2012 Holistic Assessment of Health Sector POW - Ministry of Health

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.
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