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April, 2012 Health SummitPresentation at Business
Meeting By
Kobina Atta Bainson(Lead Facilitator)
25 April, 2012
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OUTLINE
Holistic assessment of sector Maternal and Child HealthOccupational and Environmental Health
Disease Control Human ResourceOrganisation and PartnershipFinanceConclusion
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HOLISTIC ASSESSMENT – Sector Score 2008-2011
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
THEMATIC AREA 3 – Capacity development 0 +1 +1 0
THEMATIC AREA 4 – Governance and financing +1 +1 +1 0
SECTOR SCORE +4 +2 +5 +3
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HOLISTIC ASSESSMENT –Best and Worst Regions 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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INDEPENDENT REVIEW TEAM 5
HOLISTIC ASSESSMENT – Review of tool
Weaknesses in current holistic assessment tool
Revisit the HSMTDP sector wide indicators, their definitions, sources and groupings
Develop a new holistic assessment tool for subsequent assessment
31/03/2011
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MATERNAL AND CHILD HEALTH SERVICES
Progress made in delivering maternal services ANC 4+ visits 75% (71 in 2010) MIC84.7%
Skilled delivery 56% (48% in 2010) MICS 69.4%
Family planning acceptor 26% (24% in 2010)
Children fully immunized 88% ( 87% in 2010)
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MATERNAL AND CHILD HEALTH SERVICES
Worrying disparities between geographic and socio-cultural groups
Richer, educated and urban residents accessing services better
High institutional maternal mortality
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MATERNAL AND CHILD HEALTH SERVICES
High neonatal death with 60% occurring in first 24 hours
Stillbirth 22/1000 pregnancies (Central 50%)
Exclusive breastfeeding 46% (63% in DHS2008)
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MATERNAL AND CHILD HEALTH SERVICES - Recommendations
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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MATERNAL AND CHILD HEALTH SERVICES - Recommendations
Strengthen quality of care
Implement Mill. Acc. Framework to track results and resources: need to strengthen data management system
Analyse causes of high stillbirth rate in Central Region
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OCCUPATION AND ENVI. HEALTHOil 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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OCCUPATION AND ENVI. HEALTH 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 respond31/03/2011
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DISEASE CONTROL
HIV prevalence stabilized nationally, but sudden increase in Central Region
Epidemics of cholera and meningitis with mortality
NCD: policy not finalized; no governance structure
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DISEASE CONTROL
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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HUMAN RESOURCES
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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HUMAN RESOURCES –Recommendation
All stakeholders should commit to implementing HRH policies.
Reorganise service delivery to optimally use excess staff
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ORGANISATION OF SERVICESInstitutional and Organisational
Assessment Report: Major challenges in leadership and intersectoral collaboration
Integration of mental and traditional health services e.g., issues of organisation and management, referral, capacity development
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ORGANISATION –Recommend.
Leadership: create incentives for performance; strengthen accountability mechanisms
Form a working group to discuss integration of mental health services and traditional medicine
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PARTNERSHIP –PRIVATE SECTOR
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
: Policy framework to engage the private sector was put in place since 2003. However, by 2009, there were calls for the review of the policy to align it with current developments. The review and engagement process started in 2009 with support from World Bank and Rockefeller Foundation.: Policy framework to engage the private sector was put in place since 2003. However, by 2009, there were calls for the review of the policy to align it with current developments. The review and engagement process started in 2009 with support from World Bank and Rockefeller Foundation.: Policy framework to engage the private sector was put in place since 2003. However, by 2009, there were calls for the review of the policy to align it with current developments. The review and engagement process started in 2009 with support from World Bank and Rockefeller Foundation.: Policy framework to engage the private sector was put in place since 2003. However, by 2009, there were calls for the review of the policy to align it with current developments. The review and engagement process started in 2009 with support from World Bank and Rockefeller Foundation.
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PARTNERSHIP –TRAD MED.
Traditional medical practitioners using both approved and unapproved herbal medical preparations; issues with new FDB guidelines
Property rights issues: Reluctance of herbalist to disclose formulations in their herbal preparations
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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FINANCING
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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FINANCING
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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CONCLUSION
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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ALL HANDS ON DECK. THANK YOU