Preliminary findings from the 2011 National MICS to

the Health Summit

Is Ghana reducing Disparities and Improving Equity on key Health

Outcomes?

PRESENTATION

Background of the National MICS SurveyPutting the National MICS results into the

context of the HSMTDPKey Findings:

Maternal HealthChild Health NutritionNHISWater and Sanitation

Conclusions

BACKGROUND

The Ghana National MICS (with an enhanced Malaria module and biomarker) was conducted by the Ghana Statistical Service with financial and technical support from:National Malaria Control Programme/GHSNavrongo Research CentreUSAID/CDC/ICF-MACROUNICEFGovernment of JapanUNFPAA lot of technical support from other DPs, UN

Agencies and MDAs

BACKGROUND

2010 Census Sampling Frame was used, and a total of 12,250 Households were sampled;

4 Regions (Upper East, Upper West, Northern and Central) were oversampled to provide more precise data

4 Questionnaires were used: HH, Women 15-49 yrs, Children 0-5 yrs, and Men 15-59 years;

Anthropometry, Malaria/Anaemia testing for children under-5 yrs, and salt was tested (Rapid test kits, and titration);

Survey methodology similar to that of Demographic and Health Survey (DHS), therefore, data is comparable;

Presentation only captures a few core indicators, and additional results will be available in the next one month.

OBJECTIVES OF THE MICS

Provide more current information for assessing the situation of children and women, and reporting on country progress on achieving the GSGDA goals/targets, the MDGs and the reporting requirements of other local and international development declarations and agenda;

Provide much-needed data on practices used to treat malaria among children under-five and the use of specific anti-malarial medications, bednet coverage and use, coverage of IPTP for pregnant women, treatment practices for childhood fever, and prevalence of malaria and anaemia among children age 6-59 months;

Provide baseline data for the new United Nations Development Framework (UNDAF) (2012-2016).

National MICS in the context of HSMTDP

MICS 2011 provides a mid-term snapshot on progress on key HSMTDP 2010-2013 strategic objectives

HO1: Bridge equity gaps in access to health care and ensure sustainable financing arrangements that protect the poor

HO3: Improve access to quality maternal, neonatal, child and adolescent health and nutrition services

MICS 2011 provides nationally representative data that can inform development of next health sector medium term plan.

MATERNAL HEALTH

In aggregate, positive trends in maternal care indicators, although disparities exist……..

0

40

80

12082

40

86

58.944

89

62.344

9269.4

47

9578.2

58.7

96.784.7

68.4

Maternal Care Indicators

GDHS 1988 GDHS 1993 GDHS 1998GDHS 2003 GDHS 2008 MICS 2011

Per

Cent

Target is 60% for 2013

Target is 80% for 2013

Skilled deliveries still a challenges to many women in the northern region….

Northern37%

Volta64%

Ashanti74%

Brong Ahafo64%

Western65%

Eastern78%

Upper West60%

Central63%

Upper East67%

Greater Accra90%

Northern27%

Volta54%

Ashanti73%

Brong Ahafo66%

Western62%

Eastern61%

Upper West46%

Central54%

Upper East47%

Greater Accra84%

Key  Below

50%  51-70%  Above

70%

2008 2011

Ratio of highest to lowest is 1:2.43Target: 1:1.8 (2011)Was: 1:3.1 (2008)

The richer, educated and urban residents benefiting more from

skilled deliveries…

RuralUrban

RESIDENCE

NonePrimary

Middle/JSSSecondary +

MOTHER EDUCATION

PoorestSecondMiddleFourth

RichestWEALTH QUINTILE

NATIONAL

.0 20.0 40.0 60.0 80.0 100.0 120.0

53.988.2

54.566.2

79.498.1

40.255.0

70.286.0

98.3

68.4

Assistance by TBAs during delivery reducing, but still high in some

regions…

Docto

r

Nurse

/midwife

Auxilia

ry m

idwife

Comm

unity

hea

lth o

ffice

r/nur

seTB

A

Relat

ive/o

ther

No on

e0

20

40

60

11

44

2 2

30

83

13

54

1 1

16 123

Assistance during Delivery

2008 DHS 2011 MICS

Northern33%

Volta11%

Ashanti12%

Brong Ahafo11%

Western25%

Eastern12%

Upper West13%

Central30%

Upper East4%

Greater Accra5%

Key  Above

30%  20-30%  Below20

%

Wes

tern

Centra

l

Great

er A

ccra

Volta

Easter

n

Asant

e

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Tota

l0

102030405060708090

100

8892

97

76

88 87

7975

83 85 86

88 8895

7288 87

72

63

7377

82

PNC for the newborn PNC for the mother

PNC for mother and child fairly high, although not uniform across regions…

The richer, educated and urban residents benefiting more from

PNC…

Urban

Rural

RESIDENCE

None

Primary

Middle/JSS

Secondary +

MOTHER'S EDUCATION

Poorest

Second

Middle

Fourth

Richest

WEALTH QUINTILE

TOTAL

0 10 20 30 40 50 60 70 80 90 100

PNC for the mother PNC for the newborn

Progress seen over time in prevention of malaria in pregnant women…

Wes

tern

Centra

l

Great

er A

ccra

Volta

East

ern

Ashan

ti

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Natio

nal

.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

31.0

16.1

37.3

25.018.1 21.9

34.227.7

40.3 43.7

27.5

45.5 45.7

29.4

59.8

40.8

50.8

63.7

27.9 26

52.543.7

63.067.8

62.5

40.5

74.1 76.1

63.8

74.170.2 70.2 67.1

% of pregnant women receiving at least 2 doses of IPTp

MICS 2006 DHS 2008 MICS 2011

Use of modern contraceptives increasing….

Wes

tern

Centra

l

Great

er A

ccra

Volta

East

ern

Ashan

ti

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Tota

l05

101520253035404550

1317

22 2117 16

22

6

14

2117

2429

27

16

2623

27

13

1922 23

Use of modern methods

20082011

1 in 4 women in Ghana has unmet need for Contraception

Wes

tern

Centra

l

Great

er A

ccra

Volta

East

ern

Asant

e

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Tota

l 200

8

Tota

l 201

1.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

25.1 22.619.7

37.9

22.4

29.8 27.330.4

26.3 28.0

35.3

26.4

Unmet need for Contraception

CHILD HEALTH

Some gains made in immunization, but nearly 1 in 4

children missing out on vital immunization by age 1

BCG

OPV 3

Pent

a3

Mea

sles

All v

accina

tions

0

20

40

60

80

100

120

94.2

80.1 81.4 77.7

64.493.075.5 79.9 76.5

59.9

97.890.7 92.1 88.5

77.3

% of Children fully immunized by age 1

MICS 2006 DHS 2008 MICS 2011

Target for Penta by age 1yr is 91% by 2013

Increased no. of children sleeping under ITNs, but well

below the national target of 70% by 2013

West-ern

Central Greater Accra

Volta Eastern Ashanti Brong Ahafo

North-ern

Upper East

Upper West

Total

MICS 2006

11.5 19.8 16.3 21.5 24.9 21.8 25.7 21.9 39.3 37.1 NaN 21.8

DHS 2008

35.5 18.9 17.2 40.4 35.7 25.3 50 11.2 36.8 34 NaN 28.2

MICS 2011

32.6744564927701

27.7253082019391

22.1387392424736

70.6701638059887

60.1686459117399

31.2481691782902

41.3452839036205

41.7630288939205

45.0096302322353

46.9321410747926

NaN 39.0338171852122

5152535455565758595

% of Children under-5 yrs who slept under an ITN

MICS 2006 DHS 2008 MICS 2011

LLIN Campaigns took place in these Regions

NUTRITION

Concerted efforts required to promote breastfeeding…..

2003 DHS 2006 MICS 2008 DHS 2011 MICS0

10

20

30

40

50

60

70

80

90

100

52

35

46 46

Timely initiation of breast-feeding (1hr)

1993 DHS 1998 DHS 2003 DHS 2006 MICS

2008 DHS 2011 MICS

0

10

20

30

40

50

60

70

80

90

100

7

31

53 54

63

46

Exclusive breastfeeding

Exclusive Breastfeeding Target is 70% by 2012

Some reduction in malnutrition rates, but still more than 1 in 5 children in Ghana is stunted….

Stunting Wasting Underweight0

10

20

30

40

50

60

34

9

23

31

10

20

35

8

18

28

9

14

22.8

6.2

13.4

Nutritional Status of Children under-5 yrs

1988 1993 1998 2003 2008 2011

Pe

r C

en

t

Target for U/W is 8% for 2013

Key  Above

30%  20-30%  Below20

%

Wide disparities in malnutrition across regions and poverty quintiles - Stunting

Northern32%

Volta27%

Ashanti27%

Brong Ahafo25%

Western27%

Eastern38%

Upper West25%

Central34%

Upper East36%

Greater Accra14%

Northern37%

Volta22%

Ashanti22%

Brong Ahafo19%

Western23%

Eastern21%

Upper West23%

Central23%

Upper East32%

Greater Accra14%

2008 2011

UE and Northern well above national Target of 23%

NATIONAL HEALTH

INSURANCE

At least 60% of children have NHIS in Ghana…

Wes

tern

Centra

l

Great

er A

ccra

Volta

East

ern

Ashan

ti

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Urban

Rural

Poor

est

Seco

nd

Mid

dle

Four

th

Riches

t

Tota

l0

102030405060708090

100

NHIS Membership for Children under-5 yrs

Yes, card seen Yes card not seen

NHIS for women 15-49 yrs…

Wes

tern

Centra

l

Great

er A

ccra

Volta

Easter

n

Asant

e

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Urban

Rural

Poor

est

Seco

nd

Middle

Four

th

Riches

t

Tota

l0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Yes, card seen Yes card not seen

NHIS for men 15-59 yrs…

Wes

tern

Centra

l

Great

er A

ccra

Volta

Easter

n

Asant

e

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Urban

Rural

Poor

est

Seco

nd

Middle

Four

th

Riches

t

Tota

l0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Yes, card seen Yes card not seen

WATER, SANITATION AND

HYGIENE

Wes

tern

Centra

l

Great

er A

ccra

Volta

Easter

n

Ashan

ti

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Urban

Rural

Poor

est

Seco

nd

Middle

Four

th

Riches

t.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

71.5

80.585.6

61.8

76.5

90.5

80.4

68.4

78.3

88.6 90.7

68.6

56.4

69.8

86.0

92.0 92.1

Percentage of population with Improved Source of Drinking

Water National average is 80%, also the Target for 2013

4 regions fall below the National average

Open defecation Unimproved facilities Shared facilities Improved facilities0

10

20

30

40

50

60

70

80

90

100

22

43

29

6

2013

54

13

2316

46

15

% of Population with access to improved san-itary facilities

1990 2008 2011

Access to improved sanitation still a challenge, with wide disparities across regions…….

Sanitation Target is 21% by 2013

Northern72%

Volta25%

Ashanti10%

Brong Ahafo16%

Western12%

Eastern6%

Upper West71%

Central15%

Upper East87%

Greater Accra9%

Key  Above

25%  10-25%  Below

10%

Population with NO sanitation facilities quite high in the north…….

Majority of the unserved are the poorest, and those living in rural areas…….

0

10

20

30

40

50

60

70

80

90

100

69

91

56

70

8692 92

79

9

21

5 8 915

38

15

Water Sanitation

Progress has been made overall, but worrying geographic and socio-economic disparities persist.

Current increased focus on deprived regions should continue while watching out for other regions that may also be vulnerable.

MDG4Coverage of key child survival interventions show

improvement-immunization, malaria prevention, undernutrition

However more efforts are needed to enable equitable attainment of MDG 4 for all children in Ghana

Conclusions

MDG5 Progress on coverage of key interventions- family planning and

skilled delivery

However MDG target unlikely to be achieved at current pace and without strategic focus on structural bottlenecks

MAF-operational plan currently under development presents a huge opportunity to address these bottlenecks.

NHIS Important tool for MDG attainment that needs further scale-up

in coverage for all but particularly for the poorest populations.

‘All hands on deck’ needed for the last lap to MDG 4 and 5 goals

CONCLUSIONS (CONTD.)