HEALTH AGENDA

Outlook for 2010

In pursuit of the sector’s broad policy framework, Government will continue to concentrate on improving health outcomes by targeting resources to the following areas:

Malnutrition

As part of the efforts to achieve the health-related MDGs, nutrition will be a major focus of  the sector. Essential nutrition actions will be implemented in all regions with emphasis on complementary and supplementary feeding of infants, children, pregnant women, nursing mothers and PLHIV technical support to the nutritional aspect of the School Feeding Programme.

Emergency Services

Emergency health services will be strengthened by equipping and upgrading selected accident and emergency centres throughout the country. There will be pooling of ambulances from facilities to the National Ambulance Service (NAS). The focus will also be on developing capacities in the area of emergency care, especially through training of critical personnel at various levels and the provision of additional ambulance.

Private Sector Collaboration

Government will continue to partner the private sector in the areas of developing collaborations for investments in the health industry, promoting welfare and supporting private health care delivery. Government will also collaborate with the local pharmaceutical industry to build capacity to international standards (WHO prequalification) and competitiveness.

National Health Insurance Scheme

In order to ensure sustainable financing that will protect the poor, government will improve the operations of NHIS, particularly claims management, communications and coverage of the poor and linking LEAP with NHIS. Government will also conclude preparatory activities for the implementation of the one-time payment of premiums.

Primary Health Care Services

As part of the strategies to enhance access to health care, Government will deepen the concept of Primary Health care by focusing more on the CHPS concept which is very close to the client, while at the same time strengthening the referral system. Government will work with the District Assemblies and other stakeholders to increase the number of functional CHPS zones and upgrade the skills of CHOs.

Integrated Planning at District Levels

Government will place emphasis on strengthening the district health information system to be able to capture all health information. District planning will also be enhanced to improve coordination, transparency and efficiency.

Health Laws and Regulations

Government will continue to review, help to promulgate and implement relevant laws and regulations such as the Mental Health Law, allied health law among others.

Specialized Tertiary Services

Government will increase specialised Tertiary Services and efforts will continue to be made to establish specialised care and teaching facilities in the tertiary and regional hospitals as centres of excellence in order to provide quality specialised care and reduce expenditure
on overseas treatment.

Other Communicable Diseases

To strengthen the control of diseases in 2010, new malaria control measures will be introduced whilst HIV/AIDS prevention activities such as behavioural change communication strategies, knowledge of status campaign, and targeting at risk groups will be scaled up. Comprehensive care and support services towards achieving universal access will be scaled up. HIV sentinel survey will be undertaken and early infant diagnosis of HIV and capacity building will be emphasized.

Government also plans to introduce two new vaccines (Pneumonias I & Retrovirus) in 2011. However, preparatory activities for the introduction will commence in 2010 and will include training, social mobilization, technical support, supervisory visits, monitoring and feedback to regions and districts.

Non-communicable diseases

Prevention and control of non-communicable diseases such as hypertension, diabetes, sickle cell, cancers, mental disorders will be scaled up.

Human Resource Development

Government will focus on addressing the challenges associated with the sector’s wage bill and distribution of critical health staff. Training of middle level cadres such as mental health nurses and midwives will be scaled up and plans are on the way to upgrade post basic
programmes such as public Health, Critical Care, Perioperative, Anesthesia and Ophthalmic Nursing to degree programmes.

Traditional Medicine Practice

The official institutionalization of Traditional and Alternative complementary medicine services which began in 2009, would be expanded and strengthened to increase access to good practices in herbal and complementary medicine. Research will be carried on long-term safety and ethical manufacturing of the products into modern and convenient dosage forms under high quality control.

In addition to the above, Government will develop databases and scientific information on herbal medicines to healthcare professionals and other stakeholders in the industry to enhance the rational and safe use of approved herbal medicines.

Strengthening Health Infrastructure
As part of efforts to increase access to services, Government will continue with the extension, expansion, upgrading and equipping of polyclinics and health centres, district and regional hospitals and health training institutions. Other projects to be undertaken are:

• Construction of offices and Laboratories for Food and Drugs Board;
• Completion of works on training institutions nationwide;
• Upgrading of 3 Health Centres to District Hospitals with funding from OPEC;
• Development of MIS and ICT infrastructure of NHIS;
• Completion of selected ongoing projects in health facilities, DHMT and RHMT;
• Construction and commissioning of 5 Polyclinics/Health centres in Northern Region at
• Karaga, Kpandai, Tatale, Janga and Chereponi and a 100-bed General Hospital with Malaria Research Centre at Teshie, Accra;
• Completion and commissioning of the Korle-Bu Teaching Hospital Medical Block, and the GHS Learning Centre at Pantang.
• Development, equipping and commissioning of some CHPS compounds in selected sub-districts;
• Planning activities including contractual issues, negotiations and statutory approvals for the commencement of major rehabilitation and upgrading of Tamale Teaching Hospital, construction of 3 Regional Hospitals at Wa, Bolga and Koforidua, District Hospitals and staff housing at Madina/Adenta and Weija in Accra, Manhyia in Kumasi, Tepa, Salaga, Wenchi, Konongo-Odumasi and Twifo-Praso;
• Preparatory activities for project commencement for the supply and installation of laundry and imaging equipment in selected health facilities, re-equipping of selected health facilities with various specialized medical equipment, expansion of Radiotherapy and
• Nuclear Medicine facilities at KATH and KBTH and the construction of the Blood Transfusion Centres at the Teaching Hospitals;
• Execution of the construction of Winneba District Hospital, Tarkwa District Hospital and the Maternity Block at Achimota Hospital, Mamobi, Kaneshie and Mamprobi Polyclinics, Maternity and the children’s block at Tema General Hospital, and the phase 2 of the rehabilitation and upgrading of Bolgatanga Regional Hospital;
• Continuation of ongoing projects such as other health sector projects in the districts including staff accommodation, DHMT and RHMT, offices for the Nurses and Midwifes Council, KATH Maternity and Children’s Block; Office complex for NAS and St. John’s Ambulance, including the expansion of Nurses’ Training Institutions nationwide;
• Preparatory works including feasibility studies, needs and site assessment, appraisals, value for money audits, tendering, negotiations, funds mobilization and required approvals for Specialized Urology Centre and Specialised Neurology Centre, both at Korle-Bu Teaching Hospital, Maternity and Children’s Hospital at Ridge Hospital, Accra;
• Preparatory works will be done for the development of various Regional and District Hospitals, Health Centres, Centres of Excellence and Equipment installations, Medical Assistants’ Training Schools in Volta, Western & Northern Regions, upgrading of Cape Coast Regional Hospital into a Teaching Hospital; and the new Midwifery Training Schools in Northern Region at Damango & Nalerigu.

MANAGEMENT & COORDINATION OF HIV/AIDS ACTIVITIES

The following programmes and activities were implemented during the year:

Policy, Advocacy and Enabling Environment

A Parliamentary HIV and AIDS Tool Kit from Uganda was adapted to assist Parliamentarians advocate for more acceptable attitudes towards Persons Living with HIV (PLHIV),   right of PLHIV and also to support policy reform. The 2008 Ghana Demographic Health Survey was also drafted with input from this programme.

Co-ordination and Management of the National Response

Government co-ordinated with Development Partners and CSO’s in the agreement of priority areas for implementation and budgetary allocations, managed and monitored the decentralised response through MDAs and MMDAs and built capacity for 31 CSOs in projectimplementation, monitoring and evaluation.

Mitigation of the Socio-cultural, Economic and Legal Impacts of HIV & AIDS

10 RCCs, 196 MMDA’s, 30 Private Sector Organization’s, 34 Traditional Authorities, 14 Polytechnics and Vocational Institutions and 29 NGO’s were assisted with funding to carry out interventions aimed at stigma reduction, prevention and behavioural change, as well as orphans and vulnerable children

Prevention and Behavioural Change Communication

Key activities were:

• Increased Private Sector engagement through the Ghana Business Coalition against HIV and AIDS (GBCA); and
• Workplace policies and prevention programs targeting private sector employees were developed and implemented.

Treatment, Care and Support

Financial support was provided for 250 PLHIV Associations to assist with treatment costs, payment of NHIS, and nutritional needs.

Research, Monitoring and Evaluation

Government facilitated the harmonization of national and international indicators to streamline data collection, developed a National M&E roadmap and built the capacity of M/E focal persons. The development of a database at national and sub-national levels was also initiated.

Resource Mobilisation and Funding Arrangements

Key activities undertaken were: -

• Commencement of negotiations towards receiving US$19,000,000 Global Fund grant to Fight AIDS, Tuberculosis and Malaria to enhance national structures for HIV program.
• Development of a Partnership Framework with counterparts from the United States Government, under which Ghana will benefit from PEPFAR II funding.

PERFORMANCE MONITORING & ACCOUNTABILITY

To ensure that national resources are safeguarded and used judiciously, the following activities were undertaken:

• Setting up of additional Audit Report Implementation Committees (ARICs) and training of members;
• Continued monitoring of compliance with the Practice Framework and guidelines issued in order to ensure professional Internal Audit practice by the Internal Audit Units (IAUs);
• Improved capacity of internal audit staff in MDAs and MMDAs resulting in 169 IAUs submitting Quarterly Internal Audit Reports. Internal auditors also benefitted from training in Procurement Audit and Asset Management;
• Setting-up and establishment of 287 functional Internal Audit Units in MDAs and MMDAs out of a target of 341;
• Establishment of an Inspectorate Section of Government’s Internal Audit Agency to facilitate action on internal audit reports including, where appropriate, recommendations of prosecution and disciplinary action in respect of any breaches found after conducting an audit in MDAs and MMDAs; and
• Organisation of an Annual Internal Audit forum for 650 public service managers to deliberate on Performance Management and the role of Internal Auditing in the Public Sector.

MANAGEMENT & COORDINATION OF HIV/AIDS ACTIVITIES

527. Ghana is currently in the process of developing the 2010 POW and Budget to end the implementation of the 5-year POW for the national HIV response prepared within the context of the Growth and Poverty Reduction Strategy 2006-2009, Universal Access to Prevention, Treatment, Care and Support by 2010 and the Millennium Development Goals. The priority programmes and activities for 2010 include the following:

Policy, Advocacy and Enabling Environment

Key activities will be to:

• Enhance effective dialogue and communication on challenges posed by the epidemic with media, political, religious, traditional leadership and Civil Society at all levels;
• Develop and disseminate evidence informed and gender responsive National Strategic Framework and 5-year POW; and
• Enhance the capacity of the Judiciary and law enforcement agencies to address issues of
• stigmatisation and discrimination against PLHIV and advocate for the review of existing laws and policies on HIV and related issues.

Co-ordination and Management of the National Response

Government will strengthen human, financial and technical capacity of national, sub-national and decentralised entities to develop, implement and review programmes and also improve the co-ordination and harmonization of donor activities and funding.

Mitigation of the Socio-cultural, Economic and Legal Impacts of HIV & AIDS

Government will continue to provide care and support to PLHIV, Orphans and Vulnerable Children and carriers to ameliorate the socio-economic burden of HIV and AIDS and develop a comprehensive programme to promote the protection of rights of PLHIV, inclusion of ART on NHIS and provide legal aid. A holistic strategy will be developed
to eradicate HIV-related stigma, discrimination and negative socio-cultural practices faced by PLHIV, their families and caregivers.

Prevention and Behavioural Change Communication

Government will facilitate the provision of evidence informed combination of HIV prevention interventions, advocate and promote integrated HIV and SRH services and coordinate development and dissemination of behavioural change material in partnership with the media.

Treatment, Care and Support

Government will scale up and sustain HIV treatment, care and support including home based care, early infant diagnosis and TB/HIV co-infection, ensure quality assurance of comprehensive HIV services and application of basic standards of care and integrate logistics and procurement systems.

Research, Monitoring and Evaluation

Government will facilitate the generation of evidence informed strategic information as a basis for planning and strengthen the national M & E system to facilitate the roll out of the M&E roadmap.

Resource Mobilisation and Funding Arrangements

Government will strengthen the financial and procurement systems and processes and develop evidence based Resource Mobilisation Agenda including the creation of National HIV and AIDS Fund.

HEALTH AGENDA FOR 2009

Maternal and Neonatal Health 

The Government will improve maternal and neonatal health by increasing access to obstetric care in all health facilities to reduce maternal death. Key strategies include expansion of midwifery and nursing training institutions, deployment of qualified nurses and midwives, improvement in comprehensive abortion care services and monitoring the implementation of existing policy on free maternal deliveries.

Malaria

As part of current strategy to control and eradicate malaria, education and advocacy will be intensified to increase utilization of insecticide treated nets (ITNs) nationwide, indoor residual spraying and scale up the bio-larviciding projects to Central, Western and other Regions. Additionally, the Ministry will initiate a Mass Treatment pilot project in Greater Accra Region with the aim of eliminating malaria parasite from the defined population and establish the safety and efficacy of the method used. In furtherance to the sector‟s policy of eliminating malaria, the seven-year draft national strategic plan (2008-2015) currently under preparation will be completed for consideration by Government in 2009.

Furthermore, the Government will undertake collaborative programmes with its counterparts in Togo, Cote d‟lvoire and Burkina Faso to tackle the control and elimination of malaria.

Other Communicable Diseases

In the light of resurgence of some communicable diseases, the Ministry will, as a matter of urgency review the management of these diseases especially cholera, meningitis and yellow fever.

As part of the current strategy to control and eradicate malaria, education and advocacy will be intensified to increase utilisation of insecticide treated materials (ITMs) nationwide. Additionally, the Ministry will initiate a pilot project in Greater Accra Region with the aim of eradicating malaria parasites from the population. Furthermore, the Ministry will undertake collaborative programmes with its counterpart in Togo, Cote d‟Ivoire and Burkina Faso to tackle the control and elimination of malaria.

Non-Communicable Disease

The Government’s focus will be to strengthen the prevention, control and management of non-communicable diseases such as diabetes, cardio-vascular conditions and cancers so as to reduce their burden by improving data on risk factors and incidence of specific diseases, developing cancer registry and promote increased use of health education materials. In addition, general screening of the population for breast, cervical and prostate cancers to facilitate early detection and prompt treatment will be conducted and clinical services for non communicable diseases improved.

Community-Based Health Planning & Services (CHPS)

Under this strategy, the Government will equip and staff the CHPS compounds to cater for maternal health services. In addition, the Ministry will review training of Community Health Officers (CHOs) to include midwifery services. It will also simplify the referral system with the object of providing guidance to CHOs. Other strategies will include improving communication at CHPS level through increased use of mobile telephones and strengthen district and regional level supervision of CHPS.

Quality and Coverage of Clinical Care

The Government will place emphasis on introducing improvements in clinical care and strengthen emergency services through provision of Diagnostic and/or Scientific Equipment, promotion of rational use of medicines, development and adoption of protocol for referrals.

Emergency Preparedness and Response

To improve outcomes of medical, surgical and obstetric emergencies, a national emergency response policy and plan to guide the implementation of epidemic disease management preparedness within the sector will be prepared.

The Ministry will expand coverage of national ambulance services to 20 additional districts by procuring 20 specialized vehicles, train 200 personnel and also orientate health staff in emergency care.

Human Resource Development and Management

The Government will improve and strengthen human resource productivity within the sector by implementing performance management contracts and conducting a study on human resource productivity including development of an online human resource update. It will endeavour to match intake into training institutions with availability of practical training sites. It will also expand training programmes for middle level health cadres especially the reintroduction of community psychiatric and dental nursing training programmes. Furthermore, the Ministry will train additional 670 midwives and 190 medical assistants. It will also institutionalize Continuous Professional Development programmes for critical staff.

National Health Insurance Scheme

The National Health Insurance Scheme will be restructured to respond to the needs of the population and improve upon the issue of claims management. The latter will involve networking all DHMIS to service providers and the National Health Insurance Authority. This, among others, will help to resolve the problem of portability to make it national in coverage. It will also pursue the policy on de-linking children from their parents‟ registration and the provision of free maternal care. Furthermore Government will commence work on the implementation of the one time payment of insurance premium under the National Health Insurance Scheme. In this regard the actuarial analysis relating thereto will start in earnest.

Inter-sector Collaboration and Advocacy

The Government will embark upon major multi-sector collaboration with the view to improving sanitation and targeting safe food and water. Specifically, it will collaborate with the Ministries of Local Government & Rural Development, Education, Women & Children, Water Resources, Works & Housing and Food & Agriculture to develop relevant regulations and guidelines to ensure safety of food, water and sanitation.

Harmonization of Health Legislation

The Government will complete work on the Mental Health, Tobacco, National Health Service and National Ambulance bills for consideration of Cabinet and subsequent passage by Parliament.

Gender Mainstreaming

The Government will finalize and disseminate guidelines on gender mainstreaming in all health facilities. Gender sensitive case management protocols will also be developed. In this regard, management teams will be trained to handle gender dimensions of health service delivery. In addition, Police medical reports forms will be reviewed and standardized to facilitate data capture on domestic violence

Infrastructure Development for Effective Health Delivery

To further strengthen the programme for modernizing health care and also improve access to quality health care, the Ministry will rehabilitate all Health facilities destroyed by floods in the Northern Region. In addition, 21 Health Centres will be constructed and four existing health centres equipped and upgraded to District Hospital status. The health centres are at Essiam, Ajumako, Zabzugu and Galo-Sota. Again, Phase 1 of the Bolgatanga Regional Hospital will be completed; feasibility studies for the development of a specialized Maternity and Children‟s Hospital at Ridge will be undertaken. Similarly, offices for the Food and Drugs Board, Nurses and Midwives Council will be completed and the expansion works on training schools at Keta, Bolgatanga, Berekum, Oda, Tamale, Teshie, Sefwi Wiawso and Agogo will also be carried out.

The Government will further staff and equip CHPS compounds nationwide, and re-equip selected Regional and Districts Hospital with emphasis on Emergency and essential Obstetric care. In addition, ongoing works in selected hospitals, DHMT and RHMT Offices with high sunk cost will be completed while twenty (20) specialized ambulance vehicles will be procured for the National Ambulance service.

New projects to be initiated include redevelopment and upgrading of Tamale Teaching Hospital, Phase 2 of the rehabilitation of the Bolgatanga Hospital: the construction of five polyclinics/health centers in Northern Region at Kpandai, Tatale, Janga, Chereponi, and Karaga and the Winneba District Hospital will be completed.

A 100-bed General Hospital with Malaria Research Centre at Teshie, Accra will commence. Similarly, two Regional Hospitals with staff housing at Wa and Kumasi will also be funded. Six District Hospitals with staff housing at Adenta/Madina, Twifo-Praso, Konongo-Odumase, Wenchi, Tepa, and Salaga will be funded.

Furthermore, two District Hospitals at Bekwai and Tarkwa and Blood Transfusion Centres at Accra, Kumasi and Tamale will be funded.

Besides the projects mentioned above, preparatory works involving site selection, feasibility studies, needs assessment, appraisal, surveys and fund mobilisation for other projects in the health sector will be undertaken. Medical Assistants Training Schools in the Northern, Western and Volta Regions will be covered under this programme. The upgrading of the regional hospital in Cape Coast into a teaching hospital, the development of a new Urology Centre of Excellence at Korle-Bu and the establishment of schools of Allied Health sciences with emphasis on the training of Health Care Assistants in all ten regions and further expansion of existing training schools and the development of new Nursing and Midwifery Training Colleges will also be carried out under this programme.

Expansion works on Radiotherapy and Nuclear Medicines Services in Accra and Kumasi into centres of excellence will be pursued.

For the implementation of the above activities, an amount of GH¢921,929,472 has been allocated. Out of this, GoG is GH¢344,398,438 IGF is GH¢108,312,030 Donor is GH¢82,582,842, HIPC is GH¢11,427,000 and NHIF is GH ¢375,209,162

Performance in 2009

Government’s priorities in 2009 were on reducing maternal and neonatal deaths, enhancing health services for children, consolidating the gains made under the regenerative health and nutrition programme.

Maternal and Child Health

Direct entry into medical assistants training in Kintampo was introduced and 100 students  were enrolled. Two new midwifery schools were established in Tarkwa and Tamale to increase training of midwives.

Malaria

The seven year national Strategic Plan for Malaria Control was completed and the revised Anti-Malaria Drug policy signed by Government. In addition, Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine, additional Artemisinin-based Combination therapy (ACT)
were officially recommended for malaria treatment. Six (6) districts in the Northern region were also covered with Indoor Residual Spraying (IRS).

Other non-communicable Diseases

Government embarked on awareness creation on Asthma, Sickle cell and a sensitization training of NGO’S on non communicable diseases .

Community-Based Health Planning and Services (CHPS)

In order to reposition the CHPS strategy to provide services including maternal and child health services to the hard-to-reach areas, government conducted an in depth review of the implementation of the CHPS program.

Quality and Coverage of Clinical Care
A study is underway to determine the level of performance of the procurement, supply and distribution systems in relation to policies, procedures statutory arrangement and the financial position of the supply system. The study is aimed at strengthening the financing and functioning of the procurement and supply system.

Emergency Preparedness and Response

A Ministerial Emergency Medical Services committee has been formed with all stakeholders responsible for emergency services as members.

Human Resource Development and Management

Government developed performance agreement proposals and has engaged a technical team to study the proposal and develop implementation strategies.

National Health Insurance Scheme

Actions implemented were: -

• In order to ensure a sustainable financing and improve the operational efficiency, a review of the NHI legislation was undertaken, with a view to repealing the current Act and replacing it with a more appropriate legislation. Stakeholder consultations were held on the draft findings;
• A separate legislative amendment has been proposed to cover the police and the armed forces, and to delink the registration of children from that of their parents; and
• An actuarial assessment has been updated and various scenarios are in the process of being submitted to Cabinet.

Harmonization of Health Legislation

Major strides were made with the health sector bills. Memorandum of Instructions has been submitted to the Attorney-General’s Department for refinement.

Infrastructure Development for Effective Health Delivery

During the year under review, the following projects were undertaken:

• Construction of Winneba District Hospital;
• Construction of a 100-bed General Hospital with Malaria Research Centre at Teshie;
• Five Polyclinics/Health Centres at Kpandai, Tatale, Janga, Chereponi, and Karaga in Northern Region and Tarkwa District Hospital commenced;
• Begun phase 2 of the rehabilitation and upgrading of Bolgatanga Regional Hospital;
• Reactivation of some abandoned projects in Accra-Tema Metropolis including the Usher Polyclinic Theatre, Maternity Block at Achimota Hospital, upgrading of Maamobi, Kaneshie and Mamprobi Polyclinics; and the Maternity and Children’s Block at Tema General Hospital;
• Feasibility studies for establishing maternity and children’s hospital at Ridge Hospital was completed;
• Completion of 21 Health centres with funding from OPEC;
• Value For Money (VFM) negotiations and statutory approvals of contracts for new projects such as the major Refurbishment of the Tamale Teaching Hospital, expansion of Radiotherapy and Nuclear Medicine Centres at KBTH and KATH, construction of two (2) Regional Hospitals with staff housing at Wa and Kumasi were undertaken; and
• Other new projects which were subjected to VFM negotiations and for which contracts approved were the construction of six (6) District Hospitals with staff housing at  Adenta/Madina, Twifo-Praso, Konongo- Odumasi, Wenchi, Tepa, and Salaga; and the construction of the Blood Transfusion Centres at the Teaching Hospitals.