ST. MARTIN DE PORRES HOSPITAL, EIKWE, GHANA · 2019-03-18 · St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report 2013 St. Martin De Porres Hospital, Eikwe, Ghana Annual

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Annual Health ServiceReport 2013

ST. MARTIN DE PORRES HOSPITAL,EIKWE, GHANA

ST. MARTIN DE PORRES HOSPITAL,EIKWE, GHANA

www.eikwe-hospital.org

36 1

St. Martin De Porres Hospital, Eikwe, GhanaAnnual Health Service Report 2013

0.1.0. Content0.2.0. Annexes 30.3.0. List of Tables 40.4.0. List of Acronyms0.5.0. Essential Data0.6.0. Acknowledgment

1.0.0. Executive Summary1.1.0. Mission1.2.0. Relief & Drainage1.3.0. Climate & Vegetation1.4.0. Demography1.5.0. Socio Economic Activities1.5.1. Transport, Communication & Road Network1.5.2. Water1.5.3. Sanitation1.5.4. Educational Facilities1.6.0. Departments and Units1.7.0. Services Provided1.7.1. Health Service Delivery

2.0.0. The Identity of The NationalCatholic Health Service [NCHS]

2.1.0. Promotion & Maintenance of the Identity of theNCHS

3.0.0. Organisation & Management3.1.0. Management & Administration3.1.1. Management & Other Institutional Meetings3.1.2. Building & Equipment3.1.2.1. Health Infrastructure3.1.2.2. Medical & Other Equipment3.1.2.3. Transport3.1.2.4. Developmental Projects3.1.2.5. Power Supply .3.1.2.6. Stores and Supplies3.2.0. Partnerships3.2.1. Partnership & Internal Relationships .3.2.2. External Relationships3.3.0. Human Resource Development3.3.1. Staffing Levels3.3.2. Staff Movement3.3.3. Staff Motivation3.3.4. Staff Training & Development

4.0.0. Health Administration & Support Services4.1.0. Health Information System4.2.0. Supportive Supervision/Monitoring & Evaluation


ContentsAnnex 17 - Antenatal (ANC) AttendanceType of Data 2009 2010 2011 2012 2013

Total ANC Registrants 1,858 5,098 1,484 1308 1,354

Total ANC Attendants 12,388 14,338 15,621 18235 20,057

Total PNC Attendants 546 630 1,033 1533 2,036

Mothers Receiving TT2+ 2,103 2,738 2,815 2621 2,242

Women with 4+ ANC visits 958 1,017 649 972 1,442

Risk Detection at ANC

Registrants of Early Teen [10-14] 3 13 1 3 4

Registrants of Late Teen [15-19] 219 632 156 143 137

Registrants of Age Over 35 year 268 238 192 233

Registrants with HB Below 11 gm 1,179 777 383 324 308

Registrants of Parity 4 and Above 218 494 148 149 151

Child Heath (CWC)

No. of Children 0-11 Months 369 301 567 736 298



No. of Under 5 Children 1,216 1,196 1,797 2219 693

BCG 2,342 1,947 1,876 1998 1,900

OPV0 1,626 1,443 1,799 1934

OPV3 548 447 514 503 303

PENTA3 548 491 514 503 303

Measles 603 457 513 481 305

Yellow Fever 603 457 513 477 332

Vitamin A Supplements 2,232 1,499 1,916 1273 1,191

Growth Monitory

>80% [Well-Nourished] 9,361 10,923 13,287 17,848 7,668

70-80% [Mal-Nourished] 208 228 288 281 226

<70% [Severely malnourished] 0 0 3 3 2

Annex 18 - Delivery OutcomeType of Data 2009 2010 2011 2012 2013

No. of Maternity Beds 35 35 35 35 45Total Deliveries 2,362 2,422 2,925 3336 3,173

Total Live Births 2,213 2,359 2,761 3164 3,048Total Still Births 149 136 164 172 125- Fresh 21 14 32 41 25- Macerated 128 122 132 131 100

Total Low Births Wgt (<2.5 kg) 315 269 526 297 591No. of CS 504 534 673 768 728No. of Vacuum Extraction 11 9 17 10 10No. of Neonatal Deaths 32 59 36 55 82No. of Maternal Deaths 12 5 3 4 8No. of Maternal Death Audits 12 5 3 4 8No. of infants Deaths 88 98 73 81 124

5.0.0. Service Provision

5.1.0. Access to Healthcare Services & PerformanceOverview5.1.1. Review; Morbidity & Mortality5.1.2. Clinical Trends5.1.3. Service Utilisation5.1.4. Customer Satisfaction5.1.5. Service Quality5.1.5.1. Service Data5.1.5.2. Top Ten Diseases Analysis5.1.5.3. Curative Services5.1.5.4. Investigative Services5.1.5.4.1. Laboratory & Blood Bank5.1.5.4.2. X-Ray & Ultra Sound Scan Services5.1.5.5. Maternity Services5.1.5.6. Delivery Outcome:5.1.5.7. Post Natal Care [PNC]5.1.5.8. Maternal Mortality

6.0.0. Surgical Procedures

6.1.0. Surgeries7.0.0. Specialised Services

8.0.0. Other Services

8.1.0. Pharmacy & Dispensary8.2.0. Blood Transfusion8.30. Home Based Care8.4.0. Improving Quality of Care8.50. Mortuary Services

9.0.0. Health Prevention

9.1.0. School Health9.2.0. Expanded Programme on Immunization [EPI]9.2.1. Immunization Coverage9.3.0. MCH [ANC/PNC]9.4.0. Well Baby Clinic/Child Welfare Clinic [CWC]9.4.1. Micronutrients Deficiency Control9.4.1.1. Weaning Food Project9.5.0. Adolescent Child Health9.6.0. Diseases of Public Health Concern9.6.1. Integrated Disease Surveillance9.7.0. Malaria9.7.1. Deaths from Malaria9.9.0. Tuberculosis

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10.0.0. Health Promotio

10.1.0. Sexually Transmitted Infections [STIs]10.1.1. [STIs] HIV/AIDS Prevalence & Control10.1.2. HIV Sero Prevalence10.1.3. ANC HIV Sentinel Surveillance &

Prevention of Mother to Child Transmission[PMTCT]

10.1.4. Ante Retroviral Therapy [ART]10.1.5. Social Support Programmes10.1.5.1. Persons Living With AIDS [PLWA] Association10.1.7. Home Based Care10.2.0. Natural Family Planning

11.0.0. Health Financing .

11.1.0. Financial Management & Financing Mechanisms

11.1.1. Budget for Year 201311.2.0. Health Insurance11.3.0. Finance11.4.0. Notes To The Financial Statements for PeriodEnded Dec 31, 2014.

12.0.0. Research

Note 15 Fixed Assets Schedule

13.0.0. Conclusions & Way Forward

13.1.0. Constraints & Challenges13.2.0. Policy Thrust & Priority Areas13.3.0 Challenges13.4.0. Social Services.13.5.0 Conclusion & Way Forward

Table 1: Demographic Characteristics: Ellembelle &

Eikwe Sub Districts 2013

Table 2: Infrastructure

Table 3: Transport

Table 4: Projects

Table 5: Staff Movement

Table 6: Increasing Access to Health Care [Service]

Table 7: Increasing Access to Health Care [Staffing]

Table 8: Out Patient Visits

Table 9: Admissions

Table 10: Laboratory Investigations; Outcome

Table 11: Reproductive & Child Health

Table 12: Supervised Deliveries

Table 13: Summary of All Surgeries

Table 14: EPI; Registration & Attendance

Table 15: Immunization Coverage

Table 16: Tuberculosis [New & Relapse Cases]

Table 17: HIV/AIDS Screening

Table 18: Financial Report

Annexes

14.0.0. Annexes

Annex 1 Summary of Hospital Activities

Annex 3 Annual Ward State: 2013

Annex 4 Laboratory Investigations - Outcome: 2013

Annex 5 X-Ray Investigations

Annex 6 X-Ray Investigations-2013

Annex 7 Ultrasound Scan Investigations

Annex 8 General Surgeries

Annex 9 Surgeries: General& Obstetrics & Gynaecology

Annex 10 Improving Quality of Care

Annex 12 Smear Positive Pulmonary TB By Age Group [New

Cases]

Annex 13 TB Cohort Analysis

Annex 14 HIV/AIDS Screening [By Age & Sex] 2013

Annex 15 [V]CT & PMTCT

Annex 16 Antiretroviral Therapy [ART] Analysis

Annex 17 Antenatal [ANC] Attendance

Annex 18 Delivery Outcome

List of tables

AFP Acute Flaccid Paralysis

A/PNC Ante/Post Natal Clinic

ART Ante Retroviral Therapy

CSM Cerebral Spinal Meningitis

CHAG Christian Health Association of Ghana

CHPS Community Health Programme Services

CWC Child Welfare Clinic

DMHIS District Mutual Health Insurance Scheme

EPI Expanded Programme on Immunization

GHS Ghana Health Service

GOG Government of Ghana

IE&C Information, Education & Communication

IGF Internally Generated Fund

ITBN Insecticide Treated Bed Nets

IUD Intra Uterine Death

MOH Ministry of Health

NACP National AIDS Control Programme

NCS-DoH National Catholic Secretariat – Department of

Health

NCHS National Catholic Health Service

NHIS National Health Insurance Scheme

NID National Immunization Day

NGO Non-Governmental Organisation

OPD Out Patient Department

PHC Primary Health Care

PLWA Persons Living With HIV/AIDS

R/DHD Regional/District Health Directorate

RCH Reproductive & Child Health

STI Sexually Transmitted Infection

TBA Traditional Birth Attendant

[V]CT [Voluntary] Counselling & Testing

List of AcronymsContents Continue

“A Special Thank You”;

• Staff of St. Martin de Porres Hospital-Eikwe; for their hard work, loyalty, dedication, and

cooperation.

• National Catholic Secretariat- Dept. of Health [NCS& DOH]; general advocacy, administrative

support, supplies coordination etc.

• Christian Health Assoc. of Ghana [CHAG]; general advocacy, administrative support, salary

negotiations etc.

• Diocesan Health Secretariat [DHS], Sekondi-Takoradi Catholic Diocese; general advocacy,

administrative procedures etc.

• Ministry of Health, [MOH] Ghana Health Service [GHS]; staff salaries, logistics support and

administrative procedures.

• Medical Mission Institute [MMI], Germany; financial, equipment, spiritual and educational

support.

• Medical Mission Secular Institute [MMSI], Eikwe; financial, equipment, spiritual and educational

support.

• Society of Infant Jesus [SIJ], Ghana; personnel and spiritual support.

• St. Ann’s Community [SAC], India; personnel and spiritual support.

• German Rotary Volunteer Doctors, Germany; personnel, equipment and financial support

• Senior Expert Services [SES] Germany; ]; for personnel

• Institute of Medical Microbiology – University Medical Center [UMC] Gottingen [Germany];

research assistance

• Friends and Benefactors in Germany and Austria; medical supplies and medicines, financial

and spiritual support.

• Ghana AIDS Commission [GAC]]; Funding for PLWA Care & Support Project

• Western Regional & Ellembelle District Health Directorates; administrative procedures and

personnel.

• Her Excellency Matilda Amissah-Arthur [Second Lady]; assorted medical equipment and

supplies

• Ellembelle District Assembly; construction of bungalow, assorted medical equipment and

supplies

• St. Raphael’s Catholic Parish, Eikwe; for pastoral support, assistance in administrative

procedures and personnel.

• Eni Foundation- Ghana: financial assistance for new Antenatal Block and IE&C Activities.

• HESS Oil Company-Ghana: financial assistance for training of sponsored students

• Technicians Without Boarders[TWB]-Germany: construction of an incinerator

• All individuals, organisations and institutions: for donations for various projects, personnel

and other logistics.

We are very grateful to all and sundry for the excellent support youprovide us as we continue providing health care to the rural populationof Ghana. For your friendship, prayers and benevolence, the hospitalmanagement, staff and patients, wish to express its heartfelt gratitude.

4 5St. Martin De Porres Hospital, Eikwe, GhanaAnnual Health Service Report 2013

Name: ST. MARTIN de PORRES HOSPITAL

Institution Type: GENERAL HOSPITAL [MISSION]

Year Founded: 1959

Hospital Bed Capacity: 200

Postal Address: Post Office Box 06, EIKWE via Axim. GHANA

Telephone: [00233] [0]31 923 75/ 923 87

Home Page: www.eikwe-hospital.org

Email: [email protected]

Town: Eikwe [via Axim]

Sub District: Eikwe Sub District

District: Ellembelle

Sub District Population: 11,143

District Capital: Nkroful . District Population: 92,857

Region: Western

Diocese: Catholic Diocese of Sekondi-Takoradi. GHANA

Partner Society: Society of Infant Jesus [SIJ] Cape Coast, Ghana

Partner Society: Sisters of St. Anne’s Community [SAC] Bangalore, India

Partner Society [Foreign]: Medical Mission Secular Institute [MMSI] Wurzburg. Germany

Partner Institute: Medical Mission Institute [MMI] - Germany

Medical Director [Specialist] in Charge; Dr. Paul Cooper

Nursing Service Administrator: Rev. Sr. Comfort Buadi [SIJ]

Health Service Administrator: Mr. John Abakah

Principal Accountant: Rev. Sr. Nancy Ulahannan

Diocesan Bishop: Most Rev. Matthias K. Nketsiah

Diocesan Health Director; Mr. John I. Mawah

Hospital Chaplain: Msgr. John Adade

Essential Data

Acknowledgement

St. Martin De Perres Hospital, Eikwe, GhanaAnnual Health Report 2013


This “Annual Health Service Report" captures all services and

related activities at St. Martin de Porres Hospital, Eikwe, during

the reporting year of 2013. The report relates to past as well

as future events in so long as these have or could have an

impact on the hospital and service delivery. For statistical

records, this report covers events of the last five years; including

year 2013 which is the current [reporting] year.

The activities reported on derive from the hospital’s “5 Year

Strategic Plan of 2013 – 2017”, and address the implementation

of various set objectives, and challenges encountered therein.

2013 is the first year of implementation of the new 5 year

strategic plan for the hospital.

The report discusses performance within the reporting year

2013, and compares these with previous years, and sets an

agenda to further address unachieved targets for the ensuing

year[s]. Targets cited in this report are widely accepted

[international] health performance indicators, whose trends

are analysed in determining improvement or otherwise.

As in the last years, indicators for Reproductive & Child Health

were generally good. Coverage rates for ante and post natal

services remain high. Registered antenatal coverage increased

from 262% to 405%. The number of deliveries dipped by 4.9%

[3,336 in 2012 to 3,173 in 2013], reversing for the first time,

a four decade trend.

Expanded Programme on Immunisation [EPI] indicators,

continue to show improvement, albeit this is against a

decreasing population target with the establishment of new

‘health sub districts’ in the Ellembelle District, impacting on

the Eikwe Sub District. BCG coverage increased to 569% from

407% and Yellow Fever from 97% to 99%. The coverage for all

other antigens decreased from 98% to 91%.

Morbidity and mortality trends remain the same. The case

fatality rate for malaria for ‘children under five years’ was 2.4%

from 1.7% in previous year. Similarly, the maternal mortality

rate increased from 126/100,000LB to 262/100,000LB. Training

sessions held within and outside the facility to reverse trends

particularly for child and maternal mortalities are yet to make

impact.

Diagnostic services are highly patronised. The Laboratory, X-

Ray and Ultrasound Scan recorded increased investigations.

Maintaining these services however was very challenging

because of drastic changes in costs for reagents and materials

required for services’ upkeep.

Same challenges were encountered in the stocking of medicines

and medical supplies. Both the Western Regional Medical

Stores, as well as private sources from which supplies are

acquired, had problems delivering on orders.

The hospital was awarded for its role in health care and as a

partner of the National Health Insurance Scheme [NHIS] since

it was established a decade ago. There is strong evidence of

increases in the number of OPD attendances and hospital

admissions with the introduction of the NHIS. These however,

are yet to reflect on the finances of the facility.

Infrastructure development was key in 2013; in all, four major

reconstruction works were completed for one residential and

three non-residential structures. The focus in 2014 will be for

the construction of staff accommodation. Policy changes by

the MOH and facility commitment to human resourcing, are

gradually leading to an enhancement in some staffing norms.

Accommodation for recruited staff has become imperative.

Data quality is still an issue in all the service areas, although

this has improved. It is hoped that through training and

refresher programmes and sensitisation the situation will

continue to further improve.

In 2014 the Hospital will be 55 years since its establishment;

much is expected from its clients by way of services it provides.

It is hoped that through the strengthening of collaborative

efforts and partnerships, set objectives in the hospital’s strategic

plan will be achieved. The Hospital Management is grateful

for the immense support it continuous to receive from all and

sundry.

Executive Summary

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1.0.0. Executive Summary



Vision

“St. Martin de Porres Hospital is

committed to providing quality and

affordable health care to all people

reflecting the healing ministry of

Christ”

Mission

“St. Martin de Porres Hospital, Eikwe

is a catholic health facility in the

Ellembelle district, committed to

providing quality and affordable

health care for all people with special

focus on the poor and vulnerable.

We shall do this with honest and well

motivated staff and in collaboration

with MOH, GHS, and other

stakeholders. We shall achieve this

by working with commitment,

compassion, and respect and in the

most effective and efficient manner”

Core Values

1. Commitment

2. Compassion

3. Respect

4. Efficiency & Effectiveness

5. Good Interpersonal Relations

and

6. Honesty

1.2.0. Relief & Drainage

St. Martin de Porres Hospital, Eikwe is cited in the Ellembelle

District which is boarded to the west by the Nzema East, to

the north by Wassa West, and east by the Jomoro districts. To

the south of the district is the Gulf of Guinea. The relief of the

district is generally low lying with the highest point reaching

a height of about 135 meters above sea level. The Eikwe Sub

District is a low lying area across sea shore line between Axim

and Atuabo. The Amansure River forms the largest water body

in the sub district, and Ankobra River in the Ellembelle District.

1.3.0. Climate & Vegetation

The sub district experiences two peak rainfall periods occurring

in June and November with regular rainfall throughout the

year. Eikwe Sub District lies mainly within coastal mangroves

to its west and dry sandy grassland to the east.

1.4.0. Demography

The Ellembelle District in which the Eikwe Sub District is sited

has a population of 92,857[Projected Pop of 2010], and a

population density of about 83 per sq. km. The district has an

estimated Growth Rate of about 2.8%, and a Total Fertility Rate

of 4.0. The population density of the Ellembelle District is

uneven and higher in the southern sector. Eikwe Sub District

has a projected population of 11,143 settled in 13 communities.

Refer Table 1

Age % 0f Total Eikwe EllembelleGroups Population Sub District District

Population

Catchment Population 13 11,143 92,857

0- 11 Months 3 334 2,786

0-5 Yrs 14 1,560 13,000

<15 Yrs 26.1 2,908 24,236

10-14 Yrs 12.1 1,348 11,236

<18 Yrs 45.3 5,048 42,064

15-19 Yrs 10.6 1,181 9,843

70+ Yrs 2.7 3,009 25,071

WIFA 24.4 2,830 23,586

TABLE 1: Demographic Characteristic: Ellembelle and Eikwe Sub District 2013

Projection from 2010 Population Census

• Eikwe Population: 4,610 [approx.] Catchment Occupation: Farming & Fishing

• Ellembelle District Population; 92,857 Catchment Cash Crops: Coconut [Copra]

• Population Density: 85 per sq. km. Food Crops: Cassava, Plantain, Cocoyam, Rice

• Population Growth Rate: 3.0% [District 2.8] Ellembelle & Nzema East District Area: 8,414 sq. km.

1.1.0. Mission

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1.5.0. Socio Economic ActivitiesInhabitants of the Eikwe Sub District are mainly small

scale farmers, fishermen, and petty traders. A small

number of light industries operate in adjoining sub

districts, notably for the processing of copra oil. In recent

years the oil find in the off shore areas of the district has

created employment for some youth with artisan skills.

Gold mining has also begun in the northern sector of

the district bringing with it an influx of youth seeking

employment.

1.5.1. Transport, Communication & RoadNetworkThe district has about 70km of trunk roads, half of which

is tarred. A major stretch of the tarred roads form part

of the Trans-West African Highway. There are also 109km

of feeder roads. GSM telephone networks now operate

in the Sub District. Telecommunication has improved

and is widely used in most of the communities of the

district. Internet accessibility and connectivity however

still remains limited.

1.5.2. WaterCommunities in the Sub District have boreholes most

of which are out of order. Some communities rely on

wells and streams for water. An oil company intends

providing portable water in the Eikwe catchment area

for public and private use as part of its corporate

responsibility.

1.5.3. SanitationRefuse disposal in the district remains a huge challenge.

Disposal is indiscriminate and dumping is mainly by the

crude method. The few created waste disposal sites are

filthy and uncared for. The district has inadequate public

toilet facilities. Particularly of concern, is the litter of

plastic waste, as well as sand weaning on the beaches

and elsewhere, both of which are large business concerns,

but remain a big threat to the environment and health.

1.5.4. Educational FacilitiesEikwe Sub District has 14 Pre, 10 Primary and 6 Junior

High Schools. Educational standards are averagely low

particularly in the public schools. There are two Catholic

managed schools in the District, the Trade School for

the Physically Challenged, in Eikwe and a Girls Vocational

Institute at Awiaso both of which continue to register

low patronage in spite of their endowed infrastructure

base .

1.6.0. Departments and UnitsThe Hospital has the following main departments; Out

Patient, Wards, Health Administration & Support Services,

Primary Health Care, an Operating Theatre, Laboratory

and X-Ray.

1.7.0. Services ProvidedService areas for the review period range from clinical,

preventive, curative, rehabilitative, and health support.

Obstetrics & Gynaecology, and in the last years Surgery,

are the main stay of the Hospital attracting appreciable

numbers of clients.

1.7.1. Health Service DeliveryFor purposes of health service delivery, the district is

divided into zones [Sub Districts]. This report covers

activities of the year 2013. It provides a focus for the

way forward for the institution and discusses daily and

future challenges faced by the Hospital; its strengths as

well as weaknesses. Variances from set regional and

district targets are also discussed in the achievement of

these targets.

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2.1.0. Promotion & Maintenance of the Identity of the NCHS

The existence and work of the ‘religious’ in the diocese’s health facilities remains paramount in bringing to the fore the church’s

role in health care delivery. The Hospital presently, has personnel of two religious communities offering varied services in the

facility.

A Pastoral Care Unit and Chaplain are available to offer needed assistance to both staff and patients. The facility celebrates weekly

mass with patients and also observed the World Day of the Sick. Celebration of the feast of St. Martin de Porres, its Patron Saint

was held.

An annual retreat was organised for three staff groupings. Sessions were held to discuss issues on morality and ethics, and generally

on client reception and staff attitudes. Each of the sessions ended with a thanksgiving mass and visitation of the sick.

3.1.0. Management & AdministrationThe management of the hospital is the responsibility of a four core member Hospital Management Team [HMT] with twoco-opted members, including representations of the partnering religious communities. Daily administrative functions arecarried out with the assistance of heads of units and various committees.

3.1.1. Management & Other Institutional MeetingsThe Hospital Management Team [HMT] and Heads of Units have scheduled monthly meetings. Each department holdsmonthly meetings where its staffs’ welfare and work are discussed. Staff durbars are also held to discuss staff welfare andother general issues.

3.1.2. Building & Equipment

3.1.2.1. Health InfrastructureAll year round, artisans in the facility undertake routine maintenance of wards, residences and grounds. All structures, bothresidential and non-residential are generally in good condition. Projects earmarked for the year were completed. [ReferTable 2]. Barring the availability of funds, nurses’ bungalows and a students’ hostel are targeted for completion in year2014. The projects are geared towards upgrading staff accommodation.

3.1.2.2. Medical & Other EquipmentDonations of assorted equipment and medicines were received from organisations and individuals throughout the year.A portable ultrasound scan equipment was donated by the German Rotary Volunteer Doctors [GRVD] whose personneltogether with the Senior Expert Service [SES], Germany, volunteered services throughout the year to the facility.

3.0.0. Organisation & Management

2.0.0. The Identity of The National Catholic Health Service [NCHS]

Building Type Description Qty. Condition

Residential Includes Senior & Junior Staff Bungalows,Nurses Quarters, Guest House, Convents etc. 26 Generally Good

Non Residential General Administration, Maintenance , Wards &Washrooms, Operating Theatre, OPD Blocks,Canteen etc. 24 Generally Good

Water Tanks Overhead [10,000 Litres] Under [10,000 Litres] 1 Good

TABLE 2: Infrastructure

12 13



3.1.2.5. Power SupplyFrequent power outages and fluctuations continue tointerrupt service. Outages are a source of major concern asthey damage costly and sensitive medical equipment. Threegenerating plants are maintained for use by the facility insuch emergencies. A gradual increase in the facility’s powerneeds in recent years is necessitating the acquisition of alarger capacity generator.

3.1.2.6. Stores and Supplies“Mini stores” are found in various departments of theHospital. Stores & supplies activities are not harmonised,with no professional storekeeping. Documentation for‘Stores & Supplies’ activities, remain basic. The unit needsstrengthening in the near future to complement work ofthe account department.

3.2.0. PartnershipsCollaboration with various sector ministries, agencies anddepartments continues to improve.

3.2.1. Partnership & Internal RelationshipsThe National Catholic Health Service – [Department ofHealth] and the Diocesan Health Service remain criticalsources for administrative functioning, as well as advocatesfor the maintenance of an adequate balance, in the face ofincreasing challenges for faith based health service providers.To this end, several meetings were held in various forms bythe two departments, and to which the facility was invited.

The two religious communities of Sisters of St. Anne [India]and Society of Infant Jesus [SIJ-Ghana] work concurrentlyin the Hospital, their presence and input remains critical tothe successful running of the outfit as a catholic health unit:their members provide various services including generaladministration, nursing, and pastoral work.

3.1.2.3. Transport

The five vehicles of the hospital are all roadworthy. 393 trips, covering a distance of 87,213kms were made by all the vehicles.

Scheduled for possible replacement is the Nissan Terrano which has been in service for over 11 years. 77,679km [89%] of all

trips in the year were made as ?official? facility trips, 9,371 [11%] by the Primary Health Care and 163 for personnel private use.

Refer Table 3

3.1.2.4. Developmental Projects

Several of the targeted constructional works were undertaken. A new washroom facility was provided as part of works to the

Maternity Annex Block. Most of the projects could only be undertaken with assistance from donor partners, without which

support these could not have been achieved at all or on schedule.

Vehicle Type Use Age; [Yrs] Km. Covered Km. Stand No. Trips

VW Transporter [Van] General Purpose 4.6 7,235 165,992 23

Toyota Land Cruiser General Purpose 2.4 27,538 76,445 79

Toyota Land Cruiser Ambulance 8.7 10,279 92,303 43

Toyota Double Cabin Pick Up General Purpose 1.3 33,051 51,009 109

Nissan Terrano [4x4] General Purpose 11.1 9,110 206,905 139

TABLE 3: Infrastructure

TABLE 4: Projects TABLE 5: Staff movement

3.2.2. External RelationshipsThere has been a significant increasein the level of collaboration with theRegional and District HealthDirectorates. Personnel of the Hospitalare invited to partake in seminars,workshops and other functions at alllevels. The Ministry of Health/GhanaHealth Service through theirdirectorates provide administrative, andsome logistical support. Whilesequipment allocations from the sectorministry continue to improve personnelpostings, still has some challenges.Support is also received from someagencies and benefactors from bothwithin and outside the country.

3.3.0. Human ResourceDevelopmentA Human Resource Unit wasestablished in the facility during theyear. Staff mix and strength still remaininadequate, and create work overloadfor all levels of personnel,compromising work quality. It is hopedthat overtime the facility through theunit, will boost its human resourcecapacity and capabilities to cater in themain for present and near futureworkload.

3.3.1. Staffing LevelsAlthough staffing levels have increasedslightly over the last three years, severalof the newly recruited personnelreceive their salaries from the hospitalrather than the state. The numbers ofstaff on the government payroll totalled164 whiles that on Hospital’s InternallyGenerated Fund [IGF] numbered 75,by close of 2013. The resultantbudgetary strain on the facility isenormous. The required professionalstaffs are therefore augmented by alarge number of non- professionals andvolunteers. Generally, the facilitycontinues to have a stable workforce.

Year Total Staff New Recruit Study Leave Retired Resigned/ Vacation Deceased[Jan] Posting of Post

2011 236 9 1 1 0 0 0

2012 240 6 2 3 0 1 1

2013 255 5 1 1 1 0 1

3.3.2. Staff Movement

Project Type Planned On-Going Complete Fund Source

Renovation of Private [VIP] Ward x IGF and Donation

Renovation of Med. Officer Bungalow x IGF and Donation

Expansion of Maternity Annex Block x IGF and Donation

Fencing of Med. Officer Bungalow x IGF and Donation

Renovation of Pharmacy Block x IGF and Donation

Construction of Incinerator x IGF and Donation

Reconstruction of Antenatal Block x IGF and Donation

Refurbishing of Room [NICU] x IGF

Computerisation of Accounts x IGF and Donation

Renovation of Med. Officer Bungalow x IGF and Donation

Construction of Staff Bungalows x IGF and Donation

Construction of Student’s Hostel x IGF and Donation

3.3.3. Staff MotivationMotivational packages for staff vary in form and category. Long serving staff receive annual awards on occasion of thecelebration of the feast of the Hospital’s patron saint. Staff also enjoy in house ‘soft loans’, cash allowances etc.

3.3.4. Staff Training & Development41 requests for promotions were put in, most of which were approved by the Controller & Accountant General’s Department.

In addition to other short courses attended by staff within and outside the facility the following were/are in training forthe period for long duration courses;

• Registered General Nursing 11 [2 Completed; Aug 2013]• Midwifery 9 [2 Completed; 2013]• Community Health Nursing 4 [3 Completed; Nov 2013]• Pharmacy Technician 1 [1 Completed; Jun 2013]• Accounting 3 [1 Completed; Jun 2013]• Physician Assistant 2• Statistics 1• Medical Officer 3• Health Assistant [Clinical] 3

14 15St. Martin De Porres Hospital, Eikwe, GhanaAnnual Health Service Report 2013


5.1.3. Service UtilisationOver 75% of clients of the facility are from outside itsimmediate catchment. Services provided for both in and outpatients’, including those in the catchment communities,were well utilised. Generally, services from all the variousdepartments are well utilised by patients/clients.

5.1.4. Customer SatisfactionTwo client satisfaction surveys were conducted in 2013, andfor the first time one such survey was undertaken outsidethe facility in a nearby town. The facility was commendedfor tidiness of its wards, clean and friendly environment andthe availability of most required health services. Staff attitudesuffered most complaints, and recommendations were madefor cleaner washrooms, friendlier staff and service provisionwithout undue delay.

5.1.5. Service QualityStaff of various categories attended training programmeswithin and outside the hospital. Sessions mainly took theform of workshops to upgrade knowledge and skill in themanagement of selected ailments, and the completion ofmandatory service data reporting forms. Meetings were alsoheld to discuss Quality Assurance and related issues.

5.1.5.1. Service DataService data are gathered daily and collated for periodicreports. Most service data are collected manually. Patients’bio data and bills are directly input by computer. The plannedautomation of service data at the point of service for collationand analysis has taken off at the OPD and Administration.It is yet to be undertaken in the wards, and other units.

5.1.5.2. Top Ten Diseases AnalysisMalaria, Anaemia and Pregnancy & Related Complicationspresented for morbidity and admissions have similar trendsas in previous years. Of concern is the increasing mortalityrate for children under five years. Hypertension with OtherHeart Diseases and Diabetes continue to feature more andmore over the years. Total facility deaths recorded was 428[highest ever recorded] with the top ten causes of deathsforming 49% of all facility deaths. Ref. Annex 2

5.1.5.3. Curative Services* Out Patient Care

OPD services are offered round the clock. OPD per capitaregistered 10.5 visits. The first two prevalent ailments wereMalaria [20%], Gynaecological Disorders [9%] of all casesrespectively. OPD visits totalled 116,728. Ref. Table 8,Annex 2.

5.1.1. Review; Morbidity & Mortality

The fight against malaria in the districtgot intensified with the introductionof insecticide spraying of mosquitosthrough the AngloGold Ashanti MalariaControl Programme. Other similarcampaigns such as IntermittentPreventive Treatment [IPT], the

distribution of Insecticide Treated BedNets [ITBN] are still on-going. Althoughthe percentage morbidity for malariais on the decline, fatalities, especiallyfor children u----nder five years, remainhigh. The Case Fatality Rate forChildren Under Five Years increasedfrom 1.7% to 2.4%.Ref. Annex 11

5.1.2. Clinical TrendsTrend patterns have only differed inthe last decade with the emergence ofaliments like Diabetes, Hypertensionetc. The year saw similar trends, bothfor morbidity and mortality, as has beenexperienced in the last five years. ReferAnnex 2.

* In Patient CareThe Hospital has a bed complement of 200. The Average Length of Stay was 4.9 days, and the overall Bed Occupancy Rateregistered 94% for the year. The Maternity and Emergency Wards had the highest occupancy rates of 112% and 102%,respectively. All wards except for the Fevers Unit and Paediatric Ward registered decreases in intake. Ref. Table 9, Annex2.

Table 6: Increasing Access to Health Care [Service]

TABLE 7: Increasing Access to Health Care (Staffing)Year Total Number of Population Number Population

Population Doctors Doctor Ratio of Nurses Nurse Ration

2009 12,520 5 1:2,504 49 1:255

2010 12,921 5 1:2,584 44 1:294

2011 14,034 5 1:2,807 51 1:275

2012 10,924 4 1:2,731 58 1:188

2013 11,143 7 1:1,592 67 1:166

Note: There are 2 newly established CHPS Centres in the Eikwe Sub District

TABLE 8: Out Patients Visits

Type of Data 2009 2010 2011 2012 2013

Total OPD New 26,932 28,702 30,348 38,504 44,703

Total OPD Attendance 68,685 78,184 82,213 93,973 116,728

Total Insured Patients 33,437 49,615 53,747 72,445 94,895

TABLE 9: Admissions

Type of Data 2009 2010 2011 2012 2013

No. of Beds 175 175 175 200 200

Total Admission 13,369 14,931 14,583 14,832 14,931

Total NHIS Patients 5,357 7,281 8,369 8,819 10,109

Total Inpatients Days 58,134 57,012 56,906 60,983 56,907

Bed Occupancy Rate 93 89 89 91 94

Total Discharges 12,749 14,342 13,325 13,184 13,632

Total Deaths 389 404 362 370 428

5.1.0. Access to Healthcare Services & PerformanceOverview

Services were well patronised duringthe reporting year by the 13communities ‘officially’ in the Eikwe

Sub District as well as by those outsideit. An OPD Per Capita of 10.5 andAdmission Rate of 134% wererecorded; the former being thehighest in the last five years, and thelatter, the second highest. This

obviously is an indication of thenumbers of patients from outside theEikwe Sub District who use the facilityas their preferred choice for healthcare, and particularly for maternal care.

4.1.0. Health Information SystemAll patient registrations are now captured through acentralised computerised system. The system still needs alot of improvement, and is yet to be extended to mostservice points for direct data capture. For now, datagenerated in the wards, are still manually gathered, forcollation. Patients’ bills are also computerised. Monthlyclinical reports are submitted to the RHD through the DHD.

4.2.0. Supportive Supervision/ Monitoring & Evaluation

Several visits were made by the Sekondi-Takoradi DiocesanDirector for Health as well as by personnel from the sectorministry, the district and regional health directorates, andnational levels to the facility. Visits were mainly to assesswork progress on specific programmes/projects e.g. NationalAIDS Control Programme [NACP], National TB Programme[NTP], Malaria Control Program etc. whiles others weresupervisory and monitoring visits by external independentbodies to the Pharmacy, Wards, Administration andLaboratory of the Hospital.

4.0.0. Health Administration & Support Services

5.0.0. Service Provision

Year Total OPD OPD Per No. of Admission Bed OccupancyPopulation Attendance Capita Admissions Rate[%] Rate

2009 12,520 68,685 5.5 13,369 107 92

2010 12,921 78,184 6.1 14,931 116 89

2011 14,034 82,213 5.9 14,583 104 89

2012 10,924 93,973 8.6 14,832 136 91

2013 11,143 116,728 10.5 14,931 134 91

16 17



* Traditional Birth Attendants [TBA] ActivitiesTBAs remain important in child delivery due to the beliefsand customary practices of the Ghanaian woman. The subdistrict has 13 TBAs with 6 active. Referrals to the ANC, fordeliveries and to the PNC are rather low. For the future, andas a national policy, TBAs are being encouraged to play activeroles in post natal care, and less with deliveries as they havedone in the past.

5.1.5.6. Delivery Outcome:* Live Births;96% of all deliveries in the facility were live births [3,048from 3,173] with 1,584 males and 1,446 females; an averagebirth per month of 264. Total births decreased by 5% overthat of the previous year. The average Caesarean SectionRate of 23% was maintained. The facility is used as a referralpoint by several smaller health units in three geographicaldistricts, particularly for gynaecology and obstetrics cases.A total of 197 babies were born through multiple births. Ref.Table 12.

* Still Birth Rates;There were a total of 25 Fresh Still Births. Ref. Table 12. Thefacility Still Birth Rate reduced from 1.3% to 0.8% of all births.The lingering high rate persists even though trainingprogrammes were organised to ensure a decreasing rate.The national rate is pegged at 2%.

* Intra Uterine Death [IUD]The record of 100 macerated births [i.e. IUDs] is the lowestin six years; a decrease from 131in 2013. Several of suchcases are from mothers who are irregular and/or non-attendants at ANC. Other reasons attributed to the unusuallyhigh numbers of IUDs in the area, include, but not limitedto the use of herbs for enema or concoctions by pregnantmothers. Health personnel are left with the option ofproviding continuous education of mothers as a tool toreduce IUD numbers. Ref. Table 12.

5.1.5.7. Post Natal Care [PNC]Attendance to the clinic increases over years; the registrationof 2,036 is the highest ever and a 32% increase over theprevious year. Free health care for the expecting motherand child, implemented ten years ago with the introductionof the National Health Insurance Scheme [NHIS] is thoughtto be partly responsible for the increasing trend.

5.1.5.8. Maternal MortalityThe facility recorded 8 maternal mortalities. Refer Table 12.Death audits were carried out with midwives, senior facilitymanagers, district health officials and other health personnelfor all the deaths. Education of pregnant mothers is alwaysparamount in all recommendations. Other recommendationsincluded the training/retraining of midwives in themanagement of certain conditions. Incidentally, half of themortalities were from Ellembelle and the other half fromJomoro districts respectively.

6.0.0. Surgical Procedures

6.1.0. SurgeriesPlanned surgeries are undertaken thrice weekly. Most ofthe cases are major and minor obstetric and gynaecologicaland surgical cases; e.g. Caesarean Sections, Hysterectomies,Ectopic Pregnancies, Hernias etc. Refer Table 13, Annex 9.Most trauma cases are referred to the Regional Hospital-Takoradi, and other specialist units. A resident surgeonspecialist was recruited in the last quarter of the year.

TABLE 11: Reproductive & Child Health

Year Total Dist. Total Pop: Expected Ante Natal Clinic Post Natal Clinic Supervised Deliveries

Population [Eikwe No. of *ANC Coverage PNC Coverage Number CoverageSub District] Pregnancies Registrants Registrants

A B C D E F G H I

09 104,334 12,520 501 1,858 371 546 109 2,362 47110 107,673 12,921 517 5,098 986 630 122 2,495 48311 116,950 14,034 561 1,484 265 1,033 184 2,925 52112 91,036 10,924 491 1,304 266 1,533 312 3,336 67913 92,857 11,143 334 1,354 405 2,036 610 3,173 950

* Registrants include women registering for the first time but exclude clients registered at another facility.

TABLE 12: Supervised Deliveries

** Maternal Mortality: [Maternal Deaths/ Live Births] * 100,000

A B C D E F G H I J K L M

09 12,520 501 2,362 2,213 21 128 315 2,009 12 542 471% 0.9% 13.3%10 12,921 517 2,495 2,359 14 122 269 2,226 5 212 483% 0.6% 10.8%11 14,034 561 2,925 2,761 32 132 336 2,567 3 109 521% 1.1% 11.6%12 10,924 491 3,336 3,164 41 131 297 3,039 4 126 679% 1.3% 8.9%13 11,143 334 3,173 3,048 25 100 591 2,860 8 262 950% 0.8 17.1%

%<2.5Kg ofWeighed

Child.G/[g+h]*

100

Year

Supervised deliveries Ratio & percentages

% Sup.Deliveries[C/b]*100

% StillBirths

E/c]*100

Populationprojectionfrom 1987[Eikwe sub

district] *

Expecteddeliveries

[4% OfTotalPop]

Total[D+e+f]

Live StillBirth

IUD Below2.5Kg.

Over2.5Kg

MaternalDeaths

MaternalMortality

[I/d*100,000] **

* ReferralsThe facility serves as the referral point for over 20 healthunits in three geographical districts, including two withdistrict hospitals. Most referrals are Obstetric &Gynaecological and trauma cases. Referrals from the Hospitalwere mostly to the Regional Hospital [Western] in Sekondi,and Specialist Centres.

5.1.5.4. Investigative Services5.1.5.4.1. Laboratory & Blood BankThe laboratory undertakes a range of services includingbacteriology and biochemistry. A total of 151,556

investigations were carried out; an increase of 15% overthe previous year. The biggest challenge for the unit is theavailability and costs for reagents and other lab supplies.Quarterly supervisory and monitoring visits were made bypersonnel from the Regional Public Health Reference Lab– Takoradi. Other visits were made by teams from theNational STI/AIDS Control Programme [NACP] and MalariaControl Programme. The Medical Mission Institute, [MMI]Germany, continues to assist with the undertaking externalculture and sensitivity control tests. MMI in collaborationwith the unit also undertook two research projects duringthe year. Refer Table 10, Annex 5

5.1.5.4.2. X-Ray & Ultra Sound Scan Services6,089 X-ray investigations were undertaken, 41% of whichwere Chest X-Rays. Investigation trends remained same,with an average of 507 investigations made per month.

A total of 9,576 ultrasound scan investigations wereundertaken. Scans were mainly for pregnancy relatedinvestigations. With a high ANC attendance, the equipmentis well utilised with an average of 800 investigations permonth.

5.1.5.5. Maternity Services* Safe Motherhood* Ante Natal Care.ANC registrants and attendances are high. New Registrantsrecorded 1,354 with 11,143 attendances [an average visitper client of 8.2. [Refer Table 11.] Many expecting mothersuse the facility not only for antenatal care but also to deliverof their babies. The facility has a residentObstetrician/Gynaecologist.

Table 10: Laboratory Investigations; Outcome

Year 2009 2010 2011 2012 2013

• Haematology 36,433 52,436 53,757 48,358 54,334

• Blood Banking 9,003 13,345 13,940 13,968 11,342

• Bacteriology 3,082 2,910 3,483 3,368 4,632

• Bio Chemistry/Serology 20,480 21,828 12,831 11,962 39,040

• Parasitology 24,161 25,649 21,948 18,440 21,825

• Urine Analysis 10,757 14,180 16,239 15,818 20,164

• Miscellaneous 211 219 218 227 219

Total 104,127 130,567 137,596 132,396 151,556

18 19


7.0.0. Specialised ServicesGynaecology &Obstetrics and Surgery are the only specialisedservices that are extensively offered in the Hospital. Clinicdays for TB, Diabetes, and Hypertension as well as focusedantenatal have been started in the OPD. Weekly service isalso provided for clients on Antiretroviral Therapy [ART].

8.0.0. Other Services

8.1.0. Pharmacy & Dispensary97% of Essential Drugs was stocked during the year. Adequatequantities of other medical supplies were also maintained.Most of the supplies are purchased from the CatholicMedicine Centre through its Pooled ProcurementProgramme, the Western Regional Medical Stores, and someprivate suppliers. Drug purchases are made from the facility?scommon fund.

8.2.0. Blood TransfusionBlood transfusion service is provided as part of the generallaboratory and not as a separate unit. Blood is mainlyorganised through a ?pool system? where clients scheduledfor major surgery are requested to provide donors whotransfuse for their use, and if not required, are banked forfuture emergencies. 699 [26%] transfusions were made tochildren and 2010 to adults.

8.30. Home Based CareThe service is offered exclusively to clients living in thecatchment of the Hospital with socio medico needs.Scheduled visits are made weekly with a team including anurse to offer counselling, nursing, food rations, etc. toclients and their relations. Funding for the programme ispartly self- generated through the PHC Mill Project;preparation and sale of weanimix [a child weaning meal]and kneading of flour. The project has been sustained forover a decade.

8.4.0. Improving Quality of CareThe Quality Improvement and Quality Assurance Teamsjoined forces and held common meetings to discuss servicequality issues. More ward in charges meetings were heldthan previously. Issues of post op wound infection, highunder five death rate, etc. topped the year?s agenda. Otherareas considered were general infrastructure and equipmentavailability.

8.50. Mortuary ServicesThe Hospital has no morbid anatomy unit. A small cold roomfacility has been provided for the temporary storage of corpsebefore their transport out of the facility. The provision ofthis service as an alternative source of income as well as anecessary service for clients who pass on, has still not gainedattention.

9.0.0. Health Prevention

9.1.0. School HealthThe programme featured more in the second half of theyear than in the first due to personnel numbers. All theJunior High, Primary and Pre Schools in the catchment werevisited; screening of students, counselling, inspection ofclassrooms and school compounds, and referrals of studentsto the Hospital were undertaken as part of services provided.Eni Foundation?Ghana provided some support for theimplementation of this programme.

9.2.0. Expanded Programme on Immunization [EPI]The official number of communities served by the Hospitalis reduced from 15 to 13 by the DHA with the creation ofnew health sub districts. EPI targets set were in the mainachieved. Routinely, all targeted communities are visitedevery month for immunisation during Child Welfare Clinics[CWC]. There were increases in both EPI registrants andconsequently attendances. Refer Table14,15 & Annex 1.

9.3.0. MCH [ANC/PNC]General health information, education and counselling aremade during ANC/PNC gatherings. Clinics are conductedfive times a week. There are more clients to the Antenatalclinics than to the Postnatal.

9.4.0. Well Baby Clinic/Child Welfare Clinic [CWC]The Well Baby or Child Welfare Clinic programme, focuseson nutrition rehabilitation and growth monitoring, and iscarried as part of EPI programmes. Weights of children belowfive years are monitored and counselling given where needed.Children with serious nutritional problems are referred tothe Hospital for further management. Practicaldemonstrations of good diets are given during CWC.

9.4.1. Micronutrients Deficiency Control9.4.1.1. Weaning Food ProjectThe facility prepares own child weaning food for children[Weanimix] in large quantities for sale. Income generatedfrom the weaning food project is used to assist supplementfunding for Home Based Care activities. Its preparation and

sale, together with the kneading of flour forms part of thePrimary Health Care?s Mill Project.

9.5.0. Adolescent Child HealthAdolescent clinics are now held daily to encourage themattend clinics and not shy away from older expecting mothers.Teenaged pregnant girls formed 27% of all registrants; anincrease from 12% in 2010. Although high, this is seen as apositive impact of the NHIS programme, as well as thefacility?s direct targeting of clientele type. The generalimplication of teenage pregnancy and consequent riskshowever is not lost on managers, and measures are beingtaken to address the trend.

9.6.0. Diseases of Public Health Concern9.6.1. Integrated Disease SurveillanceThere were no confirmed cases of Cholera, CSM, YellowFever, AFP and Measles during the year; situation has beensame for over six years. The trend can only be said to signifya reduction in number of such cases and not the completenonexistence of all of them.

9.2.1. Immunization CoverageHigh coverage was attained for all the antigens. Support from the District and Regional Health Directorates with theprovision of logistics, training and direct supervision, particularly during the National Immunization Days were crucial tothe attainment of the targets. No direct funding however was received from the DHA for the facility?s EPI activities.

TABLE 13: Summary of All Surgeries

Summary of Surgeries 2009 2010 2011 2012 2013

Total Minor Surgeries 1522 1737 1789 1401 1,524

Total Major Surgeries 1962 1630 1625 1759 1,656

Grand Total 3484 3367 3414 3160 3,180

Emergencies 508 349 618 894 800

Obstetrics & Gynaecology 2235 1734 1890 1896 1,708

General 1249 1633 1524 1264 1,472

Year 2009 2010 2011 2012 2013

Target Pop. [0-11Months] Antigen 501 517 561 491 334

Antigen [% of Target Pop] BCG No. Immunized 2,342 1,947 1,876 1,998 1,900

Coverage 467 377 334 407 569

Measles No. Immunized 603 457 513 481 305

Coverage 120 88 91 98 91

DPT3 Hip/Heb No. Immunized 548 491 514 503 303

Coverage 109 95 92 102 91

OPV 3 No. Immunized 548 447 514 503 303

Coverage 109 86 92 102 91

TT2/3 No. Immunized 599 1311 2815 2,621 2,242

Coverage 120 254 502 534 671

Yellow Fever No. Immunized 603 457 513 477 332

Coverage 120 88 91 97 99

Table 15: Immunization Coverage

Table 14: EPI; Registration & Attendance

Year 2009 2010 2011 2012 2013

Target Population [0-11Months.] 501 517 561 491 334

Registration 1,267 1,226 1,797 2,212 693

Attendance 9,653 11,149 13,297 17,848 7,560

20 21



9.7.0. MalariaTotal OPD attendances have increased over the last fiveyears. The general trend for malaria morbidity however hasreversed and is on the decline; for Children Under 5 Yearsmalaria incidences in the OPD increased by 8.8%. Malariaremains the leading cause of OPD attendance in the facility.Refer Annex 2, 10, 11.

9.7.1. Deaths from MalariaThe number of malaria admissions for Children Under FiveYears decreased by 8.9%; however Malaria Case Fatality Ratio[CFR] for same increased from 1.7% to 2.4% of all admissions.Refer Annex 10, 11. It is hoped that the start of the AngloGoldAshanti Malaria Programme [mass spraying of houses withinsecticide] in the district, together with other existingmalaria programmes, will reduce deaths from malaria incoming years. It is imperative for the facility to find ways toaddress increasing fatalities of children from malaria.

9.8.0. HIV/AIDS ProgrammesART clinics are held weekly, and the Persons Living WithHIV/AIDS [PLWA] Association, hold monthly sessions in thefacility. Some durbars were also held in the Eikwe Sub Districtcommunities and elsewhere. Talks were held in churches,and to identifiable organised groupings etc. on HIV/AIDSand related topics. Clients to the clinic number almost 2000.Antiretroviral medicines are supplied to the facility throughthe regional medical stores.

9.9.0. TuberculosisA facility policy to register only TB patients in the catchmentof the hospital, for whom treatment is also initiated, haseffectively reduced the registered TB patient numbers fromover 100 to 31, in the last 5 years. Other confirmed cases inthe hospital are referred to health units closer to patient?saddress. The practice has reduced defaulter and failure ratesto zero. Of the 31 total registered patients, 11 were ?smearpositive?. There were brief periods when drug supply by theRegional Disease Control Unit of the Ministry of Health wasinterrupted creating shortages.

10.0.0. Health Promotion10.1.0. Sexually Transmitted Infections [STIs]All patients/clients who report with Sexually Transmitted Infection[s] [STI] are referred for counselling. For selected patientswho live in the catchment of the hospital follow up visits are made by the PHC Team as part of the Home Based Care programme,with consent of the client.

10.1.1. [STIs] HIV/AIDS Prevalence & ControlRoutinely, all donors are screened for Hepatitis B & C before initial HIV spot check. Test trends are still dictated mainly bythe availability of test kits. Counselling and education are offered both in the Wards and OPD.

10.1.2. HIV Sero PrevalenceBoth rates for donors and patients who tested sero positive for HIV in 2013 are the lowest in last 5 and 8 years [5.6% and23.6%], respectively. Similar tests for expectant mothers visiting the antenatal clinic recorded 2.7%; the lowest in 7 years. Theage group of 20-39 years is the largest to test HIV+ [323 from a total of 633 -51%]. Refer Table 17, Annex 14-16. HIV Test Kitsare received through the Regional Public Health Reference Laboratory; shortages during the year implied a break in the regulartesting of all pregnant women.

10.1.3. ANC HIV Sentinel Surveillance & Preventionof Mother to Child Transmission [PMTCT]

The annual HIV sentinel research of 500 random tests onfirst time expectant mothers to the ANC revealed a reducedrate of sero prevalence; 55 from 2071 registrants [2.7%].Refer Annex 15. Increasing numbers of pregnant womenapprove of the voluntary testing after counselling. Motherswho test positive and are from distant addresses are advisedto visit heath units closer to them for follow up care. Visitsby clients for voluntary counselling have virtually dwindled,as test kits usage was limited mainly for patients and donors.Only few volunteers report to the centre.

10.1.4. Ante Retroviral Therapy [ART]The weekly clinic is heavily patronised by clients of all ages.To date almost 2,000 clients, including children, use thefacility. Monthly sessions are held by clients for peercounselling and some other social amenities. Therapyincludes food supplements given to clients who requirethis. The unit is permanently manned by PHC staff.

10.1.5. Social Support Programmes10.1.5.1. Persons Living With AIDS [PLWA] AssociationThe Persons Living With HIV/AIDS [PLWA] together withthe Orphans & Vulnerable Children [OVC] group is stillactive, although not as vibrant. Clients receive counselling,food rations, medical assistance etc. from the facility throughvarious organisations. Both groups have separate scheduledmonthly meetings in the Hospital.

10.1.7. Home Based Care2,700 domicile visits were conducted throughout the yearto persons with various conditions; TB, HIV/AIDS and otherswith medico social needs. Domicile visits are made twiceweekly. Home based care forms an integral part of servicesprovided by the Primary Health Care unit of the Hospital.

10.2.0. Natural Family PlanningThe facility offers Natural Family Planning [NFP] servicesto desiring clients. Sessions are also used as fertility clinicsto inform and educate clients who wish to have children.Patronage is rather low and keeps decreasing over time.Clients who prefer artificial family planning methods arereferred to other facilities.

11.0.0. Health Financing11.1.0. Financial Management & Financing

Mechanisms11.1.1. Budget for Year 2013A total budget of over GHõ5,500 Million was forecast forthe running of the facility for the year 2013. This was requiredfor the payment of staff emoluments, and the provision ofadministrative support, services, and investments. An amountof GHõ6,490 Million was used to run the facility by close ofyear.

11.2.0. Health InsuranceThe National Health Insurance Scheme [NHIS] has beenin operation for ten years. It has certainly increased patientload and income levels for the facility. Averagely insuredclients form about 85% of all in and out patients. All NHISclaims are prepared via a networked computerised system.

TABLE 16: Tuberculosis (New & Relapse Cases)

Year 2009 2010 2011 2012 2013

Total Pulmonary 90 87 75 29 29

Total S. Positive 63 41 34 15 14

New Cases 54 34 33 13 11

Relapse 9 7 1 2 3

Smear Neg. 27 46 41 14 14

Ex. PTB 12 12 13 0 3

Total TB 102 99 88 29 31

PULMONARYTB

SMEARPOSITIVE

2009 2010 2011 2012 2013

Total Number of Donors Screened 1,978 2,288 2,268 1,929 2,043

Total Number of Donors Positive: 240 225 255 180 115

% Of Donors Positive: 12.2 9.8 11.2 9.3 5.6

Total Number of Patients Tested: 1,681 1,738 1,431 2,232 1,965

Total Number of Patients Positive: 430 518 356 579 463

% Of Patients Positive: 25.6 29.8 24.9 25.9 23.6

TABLE 17: HIV /AIDS Screening

22 23


TABLE 18: Financial Report

Cash Flow Statement [ 1-Jan-2013 to 31-Dec-2013]

Inflow of Cash : Amt. GHC

Current Liabilities 57,996.19Current Assets 1,908,720.70Drugs Income 4,980.00Operating Incomes 880,583.74Other Incomes 184,271.23Purchases 800.00

Total 3,037,351.86Outflow of Cash :

Current Liabilities 1,069,984.44Fixed Assets 37,609.60Current Assets 85,300.00Suspense A/c 11,567.31Allowances 317,207.00Operational & Administrative Expenses 424,139.02Personnel Emoluments 471,052.86Purchases 860,685.53Repairs & Maintenance 87,726.70Stationary and Printing 39,276.35

Total 3,404,548.81Net Inflow -367,196.95

Note: This is the first year this accounting presentation has been adopted for the preparation of the Hospital?s Final Accounts. Previous years reportshave therefore not been shown here.

11.3.0. Finance

Note Income & Expenditure Statement [1-Jan-2013 to 31-Dec-2013]

Particulars [Amt. GHC] [Amt. GHC]

Trading Account :2 Drugs Income 688,495.473 Operating Incomes 910,168.744 Other Incomes 3,320,355.235 Services –Income 1,690,583.26

Total 6,609,602.70

Cost of Sales : 1,105,381.54

EXPENDITURE6 Purchases 1,105,381.54

Gross Profit : 5,504,221.16Income Statement :Allowances 17,207.00

7 Operational & Administrative Expenses 488,823.528 Personnel Emoluments 3,694,667.07

Provision for Depreciation 756,568.369 Repairs & Maintenance 87,726.70

Stationary and Printing 39,276.35

Excess of Income over Expenditure : 119,952.16

Note Balance Sheet [1-Jan-2013 to 31-Dec-2013]

Sources of Funds : [Amt. GHC]

10 Capital Account 12,600,988.49Loans (Liability)

11 Current Liabilities 273,895.68Suspense A/cExcess of Income over Expenditure 119,952.16Total 12,994,836.33

Application of Funds :12 Fixed Assets 11,491,881.2213 Current Assets 1,502,955.11

Total 12,994,836.33

TABLE 18: Financial Report

11.4.0. Notes To The Financial Statements forPeriod Ended Dec 31, 2014.The various expenditure items recorded inflationary trendsover the period, particularly for amounts expended onMedicines and Medical Supplies. The cost burden forPersonnel Emoluments was borne mainly by the CentralGovernment [85%] and from Internally Generated Funds[IGF] [15%]. Staff Allowances form part of IGF PersonnelEmoluments. Income and expenditure patterns remainedgenerally the same.

The two largest sources of income are Government ofGhana through subventions, and income generated as feesfrom patients. Similarly, Salaries & Allowances, Drugs &Medicines and Medical Supplies are the largest spendingareas.

Note 1A. Statement of Accounting PoliciesThe following form significant accounting policies adoptedby the Hospital in the preparation of its Financial Statement

B. Basis of AccountingThe financial statements have been prepared under thehistorical cost convention?

C. Depreciation PolicyDepreciation of Fixed Assets is calculated on ?Straight Line?basis, to write off at ?Cost of Assets? over their estimateduseful lives. The annual rates used are as follows;

Building 2%

Motor Vehicles 25%

Furniture & Fittings 20%

Hospital Machinery & Equipment 10%

Computer & Accessories 25%

Office Equipment 20%

D. Inventories are valued at lower of cost or net realizablevalue

St. M

artin

De

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Through a collaborative program withthe Medical Mission Institute,Wurzburg and the Institute of MedicalMicrobiology – University MedicalCenter [UMC], Gottingen [both inGermany], the hospital hasundertaken two research projects inthe last two years. A third gotunderway in the last quarter of 2013and is yet to be completed. Theresearch areas are;

• “Prevalence of bacterial andparasitic infections in Ghana - across-sectional study in pretermpregnant women” – in 2012

• Prevalence of pregnancy-relatedinfectious and non-communicablediseases in Ghanaian women andneonates – in 2013

• Comparative Study on theMicrobial Genesis of Diarrhoea-The Role of Clostridium Difficile.– Nov 2013

The hospital is grateful for theopportunity to assist in carrying outthese projects, and for all theassistance and other support itreceives through the collaborativeeffort.

24 25

Notes 2-7

Amt. [GHC] Amt.[GHC]

2 Drugs Income 688,495.47Drugs -NHIS (Deductions) (669.81)

Drugs-Inpatient (Income) 4,980.00

Drugs IPD (NHIS) 207,367.57

Drugs-OPD (NHIS) 476,817.71

3 Operating Incomes 910,168.74

Free Treatment-Services 29,585.00

AngloGold Ashanti 9,240.00

Ghana Gas Co LTD 300.67

IPD- Cash 455,739.00

Loan Repayment 87,508.00

OPD Cash 279,317.30

Others 5,485.00

UNHCR 42,993.774 Other Incomes 3,320,355.23

Donation Received 142,399.76

Credit Interest Received 18,436.82

Ellembelle District Assembly -Fuel Refund 5,762.65

Ellembelle District Health Administration-Fuel Refund 1,560.00

Gas Income 444.00

GOG Salary Subventions 3,136,084.00

Kama Pharmacy Refund –Drugs 798.00

Rent Income 11,050.00

Sanitation Income 3,820.00

5 Services –Income 1,690,583.26Service IPD-NHIS 978,149.94

Service OPD –NHIS 712,441.62

Services-NHIS (Deductions) (8.30)

6 Purchases 1,105,381.54

Drugs Purchase 586,210.89

Medical and Surgical Supplies Purchase 279,074.98

Drugs/Non Drugs -Stocks Usage 133,645.17

General Store-Stocks Usage 48,118.50

Medical Equipment -Stocks Usage 25,258.00

Medicines and Pharmaceuticals 4,074.00

Sutures Materials 29,000.00

7 Operational & Administrative Expenses 488,823.52

Accounting Software Training and Maintenance 6,200.00

Audit Fees 9,350.00

Bank Charges, Interest & Commission 5,444.97Catering-Hospital Visitors/Refugees/Patients 11,222.00

Celebrations 27,924.70

Charity and Donations Expense 7,154.50

Communication Expenses 2,746.00

Duties and Clearing Charges 4,862.90

Electrical Materials -Repairs & Maintenance 5,942.00

Free Treatment Expenses 29,585.00Fuel and Lubricants 27,878.50

Gas Expenses 3,079.50

General Supplies 31,355.70

Generator Running Expenses 5,878.00

GHAG Dues 6,105.66

Materials/Electrical Supplies -Stocks Usage 19,549.50

Non Drugs Expenses 3,040.00

Office & Administration Expenses 3,050.50ffice & Administration Expenses 3,050.50

Other Expenses 2,891.80

P.F. Contribution Deposited to QLAC 83,481.79

Registration Fees 6,620.00

Sanitation -Dislodgement of Waste 7,244.60

Staff Training & Development 163,251.00

Staff Uniforms 1,399.00

Travel Allowance 9,406.00

Travelling & Transport 2,483.60

Utilities (Water & Electricity) 1,676.30

Account Name Balance As At 2013 Balance As At 2012Ghana Comm. Bank [Current]-Axim 13,942.90 41,361.77Ghana Comm. Bank [Savings]-Takoradi 205,308.57 416,871.75Ghana Comm. Bank [Current]-Takoradi 68,131.50 210,746.24Cash & Cheque At Hand 48,627.10 34,227.26

Total 336,010.07 703,207.02

Notes 14: Bank & Cash Balance

Notes 8-9

Notes 10-13 Note Statement of Financial Position [1-Jan-2013 to 31-Dec-2013]

Amt. [GHC] Amt. [GHC]

10 Capital Account 2,600,988.49 Accumulated Fund 3,205.90

Final Accounts 12,597,782.5911 Current Liabilities 273,895.68

Accounts Payable 290,558.19Accruals [-]16662.51

12 Fixed Assets 11,491,881.22 Accumulated Depreciation [-]1317123.50

Building @ Cost 8,618,492.00Building Work in Progress 673,600.00Computers & Accessories @ Cost 98,398.00Furniture & Fittings @ Cost 110,752.60Hospital Machines/Equipment@ Cost 3,034,296.50 Minor Equipment 2,573.00

Motor Vehicles @ Cost 78,310.00Office Equipment @ Cost 188,040.00Tally 9 ERP Accounting Software 4,542.62

13 Current Assets 1,502,955.11Account Receivables 1,166,945.04Cash in Hand 48,627.10

Bank Accounts 287,382.97

12.0.0. Research

8 Personnel Emoluments 3,694,667.07GOG Salaries (N3½ 3 ,136,084.00Non -Mechanized Salaries 459,819.00PAYE 38,032.81SSNIT 54,396.26Staff Medical Expenses 6,335.00

9 Repairs & Maintenance 87,726.70Building Repairs 21,235.10Equipment Repairs 26,104.60Furniture & Fittings Repairs 981.00Vehicle Repairs 39,406.00

Note Income & Expenditure Statement Jan 01- Dec 31, 2013

26 27



13.2.0. Policy Thrust & Priority Areas* Retrain staff on diagnosis and management of common ailments* Enhance overall quality through continued Quality Assurance Programmes* Seek alternative sources of income* Continue to train and retrain required staff for recruitment* Seek additional donor partners and re-establish contact with existing ones

13.3.0 ChallengesSome of the major challenges faced during the period under review include the following:* Frequent and long spells of power outages interrupting work schedule, with consequent increased fuel cost.* Workload through sheer patient numbers* Delays in reimbursement for services provided to insured clients.* Inadequate personnel numbers and mix of cadre* Reduced funding [donations] for capital projects

13.4.0. Social Services.Assistance by the hospital is geared towards the poor and needy through medical and educational support. Other supportwas directly towards selected community projects including repairs to boreholes, street lamps etc. Financial assistance wasalso given to the local church parish, and selected schools.

13.5.0 Conclusion & Way ForwardAlthough the year was fraught with challenges, services and service quality were not compromised. Most of the set healthindicator targets were achieved, and in turn an achievement of the hospital?s strategic objectives for the period. Fundingremains critical in the implementation of these objectives. It is imperative therefore, that other sources of funding aresought to enable the hospital achieve its targets within specified periods.

Efforts in attaining appropriate levels of staff strength and mix needs intensification. In as much as the situation has improvedin the last years, young staff are easily attracted back to the cities. It is important that steps are taken to not only recruit,but also ?entice? and encourage new recruits to stay on.

The Hospital Management is hopeful that given present resource trends, it will be able to sustain service levels into thenext four years [strategic plan period] and beyond. However, additional resources will be required to attain new levelsenvisaged with the oil and gas find, which is quickly impacting on all fronts in the Eikwe catchment and Ellembelle andother districts.

For the Hospital Management Team;

Dr. Paul Cooper John AbakahMedical Director In Charge Health Service Administrator

• Staffing• Inadequate numbers and mix of staff• Clinical/Institutional Care• High incidence of infant and maternal mortality• High still birth rate• Financial Management

• Reliance on a single main source for income[Patients Fees]

• Delay of refunds for services to insured clients• Decreasing donated funds for capital

expenditure

26 27


Notes 15: Fixed Assets Schedule

Assets Building Furniture & Hospital Computers Office Motor Minor Tally 9; TotalsFittings Machines/ & Equipment Vehicles Equipment Account

Equipment Accessories Software

COST

As @ Jan 01, 2013 8,157,722.00 103,975.00 3,03t2,496.50 80,655.00 168,074.00 41,932.50 0 - 11,584,855.00

Disposals - - - - - - - - -

Reclassification - - - - - - - - -

Write Off - - - - - - - - -

Additions 460,770.00 6,777.60 1,800.00 17,743.00 19,966.00 36,377.50 2,573.00 4,542.62 550,549.72

Building WIP 673,600.00 - - - - - - - 673,600.00

Total 9,292,092.00 110,752.60 3,034,296.50 98,398.00 188,040.00 78,310.00 2,573.00 4,542.62 12,809,004.72

ACCUM. DEPRECIATION As At Jan 01 2013 163,154.44 20,795.00 303,249.65 20,163.75 33,614.80 19,577.50 - - 560,555.14

Year Charge [2013] 172,369.84 22,150.52 303,429.65 24,599.50 37,608.00 195,775.00 257.30 378.55 756,568.36

As @ Dec 31, 2013 335,524.28 42,945.52 606,679.30 44,763.25 71,222.80 215,352.50 257.30 378.55 1,317,123.50 NET BOOK VALUE As @ Dec 31, 2013 8,956,567.72 67,807.08 2,427,617.20 53,634.75 116,817.20 (137,042.50) 2,315.70 4,164.07 11,491,881.22

As @ Dec 31, 2012 7,994,567.56 83,180.00 2,729,246.85 60,491.25 134,459.20 58,732.50 - - 11,060,677.36

13.0.0. Conclusions & Way Forward

13.1.0. Constraints & ChallengesThese are mainly in the following areas;

1. Malaria 19,393 20.0

2. Gynaecological Disorders 8,864 9.1

3. Intestinal Worm infestation 4,307 4.4

4. Rheumatism & Joint Pain 4,290 4.4

5. RTI/Chest Infection 4,097 4.2

6. Skin Diseases & Ulcer 3,697 3.8

7. Urinary Tract Infection [UTI] 2,963 3.0

8. Pregnancy & Related Complication 2,707 2.8

9. Anaemia 2,542 2.6

10. Enteric/ Typhoid Fever 1,514 1.6

Total 54,374 56.0

Others 42,804 44.0

Grand Total 97,178 100


Annex 1: Summary of Hospital Activities

SN YEAR 2009 2010 2011 2012 2013

1 Total Number of Beds 175 175 175 175 200

2 OPD Attendance Total OPD Attendance 68,685 78,184 82,213 93,973 116,728

New Registrants 26,932 28,702 30,348 38,504 44,703

Male 9,919 10,629 11,128 13,049 14,515

Female 17,013 18,073 19,228 25,455 30,188

Children [0-14 Years] 6,790 8,508 8,441 9,452 23,439

3 Hospital Admissions Total Admissions 13,369 14,931 14,583 14,832 14,931

Male 4,726 5,225 4,563 4,284 4,795

Female 8,643 9,706 10,030 10,548 10,136

Children [0-14 Years] 5,091 6,088 4,341 4,222 4,427

4 Total Discharges 12,749 14,341 13,325 13,184 13,632

5 Total Deaths 389 404 362 370 428

Male 244 215 206 200 228

Female 145 189 156 170 200

Children [0-14 Years] 214 200 133 142 181

Deaths Within 24 Hours 187 192 186 176 206

6 Total Surgeries Major & Minor 3,484 3,367 3,414 3,160 3,180

Major Surgical 562 740 649 639 630

Major Obs. & Gynaecology 1400 1,630 1,890 1,759 1,026

Sub Total; Major 1,962 2,370 2,539 2,398 1,656

Minor Surgical 687 893 875 625 682

Minor Obs. & Gynaecology 835 844 914 776 842

Sub Total; Minor 1,522 1,737 1,789 1,400 1,524

Total; Emergency Surgeries 508 z349 618 897 873

7 Antenatal & Maternal Total ANC Attendance 12,388 14,388 15,621 18,235 20,057

New ANC Registrants 1,858 5,098 1,484 1,308 1,354

Total Deliveries; Hospital 2,362 2,422 2,925 3,336 3,173

Total Post Natal Attendance 546 630 1,033 1,533 2,036

8 X Ray Total Investigations 3,132 3,798 4,354 4,024 6,089

9 Ultra Scan Total Investigations 9,661 8,908 9,230 9,588 9,576

10 Laboratory Total Examinations 104,127 130,567 139,220 132,127 151,556

11 Primary Health Care [PHC] No. of Villages 17 17 13 11 11

No. of Communities 15 15 12 13 13

Under 5 Yrs. Clinic Attendance 9,653 11,149 13,297 17,848 7,560

Under 5 Yrs.; New Registrants 1,267 1,226 1,797 2,219 693

No. of Visits Home Based Care; AIDS,Others 2,423 2,580 2,844 2,872 2,700

28 29

DISEASES CASES % OF TOTAL

1. Asphyxia 28 6.5

2. Malaria 27 6.3

3. Septicaemia 26 6.1

4. Diarrhoea Diseases 25 5.8

5. Cardio Vascular Accidents [CVA] 21 4.9

6. Pneumonia 21 4.9

7. Anaemia 20 4.7

8. Neonatal Sepsis 20 4.7

9. Prematurity 16 3.7

10. CCF 14 3.3

Total 218 50.9

Others 210 49.1

Grand Total 428 100

NOTE: 186 of all Deaths were within 24 Hours of Admission

DISEASES CASES % OF TOTAL

1. Malaria 1,793 15.1

2. Anaemia 1,037 8.7

3. Diarrhoea Diseases 798 6.7

4. Abortion 636 5.4

5. Pregnancy & Related Complication 396 3.3

6. Hernia 376 3.2

7. Hypertension 339 2.9

8. Neonatal Sepsis 254 2.1

9. Pneumonia 194 1.6

10. Enteric Typhoid Fever 150 1.3

Total 5,973 50.4

Others 5885 49.6

Grand Total 11,858 100

Annex 2 – Top Ten Causes -2013TOP TEN CAUSES OF MORBIDITY 2013

TOP TEN CAUSES OF ADMISSION 2013

30 31



Annex 3 - Annual Ward State: 2013Ward Bed Admis- Discharges Death; Death; Death Avail. Patient Av. Daily Occupy Average. Turn Turn

Comp sions All 24Hr Rate Bed Days Bed Rate Length Over/ Overlement [%] Days Occupy [%] of Stay Bed Interval

General Adult 48 1,591 1,536 68 17 4 17,520 15,323 42 87 9.6 33 1.4

Paediatrics 55 4,162 3,879 176 66 4 20,075 17,836 49.0 89 4.4 73 0.6

Mat. & Ante 45 4,632 4,403 8 2 0 16,425 18,381 50.0 112 4.2 98 [0.4]

ER & Private 27 3,782 3,234 128 3 9,855 10,043 27.5 102 3.0 125 [0.1]

Fevers Unit 25 764 580 48 4 6 9,125 6,995 19.2 77 11.1 25 3.4

Total 200 14,931 13,632 428 186 3 73,000 68,587 188 94 4.9 70 0.3

Annex 4: Laboratory Investigations - Outcome: 2013Test Area Test Type No. Outcome Outcome- % of % of % of % of % of

Exam’d Pos Total Total Total Total Total2013 2012 2011 2010 2009

Parasitology Routine Stool Exam 848 Total Infestation 71 8.4 8.0 8.0 9.4 12Total B/F [Malaria] 20,902 B/F [Malaria] Positive 3,268 15.6 16.6 20.3 24.9 24

Haematology Total Haemoglobin [HB] 24,595 HB Above 5.0gm 24,206 98.4 91.7 97.6 96.3 95

24,595 HB Below 5.0gm 389 1.6 8.3 2.4 3.7 5Total Sickle Cell 8,416 Sickle Cell Positive 899 10.7 18.0 9.3 10.3 10

Bacteriology Total AFB 1,220 AFB Positive 235 19.3 20.1 22.8 26.3 21

Gram Stain 1,942 GO & Candida Positive 12 0.6 2.0 1.3 4.5 7Total Cultures 1,444 Sensitive Reactions 391 27.1 27.1 31.9 34.1 40Total CSF 26 CSF Positive 0 0 0 0 0 0

Blood Total Transfusion 2,709 Transfusion Under 5 Yrs. 699 25.8 22.7 22.3 30.1 22Banking

Total Cross Matching 2,758 Compatible 2,768 100 100 99.9 99.7 99.4Total Rh Factor 5,865 Rh Factor Negative 17 0.3 0.4 0.2 0.2 0.5

Bio Hepatitis B [Donors] 2,633 Hepatitis B Positive 306 11.6 11.0 10.8 15.6 15Chemistry/

Hepatitis C 70 Hepatitis C Positive 4 5.7 2.1 0 0 0Serology

Total HIV [Sent. Research] 0 HIV Positive [Research] 0 0 0 0 0 9.2Total RPR [Sent. Research] 0 RPR Positive 0 0 0 0 0 0

Annex 5: X - Ray InvestigationsX Ray Investigations Year

2009 2010 2011 2012Body Part/AreaNo. of No. of No. of No. of

Exam Exam Exam ExamHead Skull 63 118 112 92

Mandible 9 15 11 4Others 5 13 23 16

Thorax Chest 1,740 2,074 2,278 2,243Clavicle 13 13 14 24Rib 1 3 0 2Sternum 0 0 0 0

Abdomen Abdomen 317 453 453 392Spine Cervical 52 39 65 65

Thoracic 8 24 41 28Lumbar 167 122 138 120Lumber Sacral 11 0 0 1

Upper Shoulder 195 153 235 159Extremity Scapula 0 1 0 2

Humerus 48 23 51 41Elbow 30 60 39 41Forearm 46 64 93 41Wrist 20 54 49 60Hand 26 49 58 29Finger 8 11 14 10

Lower Pelvis 92 158 185 210Extremity Hip Joint 8 22 10 0

Femur 23 59 79 74Knee 154 100 148 154Leg 34 81 137 99Ankle 20 36 65 59Foot 31 50 55 52Toe 10 2 1 6

Other Other 1 1 0 0

Total 3,132 3,798 4,354 4,024

Annex 6: X - Ray Investigations 2013Body Part/Area No. of Exam

Chest-AP 2512Chest-Lateral 4Skull – AP 127Skull – Lateral 127Abdomen – AP 376Abdomen – Lateral 2Pelvis – AP 262Pelvis – Lateral 18Spine – AP 388Spine – Lateral 389Spine – Oblique 115Upper& Lower Extremeties - AP 928Upper &Lower Extremeties-Lateral 826Sinusitis - PA View 13Post Nasal Space- Lateral view 0Mandible - lateral views 2Dental Radiography 0Forensic Radiography for foreign bodies 0Barium Studies 0Myelography 0All Others 0

Total 6,089

Annex 7: Ultrasound Scan InvestigationsUltra Scan Investigations Year

2009 2010 2011 2012 2013Body Part/Area Organ/ Query No. of No. of No. of No. of No. of

Exam Exam Exam Exam Exam

Pregnancy Single 6,222 5,960 6,826 7,212 7,166Multiple 252 146 184 132 136

Media Sternum Heart 108 13 0 0 4Abdomen Kidney 211 112 59 119 78

Gall Bladder 24 29 4 0 15Liver 231 76 18 31 51Spleen 33 73 19 13 11G. Abdomen 241 694 576 389 349

Pelvis Uterus 2,079 1,594 1,543 1,593 1,721U. Bladder 93 84 1 1 17

Ovaries 53 55 0 18 28Pelvis; Other 6 2 0 0 0

Other Others 12 63 0 0 0

Total 9,565 8,901 9,230 9,508 9,576

32 33



Annex 8: General SurgeriesYear General Surgery 2009 2010 2011 2012 2013

MINOR GENERAL Circumcision 68 90 113 117 60 SURGERY Closed Reduction of Fracture & Dislocation 53 73 89 6 15

Removal of Superficial Tumours 6 81 49 1 0Repair of Minor Injuries 134 157 138 182 133Incision of Abscesses 84 186 122 159 201All Other Minor General Operations 342 306 364 160 433

TOTAL 687 893 875 625 842

MAJOR GENERAL Appendectomy 40 65 44 39 54SURGERY Hernia Reducible 240 300 314 304 332

Strangulated 31 49 19 27 16Hernia with Hydrocele 10 11 8 12 4Laparotomy

Intestinal Obstruction 0 13 3 5 1Typhoid Perforations 54 40 30 34 15Abdominal Tumours 1 11 10 12 2Exploratory 15 23 29 31 20Partial Gastrectomy 6 1 10 1 9Cholecystectomy 0 1 3 11 5All Other General 1 3 0 0 0

ORTHOPAEDIC Operation of Fracture 0 0 1 1 0Steinman's Pinning 0 0 0 0 1Amputation

Arm 0 1 1 1 1Leg 8 2 8 6 13Finger, Toes 5 11 16 8 13Correction of Deformities 0 1 11 0 1Repair of Major Injuries 27 57 36 30 34Sequestrectomy 1 0 1 4 0Other Orthopaedic Operations 6 2 1 1 0

GENITO-URINARY Nephrectomy 0 0 0 0 0SYSTEM Oophorectomy 0 0 0 1 1

Supra Pubic Cyctostomy 0 0 0 1 0Orchidectomy 13 18 12 2 4Hdrocelectomy 22 24 29 21 22Prostatectomy 0 0 0 0 1Ovariectomy 9 0 4 3 0Myomectomy 17 25 25 24 33Radical Mastectomy 7 4 7 2 3Fistulectomy 0 12 0 0 0Other Operations of the G. U. System 13 0 1 1 0

GLANDS & Thyroidectomy 0 0 1 0 1SPECIAL SENSES Spleenectomy 2 2 0 0 1

Operation for Head Injuries 0 0 0 0 0Removal of Tonsils & Adenoids 0 0 0 0 0ENT operations 0 0 0 0 0Cystoscopy 0 0 0 0 0Sigmoidoscopy 0 0 0 0 1Hemorrhoidectomy 0 2 0 0 4Exicision of Large Tumours on Body 25 44 25 46 36Thrush Operations 2 7 0 0 0Other Operations of the Special Senses 7 11 0 11 2TOTAL 562 740 649 639 630

Annex 9 - Surgeries: General & Obstetrics & Gynaecology Year 2009 2010 2011 2012 2013

OBST AND Caesarean Section 504 535 670 783 736GYNAECOLOGY Hysterectomy-Caesarean Section 7 3 5 4 4

Hysterectomy-Fibroids 74 80 49 125 93Hysterectomy-Abdominal 29 19 47 15 30Repair of V. V. Fistula 0 0 1 0 0Sterilization 40 59 37 44 49Vaginal Hysterectomy 21 13 10 11 5Salpingo-Oophorectomy 60 73 62 27 1Laparotomy

Ectopic 39 53 33 45 51Ovarian Cyst 14 16 18 13 15Exploratory 29 27 14 21 32Caesarean Section-Sterilization 19 10 30 32 11All Other Major O&G Operations 3 0 0 0 0

TOTAL 838 890 976 1,120 1,026

TOTAL OF ALL MAJOR OPERATIONS 1,400 1,630 1,625 1,759 1,656

MINOR SURGICAL O & G OPERATIONSOPERATIONS Forceps Delivery 0 0 0 0 0

Manual Removal of Placenta 60 47 60 31 15Internal Version With Extraction 0 0 7 5 0EOU for Abortion 395 350 422 520 512EOU for Metrorrhagia, Infertility, etc. 32 39 22 27 7Diagnostic D & C 35 19 46 5 1Vacuum Extraction 11 10 16 10 4Episiotomy 124 151 165 67 34Tubal Insuflation 108 106 86 71 2Hydrotubation 10 0 14 0 0Exchange Liquor 0 0 0 0 0Shirokan's 11 1 3 1 0Embryotomy 0 3 0 0 0Douglas Puncture 23 40 30 9 9Post & Ante Colopotomy 0 0 0 0 0Removal Cervical Polyp. 5 13 1 1 6Excision of Bartholin Cyst 3 5 7 0 0Secondary Suturing (abdominal) 10 50 26 23 51Suturing of Cervical Tear 3 10 9 6 41Other Minor O&G Operations 5 0 0 0 0

TOTAL 835 844 914 776 682

Annex 10 - Improving Quality of CareYear Total No. No. of % Total No. Total Under Total Under Under Five Tot. Under 5

Maternal Maternal Maternal of Cases Five Malaria Five Deaths MALARIA CaseDue toDeaths Death Death Admitted Admission Due to caseFatality MALARIA;

Audited Audits [MALARIA] MALARIA Rate EikweSub Dist

2009 12 12 100 3,484 2,300 59 2.6 42010 5 5 100 3,931 2,578 52 2.0 22011 3 3 100 2,452 1,524 29 1.9 02012 4 4 100 1,850 892 15 1.7 02013 8 8 100 1,793 817 20 2.4 0

Annex 11 - Malaria Morbidity & Mortality

Indicator 2009 2010 2011 2012 2013

Children Under Morbidity 2,795 4,334 3,337 4,257 4,6295 Yrs. Admissions 2,120 2,578 1,524 897 817

Deaths 59 52 29 1520% Morbidity/Admission 76 59 46 21 18% Admission/Death [CFR] 2.8 2.0 1.9 1.7 2.4

Children Above Morbidity 12,808 13,589 13,110 13,956 14,7645 Yrs. Admissions 1,178 1,353 928 958 976

Deaths 16 11 9 3 7% Morbidity/Admission 9.2 10.0 7.1 6.9 6.6% Admission/Death [CFR] 1.4 0.8 1.0 0.3 0.7

34 35



Annex 12 - Smear Positive Pulmonary TB By Age Group (New Cases)

0-14 15-24 25-34 35-44 45-54 55-64 65+ Total G. Total

Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem

2009 0 0 3 1 8 7 5 2 5 1 3 0 4 0 29 11 40

2010 0 0 1 1 5 6 7 4 4 2 3 0 1 0 21 13 34

2011 0 1 3 1 4 8 5 4 0 3 0 4 0 0 12 21 33

2012 0 0 0 0 2 1 4 2 1 1 0 0 1 1 8 5 13

2013 0 0 1 0 1 0 2 0 2 2 1 1 1 0 8 3 11

Annex 13 - TB Cohort Analysis

2004 2005 2006 2007 2008 2009 2010 2011 2012

New Smear Positive 79 48 90 54 54 63 34 33 13

Cure Rate 49.0 37.0 51.0 61.0 87.0 30.2 20.6 30.3 84.6

Combined Rate 88.6 81.3 75.5 81.0 93.0 50.8 79.5 81.8 92.3

Defaulter Rate 2.5 4.1 15.0 13.0 2.0 7.9 8.8 0.0 0.0

Failure Rate 0.6 0.5 3.0 0.0 0.0 2.9 6.1 0.0

Death Rate 0.6 3.1 6.0 5.5 2.0 4.8 5.9 9.1 7.7

Transfer Rate 5.6 4.1 1.0 0.0 3.7 1.6 2.9 3.0 0.0

Annex 14 - HIV / AIDS Screenina (By Aae & Sex) 2013

Source Sex Screening Age Group

& 0-11 1-4 5-9 10-14 15-19 20-34 35-44 45-59 60Yrs Grand

Outcome Mths Yrs. Yrs. Yrs Yrs Yrs Yrs Yrs + Total

Blood Mal. Total 0 0 0 0 47 1538 395 47 13 2040Donors Pos. 0 0 0 0 2 90 22 1 0 115

Fem. Total 0 0 0 0 0 3 0 0 0 3Pos. 0 0 0 0 0 0 0 0 0 0

S. Total Total 0 0 0 0 47 1541 395 47 13 2043Pos. Pos. 0 0 0 0 2 90 22 1 0 115

Patients Mal. Total 0 6 26 14 14 234 182 188 34 698Pos. 0 0 3 2 0 40 45 42 6 138

Fem. Total 0 2 30 19 59 606 313 205 33 1267Pos. 0 1 2 4 6 160 88 57 7 325


[V]CT Mal. Total 0 0 1 0 0 1 1 0 0 3Pos. 0 0 0 0 0 0 0 0 0 0

Fem. Total 0 2 0 2 0 3 0 2 0 9Pos. 0 0 0 0 0 0 0 0 0 0


PMCT Fem. Total 0 0 0 8 202 1403 428 28 2 2071Pos. 0 0 0 0 4 33 17 1 0 55

Grand Total Screening 0 10 57 43 322 3788 13z19 470 82 6091Total Total Positive 0 1 5 6 12 323 172 101 13 633

Annex 16 - Antiretroviral Theraphy (ART) Analysis

Analysis Year 2006 2007 2008 2009 2010 2011 2012 2013

CD4 Cell Count 87 280 393 631 548 677 861 789

No. CD4 Count <250/350 49 126 191 331 197 280 285 300

No on ARV 27 92 118 163 178 167 187 225

No. on ARV Dead 5 22 31 12 6 6 8 15

NOTE: Treatment for ART started in 2006

Documents

ST. MARTIN DE PORRES HOSPITAL, EIKWE, GHANA · 2019-03-18 · St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report 2013 St. Martin De Porres Hospital, Eikwe, Ghana Annual