Transcript Ghana Health sector review 2009

 Holistic assessment of sector
 Maternal and Child Health
 Occupational and Environmental
Health
 Disease Control
 Human Resource
 Organisation and Partnership
 Finance
 Conclusion
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2008
2009
2010
2011
GOAL 1 – IMR, U5MR, MMR
n/a
n/a
n/a
n/a
GOAL 2 – HIV, Guinea Worm
0
0
+1
+1
GOAL 3 – Equity
+1
0
+1
+1
THEMATIC AREA 1 – Health Lifestyle, W&S
+1
-1
n/a
n/a
THEMATIC AREA 2 – Health, reproduction,
nutrition
+1
+1
+1
+1
0
+1
+1
0
THEMATIC AREA 4 – Governance and financing
+1
+1
+1
0
SECTOR SCORE
+4
+2
+5
+3
THEMATIC AREA 3 – Capacity development
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Western and Central Regions best performing
Greater Accra and Northern regions worst
performing
Recommendation
Disseminate lessons from Central and Western
regions
Reward scheme for best performing regions
Explore reasons in GAR and Northern
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Weaknesses in current holistic assessment
tool
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Revisit the HSMTDP sector wide indicators,
their definitions, sources and groupings
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Develop a new holistic assessment tool for
subsequent assessment
31/03/2011
INDEPENDENT REVIEW TEAM
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Progress made in delivering maternal services
ANC 4+ visits 75% (71 in 2010) MIC84.7%
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Skilled delivery 56% (48% in 2010) MICS 69.4%
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Family planning acceptor 26% (24% in 2010)
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Children fully immunized 88% ( 87% in 2010)
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Worrying disparities between geographic
and socio-cultural groups
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Richer, educated and urban residents
accessing services better
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High institutional maternal mortality
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High neonatal death with 60% occurring in
first 24 hours
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Stillbirth 22/1000 pregnancies (Central
50%)
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Exclusive breastfeeding 46% (63% in
DHS2008)
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Implement MAF: but should be flexible to
address local needs; timely and wide
dissemination of plan; clarify role of EU
support
Analyse the causes of worsening trend in
institutional MMR e.g., use confidential
enquiries
Conduct qualitative studies to explore
underlying reasons
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Strengthen quality of care
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Implement Mill. Acc. Framework to track
results and resources: need to strengthen
data management system
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Analyse causes of high stillbirth rate in
Central Region
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Oil and gas industry
Direct effects: pollution, hazards
Indirect effect: communicable and non
communicable diseases
Recommendations
Conduct health impact assessment
Strengthen health systems including
emergency response, M and E
31/03/2011
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Climate change and Health
Extreme climate changes have implications on
morbidity and mortality: e.g. malaria,
diarrhoeal diseases
Current POWs lack direction in Climate
Change
Recommendations
Need to sharpen policy to respond to Climate
Change Challenges
Improve sector capacity to respond
31/03/2011
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HIV prevalence stabilized nationally, but
sudden increase in Central Region
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Epidemics of cholera and meningitis with
mortality
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NCD: policy not finalized; no governance
structure
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Recommendations
HIV: Commission an in-depth study into the
high prevalence in Central Region
Epidemics: Continually strengthen epidemic
response
NCD: Finalize the NCD policy; Establish the
proposed governance structure for NCDs
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Significant increase in number of nurses,
midwives and doctors
Equitable distribution of staff improved, but NR
and UWR are understaffed
Poor adherence to targets set in HRH Policies &
Strategies (2007-2011).
Quality compromised when focus is just to
increase numbers
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All stakeholders should commit to implementing
HRH policies.
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Reorganise service delivery to optimally use
excess staff
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Institutional and Organisational
Assessment Report: Major challenges in
leadership and intersectoral
collaboration
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Integration of mental and traditional
health services e.g., issues of
organisation and management, referral,
capacity development
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Leadership: create incentives for
performance; strengthen accountability
mechanisms
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Form a working group to discuss integration
of mental health services and traditional
medicine
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: Policy framework to engage the private sector was put in place since 2003. However, by 2009, there were calls for the rev
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Policy framework to engage the private
sector was in place in 2003;
Policy not disseminated; no implementation
plan yet call for review in 2009
Key challenges facing private sector are
difficulty in attracting critical staff; low NHIS
reimbursement
Recommendation
Finalize policy and develop implementation
plan; strong political support
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Traditional medical practitioners using both
approved and unapproved herbal medical
preparations; issues with new FDB guidelines
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Property rights issues: Reluctance of herbalist to
disclose formulations in their herbal preparations
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Recommendations
Organise a stakeholder meeting to address
challenges
The Ministry of Health should work to protect the
property rights of herbalists
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NHIS reforms: electronic claims processing;
introduction of call centres; capitation
Since 2010 NHIS has been running a deficit which
grew in 2011; raises issues with scheme’s survival
Fund investment reduced by 50%
Capitation excludes medicines; affects cost
containment strategies
Achieving universal access: issues 1.financing
should match access; 2. allocating resources
efficiency
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Expenditure per capita US$35 (28 in 2010)
IGF study: Weak controls and limited capacity for
data management. Study did not conduct
detailed analysis of utilization
Recommendations
Develop strategies to increase revenue
Revise guidelines on use of IGF
Strengthen capacity for data management
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Progress made in maternal and child health
services
Worrying disparities between geographic and
socio-cultural groups
Need to urgently reduce the high institutional
mortality rate and stillbirths to rapidly
achieve MDGs 4 and 5
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