Sameye Clinic @ Half Assini

Hospital – 1 Half Assini, Health Centre – 3, Tikobo No. 1, Elubo and Ekabaku, Clinics – 6, Bonyere-Ezinlibo, elubo, Twenen, Tikobo No. 1 and Newtown, Primary Health Care Centres – 5, Mpataba, Ahobre No. 2, Bawia, Samenye and Allengenzulley.

There is one hospital at Half-Assini, the district capital, which is also a Government Hospital.  The district has three (3) Health Centres at Tikobo No.1, Ekabaku and Elubo.  In addition to this, there are community clinics located at Half Assini, Newtown and Twenen, Tikobo No. 2, and Samenye.  CHPS Compound are also at Takinta, Mpataba, Nuba and Kengen.

Incidence of Diseases:  HIV/AIDS

The AIDS situation in the district is quite alarming considering the fact that Jomoro shares common border with La-Cote D’Ivoire which has the highest rate of infection in the sub-region.  More worrying is the fact that both nationals share things in common.

There are regular cross border activities between the two countries as far as Jomoro is concerned.  Elubo, Newtown and Jaway Wharf are the main point of entry.  Long distance truck drivers from neighboring countries pass through Elubo where most often they have to spend nights waiting for their goods to be cleared.

This situation give rise to immoral sexual practices.  These have given rise to the influx of school drop outs and Commercial Sex Workers.  The government and for that matter Jomoro Municipal Assembly is putting in measures to check and prevent new infections.  Refer to tables in pdf file below.

The above figures were obtained from mothers with complications during delivery, blood donors, and those with serious and chronic medical problems.  A little below 5% came out voluntarily for test.  That is to say that the figures is not a true reflection of the situation on the ground.

The realization that the issue had not been a health but rather a social problem a multi-sectoral approach has been taken to tackle the menace.  NGOs, CBOs together with the District Aids Committee have put in place interventionist programmes as follows: 

• Awareness creation in communities and schools
• Education on mode of transmission in schools and communities
• Prevention of new infections (ABC)
• Formation of CBO, NGO
• Condom distribution
• Setting up of Voluntary Counseling and Testing (VCT) centres

The District has two NGOs and about eight CBOs in place to fight the menace.  About 220 million was released by Ghana Aids Commission for AIDS activities in the district.  However, there are still some challenges.  This includes:

1.     The perception of people as regards people living with AIDS

2.     The low patronage of condom which could be linked to increase in teenage pregnancy

• Refusal to go in for VCT
• Setting up of a VCT centre in the district
• Stigma and discrimination
• OVC not yet captured due to inability to identify PLWHA
• Care and support for PLWHAS

Malaria

Malaria ranks the first of the top 10 diseases in the district.  The number of cases reported were 13,303, 21,817 and 14,949 in 2002, 2004 and 2005 respectively. Since mosquitoes have been identified as the main agents of transmission of the disease there is the need for the district to embark on environmental cleanliness to prevent its spread.  The district, in 2003, recorded a total of 17,053 reported cases of malaria.  This represented 14% of the total district population.  Set target was to reduce malaria incidence by 10%.  This target was to be achieved by implementing measures such as using treated bed nets to reduce man-mosquito contact, desilting of stagnant waters and clearing of overgrown weeds and bushes.

High cost of treatment contributed to low patronage of patients at health facilities.  The table below shows a three-year trend of malaria incidence:

Guinea Worm

Guinea worm disease is not important in the district.  There were only 2 guinea worm cases in 2005.  however, these were imported cases from the northern part of the country.

Availability Of Health Professional

The District has only 1 Doctor, 3 Medical Assistants, 47 Nurses and 15 Midwives.  However, the district seems to have a satisfactory level of the other staff when compared to the national average.

Infrastructure

Generally the district has good infrastructure for health facilities.  However, staffs of District Health Directorate are without accommodation and live in rented premises.  This situation is also the same at Elubo.  At Ekabaku which is a Health Centre, the entire structures are in deplorable state and needs total rehabilitation.  The Ghana Health Service is putting up one residential bungalow for the District Director of Health Services in the district at Half Assini.

The sub-district has also got equipment problems.  For example, Elubo, Tikobo 1 and Samenye Health Centre are in dire need of laboratory equipments.  The inadequacy of freezers and weighing scales, hamper the smooth delivery of service in the storage of vaccines and weighing of children under 5 and pregnant women.

Access To Health Facilities

Geographical access to health facilities is optimal.  The survey conducted to examine the distance of the people to the nearest health facility indicated that 39.9% only travel between 0-1 km to access health care, 14% (2-3km), 5.6%
(4-5km) 16.7% (6-7km) 4.2% (8-9km) and 19% (10+km)

Another response to the use of health facilities also indicates that 48.7% of the people access health care within the community in which they are residing.  42.6% of the people access health care outside their communities but within the district and only 8.6% access health care outside the district.

The survey also brought to the fore that, of the people who access health care outside the district, 66% attend Eikwe Hospital in the Nzema East District.  26.5% also attend Effia Nkwanta Hospital at Takoradi and 7.3% constitute those who attend hospital elsewhere apart from these hospitals.

Infant Mortality Rate

Some of the caused of infant deaths are malaria with anemia, pneumonia and gastroenteritis.  These deaths mostly occur due to mothers and caretakers failure to send the children for prompt diagnosis and treatment.  Infant mortality between 0-11 months in 2004 was high.  It rose from 0.5 in 2003 to 1% in 2004 and then dropped to 0.5 in 2004.  This could be attributed to high increase in ANC services at the health facilities and outreach points.

Maternal Mortality Rate

In 2004, the district recorded zero and this was due to the absence of resident medical officer where some pregnant women with problems did not attend hospital at all or an early intervention of referring them to another hospital outside the district.  Some of the setbacks were lack of blood transfusion services and the absence of storage of blood to save lives.  Maternal mortality is low in the district.  There was only one death in 2003, no death in 2004 and 1 in 2005.  This scenario could be explained by the fact that most of the mothers prefer to deliver at Eikwe in the Nzema East District where there is always a gynaecologist, whom they know very well.  For this reason hospital attendance by expectant mothers are lower at the Half Assini Hospital.

Status Of The District Health Insurance Scheme

The Jomoro Municipal Health Insurance Scheme commenced in operation in October 2004 after it had fully registered with the Registrar General Department and the National Health Insurance Council (NHIC).

The Insurance Scheme is an alternative health care payment system which has a risk pooling effect.  This is against the backdrop of several efforts by government to replace the “Cash and Carry” Health Financing System.

The system is a health care payment that spreads the risk of incurring health care cost over a group of subscribers.  Thus, an insured patient does not have to pay directly from his or her pocket for health service at the time of use.

The scheme seeks equity and bridging inequality gap in health status that exists across the regions and also provide protection for the poor through cross-subsidization from the better offs to the poor.

Performance

The performance of the Jomoro Health Insurance Scheme is not encouraging.  This assertion is informed by the number of:
1)    People who access health care in the district, 
2)    Household survey by means of settlement of cost of health care
3)    Target set for the year 2005.

From the above table as high as 98.6% of the people who access health facility use the Hospital and Rural Clinics in the district.  Only 0.7 and 0.7% use the Drug Store and Traditional Healers respectively.

In spite of the above positive situation Table 14 below which indicates the success or otherwise of the Health Insurance depicts another scenario.

Only 16.7% access health care by the District Health Insurance Scheme in the district whilst 83.3% use the old cash and carry system.  The implication is that a disproportionately high number of the population are making affront payment for health care which makes the Government vision of abolishing cash and carry far-fetched.  There is the need for the scheme to reach more people outside the insurance scheme.

Target For 2005

The Jomoro Mutual Health Insurance Scheme registered only 1079 clients by December 2005 against its target of 2000.  In spite of the fact that the target set was low, the district could not reach the 2000 benchmark set by the NHIS for District Health Insurance Schemes in the country.

Health is one of the key components to the development of any community, and therefore, the needed resources should be provided to ensure the provision of efficient health services to the population.

The district is among the best districts with well-sited health facilities. This can be attested to by the location of service facilities and the road network linking these facilities to communities which access their services.

The Health Sector of the district is, however, not without problems.  Issues of staff turnover high immunization dropout, high tuberculosis defaulter rate, high incidence of malaria, low supervise delivery and low postnatal care among others are some of the sectors lot.

With the scaling up of the Community-Based Health Planning Services (CHPS) by the Ghana Health Service, the sector, in collaboration with the District Assembly earmarked two communities; Kengen and Nzimtianu to benefit from the construction of CHPS compounds with support from Social Investment Fund (SIF).

These CHPS compounds, started in 2003, were completed in 2004, and inaugurated in the same year.  Refer to tables in pdf file below.

From the ten top diseases reported at the health facilities, malaria was consistently number one for a four-year trend.  The cases reported were also significantly high.  This showed the economic importance of the disease and the need for a district wide intervention.

Reported measles cases showed a significant increase in 2004 and a slight decrease in 2005.  This was, however, due to the fact that cases which reported with rash and fever were treated as suspected measles.

Incidence of Teenage Pregnancy reported

Teenage Pregnancy is a challenge facing the district but there has been a gradual decline from 26.1% in 2001 to 22.9% in 2004 with a further decline to 20.8% in 2005.  Though in terms of figures it increased in 2005, this is due to the free deliveries instituted in health facilities which made most women to register their pregnancies.

The decline of teenage pregnancy is also made possible by education going in communities, schools and other places about HIV infection and teenage pregnancy if one engages in unprotected sex.

Expanded Programme On Immunization

This programme aims at protecting children within the target population of 0-11 months against the nine vaccine-preventable childhood diseases.  These diseases are; tuberculosis, measles, poliomyelitis, yellow fever, diphtheria, pertussis, tetanus, hepatitis B and haemophilus influenza (penta). The table below shows the district performance for a three-year trend:

The district performance for 2003 with reference to Penta 3 as the proxy indicator was 77.3%.  This was far below the national set target of 90%.  The district, therefore, projected a medium-term target of 90% to be attained by the end of 2005.  At the end of the projected period the performance stood at 86.0% leaving a gap of 5%.

Tuberculosis

The district defaulter rate for 2003 was 35% as against the national set target of below 10%.

Medium-term projection for the period 2003-2005 was 10% but by the end of period, the district achieved a defaulter rate of 27%, thereby, creating a gap of 17%.