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

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

ALL HANDS ON DECK. THANK YOU