Health Ghana - Reference Report

Introduction

Background
Over the years, rapid technological developments in the world have given rise to a number of revolutions; the Agricultural Revolution that enabled the developed world to feed themselves and to lift their citizenry from the abyss of poverty and starvation, the Industrial Revolution that accelerated the pace of industrial development by replacing horsepower and manpower with that of the machine, and the Nuclear revolution that catapulted man from solid earth to weightless orbits, thus heralding the advent of Satellite Technology and Services. As the 20th Century draws to a close, the Industrial Revolution has reached its zenith and we are now at the threshold of another revolution, the Information Revolution.
The information revolution brings in its wake a society that will be dominated by Information and Communication Technologies (ICTs). This era, dubbed the Information Age, is advancing rapidly in the developed world and will play a vital and critical role in determining which countries will survive economically and which will remain economically isolated. The key to this revolution is the technology that allows data, documents, still and moving images and sound to be stored digitally, and to be accessed instantly, regardless of where they are physically stored. This phenomenon is the direct result of the growth of the global data communication networks, the Internet being the best known example. Therefore countries that wish to ride on the information revolution to enhance the socio-economic development process of their countries need to put in place a number of local infrastructure and resources such as:

• a modern telecommunication infrastructure (preferably based on digital technology) with international connections of sufficient bandwidth (throughput capacity);
  
• an adequate tele-density (i.e. the number of telephone lines per 100 inhabitants);
  
• reliable domestic electricity supplies and well developed national technology infrastructures;
  
• an adequate level of computer literacy (which will necessarily involve improved levels of education and training);
  
• an adequate computer density (i.e. number of personal computers per 100 inhabitants);
  
• sufficient interest on the part of local and international private sector organisations to invest in developing technology infrastructures and in setting up communication and information services; and
  
• sufficient public interest in the services offered by these private sector providers, combined with a willingness to change traditional ways of life.
  In many developing countries these conditions are either non-existent or if they exist, the infrastructure are often dilapidated or are concentrated in the more affluent urban areas, while inhabitants of rural areas have little or no access to them.
  In line with it’s mission to assist developing countries to keep up with the latest developments in ICT, the International Institute for Communication and Development (IICD) has formulated intervention strategies that place emphasis on developing electronic communications applications that can be used to improve the range and the access to basic social services such as health care, education, public information and the environmental protection, particularly by the underprivileged in society.
  
  The ICT Roundtable conference on Health is set up as a follow up to the National ICT Roundtable conference organised in May 1998 in Accra. The National ICT Roundtable was hosted by the Internet Society of Ghana (ISOG), with the support of the Ministry of Communications and IICD. The conference resulted in a set of ICT policy recommendations for the country and in the implementation of a number of ICT projects in the areas of education, environment and commerce.
  The ICT Roundtable conference on Health will be hosted by ISOG, with the Ministry of Health and the Ministry of Communication as partner organisations and IICD as the facilitator.
  
  Theme
  The main theme of the Roundtable conference is to provide all national stakeholders with a platform for discussion on the role of ICTs in the health sector of Ghana.
  The theme is concentrated around the collection and dissemination of information on health in the following suggested areas:
  
• Administration and financial information
  
• Patient data
  
• Epidemiological data
  
• Drug Registration
  
• Related environmental information (water - sanitation - resources)
  
  Objectives
  The ICT Roundtable conference on health envisions contributing to the following objectives:
  
• Context building on the role of ICTs in the development of the health sector on the basis of existing national health policies
  
• Identification of ICT priorities and leverage areas in the health sector
  
• Development of ICT policy recommendations for the health sector in selected areas
  
• Development of annotated ICT projects in the selected areas
  
  Summary of Vision 2020 and the particular visions on and implications for the Health Sector
  
  Summary of Vision 2020
  In 1995, Ghana launched a programme of economic and social development policies dubbed “Ghana -Vision 2020” . This 25 year programme envisaged to transform the country’s economy from its present low-income status to that of a middle-income country of the ranks of the so-called Newly Industrialized Countries by the year 2020 as a Long Term objective. In order to realise this vision, Vision 2020 looked at the Current Level of social and economic development as a benchmark against which future progress can be measured. In addition, a Medium Term (The First Step: 1996-2000) objective to consolidate the foundations for accelerated economic and social development in the Long term was also launched.
  
  The Health Sector
  The overall objective of the national health policy is to improve the health status of all Ghanaians.
  
  Current Level of Health Services
  Average Life Expectancy in Ghana at 55 years is lower than the average of 63 years for all developing countries. High rates of Infant Mortality at 87 per thousand and Child Mortality at 143 per thousand have heavily reduced the Life expectancy at birth. However, for those who survive the first five years, Life Expectancy is 63 years which is lower than the Life Expectancy at birth in industrialised countries at 75 years.
  Factors leading to the low life expectancy include: Lack of protection from preventable diseases, contaminated water, insanitary living conditions, poor nutrition and heavy manual labour especially in rural areas. Also an estimated 60% of the total population have access to health care but this figure drops to 45% in the rural areas. Malnutrition is also a serious problem in Ghana, especially among young children and pregnant women.
  Medium Term
  In the Medium term a firm foundation must be built for the improvement in the quality of health care as well as for increasing access to health facilities. It will also be necessary to establish an enabling environment for health that should take cognizance of external factors to the health system such as cultural attitudes and the environment in which the population lives.
  
  Objectives
  
• Significant reductions in the rates of infant, child and maternal mortality rates.
  
• Effective control of risk factors that expose individuals to the major communicable diseases.
  
• Access to health services increased, especially in the rural areas.
  
• Establishment of a health system effectively reoriented toward delivery of public health services.
  
• Effective and efficient management of the health system strengthened.
  
• Reduction of Malnutrition among children and lactating mothers.
  
  Guidelines
  To achieve the above stated objectives, the following are the proposed guidelines:
  
• Extend coverage and access to basic health services, including maternal and child care.
  
• Consolidate and strengthen the Primary Health Care System
  
• Rationalise the spatial distribution of all types of health facilities.
  
• Improve financial and cost effectiveness in the provision of health care services.
  
• Strengthen surveillance and control of communicable and non-communicable diseases, especially malaria and AIDS.
  
• Strengthen district level management and further decentralize health management to community level.
  
• Promote medical research into forest resources and encourage the development and use of locally-produced standardised herbal medicament.
  
• Strengthen and improve co-ordination and collaboration between health agencies and organizations involved in related sectors, especially education, agriculture, water and sanitation, housing and forest resources.
  
• Promote private sector and NGO involvement in health delivery, particularly in the rural areas.
  
  Long Term Objectives
  The long term objectives as summarized below include:
  
• Increase life expectancy at birth and significantly reduce infant and child mortality.
  
• Reduce the incidence of communicable and preventable diseases, especially among children.
  
• Reduce the incidence of water-borne and other environmental diseases arising from insanitary practices and inadequate accommodation.
  
• Ensure adequate access to health services for all Ghanaians.
  
  Summary of Health Sector Programme of Work and the vision on and implications for ICTs in the programme
  
  Summary of the Health Sector Programme of Work
  Taking inspiration from the Ghana Vision 2020 document, the Ministry of Health published its Medium Term Strategic document in September 1995, to guide the development of the health sector in the Medium Term. To operationalise the Medium Term Strategy, MoH in consultation with the donor community, regional and district level health management, identified the key medium term objectives set out in the Strategy for their achievement. These formed the basis of the Health Sector 5 Year Programme of Work (5YPOW).
  The POW identified some major challenges facing the health sector as:
  
• Limited access to health care: Geographic access, access to basic services, financial access.
  
• Inadequate service quality.
  
• Inadequate funding of health services.
  
• Inefficient allocation of resources.
  
• Poor community, intersectoral and private sector linkage.
  
  Objectives
  The Stated Objectives for the medium term in the POW are as follows:
  
• Increased geographical and financial access to basic services.
  
• Better quality of care in all health facilities and during outreaches.
  
• Improved efficiency in the health sector.
  
• Closer collaboration and partnership between the health sector and communities, other sectors and private providers both allopathic and traditional.
  
• Increased overall resources in the health sector, equitably and efficiently distributed.
  For each stated objective, the POW designed strategies and interventions to aid in achieving these objectives. Below are the objectives of the seven strategies.
  
• To strengthen primary health services (district health services, i.e. services provided by sub-districts, district hospitals, and district health management teams)
  
• To re-orient secondary and tertiary services delivery to support primary health services.
  
• To develop and implement a programme to train adequate numbers of new health teams to provide and manage these services.
  
• To improve capacity for policy analysis, performance monitoring and evaluation, and regulation of service delivery by health professionals.
  
• To strengthen central support systems for human resources, logistics and supplies, financial and health information management.
  
• To promote private sector involvement in the delivery of health services.
  
• To strengthen intersectoral collaboration.
  
  Implications for ICTs in the 5YPOW
  The implications for ICTs in the 5YPOW was minimal. However, the POW mentioned the setting up of a Financial Information Systems (Information Technology, tools for data collection, analysis and reporting). It also touched on the need to improve communication with stakeholders and also within the various levels of the health sector.
  
  In the Health Sector 5 Year Programme of Work 1997-2001, 1997 Annual Review, the following ICT related constraints were identified:
  
  Public Health and Epedmiology
  “Health Management Information System
  The organization of the Health Information System is still cumbersome. At the programme level, there are good and nicely presented data available; however, it is very challenging to obtain a comprehensive overview of all input, process and output data. The Policy Planning Monitoring and Evaluation (PPME) organized a consultancy mission in 1997 (GOG/MOH/International Records Management Trust, 1997) that recommended strategies for change and improvement. Until now, this process has not started. The problem of a fragmentation of data collection and analysis is not a new one (within and outside Ghana).
  
  Despite initiatives taken during 1997, communication (region-district, within districts) is a major constraint for adequate disease surveillance (lack of telephone lines and radio connection). This area needs close attention in 1998/1999.”
  
  As can be deduced from the above quote, there is still work to be done in harnessing ICT to help in the health delivery system in Ghana.
  
  Procurement and Supply
  “Procurement Information Management
  Identifying and acquiring, installing and using the most appropriate information management system - whether paper based, or based on commercial, proprietary or bespoke computer backed solutions, early enough in the Program of Works (POW) to assist with effective directional control of the programme, will be a major challenge. This is, of course, compounded by the fact that there are other activities in the POW which do require an appropriate MIS; and, indeed raises the wider issue of an effective information systems policy and strategy for the programme, in order to guide systems decision making and implementation. In this regard, being in the first wave of ministries to pilot the development of a government-wide financial management information system (which has a procurement component) under Public Sector Financial Management Reform Programme (PUFMARP), presents an early opportunity for MOH to grapple with this key issue.”
  
  
  “Observations made to various (medical) stores at different levels demonstrate that information is not routinely shared with key players vertically or horizontally. One reason is poor communication methods and channels, eg a number of districts are operating without a functioning telephone line. Further, the information available is not fully analysed and utilised (information related to current stock levels in all stores, re-order frequency, order size etc). An electronic link between Procurement Unit and the CMS and Regional Medical Stores (RMS), by which reliable and accurate information about stock balances, consumption and demand, order and delivery status can be speedily disseminated would enhance enormously the overall efficiency and cost effectiveness of the supply and distribution system. This requires that an effective system of stock control and procurement management information system is in place, able to generate and deliver the information required.”
  
  
  From the above, the need to have a procurement management information system in place cannot be overemphasised.
  
  Inventory of major ICT initiatives and projects in the Health Sector in Ghana
  
  Communication
  Internet Email Access
  National Level: All Divisions and most units.
  Regional Level: All the ten Regional Health Administrations (RHAs) and most of the Regional Hospitals.
  District Level: A few District Health Administrations (DHAs) and District Hospitals
  The two Teaching Hospitals also have access to Internet Email.
  All the Health Research Institutions:
  
  Radio and Data Communication
  Volta Region
  The Region has installed a Radio network linking all the 12 (DHAs) to the Regional Health Administration for voice commnunication. In the Keta District, the radio link has been further extended to the Sub-District Health Administrations (SDHA). The Radio network is also linked to the Regional Director’s vehicle. Furthermore the Regional Health Administration has installed a Local Area Network (LAN) linking all the units within the office. The RHA intends to link up all the DHA’s to the Regional LAN via dialup connections using the existing Ghana Telecom telephone network. The region has thus improved its data and voice communication.
  
  Upper West Region
  A radio link has been established between selected District Hospitals in the region and remote health facilities in their catchment area. These remote health facilities use the radio to summon ambulances from the hospitals for emergency cases. The DHA also uses the radio for communicable disease surveillance in the remote health facilities. The region has also set up a Regional Email network for data commnunications that links up all the 5 DHAs to the Regional Health Administration via dialup connections using Ghana Telecom telephone network.
  
  Upper East Region
  A Geographical Information System (GIS) has been developed at the RHA for disease surveillance.
  
  Local Area Network Initiatives
  The following divisions/units have installed LANs in their offices.
  Human Resources Division of the MoH
  National Tuberculosis Programme
  Ghana National Drug Procurement
  Procurement Unit of MoH
  Central Medical Stores
  Navrongo Health Research Centre
  Kintampo Health Research Unit
  
  Financial Administration
  MoH has developed the REPAC software to capture and analyse Recurrent Expenditure at the National and Regional Levels. This is being implemented in all the regions. The Regional Accountants forward their financial returns on diskettes to the National Level for consolidation. This was developed with Donor support.
  MoH has also developed a Capital Expenditure Monitoring System (CapEMS) software. This is used to capture and analyse all capital expenditure in the MoH and is currently being implemented at the National Level.
  
  Drugs and Supplies Management
  The Procurement Unit is in the process of testing a procurement software. This database helps to evaluate all bids tendered for the supply of drugs and supplies. The main aim of the software is to assist MoH get the best value for money for all her procurement.
  Central Medical Stores
  The Central Medical Stores has a computerised stock management system that monitors stock purchases, storage and distribution to the various Regional Medical Stores.
  
  Tetteh Quarshie Memorial Hospital, Eastern Region
  MoH is developing a comprehensive computer assisted Hospital Information System. The first part of this project, the drug management system, is currently at the pilot stage. The other components of this system are also being worked on.
  
  Research Institutions
  Navrongo Health Research Centre (NHRC)
  The NHRC has developed a Demographic Surveillance System (NDSS) for Kasena-Nankana district. This system tracks the population in the catchment areas. It monitors births, deaths, migration in , migration out, and marriages. They use the data for various research work such as the Vitamin A Supplemmentation Trials, Impregnated Bednet Use Study etc. NHRC has also developed a GIS system to map the database in the NDSS. It is presently involved in another GIS project: Mapping Malaria Research In Africa.
  
  Kintampo Health Research Unit
  The research unit developed a surveillance database for tracking and monitoring the children in the study areas who were in the Vitamin A Supplementation Trials research.
  
  Health Administration
  Estates Management Unit (EMU)
  EMU is building a database of selected health facilities in the country. The database contains scanned pictures of these facilities, physical dimensions, current state of the infrastructure, drainage systems, water, electricity, access roads etc. This information will help MoH in making informed decisions when it comes to rehabilitating and/or rebuilding health facilities. This database will be installed in all the RHA and linked via email to the national database.