodology that
ensured full transparency of calculations.
The assessment will be presented at the April Health Summit where overall performance of the sector and
possible factors, which may have influenced the performance, can be discussed.
The purpose of the initial assessment is to form a basis for a balanced discussion between the Ministry of
Health, its agencies and development partners to reach a common conclusion of the sector’s performance.
The initial assessment has three steps:
First, each indicator and milestone is assigned a numerical value of -1, 0 or +1 depending on realization of
milestones and trend of indicators. While indicators which normally are measured on annual basis are
included in each year’s assessment, indicators which are not measured on annual basis (e.g. survey based
information like MICS, DHS etc.) are only included in the assessment if new information is available.
Milestones are assigned the value +1 (colour coded green) if the review team is provided with evidence
from the relevant authority that documents the realization of the milestone; otherwise it is assigned the
value -1 (colour coded red).
Indicators are assigned the value +1 (colour coded green) if
The indicator has attained the specified annual target regardless of trend, or
64

The indicator has experienced a relative improvement by more than 5% compared to the previous year’s
value
Indicators are assigned the value -1 (colour coded red) if
The indicator is below the annual target and has experienced a relative deterioration by more than 5%, or
No data is available (only applies to annually measured indicators and not to survey indicators)
Indicators are assigned the value 0 (colour coded yellow) if
The relative trend of the indicator compared to previous year is within a 5% range, or
The indicator was not reported the previous year (for annually measured indicators) or the previous survey
(for survey indicators)
Second, the indicators and milestones are grouped into Health Objectives as defined in the HSMTDP and
the sub total of indicators and milestone values are calculated for each group. Health Objectives with a
positive score are assigned a value of +1, -1 if the total score is negative and 0 if the total score is 0.
Third, after assigning a numerical score to each of the Health Objectives the scores are added to determine
the sector’s score. A positive sector score is interpreted as a highly performing sector, a negative score is
interpreted as an underperforming sector and a score of zero is considered to be sustained performance.
Assessment of indicators and milestones
Health Objective 1: Bridge equity gaps in health care and ensure sustainable financing arrangements that
protect the poor
Milestone: Review of CHPS undertaken with stakeholders and re-zoning of CHPS completed
2012 Performance: no information
Source: MOH
Outcome: 0
The Ministry of Health organised a joint monitoring visit to five regions, namely Central, Greater Accra,
Ashanti, Northern and Upper East Region to ascertain the status of Implementation of the Communitybased
Health Planning and Services (CHPS). The findings of the joint monitoring visit were presented at the
November business meeting in form of a policy brief.
The process of rezoning of CHPS into zones coterminous with the District Assembly electoral areas was
initiated.
Since the review was performed but the rezoning was not completed, the Ministry proposes that this
milestone is given the score of 0.
% children 0-6 months exclusively breastfed
2012 Performance: 45.7%
2012 Target: 70%
Source: MICS 2011
2003 2006 2008 2012
53.4% 54.0% 62.8% 45.7%
65

Outcome: -1
Result: The proportion of children below the age of 6 months exclusively breastfed has significantly
dropped since 2008, and the current performance is below 2003 levels.
Discussion: At district level, health activities to promote good nutrition including exclusive breastfeeding
have received decreasing attention and priority over the past years. Because of limited financial and human
resources and since these activities are less integrated into the routine district level activities than for
example EPI, the tendency has reportedly been to give preference to other activities. Moreover, head
quarter’s monitoring and support to regions and districts in the area of nutrition has reduced.
The ministry is concerned about this trend and will work with its agencies to strengthen nutrition activities
and promote exclusive breastfeeding.
Equity – Poverty (Poorest/Richest U5 mortality rate)
2012 Performance: 2.04
2012 Target: 1.5
Source: MICS 2011
Outcome: -1
Wealth Quintile 2003 2008 2012
Lowest 128 103 106
Second 105 79 85
Middle 111 102 83
Fourth 108 68 86
Highest 88 60 52
Ratio 1.45 1.72 2.04
Result: The under-five mortality inequality gap between lowest
and highest wealth quintile is widening, and the poorest
children a significantly worse of than children from any other
quintile. Moreover, it is evident that children from the richest
quintile are significantly better of the any other quintile. The reduction of under-five mortality since DHS
2003 is also highest among children from the richest quintile (41%) and lowest among the poorest children
(17%).
Discussion: While children of the richest quintile seem to be on track to meet the MDG target of reducing
under-five mortality rate, children from other quintiles and especially the poorest children are faring much
worse. The same widening of inequity is observed for infant and neonatal mortality rates. Since 2003 there
seems to have been no reduction of infant mortality and only slight reduction in neonatal mortality among
the poorest children while reduction of infant and neonatal mortality among the richest was 34.5% and
42.9%, respectively.
The ministry whish to perform further analysis of these trends to isolate the determinants of high mortality
among children, e.g. urban/rural dwelling, socio-economic status, education status of parents, child gender
etc. in order to device strategies to ensure more equitable health development for children in Ghana.
Wealth Quintile 2003 2006 2008 2012 Reduction since 2003
Lowest 61 75 59 61 0.0%
Second 64 79 45 50 21.9%
Middle 73 65 70 54 26.0%
Fourth 66 65 45 52 21.2%
Highest 58 64 46 38 34.5%
Table 20: Infant Mortality Rates by wealth quintile, Source GHS 2003/2008 and MICS 2006/2011
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Wealth Quintile 2003 2008 2012 Reduction since 2003
Lowest 37 31 35 5,4%
Second 40 27 28 30,0%
Middle 49 44 35 28,6%
Fourth 38 31 37 2,6%
Highest 42 31 24 42,9%
Table 21: Neonatal Mortality Rates by wealth quintile, Source GHS 2003/2008 and MICS 2011 (no information about neonatal
mortality rate in MICS 2006)
Equity – Geography (Supervised Deliveries)
2012 Performance: 1:1.53
2012 Target: 1:1.7
Source: GHS
Outcome: +1
Result: The equity index for supervised
deliveries by region is improving and
reached the target of being below
1:1.7. In 2012, there was improved
2006 2007 2008 2009 2010 2011 20012
CR 74.0% - 56.3% - -
UER - 43.5% - - 58.8% 66.3% 68.6%
BAR - - - 53.7% -
WR - 17.6% - - -
NR 25.1% - 26.0% 36.1% -
VR - 31.1% 39.9% 45.0%
Ratio 1:2.95 1:2.47 1:2.17 1:1.49 1:1.89 1:1.66 1:1.53
performance among both the best and worst off regions. Almost all regions’ performance was above 50%
except VR at 46.5% and NR at 49.9%. Three regions were above 60%, namely UER (68.7%), BAR (65.9%) and
CR (60.1%).
Discussion: Coverage of supervised deliveries continued to increase in all regions except for AR, which
experienced a drop of 2.1%. Over the past 3 years, the highest improvement in coverage is observed in
UWR with an impressive 53.7% increase since 2009. The national increase for the same period was 28.2%,
while the national increase over the past 5 years has been 66.5%. While some of this increase can be
contributed to improved data collection, the ministry considers this also to be the consequence of specific
policy interventions to improve access to maternal services, e.g. HIRD and the Free Maternal Health Care
Policy introduced in 2008.
When linking the regional figures for supervised deliveries to neonatal mortality reported in the MICS 2011,
there seems to be a relation between low coverage of supervised deliveries and high level of neonatal
mortality. The causes of neonatal mortality are multifaceted, and the relation is not without exceptions,
which raises the question about quality of the provided maternal services and their impact on both
neonatal and maternal mortality and morbidity.
Since 2010, VR has been the poorest performing region. While the region has improved supervised
deliveries with close to 50% since 2010, the region should still receive special attention and support to
catch up with the other regions.
Results: Equity for supervised delivery improved for the year under review. The performance was better
than the target of 1:1.7 for the year 2013. There is an overall improved performance for supervised
delivery for all the regions. All regions are above 50% except VR at 46.5% and NR at 49.9%. Three regions
are above 60%: BAR (65.9%), CR (60.1%) and UER (68.7%).
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Discussion: The good performance may be attributed to Improved financial access from the free maternal
health care policy. Although Volta region is showing an improvement in supervised delivery, it has
consistently been the lowest performer with regards to supervised delivery for the past three years. Volta,
Northern and Western Regions have high midwife WIFA population ratio compared to the other regions. Of
the three regions with few midwives in relation to their WIFA poulation, only Western Region had
supervised coverage above 50%. This is due to midwives in the Western Region doing averagely more
deliveries per midwife than in any other region(204 deliveries/midwife).This is above the WHO
recommeded 175 deliveries/midwife.
Upper East Region continues to improve its supervised delivery coverage over the years. It will be of benefit
to the whole health sector to look at the strategies that have been put in place for them to achieve this
consistent results.
The performance of Volta Region with regards to skilled delviery needs to be addressed. There are various
reasons for this performance which came up in the Joint monitoring visit report to the Region in 2011,
among the issues are inadequate infrastructure, ageing and inadequate numbers of midwives and the fact
that Volta Region is one of the regions with very few maternal and child health interventions outside the
regular budget provided by the Ministry of Health. The region will need to be targetted for special
attention.
AR WR NR BAR CR VR UER ER UWR GAR Ghana
‘06 40.8% 34.8% 25.1% 47.4% 74.0% 35.4% 38.4% 38.7% 28.8% 42.2% 44.5%
‘07 26.7% 17.6% 27.7% 34.5% 22.3% 33.3% 43.5% 43.1% 32.9% 43.1% 32.1%
‘08 35.0% 39.1% 26.0% 49.8% 56.3% 37.5% 40.4% 48.0% 40.6% 50.2% 42.2%
‘09 42.4% 42.6% 36.1% 53.7% 52.5% 39.4% 52.6% 52.1% 36.7% 47.9% 45.6%
‘10 47.1% 46.6% 36.3% 53.1% 48.2% 31.1% 58.8% 47.1% 44.8% 50.1% 48.7%
‘11 51.4% 53.5% 42.8% 62.4% 56.9% 39.9% 66.3% 52.0% 51.3% 54.5% 54.8%
‘12 50,3% 57,6% 49,9% 65,9% 60,1% 46,5% 68,7% 55,3% 56,4% 57,2% 58.5%
Table 22: Coverage of supervised deliveries by region, 2006-2012, Source GHS
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Figure 15: Supervised deliveries by region 2006-2012, source GHS
Equity – Geography (Nurses/Population ratio)
2012 Performance: 1:1.73
2012 Target: 1:1.95
Source: HR – MoH
Outcome: +1
Result: Ratio did not improve over 2011
performance, but reached target of
being below 1:1.95. The poorest staffed
region is NR with 75% more citizens per
2007 † 2008 † 2009 2010 2011 2012
GAR - 1:952 - 1:1,043 1:918 1:917
AR 1:1,429 1:1,932 - 1:2,077 1:1,586
NR 1:1,934 1:1,601
UER 1:3,225 - 1:1,069 -
Ratio 1:2.26 1:2.03 1:1.81 1:1.99 1:1.73 1:1.75
†2007 and 2008 figures include midwifes.
nurse than best performing region and 28% more citizens per nurse compared to the national average.
Equity has however improved significantly overall since 2007.
Discussion: The improvement over the years has been due to the establishment of new nursing training
schools in all the regions. The recent stagnation is probably due to the high failure rate among the nursing
students over the past two years that has reduced the number of nurses who are passing out of the
schools. ( Pass rate from Nurses and Midwife Council Report)
Equity – Gender (Female/Male NHIS Card Holder ratio)
2012 Performance: 1.23
2012 Target: Target not specified in POW 2012
Source: MICS 2012
Outcome: 0
2008 2012
Ratio 1.27 1.23
69

Result: NHIS cardholders became slightly more equal between the sexes. Trend below 5% and no target
established, therefore neutral outcome.
Discussion: Women have higher need for health care services (including maternal care) over the life span.
Until NHIS reaches universal coverage, the ministry both expect and desire relatively higher female
enrolment.
Equity – Poverty (Poorest/National NHIS Card Holder ratio – Women only)
2012 Performance: 0.69
2012 Target: Target not specified in POW 2012
Source: MICS 2011
Outcome: -1
Wealth Quintile 2008 2012
Poorest 27.9% 28.7%
National 34.1% 41.6%
Ratio 0.82 0.69
Result: The socio economic inequity of NHIS coverage has significantly
worsened since 2008. The MICS survey demonstrates a modest increase in cardholders among the poorest,
but this increase is largely overtaken by a national increase in cardholders of 22.0%.
Discussion: The observed inequity indicates that there continues to be a financial access barrier for Ghana’s
citizens from the lowest wealth quintile to enrol onto NHIS and/or maintain a valid card. Reports from the
district hospitals suggest that the poorest citizens choose to register with NHIS when they need health
services and subsequently discontinue their membership. This leads to adverse selection, which potentially
can create challenges for the financial sustainability of NHIS.
The above findings contrast the recent evaluation of the Free Maternal Health Care Policy that concludes
that equity in NHIS membership provided by the policy is improving. The study also reports an unanimous
agreement among all respondents that the introduction of the free maternal health care policy has
increased the level and the equity in the utilisation of health facilities for delivery.
Out Patient Visits
2012 Performance: 1.17
2012 Target: 0.88
Source: GHS
Outcome: +1
2006 2007 2008 2009 2010 2011 2012
0.55 0.69 0.77 0.81 0.92 1.05 1.17
Results: OPD per capita continue previous years’ increase. In 2012, the relative increase was 11% and OPD
pre capita reached 1.17, more than doubling 2006 figure. The OPD per capita of Ashanti Region dropped
significantly.
Discussion:
The National Health Insurance since its introduction has led to increase in utilization of OPD services across
all the regions. 80.1% of total Outpatients seen were insured. Regions like Upper East Region and Brong-
Ahafo Regions which share borders with neighbouring countries and have old and well known facilities
close to the border, has OPD per capita above 1.5 with some of their patients coming from the
neighbouring countries. Volta Region however because of inadequate facilities especially in the Northern
70

parts of the region has not benefitted greatly from the influx of patients from the neighbouring countries
compared to the other two regions.
61.4% of those attending outpatient were females. For the males children 1-4years were seen more at the
OPD than any age group. For the females those between 20-34years were seen more at the OPD compared
to the other age group. Overall women between the ages of 20-34years were seen more at the OPD than
any other age group for males or females
Figure 16: OPD visits by gender and age-group 2012, source GHS
Ashanti region like all the regions was showing an increase in OPD attendance till 2012 when it experienced
a drop in OPD per capita. It was the year also that the capitation was piloted in the Ashanti Region. It is not
clear whether this reduction in OPD was due to reduction in inappropriate utilization by insured clients or
reduction in access on account of the capitation. Discuss possible relation between AR capitation pilot and
reduced OPD/capita. Ashanti Region was also the only region where the proportion of OPD clients with
insurance fell( from 82.6% to 76.9%).
Northern Region OPD per capita might be a reflection of poor geographical access in the Region. Although
finacial access has been facilitated with the health insurance with 88.9% of their total OPD being insured
clients, their overall OPD per capita remain low compared to the other regions.
With the increase in OPD visits accross the regions, there has not been significant imporvement in
infrastructure of most of the facilties to accomoodate these increases. It is now more important than ever
to ensure good service and clinical quality. Strategies for quality assurance for clinical care services should
be developed for inclusion in new HSMTDP.
71

Figure 17: OPD per capita by region, 2006-2012, Source GHS
AR WR NR BAR CR VR UER UWR ER GAR Ghana
2006 0.59 0.57 0.3 0.91 0.5 0.41 0.55 0.46 0.65 0.47 0.55
2007 0.72 0.72 0.31 1.02 0.7 0.51 0.69 0.65 0.94 0.6 0.69
2008 0.73 0.86 0.49 1.3 0.68 0.73 1.01 0.7 0.97 0.51 0.77
2009 0.89 0.69 0.53 1.15 0.71 0.69 1.37 0.72 0.95 0.51 0.81
2010 0.96 1.12 0.64 1.19 0.75 0.64 1.45 0.88 1.01 0.59 0.92
2011 1.17 1.35 0.62 1.48 0.79 0.87 1.40 1.06 1.18 0.64 1.05
2012 0.96 1.44 0.70 1.63 1.00 1.01 1.99 1.12 1.38 0.95 1.14
Table 23: OPD per capita by region, 2006-2011, Source GHS
% population living within 8 km of health infrastructure
2012 Performance: N/A
2012 Target: N/A
Source: N/A
Outcome: 0
2010 2012
N/A N/A
Survey data not available for 2012 POW review.
Doctor:Population Ratio
2012 Performance: 10,452
2012 Target: 9,700
Source: HR - MOH
Outcome: 0
2006 2007 2008 2009 2010 2011 2012
1:15,423 1:13,683 1:13,499 1:11,649 1:11,698 1:10,217 1:10,452
Result: Doctor: population ratio did not change much . Neutral outcome. Large regional variances with 11
times more doctors per population in GAR compared to UWR. Almost 4 times higher population per one
doctor in UWR compared to national average.
Discussion:
72

Greater Accra continue to be the Region with the highest number of doctors per capita. Fifty percent of all
Ghana’s doctors are in Greater Accra Region and another 20% are in Ashanti Region. The number of doctors
in training in Greater Accra Region might be accounting for this high numbers. The proportion of female
doctors in Greater Accra is higher than for the other Regions, indicating that some of these doctors are in
Greater Accra Region because of domestic reasons. Northern Region has consistently improved its doctor
population ratio over the past three years, however this increase has only benefitted the Teaching Hospital.
Of the 25 Hospitals in Ghana without doctors 8 of them are found in the Northern Region. There is the need
for establishment of clear staffing norms for faciltiies and the Ministry of Health need to have a strategy to
address the inequitable distribution of doctors
Figure 18: Doctor: population ratios (lower is better), 2009-2012, Source MOH
AR WR NR BAR CR VR UER UWR ER GAR Ghana
No. of docs. 2009 600 80 50 140 87 78 34 17 157 839 2,082
No. of docs. 2010 562 91 72 141 88 80 29 14 155 876 2,108
No. of docs. 2011 630 91 117 145 106 91 27 18 165 1,085 2,475
No. of docs. 2012 519 89 137 154 104 90 27 18 139 1,204 2,481
Pop. / 1 doc. 2012 9,715 27,775 19,163 15,705 22,505 24,728 39,697 40,502 19,748 3,540 10,452
Table 24: Total number of doctors 2009 to 2012 and doctor/population ratio for 2012 (lower is better), source HR - MoH
Nurse:Population Ratio
2012 Performance: 1,251
2012 Target: 1:900
Source: HR – MOH
2009† 2010† 2011 2012
1:1,497 1:1,489 1,240 1:1,251
Outcome: 0
73

Result: Nurse:population ratio has remained stagnant. This has resulted in a neutral outcome for this
indicator. The highest concentration of nurses are in Greater Accra Region and Upper East Region. Lowest
are in Northern Region and Ashanti Region.
Discussion: The decision of Upper East Region of implementing strictly the policy of retaining nurses that
train in their Region appear to be yielding fruits. Regions like Northern Region should also adopt this
approach.
Numbers of midwives are reducing across all the regions with the exception of Ashanti Region which
showed a marginal increase in numbers of midwives. The training and deployment of midwives is not
keeping pace with those going on retirement. There is the need to get more nurses into training, this can be
accelerated if the community health nurses can be given diplomas instead of certificates when they
undertake the post-basic midwifery course. Most of them are reluctant to enrol in the post-basic midwifery
course because they are awarded certificates.
AR WR NR BAR CR VR UER UWR ER GAR Ghana
Total no. of nurses 2009 2,325 1,422 1,191 1,214 1,373 1,533 892 586 1,994 3,698 16,228
Total no. of nurses 2010 2,397 1,376 1,194 1,207 1,370 1,477 904 583 1,914 3,846 16,268
Total no. of nurses 2011 3,096 1,712 1,645 1,562 1,655 1,733 1,142 725 2,259 4,502 20,031
Total no. of nurses 2012 3,253 1,739 1,640 1,645 1,873 1,789 1,152 775 2,219 4,649 20,734
Pop. / 1 nurse 2012 1,550 1,422 1,601 1,470 1,250 1,244 930 941 1,237 917 1,251
Table 25: Total number of nurses 2009 to 2012 and nurse/population ratio for 2012 (lower is better), source HR - MoH
AR WR NR BAR CR VR UER UWR ER GAR Ghana
Total no. of midwifes 2009 606 276 279 341 291 381 197 153 478 792 3,794
Total no. of midwifes 2010 630 277 299 356 284 353 190 145 462 784 3,780
Total no. of midwifes 2011 754 279 298 370 308 358 198 147 489 833 4,034
Total no. of midwifes 2012 779 277 274 352 294 303 190 131 451 812 3,863
WIFA/1 midwife 2012 1,553 2,142 2,300 1,649 1,911 1,763 1,354 1,336 1,461 1,260 1,611
Table 26: Total number of midwifes 2009 to 2012 and midwife/population ratio for 2012 (lower is better), source HR - MoH
Health Objective 2: Strengthen governance and improve efficiency and effectiveness of the health system
Milestone: System for performance contracting introduced
2012 Performance: no information
Source: MOH
Outcome: +1
In 2012, the ministry introduced performance contracts with four agencies, the three teaching hospitals
and Ghana Health Service. The ministry will sign performance contracts for 2013 with all its agencies.
% MTEF on Health
2012 Performance: 15.4%
2012 Target: 15.0%
Source: MoH
Outcome: +1
2007 2008 2009 2010 2011 2012
14.6% 14.9% 14.6% 15.1% 15.8% 15.4%
% Non-wage GOG recurrent budget allocated to district level and below
2007 2008 2009 2010 2011 2012
74

2012 Performance: 38.5%
2012 Target: 50%
Source: MoH
Outcome: -1
49.0% 49.0% 62.0% 46.8% 55.3% 38.5%
Per capita expenditure on Health (USD)
2012 Performance: 50.7
2012 Target: 30 USD
Source: MoH (draft financial statement – exhibit B, p. 5)
Outcome: +1
2007 2008 2009 2010 2011 2012
23.0 23.2 25.6 28.6 35.0 50.7
Budget Execution Rate of Item 3
2012 Performance: 86.8%
2012 Target: >95%
Source: POW 2011 and draft financial statement
Outcome: +1
2007 2008 2009 2010 2011 2012
110% 115% 80% 94% 82.1% 86.8%
% of annual budget allocations to item 2 and 3 disbursed by end of December
2012 Performance:
2012 Target: 50%
Source: MoH
Outcome: -1
2007 2008 2009 2010 2011 2012
Disbursed by end June n/a 23.0% 39.0% 31.0% -
Disbursed by end December - - - - 89.8%
% Population with valid NHIS card
2012 Performance:
2012 Target: 70.3%
Source: NHIA
Outcome: 0
2007 2008 2009 2010 2011 2012
Members 36.2% 44.7% 50.0% - -
Active Card holders - - - 33.1% 32.8% 34%
Result: The number of cardholders increased to 8,645,483 providing an NHIS coverage of 33.3%. There are
significant regional variances with UWR and UER leading. A significant drop by over 25% was observed in
AR.
Discussion:
75

% of claims settled within 12 weeks
2012 Performance:
2012 Target: 70%
Source: NHIA
Outcome: -1
% of IGF from NHIS
2012 Performance:
2012 Target: 75%
Source: MOH
Outcome: -1
2007 2008 2009 2010 2011 2012
n/a n/a n/a n/a n/a -
2007 2008 2009 2010 2011 2012
n/a 66.5% 83.5% 79.4% 85% -
Health Objective 3: Improve access to quality maternal, neonatal, child and adolescent health and
nutrition services
Milestone: Pneumocococcal and rotavirus vaccines successfully introduced
2012 Performance:
Source: GHS
Outcome: +1
Vaccines were introduced to the EPI programme in 2012.
Maternal mortality ratio
2012 Performance: No new data for 2011
2012 Target: N/A
Source: N/A
Outcome: N/A
2008 2012
451 -
Survey indicators are not measured on annual basis.
76

Total fertility rate
2012 Performance: 4.3
2012 Target: 3.8
Source: MICS 2011
Outcome: -1
1998 2003 2008 2012
4.6 4.4 4.0 4.3
Result: The total fertility rate worsened in 2012, and at 4.3 it is now almost back to the 2003 rate.
Discussion: While total fertility rate has worsened, the contraceptive prevalence rate for the same period
has improved significantly. Moreover, unmet need for family planning reduced from 34.0% in 2003 to
26.4% in the 2011 MICS. These factors indicates that access to family planning is improving and raise
concern that the increase in fertility may be a statistical variation that is not a true reflection of
performance.
Contraceptive Prevalence Rate (for modern methods – women 15-49 years married or in union)
2012 Performance: 23.4%
2011 Target: No target specified
Source: GHS
Outcome: +1
1998 2003 2006 2008 2012
13.3% 18.7% 13.6% 16.6% 23.4%
Results: The contraceptive prevalence rate has markedly increased since 2008. The positive trend observed
in the survey, is supported by routine information, which shows a significant increase in short-term CYP and
minimal increase in long-term CYP.
Discussion: Survey figures are consistently showing increased use of modern family planning methods and
reducing unmet need for family planning. This is consistent with routine figures from the public sector.
Analysis by GHS shows that an increasing proportion of family planning clients are accessing the services
from the private sector including pharmacy shops, since this is more convenient for the clients. This leads
to incompleteness of the data collected by GHS. Some of the long-term methods can only be administered
by midwifes and doctors. Since both midwives and doctors are likely to be occupied with other activities,
these methods cannot be administered to meet the demand. The ministry currently considers the
possibility for task shifting administration of these long-term family planning methods to other health
personnel.
Results: Contraceptive prevalence rate from the MICS showed a significant increase from 16.6% to 23.4%.
The routine Family planning Acceptor rate however reduced slightly. Couple Year protection has similarly
increased compared to the previous year 2011. Upper West Region recorded a family planning acceptor
rate of 43.8% while Ashanti Region reported a low coverage of 15.8%.
Discussion: The increase in Total Fertility rate as recorded in the MICS is not consistent with the increase in
CPR found in the same survey. There might be the need to investigate this further. The completeness of
data on Family planning from the traditional facility sources, both Public and private has improved with a
reporting rate of 93.9% from these facilities.
77

From the MICS unmet need for Family planning has reduced to 26.4% indicating an improved access to
family planning services, which is also reflected in the routine service data.
CYP AR WR NR BAR CR VR UER UWR ER GAR Ghana
2010 181,281 78,945 29,155 58,837 56,880 47,027 19,831 25,163 80,879 54,662 632,660
2011 94,796 47,268 74,625 121,181 96,635 51,093 28,048 19,633 104,566 30,667 668,512
2012 1,922,289
Table 27: CYP by region 2010-2012, source GHS
% of pregnant women attending at least 4 antenatal visits
2012 Performance: 72.3%
2012 Target: 80.1%
Source: GHS
Outcome: 0
2007 2008 † 2009 † 2010 † 2011 † 2012
4+ ANC visits 62.8% 60.9% 66.6% 66.6% 70.7% 72.3%
†
AR, BAR, VR and GAR were excluded from national figure due to unreliable data
Results: ANC 4+ increased, but the relative increase of 2.2% was below the 5% threshold for a positive
indicator outcome.
Discussion: The programme definition of ANC4+ is based on its use as a proxy quality indicator rather than a
coverage indicator. It is defined as the number of ANC registrants making the fourth visit. The definition
used in this review and previous reviews makes it a coverage indicator by looking at those expected to get
pregnant how many made the fourth visit. This is more aligned to the survey definition that asks for the
women interviewed who were pregnant the previous year how many had attended ANC at least four times
by any provider. For the 2011 MICS report this was 86.6%.
The definition of this indicator presents challenges for some of the Regions with their figures being
consistently above 100%. In the previous review the figures from Ashanti, Brong-Ahafo Volta and Greater
Accra were ommitted from the Analysis because of these errors. It is only in 2012 that all the regions have
been able to get reasonable coverage for this indicator. This shows an improvement in the data quality.
Figure 19: Antenatal care registrants and 4+ visits 2008-2012, source GHS
ANC 4+ AR WR NR BAR CR VR UER UWR ER GAR Ghana
2008 - 49.0% 54.4% - 62.7% 35.7% 55.0% 47.3% 45.7% 86.0% 60.9%
78

2009 - 59.7% 78.2% - 87.4% 46.9% 71.8% 70.2% 59.0% - 66.6%
2010 - 70.5% 71.9% 81.4% 80.7% 46.7% 72.5% 63.5% 55.3% - 71.1%
2011 73.9% 70.9% 68.4% 67.4% 90.8% - 85.6% 59.2% 59.3% - 71.3%
2012 70.3% 71.6% 70.8% 66.9% 88.2% 60.2% 84.7% 54.4% 62.9% 82.6% 72.3%
Table 28: ANC 4+ by region 2008-2012, source GHS
Infant mortality rate
2012 Performance: 53
Target: 30
Source: MICS 2011
Outcome: -1
1998 2003 2006 2008 2012
57 64 71 50 53
Results: The infant mortality rate was 53 and increased by 6% over the DHS 2008 figure.
Discussion: The national IMR increased only slightly since 2008, but this national average does not show
some large regional variations. While IMR is highest in Volta Region, the infant mortality rates of Upper
West, Northern and Brong-Ahafo Region are nearly as high. The reported trend in VR and BAR is worrying
with significantly worsening of IMR. Since 2003, UWR has made an impressive effort to bring IMR down
from 105 to 67.
With the scale-up of CHPS, increased utilisation of ITNs, high EPI coverage and improving coverage of skilled
deliveries (have we forgot other important initiatives?) since 2008, the ministry did expect to see an
improvement of both IMR and U5MR. The ministry plans to analyse the underlying data thoroughly to
identify reasons for the observed stagnation in child mortality indicators.
AR WR NR BAR CR VR UER UWR ER GAR Ghana
DHS 2003 80 66 69 58 50 75 33 105 64 45 64
MICS 2006 72 45 83 88 69 57 68 114 61 60 71
DHS 2008 54 51 70 37 73 37 46 97 53 36 50
MICS 2012 43 50 66 66 55 68 58 67 38 37 53
Table 29: Infant mortality rate 2003 – 2012, source DHS (2003 and 2008) and MICS (2006 and 2012)
Under-five mortality rate
2012 Performance: 82
2011 Target: 50
Source: MICS 2011
Outcome: 0
1998 2003 2006 2008 2012
108 111 111 80 82
Results: The under-five mortality rate remained stagnant since 2008.
Discussion: Despite stagnation of national average of under-five mortality rate, significant regional
variations occurred. Northern Region and Upper West Region have since 2003 had relatively high U5MR.
While UWR was able to bring down U5MR by 50%, the U5MR in NR saw only limited improvement.
79

AR WR NR BAR CR VR UER UWR ER GAR Ghana
DHS 2003 116 109 154 91 90 113 79 208 95 75 111
MICS 2006 113 66 133 142 108 86 106 191 93 92 111
DHS 2008 80 65 137 76 108 50 78 142 81 50 80
MICS 2012 86 67 124 104 88 89 98 108 61 56 82
Table 30: Under 5 mortality rate 2003 – 2012, source DHS (2003 and 2008) and MICS (2006 and 2012)
Figure 20: Under 5 mortality by region 2003-2012, source DHS (2003 and 2008) and MICS (2006 and 2012)
% Deliveries attended by a trained health worker
2012 Performance: 58.5%
2012 Target: 60.0%
Source: GHS and THs
Outcome: +1
2006 2007 2008 2009 2010 2011 2012
44.5% 35.1% 42.2% 45.6% 48.7% 54.8% 58.5%
Results: Coverage of supervised deliveries has steadily increased since 2007 to 58.5% in 2012, a relative
increase of 6.7% over 2011.
Discussion: The MICS gave the country a skilled attendant at delivery coverage of 68.4%. With
improvement in the data collection on skilled attendant delivery the routine data will be aligning
reasonably well to the survey data from MICS or DHS.
Under-five prevalence of low weight for age
2012 Performance: 13.4%
2011 Target: 8.0%
Source: MICS 2011
Outcome: 0
2006 2008 2012
18% 13.9% 13.4%
Results: Under-five prevalence of low weight for age reduced by 3.6% to 13.4%.
80

Discussion: The slow reduction in the under-five prevalence of low weight for age is a reflection of the low
performance of the sector in nutrition in general. The target of 8.0% is far from being achieved. The
coverage of nutrition intervention in the country is not high. Most of the interventions like community
management of acute malnutrition and community growth promotion cover only few districts and regions.
There will be the need to fully integrate nutritional interventions into the activities of all the Districts in
Ghana. The child nutrition campaign launched in May 2012 with the theme ‘Eating Healthy for Goodlife’ ,
brought child nutrition to the attention of the general public
Health Objective 4: Intensify prevention and control of communicable and non-communicable diseases
and promote a health lifestyle
Milestone: Healthy lifestyle integrated into basic school and teacher training curricula
2012 Performance: Achieved
Source: RHN, PPME, MOH
Outcome: +1
Results: In 2012, healthy lifestyle was integrated into basic school and teacher training curricula.
Milestone: 50% reduction in Yaws prevalence achieved
2012 Performance: Not achieved
Source: GHS
Outcome: -1
HIV prevalence among pregnant women 15-24 years
2012 Performance:
2012 Target:

taken from finger or heel for testing. Based on the, the ministry is concerned about the clinical quality of
services, especially diagnostic services related to malaria, and expects that a significant proportion of
expected malaria cases are in fact not caused by malaria infection.
The national prevalence of malaria parasitaemia in children aged 6-59 months based on microscopy was
27.5% with the highest prevalence in UWR (51.2%) and NR (48.3%). Lowest prevalence was recorded in
GAR (4.1%). Despite no clear evidence of causality, it is obvious to relate the high under-five mortality rate
in UWR and NR to high prevalence of parasitaemia, and intensify malaria control activities in these two
regions.
Results: Use of ITN has improved by almost 50% since 2008.
Discussion: The MICS survey measuring this indicator was done when only two Regions have completed
their hang-up campaigns. With the completion of the hang-up campaigns for the whole country, 7,645,745
LLINs have been distributed and household ownership of ITNs stands at 96.7%. It is likely that the
percentage of under five sleeping under ITN will be higher than 41.5%
The under five malaria case fatality rate for the country has dropped from 1.2 to 0.6.
% children fully immunized by age one - Penta 3
2012 Performance: 87.7%
2012 Target: 91.4%
Source: GHS
Outcome: 0
Results: EPI coverage has been stable close to 90% since 2007. Insignificant improvement over 2011.
Discussion: The Penta 3 coverage over the years has remained consistently above 80%. This is a
demonstration of the strength of the EPI programme. The effect of low and erratic flow of funds to the
district level which is an issue of great concern appear not to have had much impact on delivering of
immunization service. A lot more effort and input however will be needed to move the coverage to 90%.
The MICS gave a coverage of 92.1% for Penta 3.
The Penta 3 coverage in Upper West Region has been going down over the years but the MICS gave a
coverage of 97.4% , so possibly the reduction being seen might be due to low reporting. The same situation
pertains in Greater Accra Region with a low routine coverage for Penta 3 but relatively high MICS coverage.
There is the need to improve data collection especially from the private facilities in the major Metropolitan
areas like Accra and Kumasi.
6.
2006 2007 2008 2009 2010 2011 2012
84.2% 87.8% 86.6% 89.3% 85.9% 86.5% 87.7%
82

Figure 21: Penta 3 coverage by region 2006-2012, source GHS
AR WR NR BAR CR VR UER UWR ER GAR Ghana
2008 76.8% 89.0% 114.5% 97.3% 92.2% 83.8% 94.8% 93.0% 87.5% 68.3% 86.6%
2009 83.7% 88.6% 123.0% 95.0% 96.6% 82.9% 105.9% 94.5% 90.1% 72.7% 89.3%
2010 84.6% 96.3% 110.4% 83.3% 85.6% 66.4% 87.3% 79.9% 86.9% 77.9% 85.9%
2011 87.9% 98.4% 105.3% 94.3% 82.7% 76.4% 87.4% 78.3% 86.8% 70.0% 86.5%
2012 84.7% 94.2% 107.5% 97.4% 86.0% 78.5% 87.1% 72.1% 90.3% 76.5% 87.7%
MICS 2011 97.6& 98.1% 91.7% 97.5% 85.3% 83.4% 97.7% 97.4% 94.5% 89.1% 92.9%
Table 31: Penta 3 by region 2008-2012, source GHS and MICS 2011
HIV Clients receiving ARV therapy
2012 Performance: 73,339
2012 Target: 80,014
Source: NACP
Outcome: +1
2006 2007 2008 2009 2010 2011 2012
7,338 13,429 23,614 33,745 40,575 59,007 73,339
Results: HIV Clients receiving ARV therapy continues to increase.
Discussion: The increase in the number of HIV clients receiving ARV therapy is encouraging, however with
the uncertainty surrounding the continuous supply of ARVs there are concerns about the interruption of
treatment of clients. This development if not addressed promptly can result in development of resistance
of the HIV virus to the drugs that are currently being used by the programme. There is an urgent need with
the lost of the Global Fund funding to look at how the country is going to ensure continuous supply of ARVs
for the increasing clients.
Guinea Worm
2012 Performance: 0 cases
2012 Target:

Results: There has not been a single case of Guinea Worm in Ghana since May 2010.
Discussion: Transmission of guinea worm has been interrupted. The country continues to maintain
surveillance for Guinea worm. 875 of rumours of guinea worm cases were investigated within 24hours.
Stop Guinea worm teams have been deployed in 16 previously endemic districts in Brong-Ahafo, Northern
Region and Volta Region. A team from WHO visited the country and raised concerns about the surveillance
system. The surveillance system need to be improved to ensure the country is certified as guinea worm
free.
% households with improved sanitary facilities
2012 Performance: 15.0%
2012 Target: 21.3%
Source: MICS 2011
Outcome: +1
2006 2008 2011
Not shared 12.4% 15.0%
Total 60.7% 71.2% 60.9%
Results: The sector wide indicator is defined as coverage of sanitary facilities that are not shared, which
increased by 21% to 15% of the population covered.
Discussion: While the proportion of the population with access to improved sanitary facilities that are not
shared increased, the access to all improved sanitary facilities, shared and not shared, reduced. Actions to
improve coverage are done in cross-ministerial collaboration with other ministries.
% households with access to improves source of drinking water
2012 Performance: 79.3%
2012 Target: 80%
Source: MICS 2011
Outcome: -1
2006 2008 2012
78.1% 83.8% 79.3%
Results: The access to improved sources of drinking water worsened since 2008 and came slightly under the
set target of 80%.
Discussion:
Obesity in adult population (women age 15-49 years)
2012 Performance: No new data
2012 Target: n/a
Source:
Outcome: n/a
Survey indicator not measured in 2012.
2003 2008 2012
8.1% 9.3% -
TB treatment success rate
2012 Performance: 86.2% (2011 cohort)
2011 Target: 89%
2006 2007 2008 2009 2010 2011
74.5% 84.6% 85.4% 87.0% 85.3% 86.2%
84

Source: National TB Programme
Outcome: 0
Results: TB treatment success rate improved slightly over 2011, but the increase was within the 5% margin
of sustained performance.
Discussion: Treatment success rate continues to improve although the target of 89% was not achieved. The
adverse outcomes reduced from 16.7% to 13.8%. The fieldwork to determine the prevalence of
tuberculosis was started.
Health Objective 5: Strengthen institutional care including mental health service delivery
Milestone: Functional ambulance stations in 60% of district capitals
2012 Performance: Achieved
Source: National Ambulance Service
Outcome: +1
NAS expanded significantly in 2012 opening 97 new stations in 2012. Total number of stations is 121 in 120
districts. With 172 district capitals, 70% of districts are covered, and the milestone of covering 60% of these
with ambulance stations was achieved.
Psychiatric patient treatment and rehabilitation rate
2012 Performance: 84.8%
2012 Target: 25% over 2009 baseline
Source: Chief Psychiatrist
Outcome: 0
2010 2011 2012
- - 84.8%
Result: Total Number of patients treated during the year was 67,732 and the total treated and discharged
and number of outpatients treated was 57,404. The rehabilitation rate is calculated as 84.8%. Since this is
the first year rehabilitation rate is reported and since there is no figure specified as target, the outcome for
the holistic assessment is zero.
Discussion: The standard definition of rehabilitation is that treated patients are integrated and able to leave
a normal life again. Measuring this indicator under present circumstances is difficult considering the
human resource and capacity constraints of the psychiatric sector. The indicator was therefore calculated
bas the proportion of patients treated and discharged who are seen at outpatient departments on regular
basis. The psychiatric patient treatment and rehabilitation rate was calculated as 84.8%.
The M&E Unit of the Ministry of health should enter into discussion with the Chief psychiatrist to refine and
sharpen this indicator to ensure appropriate preparations are made to collect the appropriate and agreed
data subsequently. The issue of contention is the contextual definition of rehabilitation.
Equity index: Ratio of mental health nurses to patient population
2012 Performance: 1:63
2012 Target: 25% over 2009 baseline
Source: Chief Psychiatrist
2010 2011 2012
- - 1:63
85

Outcome: 0
Result: The total number of mental health nurses in the three psychiatric nurses was 1068. This comprises
both community psychiatric nurses and registered mental nurses. Total number of patients seen during the
year was 67,732. The ratio therefore calculates to 1 nurse per 63.4 patients.
Discussion: There is an issue of the appropriateness of the denominator. The chief psychiatrist would
expect the denominator to reflect the estimated number of people with psychiatric disorder in the
community, which is estimated as 10% of total population of the country. Such estimate would amount to
2.59 million patients. However we looked at the intent of the indicator, which is to measure the workload
of nurses in the psychiatric sector of the Ministry of Health. The ratio of mental health nurses to patient
population was therefore estimated as 1:64.
Number of community psychiatric nurses trained and deployed
2012 Performance: 400
2012 Target: 25% over 2009 baseline
Source: Chief Psychiatrist
Outcome: 0
2010 2011 2012
- - 400
Result: Current crop of community psychiatric nurses amount to 400.
Discussion: No formal training exists for training community psychiatric nurses. All community psychiatric
nurses are registered nurses, which have been converted to practice as community psychiatric nurses. For
this reason, the indicator is problematic. How is community psychiatric nurse defined? This is a question
the team want answered to support future decision regarding training and capacity building.
% tracer psychotropic drug availability in hospitals
2012 Performance: 85%
2012 Target: 70%
Source: Chief Pharmacist
Outcome: +1
2010 2011 2012
68% 64% 85%
Institutional infant mortality rate
2012 Performance: 6.4
2012 Target: No target specified in POW 2012
Source: GHS
Outcome: +1
2008 2009 2010 2011 2012
7.0 7.4 6.8 4.9 2.2
Results: Institutional IMR improved significantly in 2012 with more than 50% reduction.
Discussion: There are issues with the data quality and accuracy of this indicator, especially with regards to
the capture of all deaths occurring in children under one year in the health facilities need to be recognised.
The consistently high immunization rate and the drop in vaccine preventable diseases like measles can
result in the low Institutional infant mortality that we are seeing. The county has not recorded any deaths
due to measles since 2003
86

Basket of critical equipment functioning in hospitals
2012 Performance: No data
2012 Target: 80%
Source: No data
Outcome: -1
2010 2011 2012
- - -
Result: No information available to MOH
% tracer drugs availability in hospitals
2012 Performance: 85.7%
2011 Target: 90%
Source: Chief Pharmacist
Outcome: +1
2010 2011 2012
86.4% 94.1% 85.7%
% of hospitals assessed for quality assurance and control
2012 Performance: No data
2012 Target: 90%
Source: No data
Outcome: -1
2010 2011 2012
- - -
Result: No information available to MOH
Institutional under-five mortality rate
2012 Performance: 4.0
2012 Target: No target specified
Source: GHS
Outcome: +1
2008 2009 2010 2011 2012
9.0 10.2 9.7 9.7 4.0
Results: Institutional under five mortality has improved significantly in 2012 with more than 50% reduction
overall. All the districts experienced reduction with Upper West having a reduction of 91%.
Discussion: The non-inclusion of Northern and Central Region in the analysis shows that there are data
quality issues. Although there are concerns about the completeness and accuracy of the mortality data, the
observed drop in the institutional under-five mortality rate may be a reflection of the improvement in
access to care that ensures that children are treated promptly. Health Insurance and community
management of malaria, diarrhoea and acute respiration are the main interventions that have improved
access to care in the districts. The introduction of community management of malaria, diarrhoea and acute
respiratory infection is addressing the major causes of deaths in children under five years. This may also be
contributing to this decline. The community interventions for the three diseases are being implemented
nationwide, but in Upper West Region, Northern Region and Upper East Region almost all the districts are
now implementing the community based treatment for malaria, diarrhoea and acute respiratory infection.
87

Figure 22: Under-five deaths by region 2008-2012. Not adjusted for population sizes. CR and NR excluded because of unreliable
data.
Institutional MMR
2012 Performance:
2012 Target: 160
Source: GHS
Outcome: +1
2006 2007 2008 2009 2010 2011 2012
GHS (incl. TBAs) 187 230 200 170 164 174 154
GHS (incl. TBAs) + THs† - - 190 211 193
† MMR at Teaching Hospitals is based on number of supervised deliveries as proxy of live-births
Results: Institutional Maternal Mortality dropped significantly from 2011 to 2012. At Komfo-Anokye
Teaching Hospital the iMMR continued to be high with 1,252 deaths per 100,000 deliveries. Korle-Bu has
reduced iMMR from 1,133 in 2011 to 841 in 2012.
Discussion: Korle-Bu Teaching hospital has reduced institutional maternal mortality ratio significantly from
1,133 maternal deaths per 100,000 deliveries in 2012 to 841 in 2012. During the year, Korle-Bu initiated
and strengthened several interventions to improve maternal services, including education of hospital staff
and general public on unsafe abortion, renovation of maternity OPD, addressing staff attitude, training in
basic life support and establishment of blood bank at maternity lab. These initiatives appear to have had a
positive impact on maternal mortality in the hospital.
During 2012, Komfo-Anokye Teaching Hospital established a blood bank at the maternity area and all
maternal deaths were audited. Despite these initiatives to improve maternal services, the hospital
continued to have a high maternal mortality ratio of 1,252 maternal deaths per 100,000 deliveries in 2012
compared to 1,199 of the previous year. In average, every second day a pregnant woman dies at KATH. The
top-causes of maternal death at KATH were conditions related to high blood pressure, i.e. eclampsia and
pre-eclampsia. Post partum haemorrhage was the second highest cause and abortion was third.
The continuous high maternal mortality ratio at the teaching hospitals calls for stronger and more
structured collaboration between the teaching hospitals and the referring hospitals and clinics
Recent investigations by Foods and Drugs Authority have revealed poor quality of the investigated
medicines, which are potentially life saving in case of maternal emergencies. Almost 70% of all 279 samples
of Oxytocin failed the quality test. Sub-standard medicines are likely to have a negative impact on maternal
88

mortality ratio at all levels of the health care system. The ministry finds it highly concerning that women die
because of substandard medicines and critical for the sector to analyse and address causes of the problem.
Step 2: Grouping of indicators and milestones
Health Objective 1: Bridge equity gaps in health care and nutition services and ensure sustainable financing arrangements that
protect the poor
1 % children 0-6 months exclusive breastfed -1
2 Equity: Poverty (U5MR) -1
3 Equity: Geography - Services (supervised deliveries) +1
4 Equity: Geography - Resources (nurse:population) +1
5 Equity: NHIS - Gender (Female/Male cardholder ratio) 0
6 Equity: NHIS - Poverty (Ratio lowest wealth quintile to whole population who wholds NHIS cards) -1
7 Outpatients attendance per capita (OPD) +1
8 % population living within 8 km of health infrastructure n/a
9 Doctor: population ratio 0
10 Nurse: population ratio 0
Milestone: Review of CHPS undertaken with stakeholders and re-zoning of CHPS completed 0
Total Health Objective 1 0
Health Objective 2: Strengthen governance and improve efficiency and effectiveness in the health system
1 % total MTEF allocation on health +1
2 % non-wage GOG recurrent budget allocated to district level and below -1
3 Per capita expenditure on health +1
4 Budget execution rate (Item 3 as proxy) +1
5 % of annual budget allocations to items 2 and 3 (GOG and SBS) disbursed to BMCs by end of year -1
6 % of population with valid NHIS membership card 0
7 Proportion of claims settled within 12 weeks -1
8 % IGF from NHIS -1
Milestone: System for performance contracting introduced +1
Total Health Objective 2 0
Health Objective 3: Improve access to quality maternal, neonatal, child and adolescent health services
1 Maternal Mortality Ratio (MMR) per 100,000 live births n/a
2 Total Fertility Rate -1
3 Contraceptive Prevalence Rate +1
4 % of pregnant women attending at least 4 antenatal visits 0
5 Infant Mortality Rate (IMR) per 1,000 live births -1
6 Under 5 Mortality Rate (U5MR) per 1,000 live births 0
7 % deliveries attended by a trained health worker +1
8 Under 5 prevalence of low weight for age 0
Milestone: Pneumocococcal and rotavirus vaccines successfully introduced +1
Total Health Objective 3 +1
Health Objective 4: Intensify and control of communicable and non-communicable diseases and promote a health lifestyle
1 HIV prevalence among pregnant women 15-24 years -1
2 % of U5s sleeping under ITN +1
3 % of children fully immunized by age one - Penta 3 0
4 HIV+ clients ARV treatment +1
5 Incidence of Guinea Worm +1
6 % households with improved sanitary facilities +1
7 % households with access to improved source of drinking water -1
8 Obesity in population (women aged 15-49 years) +1
9 TB treatment success rate 0
Milestone: Healthy lifestyle integrated into basic school and teacher training curricula
89

Milestone: 50% reduction in Yaws prevalence achieved
Total Health Objective 4 +3
Health Objective 5: Strengthen institutional care, including health service delivery
1 Equity index: Ratio of mental health nurses to patient population 0
2 Number of community psychiatric nurses trained and deployed 0
3 % tracer psychotropic drug availability in hospitals 0
4 Institutional infant mortality rate +1
5 Basket equipment functioning in hospitals -1
6 % tracer drugs availability in hospitals -1
7 % of hospitals assessed for quality assurance and control -1
8 Institutional under-five mortality rate +1
9 Institutional MMR +1
Milestone: Functional ambulance stations in 60% of district capitals +1
Total Health Objective 5 +1
Table 32: Health Objective group scores
Step 3: Sector score
The outcome of the holistic assessment based on the HSMTDP indicators and cluster in 2012 is positive
with a score of +3, which is interpreted as a highly performing sector.
Health Objective 1 0
Health Objective 2 0
Health Objective 3 +1
Health Objective 4 +1
Health Objective 5 +1
Sector score +3
Table 33: Holistic Assessment Tool Sector score
90

Annex 4: Indicator definitions and calculations
Indicator Numerator Denominator Source Calculation 2012 (4%)
% children 0-6 months exclusive
breastfed
Equity Index: Poverty (Richest/Poorest
U5 mortality rate)
Equity Index: Geography (supervised
deliveries)
Equity Index: Geography
(nurses:population)
Number of children 0-6 months exclusively
breastfed
U5MR among children of lowest wealth quintile
Proportion of deliveries attended by a trained
health worker in best performing region
Number of nurses by total population in best
performing region
Number of children 0-6 surveyed MICS 2011 Rate stated in report
U5MR among children of highest wealth
quintile
Proportion of deliveries attended by a
trained health worker in poorest performing
region
Number of nurses by total population in
poorest performing region
MICS 2011
GHS
HR – Ministry of Health.
Population data from GHS
106 per 1,000/52 per
1,000
Equity Index: Gender (NHIS registration) Number of women 15-49 being active NHIS
Number of men 15-49 being active NHIS MICS 2011
members
members
Equity Index: Poverty (NHIS registration) Number of women 15-49 being active NHIS
Number of women 15-49 being active NHIS MICS 2011
members in lowest wealth quintile
members in the whole population
Outpatient attendance per capita Number of OPD encounters (GHS, CHAG, Teaching Total population provided by GSS
GHS
Hospitals)
% population living within 8 km of
health infrastructure
Doctor:Population ratio Number of doctors registered at IPPD/MoH Total population provided by GSS HR – MoH. Population data
from GSS
Nurse:Population ratio Number of nurses registered at IPPD/MoH Total population provided by GSS HR – MoH. Population data
from GSS
% total MTEF on Health MTEF allocated to health. Sources: GOG + Donor + Total MTEF for GOG
GHS
IGF + HIPC + NHIS
% non-wage GOG recurrent budget APOW allocation to districts Total allocation GHS
allocated to district level and below
N/A
Per Capita Expenditure on Health
Budget Execution Rate of Item 3
Total expenditure on health in Ghana Cedis * Cedit
to USD exchange rate (Bank of Ghana per
31.12.2011)
Item 3 disbursements from GOG + SBS + HF + HIPC
+ NHIS (subsidies + distress + MoH allocation)
Total population provided by GHS - GHS
POW item 3 budget (same sources).
GHS
GHS
% of annual budget allocations to items
2 and 3 disbursed by end of December
Disbursements for item 2 and 3 by end of
December. Sources: GOG and SBS.
Total budget allocations for item 2 and 3
(same sources)
GHS
% Population with valid NHIS
Membership
Proportion of claims settled within 4
weeks
Total number of active NHIS members (valid NHIS
card holders)
Number of claims reimbursed (disbursed from
DMHIS accounts) within 4 weeks of reception by
Total population provided by GHS
Proportion provided by NHIA
Total number of claims received by DMHIS No information -
91

DMHIS
% IGF from NHIS IGF from NHIS Total IGF No information -
Maternal Mortality Ratio (MMR) per
No information -
100,000 livebirths
Total Fertility Rate MICS 2011 Rate stated in report
Contraceptive Prevalence Rate MICS 2011 Rate stated in report
% of pregnant women attending at least
4 antenatal visits
Number of pregnant women with 4 or more ANC
visits
Expected number of pregnancies
GHS
(based on 4% pop.)
Infant Mortality Rate (IMR) per 1,000
livebirths
Under 5 Mortality Rate (U5MR) per
1,000 livebirths
% deliveries attended by a trained
health worker
Number of deliveries supervised by trained health
worker
Number of expected deliveries
MICS 2011
MICS 2011
GHS and Teaching Hospitals
(based on 3% pop.)
Rate stated in report
Rate stated in report
(based on 4% pop.)
(based on 3% pop.)
Under 5 prevalence of low weight for Children under 5 years Weight for age % below -2
MICS 2011
Rate stated in report
age
sd
HIV Prevalence among pregnant women n/a n/a National AIDS Control
n/a
15-24 years
Programme. Sentinel
Surveillance report.
% U5s sleeping under ITNs Number of surveyed U5s sleeping under ITN the Number of surveyed children MICS 2011 Rate stated in report
previous night
% Children receiving Penta 3 Number of children who received Penta 3 Expected number of children 0-12 months GHS
(based on 4% pop.)
(based on 3% pop.)
HIV positive individuals receiving ART Number of HIV positive individuals receiving ART n/a NACP n/a
Incidence of Guinea Worm Number of new cases n/a GHS n/a
% households with improved sanitary
MICS 2011
Rate stated in report
facilities (NOT SHARED)
% households with access to improved
MICS 2011
Rate stated in report
source of drinking water
Obesity in population (women aged 15-
49 years)
No information
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TB success rate
Psychiatric patient treatment and
rehabilitation rate
Equity index: Ratio of mental health
nurses to patient population
Number of community psychiatric nurses
trained and deployed
% tracer psychotropic drug availability in
hospitals
Number of patients proven to be cured of TB after
completion of therapy
Number of patient commencing anti-TB
therapy
National TB Programme
annual report
Rate provided by NTP
Number of OPD patients at psychiatric facilities Number of patients discharged from mental Mental Health Authority
facilities
Number of mental health nurses
Number of OPD patients at psychiatric Mental Health Authority
facilities
Number of community psychiatric nurses trained Mental Health Authority n/a
Chief pharmacist
Chief pharmacist
provided the rate
Institutional infant mortality rate Number of institutional deaths among children 0- Number of institutional live births
GHS
11 months
Basket equipment functioning in
No information
hospitals
% tracer drugs availability in hospitals Chief pharmacist Chief pharmacist
provided the rate
% of hospitals assessed for quality
No information
assurance and control
Institutional under-five mortality rate Number of institutional deaths among children 0-
59 months
Number of institutional live births
Institutional MMR
Number of maternal deaths at government and
CHAG institutions, including deaths recorded by
GHS supervised TBAs
Number of live births in government and
CHAG institutions, including deliveries by
GHS supervised TBAs
GHS 1,188/615,388
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Annex 5: Analysis framework for POW 2012 implementation
HO1: Bridging equity gaps in access to health care and nutrition services, and ensure sustainable financing
arrangements that protect the poor
Strategies Priority actions Activities Expected Output s Status of implementation and comments
1.1 Strengthen district
health system with a
particular emphasis on
primary health care
1.1.1 Improve coverage
of PHC services at subdistrict
level through
community health
systems
Continue to expand CHPS
coverage to achieve 500 new
functional zones
500 new CHPS zones functional 1. Achieved 516 new functional CHPS zones
2. Training and deployment of newly qualified
Community Health Nurses has been carried out.
3. Monitoring and support visits carried out
specifically by public heath teams at regional and
district levels
• Difficulty embedding CHOs in community.
• Relate to Costing Study of 8 staff per CHPS
in average.
• Inadequate equipment.
Improve local government
support for CHPS through
providing orientation to
regional and local
government staff on the
revised CHPS policy and
strategy
Staff in 10 regional and 170
district local government
offices oriented on revised
CHPS policy and strategy to
support implementation
Construction of increased
number of CHPS compounds
initiated using MMDA funds
Activities carried out not available to PHD at HQ.
Process initiated but not completed due to lack of
funds.
Very important that must be coordinated and done.
1.2 Develop sustainable
financing strategies that
protect the poor and
1.2.1 Develop
comprehensive health
financing framework
Develop a comprehensive
Health Care Financing
Strategy
A comprehensive health
financing strategy developed
and disseminated
This activity was not achieved
94

vulnerable
Update National Health
Accounts and initiate
institutionalisation
National Health Accounts II
completed
National health accounts updated. Draft report
presented to the Ministry of Health. Will be discussed
at health summit.
Arrangements are made to incorporate data
collection tools into already existing surveys like GLSS
and DHS.
Piloting of capitation
payment in Ashanti region
Pilot project in progress
Capitation piloted. Mid-term evaluation conducted
and preliminary findings presented and discussed
with stakeholders. Draft report will again be discussed
at health summit.
The ministry should provide leadership in monitoring
the roll-out to other regions.
1.2.1 Develop
comprehensive health
financing framework
Pilot project on identification
of the poor using the
common targeting
instrument
Improved mechanisms for
identification of very poor for
NHIS coverage
Some categories of persons with disability to be
covered under the exemption policy
Mental health patients to be covered under the
exemption policy for services within the benefits
package
Common targeting mechanism developed and being
piloted in 90 districts
1.3 Increase availability and
efficiency of human
resource
1.3.1 Revise and
implement the human
resource strategy
Develop and implement
Human resource deployment
plan.
New HRH deployment plan
available and implementation
started
Scaling up human resource information system by the
end of first quarter. This will form the basis for the
HRH deployment plan.
A tool was developed to guide individual institutional
staffing norms.
A draft HR policy was circulated.
95

HO2: Strengthen Governance and improve the efficiency and effectiveness of the health system
Strategies Priority action Activity Expected Output Status of implementation and comments
2.1 Develop capacity to
enhance the performance of
the National Health system
2.1.1 Leadership and
management capacity
development at all levels
Train and equip DHMTs and
sub-district teams in
managerial and leadership
skills (LDP) in 50 deprived
districts to improve quality
service delivery
50 deprived districts trained
and equipped
150 participants from 44 districts in UER, UWR and NR
were trained.
MOH should strengthen the DHMTs and SDHTs
through technical and managerial capacity building.
Introduce a structured inservice
training for the senior
personnel of the MOH and
Agencies in evidence-based
policy making and
programme monitoring
Training programme developed
and senior officers trained in
evidenced-based policy and
programme monitoring
This activity could not be undertaken. This is the
second year running.
MOH PPME responsible in POW.
Use technical assistance to
strengthen capacity in
priority areas, including M&E
and Public Financial
Management (PFM)
Improved capacities in priority
areas
Two long-term advisors embedded in Ministry of
Health PPME, M&E and PBU.
2.1.2 Performance
Contracting
Implement performance
contracting for all agencies
and training institutions
Performance contract signed
with all agencies and training
institutions and implemented
Performance contract was signed with the Ghana
health Service and the Three Teaching hospitals.
Performance contracts will be signed with all agencies
in the coming year.
2.1.3 Enforce adherence
to sound PFM practices
Prepare agencies in readiness
for decentralization
(composite budgeting etc)
and for full implementation
of PBB
All agencies familiar with
composite budgeting
PBB being implemented
A three-member committee was established to work
towards engaging stakeholders to discuss options and
implication. Committee has been working in-house
and intends to start serious engagement in 2013.
No clear guidelines on how the health sector should
be involved in composite budgeting at district level.
96

Some district assemblies organized meetings to
integrate health into the composite budget.
With the evolving decentralization the role of national
level in implementing PBB at district level is unclear.
Flow of funds to districts not clear. In 2012, some
funds flowed through GHS, some through district
treasuries.
2.2 Strengthen the
regulatory framework
2.2.1 Support the
implementation of the
revised health sector
regulation
Development of Legislative
instruments (LI) for Acts that
were passed in 2011
LIs developed for the health
Acts passed in 2011
LIs for Health Institutions and facilities Act (Act 829),
Specialist Health Training and Plant medicine
Research Act (Act 833), Mental Health Act (Act 846),
Public Health Insurance Act (Act859) will be
developed in 2013. First two are in the ongoing.
MOH should lead the process and invite a working
group to develop LIs.
Establish Health Facilities
Regulatory Authority,
Ambulance Agency and the
Mental Health Authority
Health Facilities Regulatory
Authority, Ambulance Agency,
and Mental Health Authority
established
Laws for Health Facilities Regulatory Authority, and
Mental Health Authority have been passed.
Development of Legal instruments is underway to
operationalise the laws. The passage of the
ambulance agency is outstanding
2.3 Strengthen intersectoral
collaboration and
public-private partnership
2.3.1 Finalize and
implement private sector
policy
Complete the revision of the
private sector policy and
disseminate same
Revised Private Sector Policy
disseminated and implemented
Private sector policy has been developed. Printing and
disseminating of policy is outstanding.
2.3.2 Promote intersectoral
collaboration
Develop and implement a
plan for strengthening intersectoral
collaboration
Plan developed and being
implemented
Plan developed through the creation of cross sectoral
working group on health with NDPC providing
leadership
97

2.4 Strengthen systems for
improving the evidence base
for policy and operations
research
2.4.1 Develop a national
monitoring and
evaluation framework for
the sector
Finalise and implement the
expanded National M&E
Framework for the sector
National M&E Framework
finalized and implemented
The draft M&E framework was completed and
circulated for comments. It has however been agreed
to align the framework with the forth coming
HSMTDP II.
2.4.3 Strengthen health
information management
Establish the national health
sector data repository
National health sector data
repository established
(including private sector data)
Refurbishment of CHIM for National Data repository
is almost complete
Furnishing and equipment yet to be in place.
Temporary repository set up with online service data
HO3: Improve access to quality maternal, neonatal, child and adolescent services
Strategies Priority action Activity Expected Output Status of implementation and comments
3.1 Reduce the major causes
contributing to maternal
and neonatal deaths
3.1.1 Implement the MAF
Country Action Plan for
improved maternal and
newborn care
Evaluate the free maternal
care policy, disseminate
report, and implement
recommendations
Report available and
recommendations taken on
board
The terms of Reference and contracting of
consultants have been done. Study is expected to be
undertaken in the first quarter of 2013
Implement the MAF and
activities that will address the
gaps identified in the EmONC
assessment
At least 50% of identified
health centres provided with
basic obstetric care equipment
A national assessment report was completed and
incorporated into the MAF action plan. The regional
MAF work and procurement plans plan have been
completed and implementation of some aspects of
the plan have started in all the regions
Provide blood safety
equipment to selected
hospitals
At least 25% of hospital blood
banks nationwide appropriately
equipped and made functional
34 health facilities were provided with cold chain
equipment: deep freezers, chest freezers, plasma
freezers and cold boxes for storage and
transportation of blood and blood products.
Provide emergency obstetric
care equipment to three
remaining regions namely
Upper West, Greater Accra
EmOC equipment provided and
in place for the three regions
These three regions are still outstanding.
98

and Volta
3.2 Reduce the major causes
contributing to child
morbidity and deaths
3.2.1 Implement the Child
Health policy and strategy
Establish the baseline and
introduce pneumococcal,
meningococcal and rotavirus
vaccines including second
dose of measles vaccines
Baseline for new vaccines
established
Three new vaccines and a
second dose of measles
introduced
All activities fully implemented. All vaccines
introduced following the establishment of baseline
incidence
All activities including national launching, public
education/social mobilization, training and actual
vaccination exercise have been carried. AEFI
monitoring also conducted and still ongoing.
Pneumococcal, rotavirus, meningococcal and second
dose of measles vaccinations are now part ongoing
routine EPI programme activities.
Mass meningitis vaccination for age group 1-29 years
was successfully carried out in the three northern
regions MenAfriVac (Coverage 98.1%). Surveillance
including use of PCR for diagnosis is ongoing
Implement community case
management of malaria,
pneumonia and diarrhoea
Community case management
services in a number of districts
Following activities carried out:
1. Training and re-training (over 6,000 trained)
2. procurement and distribution of logistics (bicycles,
toolboxes, wellington boots, raincoats etc
3. Funds released to regions to implement HBC
activities
4. National wide monitoring carried out
A total of 136 districts are implementing community
case management
A total of 136 districts implementing strategy.
Challenges including stock-outs of ACTs, poor
commitment of some HBC and supervisors, and
99

inadequate logistics for all training HBCs.
Home-based treatment is currently not covered
under NHIS. This challenge needs to be sorted out.
Scale up national nutrition
interventions in support of
Scaling Up Nutrition (SUN)
National nutrition interventions
scaled up
Draft policy for scaling up nutrition developed.
Stakeholder consultation is yet to be undertaken for
policy to be finalised. Strategic plan will be developed
after the policy is approved.
3.3 Improve the health of
adolescents and youth
3.3.1 Implement the
Strategic Plan for
adolescent health and
development
Implement standards for
adolescent and youth friendly
health services in Ghana
Standards implemented in a
number of regions / districts
3.4 Improve nutritional
status of women and
children
3.4.1 Develop and
implement National
Nutrition Policy and
Strategy
Disseminate and implement
the National Nutrition Policy
Nutrition policy and strategy
disseminated in 10 regions
Draft policy for scaling up nutrition developed.
Stakeholder consultation is yet to be undertaken for
policy to be finalised. Strategic plan will be developed
after the policy is approved.
HO4: Intensify prevention and control of communicable and non-communicable diseases and promote healthy
lifestyle
Strategies Priority action Activity Expected Output Status of implementation and comments
4.1 Improve upon
prevention, detection and
case management of
communicable diseases
4.1.1 Prevention and
control of communicable
diseases
4.1.2 Prevention,
detection and
management of
HIV/AIDS, TB and malaria
Provide ICT equipment
support to 86 district level
disease surveillance units
Implement national strategic
plan to reduce new HIV cases
86 districts provided with ICT
equipment
New HIV cases reduced
A total of 180 computers and accessories were
procured. Distribution is still ongoing.
Malaria Control programme procured 150 and
International Association of Public Health Institutes
procured 30 with moderns.
Implementation of national strategic plan has started.
Some of the activities conducted include:
1. HIV Counselling and Testing including Know Your
Status campaign
2. PMTCT Services- testing of pregnant women, ARVs
for positive mothers
100

Implement national strategic
plan to increase TB case
detection and cure rate
Implement national strategic
plan to reduce malaria case
fatality among pregnant
women and children
TB case detection and cure rate
increased
Case fatality reduced
3. ART services at all the centres
4. Sentinel surveillance carried out and data being
analysed
Analysis of Sentinel Survey carried out is ongoing.
Results will indicate extent of progress with respect
New HIV infections etc
Implementation of national strategic plan has started.
Some of the activities conducted include:
1. Training of regional and district teams for case
detection among vulnerable groups
2. Capacity building for laboratory staff
3. Active case findings in Accra Metro areas
4. Routine screening of TB among health care
providers established (KATH and KBTH)
5. Regional Referral clinicians identified and managing
referred cases
6. Nutritional assessment, Counselling, and support
with provision of food for TB patients, and PLHIV with
support from FHI 360°
These activities have significantly improved TB
outcomes.
1. Case notification as at June 2012 was 6,500 as
against 8,104 for the Jan-Dec. 2011)
2. Treatment success = 86.2%
Implementation of national strategic plan has started.
Some of the activities conducted include:
1. Procurement and distribution of ATs through
AMFm programme
2. Diagnosis using RDTs and microscopy
3. LLINs Hang Up campaign in all regions
4. IPT-P
5. IRS in Ashanti and Northern Regions
6. Limited larviciding
7. Public education
There has been improvement in most of the process
indicators including IPT-P2 coverage, household
ownership, proportion of confirmed cases etc.
101

Malaria Case Fatality among all malaria cases
admitted was 0.6%.
Surveillance activities including case searches were
intensified; Public education ongoing. No case of
Polio or confirmed Guinea Worm seen.
Eradication status, i.e. zero cases maintained
throughout the year.
1. Conducted one integrated round of community
based Mass Drug Administration (MDA) for LF, Oncho
in 121 districts (Coverage 73.6%)
2. Conducted one integrated round of school and
community based MDA for SCH in 120 districts and
STH in 170 districts (Coverage 80%)
3. Supported TF surveillance activities in 29 districts
where Trachoma transmission has been broken.
4. Constituted and held two Intra Country
Coordinating Committee (ICCC) for the NTD program
6. Finalized 2011 to 2015 NTD Master Plan for Ghana
in collaboration with WHO and share with
stakeholders
1. MDA coverage for (Oncho and LF)=73.6%
2. School based Schisto treatment=80%
3. Prevalence of Oncho in 34 villages surveyed: 0-32%
with 5 of the villages above threshold of 5%.
4. Entomological surveyed showed infections at Sissili
and Mo river basins
50% reduction was not achieved.
Yaws logistics were distributed to all regions
Monitoring visits conducted
Yaws programme launched
Some regions have not completed their simplified
yaws baseline mapping, implementation of MDAs and
monitoring of endemic communities.
Poor contact tracing and treatment means poor yaws
elimination activities.
All districts are below the target of: - Contact: Case
4.1.3 Prevention,
detection and
management of diseases
of epidemic potential and
those targeted for
eradication
Maintain polio free status
and validate eradication of
guinea worm and polio
Increase coverage of
community activities for
Neglected Tropical Diseases
(NTDs) especially
onchocerciasis, lymphatic
filariasis, trachoma, yaws and
leprosy
Guinea worm and polio
eradication status maintained
Increased case detection for
NTDs
50% reduction in yaws
prevalence achieved
102

atio of 10.
4.2 Improve prevention,
detection and management
of non communicable
diseases
4.2.1 Implement
Regenerative health and
nutrition programme
Incorporate healthy lifestyles
into basic school and teacher
training curricula
Healthy lifestyles incorporated
into curricula
Healthy lifestyles incorporated into curricula of 1 st
and 2 nd cycle institutions. Textbooks and practical
guide developed for tertiary institutions and health
training institutions. Training of lecturers of health
training institutions to be conducted soon
Not done, however, a proposal to set up alcohol
support centre at the Accra psychiatric hospital and
Pantang was developed and sent to Chief Director.
Cancer control strategic finalized and submitted to
PPME (GHS) for printing and dissemination. No funds
secured yet for printing.
Document not printed for dissemination due to lack
of funds.
Not done.
1. Guidelines were developed in collaboration with
ICD.
2. Routine screening of patients who attend facilities
is however ongoing.
Information on status of dissemination of guidelines
to be ascertained from ICD;
Routine unstructured screening ongoing.
Support the
alcohol/substance abuse
facility at Pantang
Implement the national
strategy for cancer control
and expand screening
program for hypertension,
diabetes and sickle cell in all
regional hospitals
Improved functioning of the
Pantang alcohol/substance
abuse services
National Strategy for Cancer
Control disseminated in all
regional hospitals
4.2.2 Scale up detection
and management of non
communicable diseases
Screening centres for
hypertension, diabetes and
sickle cell established in all
regional hospitals
HO5: Improve Institutional care, including mental health service delivery
Strategies Priority action Activity Expected Output Status of implementation and comments
5.1 Enforce standards,
guidelines and protocols to
improve the quality of
institutional care
5.1.2 Ensure the
availability of equipment
and infrastructure
required for adherence to
standards, guidelines and
protocols
Complete and commission
the Tarkwa District hospital
Tarkwa District hospital
completed and commissioned
Civil Works for Tarkwa District Hospital is at 98%
completion.
Bidding for Tarkwa Hospital Equipment has
commenced
Bidding Documents for Tarkwa furniture finalized
Construct District hospital at Bekwai District hospital 50% Construction of Bekwai District Hospital commenced
103

Bekwai completed in August 2010 and at 52% Completion
Bidding Documents for Bekwai Equipment and
furniture finalized
Completion of 5 Polyclinics at
Babile/ Brefo, Wechau, Ko,
Lambuse and Han
5 Polyclinics at Babile/ Brefo,
Wechau, Ko, Lambuse and Han
completed and commissioned
Construction of five (5) Polyclinics at Wechau, Babile,
Lambussie,Ko and Hain in the Upper West Region
were completed and commissioned.
Construct 30 CHPS compound
in 6 regions
Completion of Offices for the
Nurses’ and Midwives Council
(NMC) at Okponglo, Accra
30 CHPS compound
constructed in 6 regions and
commissioned
Offices for the NMC at
Okponglo, Accra completed
and commissioned
8 compounds completed. Another 11 compounds are
at various stages of completion.
Project has been reactivated. Contractor has moved
to site. Works ongoing
Expansion of 6 Health
Training Institutions at
Goaso, Nandom, Agogo,
Pantang, Hohoe and Wa
Major Rehabilitation and
upgrading of Tamale
Teaching Hospital (TTH)
including housing programme
for staff
6 Health Training Institutions
expanded
Upgrading and rehabilitation of
TTH completed and
commissioned
75% of housing programme for
staff at Tamale Teaching
Hospital completed
Works at Agogo and Hohoe nearing completion.
Procurement Procedure completed for award of
contract(Goaso, Nandom, Pantang)
First phase of the upgrading and rehabilitation
completed in the following areas(New building, block
E,8theartres, ICU, CSSD, Radiology, A&E Department,
Paediatric block, Mothers block, Medical gas,
underground water storage
75% of Tamale Teaching Hospital housing component
completed
Major Rehabilitation and
upgrading of Phase 3 of
Phase 3 rehabilitation of
Bolgatanga regional hospital
Still at the pre-contract phase. All necessary
documentations have been prepared. Awaiting “no
104

Bolgatanga Regional Hospital about 50% completed objection” from the Saudi’s who are the financiers.
Upgrade Radiotherapy and
Nuclear Medicine project at
KBTH and KATH
Upgrading of radiotherapy and
nuclear medicine project in
KATH and KBTH about 80%
completed
Supply of equipment for KATH and KBTH is expected
in the Country by May, 2013.
Supply and Install Medical
equipment in 8 regional, 3
teaching and 90 District
hospitals nationwide
First phase of medical
equipment supplied and
installed in 8 regional, 3
teaching and 90 district
hospitals nationwide
• MRI/CT installed and are being tested
• Pediatric surgery theatre completed.
• First phase of kitchen completed
• Laundry installations on-going
• Pre-installation works on-going in main
radiology department
• 260 new beds, 70 patient trolleys, 140 BP
apparatus, 35 weighing scales delivered
and distributed across wards in the hospital
CT scan buildings on-going in Ridge, Koforidua,
Sunyani, Cape Coast, Effia-Nkwanta hospitals
Deliveries to PML, Tema General Hospital, Castle
Clinic
Supply and install digital X-
Ray equipment for 23
hospitals
Digital X-Ray equipment for 23
hospitals supplied and installed
5.2 Strengthen the system
capacity for emergency
response
5.2.1 Develop and
strengthen framework for
emergency response
Expand coverage of
ambulance service
80 operational district
ambulance stations established
97 new operational district ambulance stations
established
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5.3 5.3.1 Expand access to
safe blood and blood
products
Develop systems for blood
safety and availability in
health facilities
Systems developed for
effective and efficient blood
services nationwide
A National blood collection plan was developed.
Process for recruitment and training of 10
professional blood donor recruiters initiated with
HRDD of GHS. A training workshop was organised in
November for 10 Blood Donor recruiters by TA
consultants of Safe Blood for Africa foundation under
the CDC/PEPFAR task order
5.4 Ensure commodity
security of health
technologies for medical
products including
traditional medicines
5.4.1 Finalize and
implement guidelines for
health technologies for
medical products
including traditional
medicines
Implement the commodity
security recommendations
Recommendations of
commodity security report
implemented 1
The Technical Working Group completed the
preparation of the 5 Year Master Plan for Supply
Chain Management. Consultations with relevant
stakeholders were completed. A cabinet memo was
signed by the Hon. Minister of Health for onward
submission to cabinet.
The Head of the SCMU has since been appointed. The
RDHS and Regional DDPS Groups have separately
protested against the attempt to centralize
procurement
5.5 Increase access to
mental health services
5.5.2 Establish mental
health services in all
regional hospitals
Develop community mental
health strategy
Community mental health
strategy developed and
disseminated
A community mental health strategy have been
developed and awaiting printing.
1 Director of P&S to provide 2 critical activities
106

Annex 6: Capital Investment Update POW 2012
sn Facility Type Locations Name of Contractor Source of Funding Cost Status Agreement
Town
Region
Date
ONGOING PROJECTS
1 District Hospitals Konongo Odumase Ashanti Euroget de-
Salaga
Northern
Invest/Subcontractors
Tepa
Twifo Praso
Nsawkaw
Adenta/Madina
Ashanti
Central
Brong Ahafo
Greater Accra
2 Regional Hospitals Wa Upper West Euroget de-
Kumasi
Ashanti
Invest/Subcontractors
Euroget de-Invest
Euroget de-Invest
US$339,000,000 All the necessary technical
agreements have been reached
between MOFEP and Barclays Bank
PLC on one hand and Euroget De-
Invest for the take-off of the
project. All the design works and
preliminary site clearing and
hording have been completed on all
the 8 sites
3 Polyclinics Odumase/Kwatire Brong Ahafo VAMED VAMED € 8,650,000.00 Site handed over. Works have
Wamfie
Brong Ahafo
commenced
Nkrankwanta,
Bomaa
Takyimantia
Brong Ahafo
Brong Ahafo
Brong Ahafo
Total
Disbursement
Undisbursed
Balance
15/11/12 $19,040,060.00 $319,959,940
1/11/11 € 2,162,500.00 € 6,487,500.00
4 Upgrading of Teaching Hospitals Tamale Northern SIMED/CONSAR LTD. ORET/Fortis Bank € 39,300,000.00 Sectionally completed including 26/01/2010 € 30,479,362.15 € 8,820,637.85
New Buildings Block E,8 Theatres,
ICU,CSSD, Radiology, A&E
Department, Peadiatric Block,
Mothers Hostel, Medical GAS,
Underground Water Storage etc.
5 Housing Tamale Northern CONSAR LTD. GOG GHC10,834,560.00 Construction works about 75%
GHC7,869,198.70 GHC2,965,361.00
complete
Consultancy
Osei Kuffuor, Sohnes &
Partners
€ 1,077,500.00 11/1/10 € 1,050,562.50 € 26,937.50
6 Supply and Installation of 5MVA,
34.5/11 KV Bulk Power
7 Radiotherapy & Nuclear
Medicine Centre
8 Health Services Rehab Project III Tarkwa Western
Region
9 Rehab and expansion of Bolga
hospital project phase III
10 Health Services Rehab III Blood
Transfusion Centre
11 construction of Trauma and
Acute Care Centre for Korle-Bu
Teaching Hospital
Tamale Northern IESL LTD. GOG $ 1,336,779.23
GHC 874,895.00
Works ongoing and about 75%
complete
13/3/12 $1,013,779.50
GHC750,608.00
$322,999.73
GHC124,286.35
KATH Ashanti OFID US$13,500,000.00 *Contract awarded for Supply of 3/4/09 $414,429.87 $743,559.72
KBTH Greater Accra BADEA equipment. 1st batch of equipment
expected by end of March.
* Designs and estimates of the civil
works have been submitted by
Consultants for review.
$329,129.87
African Development UA17,640,000.00 construction and equipping of 6/4/03
Bank
District Hospitals in Tarkwa and
Bekwai Ashanti Ecowas Fund UA 5,199,718.00 Bekwai would be completed by
April, 2013. The civil works are
completed awaiting the equipment
installations
18/06/2010
Bolgatanga Upper East GOV'T OF SAUDI
SAR 45,000,000.00
ARABIA
Accra, Kumasi and
Nordic Development
€ 8,300,000.00 30/08/2003
Tamale
Fund
Korle Bu Greater Accra SAUDI, OPEC &
BADEA
US$45,000,000.00
The Ministry has got both cabinet
and parliamentary approvals. The
process for the selection of
consultants is currently under way
12 Rural Health Services Project II Nationwide Nationwide OPEC Fund $8,500,000.00 3 District Hospitals and 19 out of 21/12/2005
107

the 21 healthcentres have been
completed and handed over.
Outstanding works currently
ongoing on 3 uncompleted ones.
13 Laundry Project Nationwide Nationwide KBC Bank of Belgium € 2,867,233.00 Parlimentary and Cabinet
Approved, doc. sent to MOFEP for
VFM audit
14 Ongoing Capital Projects Nationwide Nationwide General Capital
Corporation of USA
€ 300,000,000.00 Awaiting Parliamentary Approval
15 Installation of Xray Equipment in
Selected District Hospital
St. Peter's Hosp.
Jacobu
Mankranso Dist.
Hosp.
St. Patrick Hosp.,
Offinso
Atebubu Dist. Hosp.
Dormaa Muni Hosp.
Holy Family Hosp,
Duayaw Nkwanta
Abura Dist. Hosp.
Ajumako Dist. Hosp.
Assin North Muni.
Assembly
Mfantsiman Muni.
Hosp.
St. Martins Hosp.
Enyiresi DH
Weija Hosp
Maamobi Polyclinic
Pantang Psychiatry
St. Joseph Hosp,
Nkwanta
Adidome Hosp
Dodi Papasi Hosp
Ashanti FSC € 4,970,029.83 Equipment supplied and installed in
all beneficiary hospitals
Ashanti
Ashanti
Brong Ahafo
Brong Ahafo
Brong Ahafo
Central
Central
Central
Central
Eastern
Eastern
Greater Accra
Greater Accra
Greater Accra
Volta
Volta
Volta
16 Ambulances NAS KFW € 10,000,000.00 161 Ambulances received and
allocated by NAS
17 Accelerating TB Case Detection
in Ghana
18 Cons. & Equi. Of 597-Bed
University Hosp. In Legon, &
additional works in Ho Regional
& Hohoe Dist. Hosp.
Nationwide Nationwide ORIO Dev. Stage complete, awaiting
cabinet approval. yet to commence
implementation
Accra
Ho
Hohoe
Greater Accra
Volta
Bank Hapoalim B.M.
of Israel
$359,000,000.00 The supply contract has been
signed and sod has been cut for
works to commence in November,
2012. Finalisation of pre-contract
works. This is a turnkey project
which is scheduled to be completed
within 24 months
28/11/11 € 3,712,127.21 € 1,257,902.62
11/8/10 € 9,500,000.00 € 500,000.00
19 Polyclinics Odumase/Kwatire Brong Ahafo VAMED VAMED € 8,650,000.00 Site handed over. Works have
1/11/11 € 2,162,500 € 6,487,500
Wamfie
Brong Ahafo
commenced
Nkrankwanta,
Brong Ahafo
Bomaa
Brong Ahafo
Takyimantia
Brong Ahafo
20 Supply of Equipment Selected Institutions Nationwide OPIC/Deutsche Bank
Of New York
$267,000,000.00 The Project is ongoing, 1/11/11 $193,040,060.00 $73,959,940.00
108

21 1 Regional Hosp., Ridge Greater Accra Bouygues Batiment Int. HSBC Bank & Exim
Bank, USA
22 Construction of 7 District
Hospitals and Intergrated IT
systems
Sekondi
Abetifi
Garu
Kumawu
Fomena
Western
Eastern
Ashanti
Ashanti
NMS Infrastructural
Limited/ Barclays
Bank PLC and
Barclays Bank Ghana
Limited
Dodowa
Greater Accra
Takoradi
Western
US$250,000,000.00
$
175,000,000.00
Cabinet and Parliamentary
approvals have been gotten and
currently Value for Money
Assessment is on-going. The
completion of the VFM assessment
will culminate into the signing of
the supply contract
The VFM assessment and
negotiations have been completed.
The Contract has been signed and
ready for take off upon the final
review of the designs
23 Supply of 200 Ambulance Nationwide Big Sea Stanbic Bank $15,800,000.00 Executive and Parliamentary
Approval Received. Awaiting VFM
24 Maternity and Children's Block KATH Ashanti S. K. Mainoo & Co.
Ltd./Cymain (GH) Ltd.
(Civil Works)
Consultancy Services for
Maternity and Children's Block
GOG GH¢49,921,857.74 Works ongoing. Civil works about
55% complete
19/11/12 $9,287,000.00
GH¢ 8,825,156.54
US$250,000,000.00
AESL (Consultancy) GH¢997,870.68 GH¢345,855.74 GH¢652,014.94
25 Maternity and Children's Facility Tema Greater Accra Proko (GH) Ltd. GOG GHC 1,687,462.48 Works ongoing. Civil works about
45% complete
Consultancy Services for the
Maternity and Children's Facility
Izmatrix Architects &
Dev. Consultants
GH¢153,405.68
26 Upgrading of Old Tafo Hospital Tafo Ashanti Konneh Ent. Ltd. GOG GH¢2,380,700.08 Project reactivated. Works ongoing 2012 GH¢2,380,700.08
27 Construction of OPD at Manhyia Kumasi Ashanti GH¢ 800,000.00 Project has been reactivated for
2012 GH¢ 800,000.00
Hospital
completion
28 Remodelling of existing
structures to classrooms, Staff
Accomodation and kitchen for
CHNTS, Fomena
Consultancy Services for the
Remodelling of Existing
Structures to classrooms, Staff
Accomodation and kitchen for
CHNTS, Fomena
29 Construction of Wards, CSSD a&
Laundry, Theatre, Mortuary and
Block of flats for Akatsi District
Hospital
30 Completion of Classroom, Hostel
and External works at NTC,
Agogo
Construction of 4-Unit Classroom
Block at Agogo
Consultancy Services for the
Construction of 80 capacity
Hoste and 4-Unit Classroom
Block at Agogo
31 Construction of Classroom and
External works at NTC, Cape
coast
Fomena Ashanti M. Barbissotti & Sons
Co. Ltd.
GH¢ 689,627.86 GH¢ 997,834.62
GOG GH¢ 3,082,355.65 Project reactivated. Works ongoing Feb. 2013 GH¢136,865.40 GH¢2,945,490.25
AESL (Consultancy) GH¢ 2,691,110.89
Akatsi Volta Maripoma Ent. Ltd. NHIS GHC 12,356,887.56 Approval received from CTRB,
Award notification given and
contract sign. Awaiting site handing
over
GHC 12,356,887.56
Agogo Ashanti Paafcons GH. Ltd. GOG GHC1,265,860.14 The project which is about 70% was 1/4/05 GH¢424,472.66 GH¢526,000.54
stalled for about 2years has been
reactivated and the contractor has
Gecam Superior Co. Ltd. GH¢ 229,463.18 moved site to complete the works.
GH¢182,927.09 GH¢46,536.09
Sufficient provision has been made
Design Habitat GH¢ 85,423.76 in the 2013 budget to make sure
GH¢32,150.39 GH¢ 52,673.37
the project does not lack funds until
it’s completion
Cape Coast Central Kofi Essuman Ent. Ltd. GOG GH¢3,764,539.92 Contractor on site to complete the
additional external works (Power
supply, sanitary area, cooking area,
retaining wall, etc.) The project is
GH¢2,237,694.98
GH¢1,679,529.43
Consultancy Services for the Bows Consortium Ltd. GH¢165,443.65 GH¢165443.65
109

Construction of Classroom and
External works at NTC, Cape
coast
about 80% complete
32 Rehabilitation of Offices for
Ghana National Drugs
Programme and Procurement
Unit
33 Rehabilitation of Offices and
Workshop for Tema Mechanical
Workshop
34 Construction of Office complex
for St John Ambulance and
National Ambulance Service
35 Construction of New facilities in
13 Health Training Institutions
Accra Greater Accra Philiyanco Co. Ltd. GOG GHC772,113.11 Work is ongoing and progressing
steadily. The roof beams have been
cast and waiting for the concrete to
cure before erecting the roof
trusses to receive the roofing. This
project was initiated after the GNDP
office was gutted by fire in 2010.
The project is about 48% complete
Tema Greater Accra Philiyanco Co. Ltd. GOG GHC1,356,773.62 Contractor has already moved to
site and the works are progressing
steadily
Accra Greater Accra Prime Star Ltd. GOG GHC1,660,639.94 Work is ongoing and progressing
steadily about 95% complete. The
Ministry’s inability to honour claims
or certificates has caused so much
delay in the completion of the
project. The last certificate for
instance was received in
September, 2012 but is yet to be
honoured.
Goaso MTS -
Classroom Block Lot
1A
Goaso MTS -Hostel
Block Lot 1B
Pantang HATS-
Classroom Block Lot
2A
Pantang HATS-Hostel
Block Lot 2B
Kokofu HATS
Classroom Block Lot
3
Hohoe MTS
Classroom Block Lot
4
Nandom MTS
Classroom Block Lot
5
Asankragua HATS
Classroom Block Lot
6
Wa HATS Classroom
Block Lot 7A
Wa HATS Hostel
Block Lot 7B
Tarkwa MTS
Classroom Block Lot
8
Korle Bu POCCN
Classroom Block Lot
9
Brong-Ahafo
Akate Farms & Trading
Co. Ltd .
GOG/NHIS GH¢ 2,107,782.27 a Approval received from CTRB.
Contracted Awarded and signed.
FB Telmax Investment
GH¢ 2,788,305.41
Ltd
Greater Accra Asaric Co. Ltd GH¢1,989,757.62
Hardwick Ltd. GH¢ 2,918,227.74
Ashanti Survivor Ltd. GH¢ 2379907.24
Volta Alnort Co. Ltd GH¢ 2328316.05
Upper West K. A. Estates GH¢ 2,137,527.06
Western Akalifa Ltd GH¢ 2,385,463.06
Upper West Shamrock Ent. GH¢ 2,143,180.43
Ahms world Ltd GH¢ 2,881,590.17
Western Malsons Ltd GH¢ 2,400,826.99
Greater Accra Philiyanco Ltd GH¢ 3,489,298.63
GH¢502,494.10
GH¢407,032.09
GHC1,544,529.65
GH¢269,619.01
110

Dua Yaw Nkwanta
PATS Classroom
Block Lot 10
Brong-Ahafo Samaward GH Ltd GH¢ 2,306,995.30
Nadowli MTS
Upper West Yunrams Ltd. GH¢ 2,450,105.29
Classroom Block Lot
11
Nadowli MTS Hostel
High Trust GH. Ltd. GH¢ 2,355,230.96
Block Lot 12
Sampa HATS
Brong-Ahafo Barnes-Say Ltd. GH¢ 2,233,449.13
Classroom Block Lot
13
Kete-Krachi MTS Volta Bawahuud Ltd. GH¢ 2,475,837.00
Classroom Block Lot
14
36 Completion of Shama Polyclinic Shama Western Bremu Const. Ltd. GOG GH¢ 2,332,110.4 GH¢ 267,861.41 GH¢ 2,064,248.99
Consultancy Service for the
Cost Plan Consult GH¢ 438,201.75 Nil GH¢438,201.75
Completion of Shama Polyclinic
37 Completion of Reconstructive KBTH Accra F. F. Const. Ltd. GOG GH¢ 831,251.08 GH¢ 823,255.04
Plastic Surgery and Burns Centre
Consultancy Service for the
Bows Consultium Ltd. GH¢ 83,125.10
Completion of Reconstructive
Plastic Surgery and Burns Centre
38 Refurbisgment/Upgrading of the
Kaneshie Polyclinic to District
Hospital
Accra Greater Accra Sambros Complex Ltd. GOG
Consultancy Service for the
Refurbisgment/Upgrading of the
Kaneshie Polyclinic to District
Hospital
39 Completion of office complex for
Nurses and Midwives council
Consultancy Services for the
Completion of office complex for
Nurses and Midwives council
40 Water Improvement programme Various Upper East,
Northern &
Brong Ahafo
41 Refurbisgment/Upgrading of the
Kaneshie Polyclinic to District
Hospital
Consultancy Service for the
Refurbisgment/Upgrading of the
Kaneshie Polyclinic to District
Hospital
42 Rehabilitation of Bechem
Hospital
43 Construction of 59 CHPS
Compounds and Equipping of 68
44 Renovation of the Centre for
Health Information Management
Optimum Shelter
Partnership
Okponglo Greater Accra GOG/IGF GH¢1,319,137.09
GH¢ 70,230.15
In the process of putting together
all the necessary documentation
leading to the reactivation of the
project. The Contractor is however,
at the site doing some minor works
awaiting the Consultants’ directives.
The project is about 40% complete
GHC 531,637.09
GH¢ 55,165.50
Accra Greater Accra Sambros Complex Ltd. GOG
Sambix Ltd. GOG GHC1,898,600.00 The Contractor has already moved
to the various sites since June, 2012
and the works are progressing
steadily
Optimum Shelter
Partnership
Bechem Brong Ahafo SAGES CONSULT GHANA GOG GHC 210,227.13
LIMITED
North West Consortium
Various Upper West JAICA
Korle-Bu Sch. Of
Hygiene
Greater Accra Maruks Contract Work GOG GH¢ 97,753.00 Work is ongoing and progressing
steadily about 75% complete.
GHC 569,580.00
GH¢ 60,958.53
111

Offices at Korle-Bu School of
Hygiene
GHS PROJECTS
1 Proposed Construction of
Catering & Support Services and
External Works at GHS Learning
Centre at Pantang Lot 1C
Pantang Greater Accra Malsons Ltd. GOG GH¢1,972,984.97 Work in progress and about 89%
complete
GH¢ 2,553,427.68
Proposed Construction of
Conference Facility at GHS
Learning Centre at Pantang Lot
1A
Rich Bebe Agencies Ltd. GOG GH¢2,873,706.57 GH¢ 3,118,489.55
Consultancy Services for the
Proposed Construction of GHS
Learning Centre at Pantang
FAB Arch Consult GOG GH¢631,564.92 GH¢ 634,118.98
2 Completion of Outpatient
Department at Pantang
Psychiatric Hospital, Accra
Pantang Greater Accra Micador Const. Wks.
Ltd.
GOG GH¢ 397,273.69 Work in progress and about 97%
complete
2011 GH¢ 397,273.69
3 Refurbishment of Children’s
Block for Korle-Bu Teaching
Hospital, Accra
KBTH Greater Accra Rich Bebe Agencies Ltd. GOG/IGF GH¢ 3,499,999.85 Contractor has moved to the sites
and waiting for the payment of
Aadvance Mobilization
2012
4 Remodeling of 4-Storey Office
Block for Disease Control Unit
KBTH Greater Accra Rich Bebe Agencies Ltd. GOG GH¢ 2,428,322.39 Work in progress and about 75%
complete
1/3/12 GH¢ 1,652,432.99
PIPELINE PROJECTS
1 Regional Hospitals Wa Upper West China Shanghai $200,000,000.00 Awaiting Cabinet and Parliamentary
Approval
2 Five Healthcare Projects (Cape
Coast Hospital, KATH, KBTH,
10New District Hosp & Supply of
Equipt
SYMEX Healthcare
Corporation/
Infrastructure
Logistics
$590,000,000 Awaiting Cabinet Approval. The
project has been reprioritised to
construct 2 regional hospitals and 5
District Hospitals.
3 Construction of staff housing for
Tema General Hospital
Tema Greater Accra Canadian
Commercial
Corperation
Proposal and terms sheet have
been forwarded to MoFEP for
review and advise
112

4 Boosting Reproduction and Child
Health in 31New Districts &
Municipalities
ORIO
Development phase yet to
commence
5 Ambulances Exim Bank (NMEIEC) $ 530,680,000.00 Yet to seek Parliamentary Approval
District Hospitals
Polyclinics
Accomodation Units
6 District Hospital Akontombra Western ORIO Development stage-feasibility
studycompleted, awaiting
Polyclinics Bogoso Western
implementation stage
Mpoho
Western
Ellubo
Western
Nsuaem
Western
Wassa Dunkwa
Western
7 Const. Of 10DH, Supply of 350
Ambulance,Medical Devices and
setting up of National Training
Centre
International
Commercial Bank,
China/NORINCO
$432,000,000.00 Yet to seek Cabinet Approval
8 411 Bed Trauma Hospital in
Takoradi & Additional works on
Effia Nkwanta Hospital and 3
District Hospitals
Deutsche Bank,
London
$380,000,000.00 Draft loan agreement received from
funding agency, yet to proceed to
cabinet
9 Development of Additional
Services and Infrastructure for
the Tamale Teaching Hospital
Tamale Northern Canadian
Commercial
Corperation
Awaiting technical briefing on way
forward from CCC. Discussions
on MOU which is yet to be signed
10 District Hospitals International Finance
& Development
Corporation
$126,000,000.00 Loan agreement under review by
MOFEP
11 Supply of 100 Ambulance Nationwide Turkish Government $7,000,000.00 Evaluation for selection of supplier
12 150 Bed District Hosp. At
Kumawu
Kumawu Ashanti Belstar Group $100,000,000 Proposal Submitted to MOH
13 District Hospitals TECHNOFAB Eng. Ltd $100,000,000 Signed MOU, Financial Terms
Submitted to MOFEP for Review
113

14 600 Bed Teaching Hosp PP-Pettersen &
Partners Ltd
$825,000,000 Signed MOU, yet to submit firm
offer
15 Construction of 4 District
Hospitals, 4 Polyclinics with 120
Units of Staff Accommodation
Univeral Hospital
Group Limited,
Ghana
$135,000,000.00 Signed MOU
16 Construction of 10 District
Hospitals
Sonomed Limited,
Israel
$350,000,000.00 Signed MOU
17 Construction of Affordable
Housing for Doctors, Nurses and
other Medical
BATTIS CO. LTD
Request sent to MOFEP for annual
budget provision of GHC 1.5m as
repayment
18 Urology Centre at Korle Bu
Teaching Hospital with PPP
Accra Greater Accra VAMED Proposal has been sent to PPP Desk
at MOFEP for way forward
19 Construction of 12No. 75-100
bed Hospital
Various Sites
Nationwide
Anyinam,Tumu,
Buipe,Nyinahin,
Wassa
Akropong,Dam
bai
Alliance International
Partners
$260,100,000 Cabinet memo sent to Mofep for
onward transmission to Cabinet.
20 Supply of 400 Ambulance Nationwide Tanink Group $31,500,000.00 Executive Approval Received
awiating Parliamentary approval
114

Annex 7: Procurement plan
Draft 2012 Procurement Plan: MOH HQTS
Budget Period: January - December,2012
Ref
No.
Procurement Package (Description)
Estimated Need
Gh¢
Source of Funding
Procurement
Method
Start Date Expected Contract
Completion Date
1 Procurement of Pharmaceuticals 12,000,000.00 Drug Revolving Fund ICB 30/11/2011 7/08/2012
2a Procurement of Non Drug Medical Consumables 6,000,000.00 CMS Non-Drugs A/C RT 23/05/2011 21/03/2012
2b Procurement of Non Drug Medical Consumables 6,00,000.00 CMS Non-Drugs A/C ICB 23/01/2012 15/09/2012
3a Expanded Programme on Immunization (EPI) Vaccines 18,000,000.00 GAVI UNICEF 29/10/2011 17/07/2012
3b Expanded Programme on Immunization (EPI) Vaccines 3,537,000.00 GOG UNICEF 23/01/2012 20/04/2012
4a Procurement of Contraceptives 3,250,000.00 GOG ICB 01/02/2012 31/07/2012
4b Procurement of Contraceptives 4,478,000.00 GOG ICB 26/12/2011 31/07/2012
4c Procurement of Contraceptives 1,400,000.00 WAHO ICB/UNFPA 26/12/2011 27/04/2012
4d Procurement of Contraceptives 9,943,000.00 USAID USAID 06/02/2012 26/09/2012
4e Procurement of Contraceptives 2,445,000.00 UNFPA UNFPA 23/01/2012 26/08/2012
5 Procurement Psychotropics Drugs 4,043,008.00 GOG ICB 10/02/2012 27/07/2012
6a Procurement of HIV/AIDS /Antiretroviral Drugs 2,400,000.00 GOG ICB 10/02/2012 27/07/2012
6b Procurement of HIV/AIDS /Antiretroviral Drugs 22,350,874.00 Global Fund ICB 10/02/2012 27/07/2012
7 Procurement of Opportunistic Infection (Ois)
175,377.20 Global Fund
Medicines
8 Procurement of Rapid Diagnostic Test Kits 4,219,283.04 Global Fund ICB 10/02/2012 30/08/2012
9 Procurement of other Diagnostic products, supplies
5,982,242.39 Global Fund ICB 10/02/2012 30/08/2012
and equipment
10 Procurement of Insecticde Treated Nets (ITNs) (Global 150,470.00 GOG ICB 10/02/2012 27/07/2012
Fund)
11 Procurement of Artemisinin Combination Therapy 23,409,065.30 Global Fund ICB 8/03/2012 28/09/2012
Tablets
12 Procurement of other Antimalarial Medicines 1,376,234.10 Global Fund ICB 8/03/2012 28/09/2012
13 Procurement of Rapid Diagnostic Test Kits 8,066,255.89 Global Fund ICB 10/02/2012 30/08/2012
14 Procuremt of Anti-Rabies Vaccines 500,000.00 SBS ICB/NCB 27/01/2012 21/06/2012
15 Procurement of Tatanus Immuniglobulin 600,000.00 SBS ICB/NCB 02/02/2012 25/07/2012
16 Procurement of Anti-Snake Venom Serum 1,000,000.00 SBS ICB 27/01/2012 21/06/2012
17 Procurement of CSM Vaccines & Drugs 1,000,000.00 SBS ICB 27/01/2012 21/06/2012
18 Procurement of Hospital equipment,Beds &other
1,800,000.00 GOG ICB 8/03/2012 28/09/2012
Accessories
19a Printing Material and other, Publications 790,000.00 GoG NCT 27/01/2012 28/12/2012
19b Printing of Medical Forms, Publications
(CHR,Imm.Cards,etc)
2,400,000.00 Gap RT 19/12/2011 29/06/2012
115

20 Procurement of Office Equipment & Stationery for the 1,000,000.00 Gap NCT 27/01/2012 28/12/2012
Various Directorate
21 Procurement of Medical Consumables/Office
1,120,000.00 GOG NCT 16/03/2012 22
Sanitation Items for NAS
22 Supply of Logistics for Cholera 79,000.00 GOG RT 27/01/2012 21/062012
23 Extention of Contracts: Clinical Laboratory
16,765,302.40 GOG Contract 12/07/2011 21/06/2012
Strengthening Project. Phases 1 and 2
Extension
24 Procurement of 1000 Saloon Cars Under MOH, SVHPS 37,852,500.00 Car Revolving Fund ICB 23/06/2011 25/05/2012
(Health Workers)
25 Procurement of Hand Sanitizer 2,640,000.00 Gap RT 10/11/2011 24/05/2012
26 Procurement of Dental Equipment 114,400.00 Gap NCT 26/12/2011 15/06/2012
27 Procurement of Supplies and Printing of forms for
400,000.00 SBS RT 28/11/2011 25/05/2012
Buruli Ulcer Programme
28 Capital Investment Projects 717,347,070.00 GOG/SBS/EM GRANTS/MIXED
NCT 27/01/2012 28/12/2012
GRANTS/IGF/SIP/NHIL
Grand Total 921,534,082.32
116

117