ST. MARTIN DE PORRES HOSPITAL, EIKWE, GHANA

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1 ST. MARTIN DE PORRES HOSPITAL, EIKWE, GHANA Annual Health Service Report 2013 ST. MARTIN DE PORRES HOSPITAL, EIKWE, GHANA

2 Annex 17 - Antenatal (ANC) Attendance Type of Data Total ANC Registrants 1,858 5,098 1, ,354 Total ANC Attendants 12,388 14,338 15, ,057 Total PNC Attendants , ,036 Mothers Receiving TT2+ 2,103 2,738 2, ,242 Women with 4+ ANC visits 958 1, ,442 Risk Detection at ANC Registrants of Early Teen [10-14] Registrants of Late Teen [15-19] Registrants of Age Over 35 year Registrants with HB Below 11 gm 1, Registrants of Parity 4 and Above Child Heath (CWC) No. of Children 0-11 Months No. of Children Months No. of Children Months No. of Under 5 Children 1,216 1,196 1, BCG 2,342 1,947 1, ,900 OPV0 1,626 1,443 1, OPV PENTA Measles Yellow Fever Vitamin A Supplements 2,232 1,499 1, ,191 Growth Monitory >80% [Well-Nourished] 9,361 10,923 13,287 17,848 7, % [Mal-Nourished] <70% [Severely malnourished] Annex 18 - Delivery Outcome Type of Data No. of Maternity Beds Total Deliveries 2,362 2,422 2, ,173 Total Live Births 2,213 2,359 2, ,048 Total Still Births Fresh Macerated Total Low Births Wgt (<2.5 kg) No. of CS No. of Vacuum Extraction No. of Neonatal Deaths No. of Maternal Deaths No. of Maternal Death Audits No. of infants Deaths Contents Content Annexes List of Tables List of Acronyms Essential Data Acknowledgment Executive Summary Mission Relief & Drainage Climate & Vegetation Demography Socio Economic Activities Transport, Communication & Road Network Water Sanitation Educational Facilities Departments and Units Services Provided Health Service Delivery The Identity of The National Catholic Health Service [NCHS] Promotion & Maintenance of the Identity of the NCHS Organisation & Management Management & Administration Management & Other Institutional Meetings Building & Equipment Health Infrastructure Medical & Other Equipment Transport Developmental Projects Power Supply Stores and Supplies Partnerships Partnership & Internal Relationships External Relationships Human Resource Development Staffing Levels Staff Movement Staff Motivation Staff Training & Development Health Administration & Support Services Health Information System Supportive Supervision/Monitoring & Evaluation Service Provision Access to Healthcare Services & Performance Overview Review; Morbidity & Mortality Clinical Trends Service Utilisation Customer Satisfaction Service Quality Service Data Top Ten Diseases Analysis Curative Services Investigative Services Laboratory & Blood Bank X-Ray & Ultra Sound Scan Services Maternity Services Delivery Outcome: Post Natal Care [PNC] Maternal Mortality Surgical Procedures Surgeries Specialised Services Other Services Pharmacy & Dispensary Blood Transfusion Home Based Care Improving Quality of Care Mortuary Services Health Prevention School Health Expanded Programme on Immunization [EPI] Immunization Coverage MCH [ANC/PNC] Well Baby Clinic/Child Welfare Clinic [CWC] Micronutrients Deficiency Control Weaning Food Project Adolescent Child Health Diseases of Public Health Concern Integrated Disease Surveillance Malaria Deaths from Malaria Tuberculosis 36 1

3 Annexes 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 Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Demographic Characteristics: Ellembelle & Eikwe Sub Districts 2013 Infrastructure Transport Projects Staff Movement Increasing Access to Health Care [Service] Increasing Access to Health Care [Staffing] Out Patient Visits Admissions Table 10: Table 11: Table 12: Table 13: Table 14: Table 15: Table 16: Table 17: Table 18: Laboratory Investigations; Outcome Reproductive & Child Health Supervised Deliveries Summary of All Surgeries EPI; Registration & Attendance Immunization Coverage Tuberculosis [New & Relapse Cases] HIV/AIDS Screening Financial Report Contents Continue Health Promotio Sexually Transmitted Infections [STIs] [STIs] HIV/AIDS Prevalence & Control HIV Sero Prevalence ANC HIV Sentinel Surveillance & Prevention of Mother to Child Transmission [PMTCT] Ante Retroviral Therapy [ART] Social Support Programmes Persons Living With AIDS [PLWA] Association Home Based Care Natural Family Planning Health Financing Financial Management & Financing Mechanisms Budget for Year Health Insurance Finance Notes To The Financial Statements for Period Ended Dec 31, Research Note 15 Fixed Assets Schedule Conclusions & Way Forward Constraints & Challenges Policy Thrust & Priority Areas Challenges Social Services Conclusion & Way Forward List of Acronyms 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 2 3

4 Acknowledgement We are very grateful to all and sundry for the excellent support you provide us as we continue providing health care to the rural population of Ghana. For your friendship, prayers and benevolence, the hospital management, staff and patients, wish to express its heartfelt gratitude. Essential Data 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] / Home Page: 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 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. 4 5

5 Executive Summary Executive Summary This Annual Health Service Report" captures all services and related activities at St. Martin de Porres Hospital, Eikwe, during the reporting year of 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. 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 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. 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. 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. 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. 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 6 Diagnostic services are highly patronised. The Laboratory, XRay 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. The activities reported on derive from the hospital s 5 Year Strategic Plan of , and address the implementation of various set objectives, and challenges encountered therein is the first year of implementation of the new 5 year strategic plan for the hospital. 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%. St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report 2013 particularly for child and maternal mortalities are yet to make impact. 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. 7

6 Mission Vision St. Martin de Porres Hospital is committed to providing quality and affordable health care to all people reflecting the healing ministry of Christ 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 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 Commitment 2. Compassion 3. Respect 4. Efficiency & Effectiveness 5. Good Interpersonal Relations and 6. Honesty Demography TABLE 1: Demographic Characteristic: Ellembelle and Eikwe Sub District 2013 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 Groups % 0f Total Population Eikwe Sub District Ellembelle District Population , ,560 2,908 1,348 5,048 1,181 3,009 2,830 92,857 2,786 13,000 24,236 11,236 42,064 9,843 25,071 23,586 Catchment Population 0-11 Months 0-5 Yrs <15 Yrs Yrs <18 Yrs Yrs 70+ Yrs WIFA 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. 8 Core Values Mission Projection from 2010 Population Census Eikwe Population: 4,610 [approx.] Ellembelle District Population; 92,857 Population Density: 85 per sq. km. Population Growth Rate: 3.0% [District 2.8] Catchment Occupation: Farming & Fishing Catchment Cash Crops: Coconut [Copra] Food Crops: Cassava, Plantain, Cocoyam, Rice Ellembelle & Nzema East District Area: 8,414 sq. km. St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report

7 Socio Economic Activities Educational Facilities Inhabitants 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. Eikwe 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 Transport, Communication & Road Network The Hospital has the following main departments; Out Patient, Wards, Health Administration & Support Services, Primary Health Care, an Operating Theatre, Laboratory and X-Ray. The 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 Water Communities 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 Sanitation Refuse 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 Departments and Units The Identity of The National Catholic Health Service [NCHS] 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 Service 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 Organisation & Management Services Provided Health Service Delivery For purposes of health service delivery, the district is divided into zones [Sub Districts]. This report covers activities of the year 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 Management & Administration The management of the hospital is the responsibility of a four core member Hospital Management Team [HMT] with two co-opted members, including representations of the partnering religious communities. Daily administrative functions are carried out with the assistance of heads of units and various committees Management & Other Institutional Meetings The Hospital Management Team [HMT] and Heads of Units have scheduled monthly meetings. Each department holds monthly meetings where its staffs welfare and work are discussed. Staff durbars are also held to discuss staff welfare and other general issues Building & Equipment Health Infrastructure All year round, artisans in the facility undertake routine maintenance of wards, residences and grounds. All structures, both residential and non-residential are generally in good condition. Projects earmarked for the year were completed. [Refer Table 2]. Barring the availability of funds, nurses bungalows and a students hostel are targeted for completion in year The projects are geared towards upgrading staff accommodation Medical & Other Equipment Donations 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 personnel together with the Senior Expert Service [SES], Germany, volunteered services throughout the year to the facility. TABLE 2: Infrastructure 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 Overhead [10,000 Litres] Under [10,000 Litres] 1 Good Water Tanks 10 11

8 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 TABLE 3: Infrastructure Vehicle Type Use Age; [Yrs] Km. Covered Km. Stand No. Trips VW Transporter [Van] General Purpose 4.6 7, , Toyota Land Cruiser General Purpose ,538 76, Toyota Land Cruiser Ambulance ,279 92, Toyota Double Cabin Pick Up General Purpose ,051 51, Nissan Terrano [4x4] General Purpose , , 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. TABLE 4: Projects 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 External Relationships There has been a significant increase in the level of collaboration with the Regional and District Health Directorates. Personnel of the Hospital are invited to partake in seminars, workshops and other functions at all levels. The Ministry of Health/Ghana Health Service through their directorates provide administrative, and some logistical support. Whiles equipment allocations from the sector ministry continue to improve personnel postings, still has some challenges. Support is also received from some agencies and benefactors from both within and outside the country Staff Movement TABLE 5: Staff movement Human Resource Development A Human Resource Unit was established in the facility during the year. Staff mix and strength still remain inadequate, and create work overload for all levels of personnel, compromising work quality. It is hoped that overtime the facility through the unit, will boost its human resource capacity and capabilities to cater in the main for present and near future workload Staffing Levels Although staffing levels have increased slightly over the last three years, several of the newly recruited personnel receive their salaries from the hospital rather than the state. The numbers of staff on the government payroll totalled 164 whiles that on Hospital s Internally Generated Fund [IGF] numbered 75, by close of The resultant budgetary strain on the facility is enormous. The required professional staffs are therefore augmented by a large number of non- professionals and volunteers. Generally, the facility continues to have a stable workforce. Year Total Staff New Recruit Study Leave Retired Resigned/ Vacation Deceased [Jan] Posting of Post Staff Motivation Motivational packages for staff vary in form and category. Long serving staff receive annual awards on occasion of the celebration of the feast of the Hospital s patron saint. Staff also enjoy in house soft loans, cash allowances etc Staff Training & Development 41 requests for promotions were put in, most of which were approved by the Controller & Accountant General s Department Power Supply Frequent power outages and fluctuations continue to interrupt service. Outages are a source of major concern as they damage costly and sensitive medical equipment. Three generating plants are maintained for use by the facility in such emergencies. A gradual increase in the facility s power needs in recent years is necessitating the acquisition of a larger capacity generator Stores and Supplies Mini stores are found in various departments of the Hospital. Stores & supplies activities are not harmonised, with no professional storekeeping. Documentation for Stores & Supplies activities, remain basic. The unit needs strengthening in the near future to complement work of the account department Partnerships Collaboration with various sector ministries, agencies and departments continues to improve Partnership & Internal Relationships The National Catholic Health Service [Department of Health] and the Diocesan Health Service remain critical sources for administrative functioning, as well as advocates for the maintenance of an adequate balance, in the face of increasing challenges for faith based health service providers. To this end, several meetings were held in various forms by the 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 concurrently in the Hospital, their presence and input remains critical to the successful running of the outfit as a catholic health unit: their members provide various services including general administration, nursing, and pastoral work. In addition to other short courses attended by staff within and outside the facility the following were/are in training for the 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]

9 Health Administration & Support Services Health Information System All patient registrations are now captured through a centralised computerised system. The system still needs a lot of improvement, and is yet to be extended to most service points for direct data capture. For now, data generated in the wards, are still manually gathered, for collation. Patients bills are also computerised. Monthly clinical reports are submitted to the RHD through the DHD Service Provision Access to Healthcare Services & Performance Overview Services were well patronised during the reporting year by the 13 communities officially in the Eikwe Review; Morbidity & Mortality The fight against malaria in the district got intensified with the introduction of insecticide spraying of mosquitos through the AngloGold Ashanti Malaria Control Programme. Other similar campaigns such as Intermittent Preventive Treatment [IPT], the Sub District as well as by those outside it. An OPD Per Capita of 10.5 and Admission Rate of 134% were recorded; the former being the highest in the last five years, and the latter, the second highest. This Table 6: Increasing Access to Health Care [Service] Year Total OPD OPD Per No. of Admission Bed Occupancy Population Attendance Capita Admissions Rate[%] Rate TABLE 7: Increasing Access to Health Care (Staffing) Year Total Number of Population Number Population Population Doctors Doctor Ratio of Nurses Nurse Ration , :2, : , :2, : , :2, : , :2, : , :1, :166 Note: There are 2 newly established CHPS Centres in the Eikwe Sub District distribution of Insecticide Treated Bed Nets [ITBN] are still on-going. Although the percentage morbidity for malaria is on the decline, fatalities, especially for children u----nder five years, remain high. The Case Fatality Rate for Children Under Five Years increased from 1.7% to 2.4%. Ref. Annex Supportive Supervision/ Monitoring & Evaluation Several visits were made by the Sekondi-Takoradi Diocesan Director for Health as well as by personnel from the sector ministry, the district and regional health directorates, and national levels to the facility. Visits were mainly to assess work progress on specific programmes/projects e.g. National AIDS Control Programme [NACP], National TB Programme [NTP], Malaria Control Program etc. whiles others were supervisory and monitoring visits by external independent bodies to the Pharmacy, Wards, Administration and Laboratory of the Hospital. obviously is an indication of the numbers of patients from outside the Eikwe Sub District who use the facility as their preferred choice for health care, and particularly for maternal care ,520 68, , ,921 78, , ,034 82, , ,924 93, , , , , Clinical Trends Trend patterns have only differed in the last decade with the emergence of aliments like Diabetes, Hypertension etc. The year saw similar trends, both for morbidity and mortality, as has been experienced in the last five years. Refer Annex Service Utilisation Over 75% of clients of the facility are from outside its immediate catchment. Services provided for both in and out patients, including those in the catchment communities, were well utilised. Generally, services from all the various departments are well utilised by patients/clients Customer Satisfaction Two client satisfaction surveys were conducted in 2013, and for the first time one such survey was undertaken outside the facility in a nearby town. The facility was commended for tidiness of its wards, clean and friendly environment and the availability of most required health services. Staff attitude suffered most complaints, and recommendations were made for cleaner washrooms, friendlier staff and service provision without undue delay Service Quality Staff of various categories attended training programmes within and outside the hospital. Sessions mainly took the form of workshops to upgrade knowledge and skill in the management of selected ailments, and the completion of mandatory service data reporting forms. Meetings were also held to discuss Quality Assurance and related issues. TABLE 8: Out Patients Visits Service Data Service data are gathered daily and collated for periodic reports. Most service data are collected manually. Patients bio data and bills are directly input by computer. The planned automation of service data at the point of service for collation and analysis has taken off at the OPD and Administration. It is yet to be undertaken in the wards, and other units Top Ten Diseases Analysis Malaria, Anaemia and Pregnancy & Related Complications presented for morbidity and admissions have similar trends as in previous years. Of concern is the increasing mortality rate for children under five years. Hypertension with Other Heart Diseases and Diabetes continue to feature more and more over the years. Total facility deaths recorded was 428 [highest ever recorded] with the top ten causes of deaths forming 49% of all facility deaths. Ref. Annex Curative Services * Out Patient Care OPD services are offered round the clock. OPD per capita registered 10.5 visits. The first two prevalent ailments were Malaria [20%], Gynaecological Disorders [9%] of all cases respectively. OPD visits totalled 116,728. Ref. Table 8, Annex 2. Type of Data Total OPD New 26,932 28,702 30,348 38,504 44,703 Total OPD Attendance 68,685 78,184 82,213 93, ,728 Total Insured Patients 33,437 49,615 53,747 72,445 94,895 * In Patient Care The Hospital has a bed complement of 200. The Average Length of Stay was 4.9 days, and the overall Bed Occupancy Rate registered 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, Annex 2. TABLE 9: Admissions Type of Data No. of Beds 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 Total Discharges 12,749 14,342 13,325 13,184 13,632 Total Deaths

10 * Referrals The facility serves as the referral point for over 20 health units in three geographical districts, including two with district hospitals. Most referrals are Obstetric & Gynaecological and trauma cases. Referrals from the Hospital were mostly to the Regional Hospital [Western] in Sekondi, and Specialist Centres Investigative Services Laboratory & Blood Bank The laboratory undertakes a range of services including bacteriology and biochemistry. A total of 151,556 Table 10: Laboratory Investigations; Outcome X-Ray & Ultra Sound Scan Services 6,089 X-ray investigations were undertaken, 41% of which were Chest X-Rays. Investigation trends remained same, with an average of 507 investigations made per month. A total of 9,576 ultrasound scan investigations were undertaken. Scans were mainly for pregnancy related investigations. With a high ANC attendance, the equipment is well utilised with an average of 800 investigations per month. TABLE 11: Reproductive & Child Health investigations were carried out; an increase of 15% over the previous year. The biggest challenge for the unit is the availability and costs for reagents and other lab supplies. Quarterly supervisory and monitoring visits were made by personnel from the Regional Public Health Reference Lab Takoradi. Other visits were made by teams from the National STI/AIDS Control Programme [NACP] and Malaria Control Programme. The Medical Mission Institute, [MMI] Germany, continues to assist with the undertaking external culture and sensitivity control tests. MMI in collaboration with the unit also undertook two research projects during the year. Refer Table 10, Annex 5 Year 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 Total 104, , , , , Maternity Services * Safe Motherhood * Ante Natal Care. ANC registrants and attendances are high. New Registrants recorded 1,354 with 11,143 attendances [an average visit per client of 8.2. [Refer Table 11.] Many expecting mothers use the facility not only for antenatal care but also to deliver of their babies. The facility has a resident Obstetrician/Gynaecologist. Year Total Dist. Total Pop: Expected Ante Natal Clinic Post Natal Clinic Supervised Deliveries Population [Eikwe No. of *ANC Coverage PNC Coverage Number Coverage Sub District] Pregnancies Registrants Registrants A B C D E F G H I ,334 12, , , ,673 12, , , ,950 14, , , , ,036 10, , , , ,857 11, , , , * Registrants include women registering for the first time but exclude clients registered at another facility. * Traditional Birth Attendants [TBA] Activities TBAs remain important in child delivery due to the beliefs and customary practices of the Ghanaian woman. The sub district has 13 TBAs with 6 active. Referrals to the ANC, for deliveries and to the PNC are rather low. For the future, and as a national policy, TBAs are being encouraged to play active roles in post natal care, and less with deliveries as they have done in the past Delivery Outcome: * Live Births; 96% of all deliveries in the facility were live births [3,048 from 3,173] with 1,584 males and 1,446 females; an average birth per month of 264. Total births decreased by 5% over that of the previous year. The average Caesarean Section Rate of 23% was maintained. The facility is used as a referral point by several smaller health units in three geographical districts, particularly for gynaecology and obstetrics cases. A total of 197 babies were born through multiple births. Ref. Table 12. TABLE 12: Supervised Deliveries Year Population projection from 1987 [Eikwe sub district] * Expected deliveries [4% Of Total Pop] Total [D+e+f] ** Maternal Mortality: [Maternal Deaths/ Live Births] * 100, Post Natal Care [PNC] Attendance to the clinic increases over years; the registration of 2,036 is the highest ever and a 32% increase over the previous year. Free health care for the expecting mother and child, implemented ten years ago with the introduction of the National Health Insurance Scheme [NHIS] is thought to be partly responsible for the increasing trend Maternal Mortality The facility recorded 8 maternal mortalities. Refer Table 12. Death audits were carried out with midwives, senior facility managers, district health officials and other health personnel for all the deaths. Education of pregnant mothers is always paramount in all recommendations. Other recommendations included the training/retraining of midwives in the management of certain conditions. Incidentally, half of the mortalities were from Ellembelle and the other half from Jomoro districts respectively. Live Still Birth Supervised deliveries IUD * Still Birth Rates; There were a total of 25 Fresh Still Births. Ref. Table 12. The facility Still Birth Rate reduced from 1.3% to 0.8% of all births. The lingering high rate persists even though training programmes 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 lowest in six years; a decrease from 131in Several of such cases are from mothers who are irregular and/or nonattendants at ANC. Other reasons attributed to the unusually high numbers of IUDs in the area, include, but not limited to the use of herbs for enema or concoctions by pregnant mothers. Health personnel are left with the option of providing continuous education of mothers as a tool to reduce IUD numbers. Ref. Table 12. A B C D E F G H I J K L M 09 12, ,362 2, , % 0.9% 13.3% 10 12, ,495 2, , % 0.6% 10.8% 11 14, ,925 2, , % 1.1% 11.6% 12 10, ,336 3, , % 1.3% 8.9% 13 11, ,173 3, , % % Below 2.5Kg. Over 2.5Kg Maternal Deaths Maternal Mortality [I/d* 100,000] ** Surgical Procedures Ratio & percentages % Sup. Deliveries [C/b]*100 % Still Births E/c]*100 %< 2.5Kg of Weighed Child. G/[g+h]* Surgeries Planned surgeries are undertaken thrice weekly. Most of the cases are major and minor obstetric and gynaecological and 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 surgeon specialist was recruited in the last quarter of the year

11 TABLE 13: Summary of All Surgeries Summary of Surgeries Total Minor Surgeries ,524 Total Major Surgeries ,656 Grand Total ,180 Emergencies Obstetrics & Gynaecology ,708 General ,472 Table 14: EPI; Registration & Attendance Year Target Population [0-11Months.] Registration 1,267 1,226 1,797 2, Attendance 9,653 11,149 13,297 17,848 7, Immunization Coverage High coverage was attained for all the antigens. Support from the District and Regional Health Directorates with the provision of logistics, training and direct supervision, particularly during the National Immunization Days were crucial to the attainment of the targets. No direct funding however was received from the DHA for the facility?s EPI activities Specialised Services Gynaecology &Obstetrics and Surgery are the only specialised services that are extensively offered in the Hospital. Clinic days for TB, Diabetes, and Hypertension as well as focused antenatal have been started in the OPD. Weekly service is also provided for clients on Antiretroviral Therapy [ART] Other Services Pharmacy & Dispensary 97% of Essential Drugs was stocked during the year. Adequate quantities of other medical supplies were also maintained. Most of the supplies are purchased from the Catholic Medicine Centre through its Pooled Procurement Programme, the Western Regional Medical Stores, and some private suppliers. Drug purchases are made from the facility?s common fund Blood Transfusion Blood transfusion service is provided as part of the general laboratory and not as a separate unit. Blood is mainly organised through a?pool system? where clients scheduled for major surgery are requested to provide donors who transfuse for their use, and if not required, are banked for future emergencies. 699 [26%] transfusions were made to children and 2010 to adults Home Based Care The service is offered exclusively to clients living in the catchment of the Hospital with socio medico needs. Scheduled visits are made weekly with a team including a nurse to offer counselling, nursing, food rations, etc. to clients and their relations. Funding for the programme is partly 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 for over a decade Improving Quality of Care The Quality Improvement and Quality Assurance Teams joined forces and held common meetings to discuss service quality issues. More ward in charges meetings were held than previously. Issues of post op wound infection, high under five death rate, etc. topped the year?s agenda. Other areas considered were general infrastructure and equipment availability Mortuary Services The Hospital has no morbid anatomy unit. A small cold room facility has been provided for the temporary storage of corpse before their transport out of the facility. The provision of this service as an alternative source of income as well as a necessary service for clients who pass on, has still not gained attention Health Prevention School Health The programme featured more in the second half of the year than in the first due to personnel numbers. All the Junior High, Primary and Pre Schools in the catchment were visited; screening of students, counselling, inspection of classrooms and school compounds, and referrals of students to the Hospital were undertaken as part of services provided. Eni Foundation?Ghana provided some support for the implementation of this programme Expanded Programme on Immunization [EPI] The official number of communities served by the Hospital is reduced from 15 to 13 by the DHA with the creation of new health sub districts. EPI targets set were in the main achieved. Routinely, all targeted communities are visited every month for immunisation during Child Welfare Clinics [CWC]. There were increases in both EPI registrants and consequently attendances. Refer Table14,15 & Annex 1. Table 15: Immunization Coverage Year Target Pop. [0-11Months] Antigen Antigen [% of Target Pop] BCG No. Immunized 2,342 1,947 1,876 1,998 1, MCH [ANC/PNC] General health information, education and counselling are made during ANC/PNC gatherings. Clinics are conducted five times a week. There are more clients to the Antenatal clinics than to the Postnatal Well Baby Clinic/Child Welfare Clinic [CWC] The Well Baby or Child Welfare Clinic programme, focuses on nutrition rehabilitation and growth monitoring, and is carried as part of EPI programmes. Weights of children below five years are monitored and counselling given where needed. Children with serious nutritional problems are referred to the Hospital for further management. Practical demonstrations of good diets are given during CWC Micronutrients Deficiency Control Weaning Food Project The facility prepares own child weaning food for children [Weanimix] in large quantities for sale. Income generated from the weaning food project is used to assist supplement funding for Home Based Care activities. Its preparation and Coverage Measles No. Immunized Coverage DPT3 Hip/Heb No. Immunized Coverage OPV 3 No. Immunized Coverage TT2/3 No. Immunized ,621 2,242 Coverage Yellow Fever No. Immunized Coverage sale, together with the kneading of flour forms part of the Primary Health Care?s Mill Project Adolescent Child Health Adolescent clinics are now held daily to encourage them attend clinics and not shy away from older expecting mothers. Teenaged pregnant girls formed 27% of all registrants; an increase from 12% in Although high, this is seen as a positive impact of the NHIS programme, as well as the facility?s direct targeting of clientele type. The general implication of teenage pregnancy and consequent risks however is not lost on managers, and measures are being taken to address the trend Diseases of Public Health Concern Integrated Disease Surveillance There were no confirmed cases of Cholera, CSM, Yellow Fever, AFP and Measles during the year; situation has been same for over six years. The trend can only be said to signify a reduction in number of such cases and not the complete nonexistence of all of them

12 Malaria Total OPD attendances have increased over the last five years. The general trend for malaria morbidity however has reversed and is on the decline; for Children Under 5 Years malaria incidences in the OPD increased by 8.8%. Malaria remains the leading cause of OPD attendance in the facility. Refer Annex 2, 10, Deaths from Malaria The number of malaria admissions for Children Under Five Years 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 AngloGold Ashanti Malaria Programme [mass spraying of houses with insecticide] in the district, together with other existing malaria programmes, will reduce deaths from malaria in coming years. It is imperative for the facility to find ways to address increasing fatalities of children from malaria. TABLE 16: Tuberculosis (New & Relapse Cases) HIV/AIDS Programmes ART clinics are held weekly, and the Persons Living With HIV/AIDS [PLWA] Association, hold monthly sessions in the facility. Some durbars were also held in the Eikwe Sub District communities and elsewhere. Talks were held in churches, and to identifiable organised groupings etc. on HIV/AIDS and related topics. Clients to the clinic number almost Antiretroviral medicines are supplied to the facility through the regional medical stores Tuberculosis A facility policy to register only TB patients in the catchment of the hospital, for whom treatment is also initiated, has effectively reduced the registered TB patient numbers from over 100 to 31, in the last 5 years. Other confirmed cases in the hospital are referred to health units closer to patient?s address. The practice has reduced defaulter and failure rates to zero. Of the 31 total registered patients, 11 were?smear positive?. There were brief periods when drug supply by the Regional Disease Control Unit of the Ministry of Health was interrupted creating shortages. Year PULMONARY TB SMEAR POSITIVE Total Pulmonary Total S. Positive New Cases Relapse Smear Neg Ex. PTB Total TB Health Promotion Sexually Transmitted Infections [STIs] All patients/clients who report with Sexually Transmitted Infection[s] [STI] are referred for counselling. For selected patients who 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 [STIs] HIV/AIDS Prevalence & Control Routinely, all donors are screened for Hepatitis B & C before initial HIV spot check. Test trends are still dictated mainly by the availability of test kits. Counselling and education are offered both in the Wards and OPD HIV Sero Prevalence Both rates for donors and patients who tested sero positive for HIV in 2013 are the lowest in last 5 and 8 years [5.6% and 23.6%], respectively. Similar tests for expectant mothers visiting the antenatal clinic recorded 2.7%; the lowest in 7 years. The age group of years is the largest to test HIV+ [323 from a total of %]. Refer Table 17, Annex HIV Test Kits are received through the Regional Public Health Reference Laboratory; shortages during the year implied a break in the regular testing of all pregnant women. TABLE 17: HIV /AIDS Screening ANC HIV Sentinel Surveillance & Prevention of Mother to Child Transmission [PMTCT] The annual HIV sentinel research of 500 random tests on first time expectant mothers to the ANC revealed a reduced rate of sero prevalence; 55 from 2071 registrants [2.7%]. Refer Annex 15. Increasing numbers of pregnant women approve of the voluntary testing after counselling. Mothers who test positive and are from distant addresses are advised to visit heath units closer to them for follow up care. Visits by 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 Ante Retroviral Therapy [ART] The weekly clinic is heavily patronised by clients of all ages. To date almost 2,000 clients, including children, use the facility. Monthly sessions are held by clients for peer counselling and some other social amenities. Therapy includes food supplements given to clients who require this. The unit is permanently manned by PHC staff Social Support Programmes Persons Living With AIDS [PLWA] Association The Persons Living With HIV/AIDS [PLWA] together with the Orphans & Vulnerable Children [OVC] group is still active, although not as vibrant. Clients receive counselling, food rations, medical assistance etc. from the facility through various organisations. Both groups have separate scheduled monthly meetings in the Hospital Home Based Care 2,700 domicile visits were conducted throughout the year to persons with various conditions; TB, HIV/AIDS and others with medico social needs. Domicile visits are made twice weekly. Home based care forms an integral part of services provided by the Primary Health Care unit of the Hospital Total Number of Donors Screened 1,978 2,288 2,268 1,929 2,043 Total Number of Donors Positive: % Of Donors Positive: Total Number of Patients Tested: 1,681 1,738 1,431 2,232 1,965 Total Number of Patients Positive: % Of Patients Positive: Natural Family Planning The facility offers Natural Family Planning [NFP] services to desiring clients. Sessions are also used as fertility clinics to 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 are referred to other facilities Health Financing Financial Management & Financing Mechanisms Budget for Year 2013 A total budget of over GHõ5,500 Million was forecast for the running of the facility for the year This was required for the payment of staff emoluments, and the provision of administrative support, services, and investments. An amount of GHõ6,490 Million was used to run the facility by close of year Health Insurance The National Health Insurance Scheme [NHIS] has been in operation for ten years. It has certainly increased patient load and income levels for the facility. Averagely insured clients form about 85% of all in and out patients. All NHIS claims are prepared via a networked computerised system

13 TABLE 18: Financial Report Cash Flow Statement [ 1-Jan-2013 to 31-Dec-2013] Inflow of Cash : Amt. GHC Finance TABLE 18: Financial Report Note Income & Expenditure Statement [1-Jan-2013 to 31-Dec-2013] Particulars [Amt. GHC] [Amt. GHC] Trading Account : 2 Drugs Income 688, Operating Incomes 910, Other Incomes 3,320, Services Income 1,690, Total 6,609, Cost of Sales : 1,105, EXPENDITURE 6 Purchases 1,105, Gross Profit : 5,504, Income Statement : Allowances 17, Operational & Administrative Expenses 488, Personnel Emoluments 3,694, Provision for Depreciation 756, Repairs & Maintenance 87, Stationary and Printing 39, Note Excess of Income over Expenditure : 119, Balance Sheet [1-Jan-2013 to 31-Dec-2013] Sources of Funds : [Amt. GHC] 10 Capital Account 12,600, Loans (Liability) 11 Current Liabilities 273, Suspense A/c Excess of Income over Expenditure 119, Total 12,994, Application of Funds : 12 Fixed Assets 11,491, Current Assets 1,502, Total 12,994, Current Liabilities 57, Current Assets 1,908, Drugs Income 4, Operating Incomes 880, Other Incomes 184, Purchases Total 3,037, Outflow of Cash : Current Liabilities 1,069, Fixed Assets 37, Current Assets 85, Suspense A/c 11, Allowances 317, Operational & Administrative Expenses 424, Personnel Emoluments 471, Purchases 860, Repairs & Maintenance 87, Stationary and Printing 39, Total 3,404, Net Inflow -367, Note: This is the first year this accounting presentation has been adopted for the preparation of the Hospital?s Final Accounts. Previous years reports have therefore not been shown here Notes To The Financial Statements for Period Ended Dec 31, The various expenditure items recorded inflationary trends over the period, particularly for amounts expended on Medicines and Medical Supplies. The cost burden for Personnel Emoluments was borne mainly by the Central Government [85%] and from Internally Generated Funds [IGF] [15%]. Staff Allowances form part of IGF Personnel Emoluments. Income and expenditure patterns remained generally the same. The two largest sources of income are Government of Ghana through subventions, and income generated as fees from patients. Similarly, Salaries & Allowances, Drugs & Medicines and Medical Supplies are the largest spending areas. Note 1 A. Statement of Accounting Policies The following form significant accounting policies adopted by the Hospital in the preparation of its Financial Statement B. Basis of Accounting The financial statements have been prepared under the historical cost convention? C. Depreciation Policy Depreciation of Fixed Assets is calculated on?straight Line? basis, to write off at?cost of Assets? over their estimated useful 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 realizable value 22 23

14 Notes 2-7 Notes 8-9 St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report 2013 Note Income & Expenditure Statement Jan 01- Dec 31, 2013 Amt. [GHC] Amt.[GHC] 2 Drugs Income 688, Drugs -NHIS (Deductions) (669.81) Drugs-Inpatient (Income) 4, Drugs IPD (NHIS) 207, Drugs-OPD (NHIS) 476, Operating Incomes 910, Free Treatment-Services 29, AngloGold Ashanti 9, Ghana Gas Co LTD IPD- Cash 455, Loan Repayment 87, OPD Cash 279, Others 5, UNHCR 42, Other Incomes 3,320, Donation Received 142, Credit Interest Received 18, Ellembelle District Assembly -Fuel Refund 5, Ellembelle District Health Administration-Fuel Refund 1, Gas Income GOG Salary Subventions 3,136, Kama Pharmacy Refund Drugs Rent Income 11, Sanitation Income 3, Services Income 1,690, Service IPD-NHIS 978, Service OPD NHIS 712, Services-NHIS (Deductions) (8.30) 6 Purchases 1,105, Drugs Purchase 586, Medical and Surgical Supplies Purchase 279, Drugs/Non Drugs -Stocks Usage 133, General Store-Stocks Usage 48, Medical Equipment -Stocks Usage 25, Medicines and Pharmaceuticals 4, Sutures Materials 29, Operational & Administrative Expenses 488, Accounting Software Training and Maintenance 6, Audit Fees 9, Bank Charges, Interest & Commission 5, Catering-Hospital Visitors/Refugees/Patients 11, Celebrations 27, Charity and Donations Expense 7, Communication Expenses 2, Duties and Clearing Charges 4, Electrical Materials -Repairs & Maintenance 5, Free Treatment Expenses 29, Fuel and Lubricants 27, Gas Expenses 3, General Supplies 31, Generator Running Expenses 5, GHAG Dues 6, Materials/Electrical Supplies -Stocks Usage 19, Non Drugs Expenses 3, Office & Administration Expenses 3, ffice & Administration Expenses 3, Other Expenses 2, P.F. Contribution Deposited to QLAC 83, Registration Fees 6, Sanitation -Dislodgement of Waste 7, Staff Training & Development 163, Staff Uniforms 1, Travel Allowance 9, Travelling & Transport 2, Utilities (Water & Electricity) 1, Personnel Emoluments 3,694, GOG Salaries (N3 3,136, Non -Mechanized Salaries 459, PAYE 38, SSNIT 54, Staff Medical Expenses 6, Repairs & Maintenance 87, Building Repairs 21, Equipment Repairs 26, Furniture & Fittings Repairs Vehicle Repairs 39, Notes Note Statement of Financial Position [1-Jan-2013 to 31-Dec-2013] Notes 14: Bank & Cash Balance Account Name Balance As At 2013 Balance As At 2012 Ghana Comm. Bank [Current]-Axim 13, , Ghana Comm. Bank [Savings]-Takoradi 205, , Ghana Comm. Bank [Current]-Takoradi 68, , Cash & Cheque At Hand 48, , Total 336, , Through a collaborative program with the Medical Mission Institute, Wurzburg and the Institute of Medical Microbiology University Medical Center [UMC], Gottingen [both in Germany], the hospital has undertaken two research projects in the last two years. A third got underway in the last quarter of 2013 and is yet to be completed. The research areas are; Prevalence of bacterial and parasitic infections in Ghana - a cross-sectional study in preterm pregnant women in 2012 Prevalence of pregnancy-related infectious and non-communicable diseases in Ghanaian women and neonates in 2013 Comparative Study on the Microbial Genesis of Diarrhoea- The Role of Clostridium Difficile. Nov 2013 Amt. [GHC] Amt. [GHC] 10 Capital Account 2,600, Accumulated Fund 3, Final Accounts 12,597, Current Liabilities 273, Accounts Payable 290, Accruals [-] Fixed Assets 11,491, Accumulated Depreciation [-] Cost 8,618, Building Work in Progress 673, Computers & Cost 98, Furniture & Cost 110, Hospital Cost 3,034, Minor Equipment 2, Motor Cost 78, Office Cost 188, Tally 9 ERP Accounting Software 4, Current Assets 1,502, Account Receivables 1,166, Cash in Hand 48, Research Bank Accounts 287, The hospital is grateful for the opportunity to assist in carrying out these projects, and for all the assistance and other support it receives through the collaborative effort

15 Conclusions & Way Forward Constraints & Challenges These are mainly in the following areas; 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 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 Challenges Some 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 Notes 15: Fixed Assets Schedule Assets Building Furniture & Hospital Computers Office Motor Minor Tally 9; Totals Fittings Machines/ & Equipment Vehicles Equipment Account Equipment Accessories Software COST Jan 01, ,157, , ,03t2, , , , ,584, Disposals Reclassification Write Off Additions 460, , , , , , , , , Building WIP 673, , Total 9,292, , ,034, , , , , , ,809, ACCUM. DEPRECIATION As At Jan , , , , , , , Year Charge [2013] 172, , , , , , , Dec 31, , , , , , , ,317, Social Services. Assistance by the hospital is geared towards the poor and needy through medical and educational support. Other support was directly towards selected community projects including repairs to boreholes, street lamps etc. Financial assistance was also given to the local church parish, and selected schools Conclusion & Way Forward Although the year was fraught with challenges, services and service quality were not compromised. Most of the set health indicator targets were achieved, and in turn an achievement of the hospital?s strategic objectives for the period. Funding remains critical in the implementation of these objectives. It is imperative therefore, that other sources of funding are sought 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 improved in 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 the next four years [strategic plan period] and beyond. However, additional resources will be required to attain new levels envisaged with the oil and gas find, which is quickly impacting on all fronts in the Eikwe catchment and Ellembelle and other districts. For the Hospital Management Team; NET BOOK VALUE Dec 31, ,956, , ,427, , , (137,042.50) 2, , ,491, Dec 31, ,994, , ,729, , , , ,060, Dr. Paul Cooper Medical Director In Charge John Abakah Health Service Administrator 26 27

16 Annex 1: Summary of Hospital Activities SN YEAR Total Number of Beds OPD Attendance Total OPD Attendance 68,685 78,184 82,213 93, ,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 Annex 2 Top Ten Causes TOP TEN CAUSES OF MORBIDITY Malaria 19, Gynaecological Disorders 8, Intestinal Worm infestation 4, Rheumatism & Joint Pain 4, RTI/Chest Infection 4, Skin Diseases & Ulcer 3, Urinary Tract Infection [UTI] 2, Pregnancy & Related Complication 2, Anaemia 2, Enteric/ Typhoid Fever 1, Total 54, Others 42, Grand Total 97, Total Discharges 12,749 14,341 13,325 13,184 13,632 5 Total Deaths Male Female Children [0-14 Years] Deaths Within 24 Hours Total Surgeries Major & Minor 3,484 3,367 3,414 3,160 3,180 Major Surgical Major Obs. & Gynaecology ,630 1,890 1,759 1,026 Sub Total; Major 1,962 2,370 2,539 2,398 1,656 Minor Surgical Minor Obs. & Gynaecology Sub Total; Minor 1,522 1,737 1,789 1,400 1,524 Total; Emergency Surgeries 508 z TOP TEN CAUSES OF ADMISSION 2013 DISEASES CASES % OF TOTAL 1. Malaria 1, Anaemia 1, Diarrhoea Diseases Abortion Pregnancy & Related Complication Hernia Hypertension Neonatal Sepsis Pneumonia Enteric Typhoid Fever Total 5, Others Grand Total 11, 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 ,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, Laboratory Total Examinations 104, , , , , Primary Health Care [PHC] No. of Villages No. of Communities 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, DISEASES CASES % OF TOTAL 1. Asphyxia Malaria Septicaemia Diarrhoea Diseases Cardio Vascular Accidents [CVA] Pneumonia Anaemia Neonatal Sepsis Prematurity CCF Total No. of Visits Home Based Care; AIDS, Others 2,423 2,580 2,844 2,872 2,700 Others Grand Total NOTE: 186 of all Deaths were within 24 Hours of Admission 28 29

17 Annex 3 - Annual Ward State: 2013 Ward 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/ Over lement [%] Days Occupy [%] of Stay Bed Interval General Adult 48 1,591 1, ,520 15, Paediatrics 55 4,162 3, ,075 17, Mat. & Ante 45 4,632 4, ,425 18, [0.4] ER & Private 27 3,782 3, ,855 10, [0.1] Fevers Unit ,125 6, Total ,931 13, ,000 68, Annex 4: Laboratory Investigations - Outcome: 2013 Test Area Test Type No. Outcome Outcome- % of % of % of % of % of Exam d Pos Total Total Total Total Total Parasitology Routine Stool Exam 848 Total Infestation Total B/F [Malaria] 20,902 B/F [Malaria] Positive 3, Haematology Total Haemoglobin [HB] 24,595 HB Above 5.0gm 24, ,595 HB Below 5.0gm Total Sickle Cell 8,416 Sickle Cell Positive Bacteriology Total AFB 1,220 AFB Positive Gram Stain 1,942 GO & Candida Positive Total Cultures 1,444 Sensitive Reactions Total CSF 26 CSF Positive Blood Total Transfusion 2,709 Transfusion Under 5 Yrs Banking Total Cross Matching 2,758 Compatible 2, Total Rh Factor 5,865 Rh Factor Negative Bio Hepatitis B [Donors] 2,633 Hepatitis B Positive Chemistry/ Hepatitis C 70 Hepatitis C Positive Serology Total HIV [Sent. Research] 0 HIV Positive [Research] Total RPR [Sent. Research] 0 RPR Positive Annex 5: X - Ray Investigations X Ray Investigations Year Body Part/AreaNo. of No. of No. of No. of Exam Exam Exam Exam Head Skull Mandible Others Thorax Chest 1,740 2,074 2,278 2,243 Clavicle Rib Sternum Abdomen Abdomen Spine Cervical Thoracic Lumbar Lumber Sacral Upper Shoulder Extremity Scapula Humerus Elbow Forearm Wrist Hand Finger Lower Pelvis Extremity Hip Joint Femur Knee Leg Ankle Foot Toe Other Other Total 3,132 3,798 4,354 4,024 Annex 7: Ultrasound Scan Investigations Annex 6: X - Ray Investigations 2013 Body Part/Area No. of Exam Chest-AP 2512 Chest-Lateral 4 Skull AP 127 Skull Lateral 127 Abdomen AP 376 Abdomen Lateral 2 Pelvis AP 262 Pelvis Lateral 18 Spine AP 388 Spine Lateral 389 Spine Oblique 115 Upper& Lower Extremeties - AP 928 Upper &Lower Extremeties-Lateral 826 Sinusitis - PA View 13 Post Nasal Space- Lateral view 0 Mandible - lateral views 2 Dental Radiography 0 Forensic Radiography for foreign bodies 0 Barium Studies 0 Myelography 0 All Others 0 Total 6,089 Ultra Scan Investigations Year Body 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 7,166 Multiple Media Sternum Heart Abdomen Kidney Gall Bladder Liver Spleen G. Abdomen Pelvis Uterus 2,079 1,594 1,543 1,593 1,721 U. Bladder Ovaries Pelvis; Other Other Others Total 9,565 8,901 9,230 9,508 9,

18 St. Martin De Perres Hospital, Eikwe, Ghana Annual Health Report 2013 Annex 8: General Surgeries Year General Surgery MINOR GENERAL Circumcision SURGERY Closed Reduction of Fracture & Dislocation Removal of Superficial Tumours Repair of Minor Injuries Incision of Abscesses All Other Minor General Operations TOTAL MAJOR GENERAL Appendectomy SURGERY Hernia Reducible Strangulated Hernia with Hydrocele Laparotomy Intestinal Obstruction Typhoid Perforations Abdominal Tumours Exploratory Partial Gastrectomy Cholecystectomy All Other General ORTHOPAEDIC Operation of Fracture Steinman's Pinning Amputation Arm Leg Finger, Toes Correction of Deformities Repair of Major Injuries Sequestrectomy Other Orthopaedic Operations GENITO-URINARY Nephrectomy SYSTEM Oophorectomy Supra Pubic Cyctostomy Orchidectomy Hdrocelectomy Prostatectomy Ovariectomy Myomectomy Radical Mastectomy Fistulectomy Other Operations of the G. U. System GLANDS & Thyroidectomy SPECIAL SENSES Spleenectomy Operation for Head Injuries Removal of Tonsils & Adenoids ENT operations Cystoscopy Sigmoidoscopy Hemorrhoidectomy Exicision of Large Tumours on Body Thrush Operations Other Operations of the Special Senses TOTAL Annex 9 - Surgeries: General & Obstetrics & Gynaecology Year OBST AND Caesarean Section GYNAECOLOGY Hysterectomy-Caesarean Section Hysterectomy-Fibroids Hysterectomy-Abdominal Repair of V. V. Fistula Sterilization Vaginal Hysterectomy Salpingo-Oophorectomy Laparotomy Ectopic Ovarian Cyst Exploratory Caesarean Section-Sterilization All Other Major O&G Operations TOTAL ,120 1,026 TOTAL OF ALL MAJOR OPERATIONS 1,400 1,630 1,625 1,759 1,656 MINOR SURGICAL O & G OPERATIONS OPERATIONS Forceps Delivery Manual Removal of Placenta Internal Version With Extraction EOU for Abortion EOU for Metrorrhagia, Infertility, etc Diagnostic D & C Vacuum Extraction Episiotomy Tubal Insuflation Hydrotubation Exchange Liquor Shirokan's Embryotomy Douglas Puncture Post & Ante Colopotomy Removal Cervical Polyp Excision of Bartholin Cyst Secondary Suturing (abdominal) Suturing of Cervical Tear Other Minor O&G Operations TOTAL Annex 10 - Improving Quality of Care Year 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 to Deaths Death Death Admitted Admission Due to casefatality MALARIA; Audited Audits [MALARIA] MALARIA Rate Eikwe Sub Dist ,484 2, ,931 2, ,452 1, , , Annex 11 - Malaria Morbidity & Mortality Indicator Children Under Morbidity 2,795 4,334 3,337 4,257 4,629 5 Yrs. Admissions 2,120 2,578 1, Deaths % Morbidity/Admission % Admission/Death [CFR] Children Above Morbidity 12,808 13,589 13,110 13,956 14,764 5 Yrs. Admissions 1,178 1, Deaths % Morbidity/Admission % Admission/Death [CFR]

19 Annex 12 - Smear Positive Pulmonary TB By Age Group (New Cases) Total G. Total Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Mal Fem Annex 13 - TB Cohort Analysis New Smear Positive Cure Rate Combined Rate Defaulter Rate Failure Rate Death Rate Transfer Rate Annex 14 - HIV / AIDS Screenina (By Aae & Sex) 2013 Source Sex Screening Age Group & Yrs Grand Outcome Mths Yrs. Yrs. Yrs Yrs Yrs Yrs Yrs + Total Blood Mal. Total Donors Pos Fem. Total Pos S. Total Total Pos. Pos Patients Mal. Total Pos Fem. Total Pos S. Total Total Pos. Pos [V]CT Mal. Total Pos Fem. Total Pos S. Total Total Pos. Pos PMCT Fem. Total Pos Grand Total Screening z Total Total Positive Annex 16 - Antiretroviral Theraphy (ART) Analysis Analysis Year CD4 Cell Count No. CD4 Count <250/ No on ARV No. on ARV Dead NOTE: Treatment for ART started in

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