The District Health Administration became fully functional in September, 2008 with only five staff, namely; District Director of Health Services, District Public Health Nurse, Accountant, District Disease Control Officer and a Driver. The District Director of Health Services doubled as Executive Officer, Human Resource Officer and a Typist.
Mr. Frederick Kwame Ofosu
Premier District Director of Health Services
In 2009, the District had 26 Community Health Nurses (CHNs) and 8 Midwives providing public health intervention to the communities; and in 2010, there were 30 CHNs (2 were in Nursing and Midwifery Training school at Atibie) and a total of 12 Midwives.
In 2016, the total staff strength increased to 153 of which CHNs and Midwives were 64 and 13 respectively. As at the first quarter of 2017, the District Health Directorate, has the following staff supporting the District Director of Health Services in his operations:
District Public Health Nurse (1), Disease Control Officers (2), Accountant (1), Nutrition Officers (2), Health Information Officer (1) and a Driver (1). The Directorate lacks a Supply Officer, Stenographer Secretary, Human Resource Officer or Health Service Administrator, an Orderly and Security personnel.
The following offices exist in the District Health Directorate:
- Office of the District Director of Health services
- Reproductive and Child Health Unit
- Disease Control and Prevention
- Stores and Supplies
- Health Information
In 2009, the District had 18 Health Facilities including four (4) Private maternity homes, a private Clinic and Eight (8) CHPS compounds. Today, the District can boast of 24 health facilities including sixteen (16) CHPS compounds.
The District started operation with one (1) laboratory facility at St. Joseph’s Clinic and Maternity home at Kwahu Tafo but now the District is endowed with three additional laboratory facilities at Pepease, Abetifi Health centres and Kotoso Reproductive Health centre. In addition to these, there is the state of the art ultra-modern laboratory facility being constructed at Nkwatia Health Centre by a Philantropist from Nkwatia.
The District has benefited from the Member of Parliament share of NHIA fund for infrastructural developments. The Funds were used to construct Community-based Health Planning and Services (CHPS) compounds at Onyemso and Suminakese. Another compound is been constructed at Miaso. The funds were also used to rehabilitate Hweehwee CHPS compound, and Pepease Health Centre.
In 2011, Kwahu East District Health Administration in close collaboration with Japanese Organization for International Cooperation in Family Planning (JOICFP), Planned Parenthood Association of Ghana and Kwahu East District Assembly implemented a project entitled “Project for Improving Reproductive Health in Kwahu East”. It was a three year project which spanned from 1st November, 2011 to 30th December, 2014. With funding support from the Government of Japan through the Ministry of Foreign Affairs, the District benefited from a well-equipped Reproductive Health Centre at Kotoso including a mini theatre as well as well equipped and furnished four (4) CHPS compounds at Aguadze, Hyewohoden, Sempoa and Bonkrase.
The project provided a Land cruiser vehicle for the Reproductive Health centre, fibre boat as well as reconditioned bicycles for volunteers. There was also a component of capacity building for health staff and Community volunteers.
The Government of Japan is again supporting the District with the construction of a youth friendly centre for the improvement of Adolescent sexual reproductive health at Kotoso. A grant of eighty thousand six hundred United states Dollars (US$ 80,600.00) was received on 2nd February, 2016 during a contract signing ceremony held at the Embassy of Japan, Accra to finalize the project implementation process.
By dint of hard work, the Japanese have become affiliated to Kwahu East. The District is now implementing another project entitled: “Maternal, newborn and Child health promotion in Kwahu East”. It is been funded by JICA/JOICFP. The implementation period of this project is from January 2017 to December 2019. The project’s purpose is to improve access to Maternal, Newborn and Child Health (MNCH) services for women, newborn and children in Kwahu East District.
The District does not have a Hospital. However due to the proximity of the Atibie Government Hospital and the Nkawkaw Holy Family Hospital, people from Kwahu East District sometimes access medical services at these centres. Plans are affot to construct a 250 bed District Hospital at Abetifi.
The District however has 15 public health centres, clinics, Reproductive and Child Health Centres (RCH) as well as Community Clinics/CHPS and 5 private health facilities comprising of Maternity Homes and CHPS. These facilities provide outpatient services to people within and outside the district.
Health care delivery is dominated by the public sector even though it is complemented by private facilities and to a larger extent, the Traditional Medicine Practitioners (TMPs). However, majority of the traditional medicine practitioners remain unregistered and operate especially within the rural communities in the district. The contribution of NGOs such as JOICFP, PPAG and Rhode Foundation, Traditional Birth Attendants (TBAs) and Community-Based Surveillance Volunteers (CBSVs) is equally worth acknowledging in the health care delivery system. The type of health service infrastructure in the district is provided in Table 1.42.
Table 1.42: Status and Condition of health facilities
|No||Type Of Facility||Community||No. Of Staff||Staff/
|Status Of Infrastructure||Ownership
Source: KEDA-DHMT, 2014
Health Infrastructure Requirement
To improve on access to quality and affordable health care, the Asembly requires one hospital and seven additional CHPS Compounds to supplement the work of the existing facilities. The Oframase-Miaso Area council is one of the underserved areas in the district interms of health services and therefore needs urgent attention. Table 1.43 gives details of facility requirement and their locations.
Table 1.43: Health infrastructure requirement
The District has health staff strength of 130 with 136 shorfall which calls for the need to improve the staffing situation in the district. This comprise medical assistants, mid wives, CHNs, nurses, health assistants, laboratory technicians among others. These health personnel are working in the various health facilities in the District. The type of health personnel with their respecting staff strength and places of posting is illustrated in Table 1.44.
Table 1.44: Current Staffing Situation (District Wide)
|Category of staff||Standard||No. At Post||Short Fall||Excess|
|Public Health Nurse||8||2||6||–|
|Technical Officer (Lab)||6||1||5|
|Technical Officer (Bio)||5||1||4|
|Technical Officer (Epid/Leprosy).||3||2||1|
|Community Health Nurse||64||57||7|
|Ward Assistants/Health Aids||18||9||9|
Statistics from OPD records indicate an upsurge in Sexually Transmitted Diseases (STIs) and HIV and AIDS has been quite considerable in the district. According to the District Health Directorate, actual prevalence of HIV and AIDS in the district cannot be established because there is no sentinel site for HIV in the district. Voluntary counselling and testing should be encouraged whilst the necessary support is given to the people living with HIV and AIDS. However, the trends of reported HIV and AIDS cases from 2011 – 2013 have been presented in Table 1.45.
Table 1.45: HIV AND AIDS Situatution (2011– 2013)
Source: KEDA-DHMT, 2014
Risk Factors for HIV and AIDS in the District
A number of factors may be considered as potential triggers for the infection and spread of HIV and AIDS in the District particularly, Abetifi, the District Capital.
The establishment of the Presby University College as important as it may, posses a major risk factor in the spread of HIV and AIDS. This is because the Institution is patronised by people from all walks of life who may pose danger not only to their school mates but to the locals as well. The Assembly must therefore collaborate with the University Authorities to strengthen awareness creation on the pandemic in both the Campus and at the community level.
The numerous constructional works in the District is also another major risk factor. The labour force of Contractors who are brought from outside the District 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. Many of the workers on projects in the various communities Constructional works has brought key determinants in the district include mining, transport, unemployment and underemployment and social functions.
Other determinants of the deadly disease include social functions such as funerals, Easter 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, councilling and testing of revelers at especially Easter Celebrations (Tab. 1.46).
Table 1.46: Key Vulnerable and High Risk Groups in the District
|Vulnerable Groups||High Risk Groups|
|Domestic aids||Public Service Workers|
|Local residents||Revelers at Kwahu Easter|
Source: District HIV and AIDS Strategic Plan, 2010.
Impact of HIV/AIDS
Even though there is no empirical data on the impact of HIV and AIDS exclusive to Kwahu East, data available to the district, 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 district. 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 district 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.
The District Assembly in collaboration with other stakeholder such as District Health Management Team (DHMT), NGOs, CBOs and FBOs in and outside the district is undertaking series of programmes to reduce the incidence of the disease. The District HIV/AIDS Committee is charged with the responsibility of coordinating and monitoring HIV/AIDS activities in the district.
Funding for HIV and AIDS related programmes has been predominantly by the Ghana Aids Commission and the District Assembly. The Assembly’s contribution is funded from the mandatory 0.5% of its share of the District Assemblies’ Common Fund (DACF).
The District 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 Kwahu East District has been structured in line with the National Strategic Framework. The District has a 15 member multi-disciplinary District AIDS Committee (DAC) and a 5 member District Response Management Team (DRMT) team in place.
At the district level, the District Assembly is the main body responsible for monitoring NGOs/CBOs providing HIV and AIDS activities in the District. Other institutions that support in the promotion of HIV and AIDS related issues include the Department of Social Welfare/ Department of Community Development, Ghana Health Service, Ghana Education Service and National Commission on Civic Education. Additionally, there are four NGOs and one Community Based Organization currently working in the area of HIV/AIDS in the District as indicated in Tab. 1.47.
Table 1.47: HIV/AIDS related Institutions
|ORGANISATIONS||AREA OF OPERATION||SOURCE OF FUNDING|
|Monitoring of NGOs/CBOs providing HIV and AIDS activities in the District||Ghana AIDS Commission/DA|
|Department of Social Welfare/Department of Community Development||Guidance and Counseling service to victims of HIV and AIDS||Ministry/Department of social welfare/DA|
|Ghana Education Service (SHEP)||Awareness creation through workshop for Pupils, Teachers, communities (PTA/SMC etc)||Ghana AIDS Commission, Ministry of Education/DA|
|Ghana Health Service||Planning, Implementation , M&E of HIV And AIDS Programmes and activities In the District||Government of Ghana/ Ministry of Health/DA|
|National Council On Civic Education||Civic Education On Hiv And Aids To The Youth||Government of Ghana/DA|
|Jeslave Care Foundation||Awareness creation among the youth on HIV and AIDS related issues. Advocacy on behavioural changes in the District.||Ghana AIDS Commission/DA|
|Rhode Foundation||Awareness creation on behavioural change||Ghana AIDS Commission/DA|
|Islamic Research And Propagation Centre||Health education on HIV and AIDS prevention, Advocacy on Voluntary Counseling and Testing HIV and AIDS||Ghana AIDS Commission/DA
|Respondents To Human Needs
|Sensitisation on youth abstinence, Guidance and Counseling Programmes||Ghana AIDS Commission/DA
|Odo Na Eye Cbo||Peer Education on safe sex practices, abstinence and partner reduction, Condom distribution
|Ghana AIDS Commission/DA|
The district does not have an autonomous Scheme. It continues to operate as an agency under the Okwahuman South Health Insurance Scheme located in the Kwahu South District. This has made it difficult to segregate the data for the two districts. However, indications are that patronage for the Scheme is high as new people continue to register. It is the hope of the Assembly that everything possible will be done to make Kwahu East autonomous from Kwahu South Insurance Scheme in the near future to facilitate effective monitoring.
High prevalence of non-communicable diseases such as hypertension and diabetes
Low TB detection rate
Low family planning acceptor rate
Low coverage of service interventions in difficult and underserved areas
Low supervised delivery coverage
Low IPT coverage
Inadequate human resource of all categories
Limited CHPS compounds
Poor response to surveillance activities and late reporting of epidemic prone diseases
Limited staff accommodation
Lack of permanent office accommodation for District Mutual Health Insurance Scheme.