 Holistic assessment of sector  Maternal and Child Health  Occupational and Environmental Health  Disease Control  Human Resource  Organisation and Partnership  Finance  Conclusion 2

GOAL 1 – IMR, U5MR, MMR n/a GOAL 2 – HIV, Guinea Worm GOAL 3 – Equity +10 THEMATIC AREA 1 – Health Lifestyle, W&S +1 n/a THEMATIC AREA 2 – Health, reproduction, nutrition +1 THEMATIC AREA 3 – Capacity development THEMATIC AREA 4 – Governance and financing +1 0 SECTOR SCORE

 Western and Central Regions best performing  Greater Accra and Northern regions worst performing  Recommendation  Disseminate lessons from Central and Western regions  Reward scheme for best performing regions  Explore reasons in GAR and Northern 4

 Weaknesses in current holistic assessment tool  Revisit the HSMTDP sector wide indicators, their definitions, sources and groupings  Develop a new holistic assessment tool for subsequent assessment 31/03/2011INDEPENDENT REVIEW TEAM5

 Progress made in delivering maternal services ANC 4+ visits 75% (71 in 2010) MIC84.7%  Skilled delivery 56% (48% in 2010) MICS 69.4%  Family planning acceptor 26% (24% in 2010)  Children fully immunized 88% ( 87% in 2010) 6

 Worrying disparities between geographic and socio-cultural groups  Richer, educated and urban residents accessing services better  High institutional maternal mortality 7

 High neonatal death with 60% occurring in first 24 hours  Stillbirth 22/1000 pregnancies (Central 50%)  Exclusive breastfeeding 46% (63% in DHS2008) 8

 Implement MAF: but should be flexible to address local needs; timely and wide dissemination of plan; clarify role of EU support  Analyse the causes of worsening trend in institutional MMR e.g., use confidential enquiries  Conduct qualitative studies to explore underlying reasons 9

 Strengthen quality of care  Implement Mill. Acc. Framework to track results and resources: need to strengthen data management system  Analyse causes of high stillbirth rate in Central Region 10

 Oil and gas industry  Direct effects: pollution, hazards  Indirect effect: communicable and non communicable diseases  Recommendations  Conduct health impact assessment  Strengthen health systems including emergency response, M and E 31/03/201111

 Climate change and Health  Extreme climate changes have implications on morbidity and mortality: e.g. malaria, diarrhoeal diseases  Current POWs lack direction in Climate Change  Recommendations  Need to sharpen policy to respond to Climate Change Challenges  Improve sector capacity to respond 31/03/201112

 HIV prevalence stabilized nationally, but sudden increase in Central Region  Epidemics of cholera and meningitis with mortality  NCD: policy not finalized; no governance structure 13

Recommendations HIV: Commission an in-depth study into the high prevalence in Central Region Epidemics: Continually strengthen epidemic response NCD: Finalize the NCD policy; Establish the proposed governance structure for NCDs 14

 Significant increase in number of nurses, midwives and doctors  Equitable distribution of staff improved, but NR and UWR are understaffed  Poor adherence to targets set in HRH Policies & Strategies ( ).  Quality compromised when focus is just to increase numbers 15

 All stakeholders should commit to implementing HRH policies.  Reorganise service delivery to optimally use excess staff 16

 Institutional and Organisational Assessment Report: Major challenges in leadership and intersectoral collaboration  Integration of mental and traditional health services e.g., issues of organisation and management, referral, capacity development 17

 Leadership: create incentives for performance; strengthen accountability mechanisms  Form a working group to discuss integration of mental health services and traditional medicine 18

 Policy framework to engage the private sector was in place in 2003;  Policy not disseminated; no implementation plan yet call for review in 2009  Key challenges facing private sector are difficulty in attracting critical staff; low NHIS reimbursement  Recommendation  Finalize policy and develop implementation plan; strong political support 19 : Policy framework to engage the private sector was put in place since However, by 2009, there were calls for the review of the policy to align it with current developments. The review and engagement process started in 2009 with support from World Bank and Rockefeller Foundation.

 Traditional medical practitioners using both approved and unapproved herbal medical preparations; issues with new FDB guidelines  Property rights issues: Reluctance of herbalist to disclose formulations in their herbal preparations  Recommendations  Organise a stakeholder meeting to address challenges  The Ministry of Health should work to protect the property rights of herbalists 20

 NHIS reforms: electronic claims processing; introduction of call centres; capitation  Since 2010 NHIS has been running a deficit which grew in 2011; raises issues with scheme’s survival  Fund investment reduced by 50%  Capitation excludes medicines; affects cost containment strategies  Achieving universal access: issues 1.financing should match access; 2. allocating resources efficiency 21

 Expenditure per capita US$35 (28 in 2010)  IGF study: Weak controls and limited capacity for data management. Study did not conduct detailed analysis of utilization  Recommendations  Develop strategies to increase revenue  Revise guidelines on use of IGF  Strengthen capacity for data management 22

Progress made in maternal and child health services Worrying disparities between geographic and socio-cultural groups Need to urgently reduce the high institutional mortality rate and stillbirths to rapidly achieve MDGs 4 and 5 23