The DHMT in collaboration with the SDHMTs implement and manage national and regional health policies in the district. To ensure participation and maximum use of resources the district health administration collaborates with relevant stakeholders including the District Assembly and Non Governmental Organizations in the delivery of services. 

The district health sector can be categorized into 2 sectors, public and private. The Ghana health service runs the public sector providing both curative and preventive care in the district hospital, health centers and outreach stations. Community based disease surveillance volunteers have also been trained to assist in surveillance activities.

Drug outlets form a large proportion of the private sector including chemical sellers and unlimited number of drug peddlers who are mostly semi illiterate but very good salesmen. These drug peddlers can be categorized into three mainly peddlers of herbal medicine, peddlers of biomedicine moving from community to community and the neo herbalists who sell both herbal and modern drugs.

A very important group of practitioners in the health care system are the Traditional Birth attendants who have since 1978 formed part of the Primary Health Care (PHC) strategy in the district providing reproductive health care services. 

Health Facilities

There has been a significant change in the number health facilities in the district between the periods 2002 and 2005.  Apart from the increased number of outreach stations the number of facilities has more than doubled with the number of outreach points   increasing from 132 to 148 during the same period. Currently there are two Hospitals, one government (District Hospital) and one private (Ahmadiyya Moslem Hospital) are located in Nadowli the district capital and Kaleo respectively.  Table:  illustrates the distribution of the health facilities in the District.

The distribution of existing facilities is concentrated in the western half of the District. The eastern half has just xx facilities, one at Issa and the other at Kojokperi.  The average distance to a health facility in the district has reduced from 16km to about 9km. This achievement still lags behind the National target of 5-kilometer maximum distance in accessing health services.  This is indicative of poor physical accessibility to health services not withstanding the increased outreach stations and static health facilities in the district.  

Many people are also unable to access health services due to the prevailing poverty among the people. Below is a table indicating changes in health delivery within the period under review. The existing health facilities as indicated above are poorly equipped and staffed.  Patient and staff accommodation is inadequate to meet current demands and communication between communities and health delivery outlets remains poor. 

There are also no Ambulance services in the District to facilitate movement of emergency referral cases to the regional hospital for special services. These are all critical issues, which needs immediate attention by the DA and the District Health Directorate.   

Staffing

The staffing situation in the health sector is major challenge in the delivery of quality and accessible health services. The are only 4 doctors currently in the district comprising 2 expatriates and 2 nationals. Two out of the four are expatriates and are non permanent who are often replaced on short durations.

 In view of this, the current doctor /patient ratio of 1: 18387 is unreliable even though it is still below the national standard of 
The number of nurses are also inadequate with limited capacity though there have been interventions to improve their capacity through a number of training programmes. 

Nurse/patient ratio according to the health directorate currently stands at 1:1406. As a measure of closing the gap, the district assembly is currently sponsoring student nurses who intern will serve the district after completion of their course. A number of capacity building trainings are occasionally organized in collaboration with development partners to improve the capacity of nurses in the delivery of services.

Disease Prevalence

The disease pattern in the district between 2003 and 2005 did not realize any significant changes though there have been relative changes in the position of diseases as compared to the year 2003. The situation still reflects the national trend of disease prevalence with malaria occupying the first position of the top ten causes of OPD attendance. 

The current top three diseases are malaria, Acute Respiratory Infection (ARI) and Skin diseases compared to Malaria, joint pains and Pneumonia. This is a clear manifestation of poor environmental hygiene and sanitation as well as water related problems.  

Using 2003 as base year, the prevalence of the three top diseases increased between 7%-15%. While malaria went up by 14.8%, ARI and skin diseases went up by 6.9% and 6.4% respectively. These conditions can be attributed to the poor environmental Sanitation/Personal Hygiene and quality of drinking water. Table 3 compares the incidence and changes in disease pattern between 2003 and 2005

Generally, there has been significant improvement in health service delivery in the district. About 85% of the District population now seeks medical Services at existing health facilities. The table above illustrates the evidence of this fact. With the exception of malaria, there has been a considerable drop in the incidence of most the ten top diseases in the District and patronage of health facilities have improved. 

These modest achievements have been as a result of increased outreach points, an improvement in logistics situation and staff training which was made possible through support of World Vision International and World Food Programme who are development partners in the education and health sectors of the district.

Nutrition

Available reports from the district health directorate suggest unsustainable nutritional status of children and nursing mothers. Between 2003 and 2005 the nutritional status of mothers and children deteriorated from 87%.5 to 78.4% respectively. The situation has currently improved from 78.4% to 82.4% between 2004 and 2005. .

The nutrition situation in the district is due the increasing price levels of foodstuffs in the markets especially in the lean seasons and the inability of households to meet the required daily meals due to poverty. 

Surveys conducted by the GHS in the markets also indicate iodine deficiency in salt on the market, which is a contributory factor to the nutritional deficiencies. Several attempts have been made by the health directorate and other partners such as the CRS, World Vision International and the World Food Programme to support women and children with supplementary feeding by providing food items such as maize, bean, rice vegetable oil and sugar in schools and antenatal sites. 

In spite of these interventions basic nutrition education and awareness needs to be intensified to increases the people knowledge on the proper combination of food to increase the consumption of balanced diets.

Immunization

The district has experienced increased percentage coverage of its immunization programmes against the six child killer diseases between 2003-2005. Though there have been short falls in measles and yellow fever coverage due to shortage of vaccines. Daily immunization at static points, outreach services and house-to-house strategies were used to achieve the increased coverage.  

Table 26: Below illustrates the trend of increases in immunization of children between ages 0 -5 from 2003-2005

The table depicts in absolutes terms increases in the number of children immunized since 2003, but reports indicate that frequent migration have prevented the district from achieving 100% coverage. It therefore calls for increased awareness creation through public education on the need for mothers to immunize their children irrespective of their destination in the region and country as a whole. 

 HIV/AIDS                                

The debilitating effects of HIV/AIDS on the socio economic development of any society of cannot be overemphasized. In view of this The District Assembly, District Health Directorate and other development partners have embarked on a number of activities to sensitize the people on the effects and methods of HIV/AIDS infection. 

Unfortunately the awareness creation programmes have not yielded the expected results as the number of both clinical and blood donor cases continues to rise due to the risky sexual behaviours of the youth. In 2005 29 clinical cases of HIV/AIDS were recorded as against 11 cases in 2003.  During the same period, blood donor cases also increased from 1 to 14. This staggering statistic amply demonstrates the need to sit up as far as controlling the diseases is concerned.

Majority cases fell within the age group of 15-39 who form the potential labour force in the district. There is the need to develop new strategies of tackling the problem if the incidence of the disease in the district is to reduce to acceptable levels.

National Health Insurance Scheme

As part of government effort to make health care affordable and accessible to majority of people in the country, the District Mutual Health Insurance has since been in operation in the Nadowli District. A total of 123 community agents and 34 community committees of health insurance have been identified and formed respectively to assist in the sensitization, mobilization and collection of premiums. 

Since the implementation of the scheme in March 2006, a total of 1381 out of 14118 registered members have benefited from claims amounting to ¢57,756,983.00 being payments of services rendered by service providers. 

The situational report however indicates low patronage due to low awareness levels, poverty and politicization of the scheme in some parts of the district. The management intends to embark on an intensive sensitization of the people to increase the number subscribers to make the scheme sustainable.

Not withstanding the effort of the management to ensuring smooth running of the scheme, it has appealed to the District Assembly and the Ghana Health Service for support in finding solutions to some of the problem indicated below to improve upon service delivery.

1.      Inadequate means of transport

2.     Lack of spacious office accommodation

3.      Inadequate finance to carry out sensitization activities

4.      High illiteracy and poverty affecting prompt payments of premiums

5.     Delays in the submissions of claims by Partners

The general problems in the health sector include:

 Inadequate physical health infrastructure

Poor physical and economic access to health services

  Inadequate staff accommodation

Intermittent shortage of immunization vaccines

Lack of communication facilities in health centers

 Inadequate logistics and transportation facilities