Health

In line with the Municipal overall vision of excellence in disease prevention and promoting good health of the people there has been a remarkable improvement in most of the key indicators of the various health delivery programmes within the past four years.  Significant among these are the Disease Control and Surveillance program, Expanded Programme on Immunization (EPI), Safe motherhood, School Health Services, Nutrition activities and HIV/AIDS programs.

The health delivery system in the municipality is fairly good. The municipality has three hospitals comprising 1 public 1 CHAG and 1 private at Kukurantumi, Osiem and New Tafo which serve as referral centers to a number of health centers, clinics and CHPS. Records show none existence of Traditional Birth Attendants (TBAs) in the municipality, a development which can be said to result in a major gap in the chain of primary reproductive health care which emphasizes on the gate keeping concept by trained TBAs in especially rural and hard-to-reach areas.

The number of structured CHPS is also woefully inadequate compared to the number zones demarcated. The need for more CHPS compounds in the medium term cannot be overemphasized. Spatial accessibility of health services is also skewed in favour of the urban centers while rural areas can only boast of many unstructured CHPS with a few structured centers. Table 1.35 Show the existing health facilities available in the municipality while Fig 1.21 shows the spatial distribution of health facilities in the municipality.

Health Infrastructure Requirement

Data available indicates that 10 CHPS Zones lack basic infrastructure with most of them operating under trees and in mobile vans. The increase in population has also brought to the fore the need to expand CHPS compounds and equipment the compounds to provide required basic services to the people.  The assembly shall take steps to complete ongoing CHPS compounds and either initiate or support communities to construct new centers to augment the existing facilities.

Health Personnel

The exisitence of adequate and well qualified staff is a sinequanon for equitable and accessible health delivery. The staffing situation in the health sector is woefully inadequate compared to the increasing population which now stands at approximately 198,755 as against staff strength of 214 in the public sector. The health personnel comprise 29 (14%) males and 185 (86%) females indicating a high female representation in the sector. With a Doctor to Patient Ratio of 1:32,370 and Nurse to Patient Ration of 1:701 in 2016, the health sector can be said to be greatly understaff with implication on real-time service delivery. The inadequate health personnel is partly attributed to the apparent lack of staff accommodation for health staff and this gap must be addressed going forward to attract adequate qualified staff to the municipality.

Incidence of diseases

Generally, prevalence of diseases has decreases in the past four years as a result of the implementation of projects and programmes in the 2014-2017 MTDP. Performance in child immunization improved by 4% in 2017 while coverage of insecticide bed net improved by a margin of 5% in 2017. Other health interventions such as free registration the indigents under the NHIS, community surveillance systems and nutrition promotion has helped to reduce the high incidence of diseases in the municipality. However, malaria continued to remain the topmost OPD cases recording about 21.9% of all diseases followed by upper respiratory tract infection and rheumatism respectively as seen in Table 1.38.

Neglected Tropical diseases

Statistics available at the Disease Control Unit of the MHD reveals the presence of some neglected tropical diseases. In 2015, there was 1 reported case of Onchocerciasis but there hasn’t been any reported case since 2016. Schistosomiasis however decreased from 13 in 2015 to 8 cases in 2017 as shown in Table 1.39

Epidemic Prone Diseases

The Municipality has not reported a confirmed case of any of the Epidemic Prone Disease (EPDs), however, a number of suspected cases were reported and investigated in the municipality. Suspected cases of measles reported and investigated increased from 3 in 2016 to 8 in 2018. The rest of the EPDs recorded between 0-2 cases except Cholera which recorded 0 case for the period 2015 to 2018. There is the need to intensify surveillance activities on these diseases to detect and investigate cases in order to prevent or respond timely to epidemics. Table 1.40 provides details on EPDs in the municipality.

Tuberculosis Control

Incidence of TB in the municipality was a matter of concern as it also has a relationship with HIV and AIDS. Table 1.41 shows positive cases increased from 29 in 2013 to 47 in 2017 after peaking at 62 in 2015. Even though cure rate increased to 78.3% in 2017, the death rate of 2.9% is still too significant to call for stringent measures to eradicate the occurrence as TB is highly contagious and has implication for the prevalence of HIV and AIDS.

 
Family Planning

The persistent high birth and fertility rate in the municipality is an indication of a growing population which has outstripped economic development. There is therefore an urgent need for measures to improve performance of family planning strategies in the next four years in order to reduce population growth. Table 1.42 shows that family planning acceptors increased from 2551 women in 2015 to 4169 in 2018 as at November. The total couple year protection increased from 1769.9 in 2015 to 2821.8 in 2018. Strategies to attract new acceptors will be stepped up to rope in more females to help control the municipal population growth rate.

HIV and AIDS

Knowledge of HIV and AIDS is high, except that it has not been translated into positive behavioral change. People still engage in high risk sexual behaviors coupled with low condom use and multiple sexual partners. Indeed, there is a big gap between knowledge on HIV and AIDS and its effects and the people’s readiness to change their negative lifestyles.

Statistics from OPD records indicate an upsurge in Sexually Transmitted Diseases (STIs) and HIV and AIDS have been quite considerable in the municipality. There is no record on actual prevalence of HIV and AIDS as there is no sentinel site for HIV in the municipality. The assembly implemented a number of sensitization and support services aimed at reducing stigmatization and new infections.

Records available indicate an increase in the number of people who undertook voluntary testing from 1210 in 2015 to 2529 in 2018 as at November, while positive cases increased from 158 to 300 in the same period as shown in Table. 1.43 The data also indicates that more females were screened than males in all the years. Voluntary counselling and testing should be encouraged among the male population while necessary support is given to the people living with HIV and AIDS. There is the need for intensified and concerted effort by all stakeholders in the provision of education through regular durbars to demystify the condition.

 Risk Factors for HIV and AIDS in the municipality

A number of factors may be considered as potential triggers for the infection and spread of HIV and AIDS in the municipality particularly, Osiem, Tafo and Kukurantumi, the political, commercial and educational capitals respectively. The booming mining sector has resulted in the emigration of a lot of youth from both inside and outside the country with relatively high financial resources and as such are able to easily lure the girls in the mining communities who are mostly unemployed. The impact of these relationships results in both high rate of teenage pregnancies and spread of STIs including HIV. The need to step up public sensitization with emphasis on the female child cannot be overemphasized.

In another development, the numerous second cycle schools which are mostly private day-schools with its attendant laxity in discipline have exposed the youth to early sexual adventures. Records show that the development has contributed to high incidence of teenage pregnancies at Tafo and Kukurantumi, two adjoining communities with high youthful population. The Assembly must collaborate with the school authorities to strengthen awareness creation on the pandemic in both the schools and at the community level.

Besides these, the numerous constructional works in the municipality is also another major risk factor. The labour force of Contractors who are brought from outside the municipality may pose a great danger to the youth in beneficiary communities as they tend to engage in high risk behaviours when they take their wages. To this end, the Assembly must make the implementation of HIV and AIDS education as a pre-contract activity, mandatory in its Tender and Contract Documents and must ensure compliance by prospective contractors.

Other determinants of the deadly disease include social functions such as funerals, Ohum festivities and other social gathering which are on weekly and annual basis. Many people who patronize these functions meet sexual partners and engage in casual sex promoting the spread of the disease. There is therefore the need for annual and periodic awareness creation, counselling and testing of revelers at especially festivals and holidays. Table 1.44 shows an analysis of vulnerable groups.

Impact of HIV/AIDS

Records indicate that greater percentage of the HIV/AIDS infections fall within the age group of 15-49 which forms the potential labour force of the municipality. This has very serious implications because the economically active groups who are supposed to provide for the whole population are the most infected, vulnerable and high-risk group. If care is not taken the situation has the potential of having serious implications on the municipal economy. As most labour force will be lost leading to high labour cost, low productivity, low income level, high dependency ratio and increase in poverty.

This situation if not controlled can also affect health delivery by putting pressure on the existing health facilities, diversion of limited resources to support the control and prevention of the disease and reduction in life expectancy. With families, this could lead to stigmatization, pressure on incomes, increase in the number of orphans and street children and its related high dependency ratio and high poverty level.

Response Analysis

The Municipal Assembly in collaboration with other stakeholders such as Municipal Health Department (MHD), Hospitals, NGOs, CBOs and FBOs in and outside the municipality is undertaking series of programmes to reduce the incidence of the disease. The Municipal HIV/AIDS Committee is charged with the responsibility of coordinating and monitoring HIV/AIDS activities to reduce duplication of efforts and resources.

Funding for HIV and AIDS related programmes has been predominantly by the Ghana Aids Commission and the assembly’s contribution funded from the mandatory 0.5% of its share of the District Assemblies’ Common Fund (DACF). The assembly is yet to establish data on people leaving with HIV and AIDS and those affected by the pandemic such as OVCs. It is therefore important to commission a survey to identify such vulnerable groups to enable the Assembly provide the needed support to them.

Institutions involved in HIV and AIDS Programmes in the District

The fight against HIV and AIDS in the municipality has been structured in line with the National Strategic Framework. The assembly has a 15 member multi-disciplinary AIDS Committee and a 5 member Response Management Team (MRMT) team in place. At the local level, the municipal Assembly is the main body responsible for monitoring NGOs/CBOs providing HIV and AIDS activities in the municipality. Other institutions that support in the promotion of HIV and AIDS related issues include the Department of Social Protection and Community Development, Municipal Health Department, Ghana Education Service and National Commission on Civic Education.

Social Interventions

A number of social intervention programmes targeted at the most vulnerable groups in the municipality were implemented with funding from both the assembly and central government. The assembly in the period implemented social intervention programmes like the National Health Insurance Scheme, School Feeding, Capitation, Free School Uniforms and Exercise Books, Livelihood Empowerment Against Poverty (LEAP) and the Disability Fund. The successful implementation of these programmes have brought improvement in the living conditions of beneficiaries and are expected to make greater impact in the coming years.

National Health Insurance Scheme

Health insurance administration is still headquartered at the mother Assembly, the Abuakwa South Municipal Assembly. The figures in this section therefore represent both Abuakwa South and North municipalities. The active membership of Health Insurance Scheme at the close of 2016 stood at 52,637, a decrease below that of the previous year which recorded a total of 59,807 (42% males and 58% females). Females continued to dominate the membership list accounting for about 58% with males comprising 42%.

The total persons exempted from payment of premium in 2016 stood at 63% as against 45% in 2015, in line with Government’s policy on promoting free access to health care for pregnant women, aged, children and indigents as shown in Tab. 1.45. In a related development, the MHIS within 2016 implemented the African Health Market for Equity (AHME) Project which seeks to integrate the poor and vulnerable unto the health insurance scheme. The project recorded a total of 18,387 people of which 1000 were issued with ID Cards to enable them access health services. A major challenge with the NHIS is the delay in payment for service providers as well as long waiting periods at service centers which need to be addressed going forward.