Annual Report Hospital 2016

TABLE OF CONTENT

TABLE OF CONTENT……………………………………………………………..……..1

LIST OF ACRONYMS……………………………………………………………..…….2

ACKNOLEDGEMENT ……………………………………………………………………3

EXECUTIVE SUMMARY………………………………………………………….……..4

BACKGROUND…………………………………………………………………………….6

ORGANISATION AND MANAGEMENT………………………………………………..9

FINANCE………………………………………………………………………………….12

HUMAN RESOURCE…………………………………………………………………….13

EMERGENCY SERVICES……………………………………………………………….17

MENTAL HEALTH…………………………………………………………………..…..17 LABORATORY……………………………………………………………………………18

MORTUARY………………………………………………………………………..…….19

PHARMACY………………………………………………………………………………20

OPERATIONAL RESEARCH……………………………………………………………21

REPRODUCTIVE AND CHILD HEALTH………………………………………………22

STATISTICS (SERVICE OUTPUT) ………………………………………………..……..29

ACHIEVEMENTS…………………………………………………………………………49

CHALLENGES……………………………………………………………………………49

WAY FORWARD…………………………………………………………………………50

LIST OF ACRONYMS

ADMs                                                                       Admissions

AIDS                                                                           Acquired Immune Deficiency Syndrome

RCH                                                                            Reproductive and child health

ANC                                                                          Antenatal Care

ARTI                                                                         Acute Respiratory Tract Infection

C/S                                                                            Caesarean Section

CT                                                                             Counseling and Testing

CVA                                                                          Cerebrovascular Accident

HIV                                                                           Human Immune Virus

IPD                                                                            Inpatient Department

IPT                                                                            Intermittent Preventive Treatment

LBs                                                                            Livebirths

MDG                                                                         Millennium Developmental Goals

NHIA                                                                        National Health Insurance Authority

PMTCT                                                                     Preventing Mother to Child Transmission

OPD                                                                          Out-Patient Department

OPV                                                                          Oral Polio Vaccine

PNC                                                                          Postnatal Care

UTI                                                                            Urinary Tract Infection

URTI                                                                         Upper Respiratory Tract Infection

TD                                                                                Tetanus Diptheria

ACKNOWLEDGEMENT

We wish to express our heartfelt gratitude to all those who have helped us to be what we aretoday and have our interest at heart.

  • Most Rev. Peter KwakuAtuahene – Bishop, Catholic Diocese of Goaso
  • The Chairman and Board Directors       -Diocesan Health Services, Goaso
  • The Vicar General – Catholic Diocese of Goaso.
  • The Executive Director of Health         – Diocesan Health Services.
  • Regional Director of Health       -BrongAhafo Region.
  • District Director of Health      -Tano North District.
  • Nana BoakyeTromo III and Elders – Duayaw Nkwanta Tradional Council.
  • John Foundation, Maastricht -The Netherlands.
  • Vrienden Van Ghana Foundation -Laarkbreek, The Netherlands.
  • Orion of Delft, The Netherlands.
  • Wilde Geese, The Netherlands.
  • Tano North District Assembly -Duayaw-Nkwanta.
  • Paul J. J. Rompa -The Netherlands.
  • Cor Stevens -Patro n of the hospital.
  • Ton and Mary Schepens Family -The Netherlands.
  • The Department of Health                   -Catholic Secretariat – Accra.
  • The Christian Health Association of Ghana (CHAG) Accra.
  • The Staff of the Hospital -Duayaw-Nkwanta.
  • Frank Ruyter de Wildt, -The Netherlands.
  • Surgeons from Academic hospital -Maastricht
  • All those who supported us.

                    EXECUTIVE SUMMARY

  • The hospital renders twenty-four (24) hour emergency services to clients. The facility is engaged in curative, preventive, rehabilitation as well as counseling and testing for HIV/AIDS (CT/PMTCT), diabetes control and tuberculosis programmes.
  • The hospital is specialized in Orthopaedics and it is also the centre for clubfoot Management in Ghana.
  • Seventy-Five Thousand, Nine Hundred and Twenty-Eight (75,928) clients utilized our OPD Services in the year giving us O. P. D. capital of 0.8.
  • Six Thousand, Six Hundred and Twenty-Three (6,623) patients were admitted within the year.
  • Forty-four (44) staff were recruited, a total of 69 persons had their national services in 2016. This is made up of (43) forty-three paramedical service personnel and (26) twenty –six rotation nurses. (2) two staff also retired in the year under review.
  • Nineteen (19) in-service training/workshops were organized for the staff. During the same period, (6) six staff durbars were organized, (2) out of the six were emergency staff durbars to discuss urgent and critical issues.
  • The hospital had Planned Preventive Maintenance (PPM) of its machines and equipment.
  • Two (2) retreats, eight (8) health walks and two (2) clean up exercises were organized during the period.
  • Paul Rompa and Dr. Frank De Ruyter, (Orthopaedic surgeons) visited the hospital to provide various services. Another Orthopaedic Surgeon from the Academic Hospital, Maastricht also paid a working visit to the hospital.
  • Neonatal intensive care unit was established.
  • The hospital was connected to twenty – four (24) hour internet services.
  • The hospital continued its huddle exercise; all heads of department meet from 8:30am.to 9:00am. Each head is given (1) minute to present the incidence that occurred in the department for the past twenty four (24) hours.
  • The hospital carried out clinical presentation for staff throughout the year
  • The institution had its annual department performance review.
  • Two operational researches were conducted within the year.
  • We successfully recruited 44 new employees during the year.
  • Successful construction and installation of an ultramodern X-ray machine.
  • We carried out renovation of staff quarters.
  • We procured a clocking device to monitor staff attendance and this has improved staff attendance significantly.

BACKGROUND INFORMATION

St. John of God Hospital is one of the five health facilities in the Catholic Diocese of Goaso. It is the District hospital for Tano North District of the Brong Ahafo Region.

The Catholic Diocese of Goaso is the sixteenth Diocese in Ghana which was created in 1997. It has seven administrative districts namely, Asunafo North, Asunafo South, Asutifi, Tano North, Tano South Districts all in the Brong-Ahafo Region and AhafoAno North and AhafoAno South Districts of the Ashanti Region.

The Tano North District has an estimated population of 91664 (projected from the 2010 Population and Housing Census) for 2016.  The annual growth rate is 2.3%. It is bounded in the North West by Sunyani Municipality, South West by Asutifi, to the South by Tano South and to the North by Offinso Districts.

Vegetation and Climate

It has a semi deciduous forest with two seasons; rainy season (April – August) and the dry season (October – March).  The average rainfall is about 1200mm per annum.  The district experiences moderately warm climate with an average temperature of 24˚C and maximum temperature of 39˚C.  The district is drained by rivers Tano Kwasu and Subiri; the area has fairly good drainage though the soil in Duayaw-Nkwanta is high in clay. The yearly bush fire is causing deforestation.

Communication

The main trunk road from Kumasi to Sunyani passes through the district.  The other roads linking Duayaw-Nkwanta to the other smaller towns and villages within the district are untarred and it is difficult to travel to most rural communities during the rainy season.

There is an extensive telephone network including mobile phone services of Vodafone, MTN, Tigo, Espresso, Airtel and Glo.  There is 24 hour internet service in the hospital as well.

Economic Activities

The main economic activities in the district are farming and trading. The cash crops cultivated are cocoa, citrus and oil palm.  Food crops are maize, cassava, vegetables such as tomatoes, garden eggs and pepper.  There are quite a number of public and civil servants employed in various institutions.

Health Facilities

 The District has three level ‘’B’’ Health Centres, one Polyclinic and three completed CHPS zones, and St. John of God hospital is the referral facility for all the health facilities in the district.

Electricity

All major towns in the district have access to electricity. The hospital is supported by a standby generator when electricity goes off.

The Hospital

St. John of God Hospital is a Catholic Hospital in the Catholic Diocese of Goaso of the Brong Ahafo Region.  It has a bed capacity of 148 divided into General, Children, Orthopaedic, Emergency and Maternity wards. The institution also has two theatres, seven private wards, Reproductive and Child Health, Physiotherapy and Rehabilitation, Pharmacy, Laundry, Hospital Engineering and Eye departments. The institution operates 24-hour emergency service.  It has six consulting rooms and a vital signs room. The records, cashiers, billers, laboratory, health insurance, dispensary, doctors’ conference and rest rooms are all found at the O.P.D.

The administration block is separate and contains the Administrator’s Office, Accounts section, the Office for Human Resource Manager, the Secretarial and Telephone Exchange Room and a classroom for in-service training.  The hospital has a Medical store which is separate from all other departments. There are 3 morning masses in every week at 6:30 am on Tuesdays, Wednesdays and Fridays.

Health Care Services

We operate the following services:

  • Out-patient Care
  • Inpatient Care
  • Medical and Surgical Care
  • Pharmaceutical Services
  • Laboratory
  • Imaging
  • Counseling and Testing/Prevention of Mother To Child Transmission (C.T/PMTCT)
  • Diabetic Clinic
  • Tuberculosis programme
  • Orthopaedic service
  • Physiotherapy and Rehabilitation
  • Health Education
  • Reproductive and Child Health
  • Maintenance
  • Hypertensive clinic
  • Eye Clinic
  • Club foot Management
  • O&G

ORGANISATION AND MANAGEMENT

Management and Administration

The hospital has a Management Team made up of the Administrator who is the Head of Management, Medical Director, Nursing Administrator (Matron), Chaplain, Accountant and Human Resource Manager that meet monthly. Heads of Departments also meet once in every quarter and staff durbars are also held once in every quarter.  Emergency meetings are held when the need arises.

The institution also has Procurement, Quality Assurance, Project 5 Alive, Funeral, Claims Management, Accommodation, Celebration, Emergency and Infection Prevention and Control Committees. Staff prepare for Easter and Christmas by having a day of recollection each time.

Stores and Supply

All purchases of the Hospital; Pharmaceuticals, Consumables, Equipment etc. are received in the store and department who need such supplies would have to make requisitions to the stores.  Drugs are purchased from selected suppliers and are stored under suitable storage temperature and conditions.

Partnership

Internal

The Hospital has good a working collaboration and relationship with the Ministry of Health, the Ghana Health Service, the Regional Health Directorate, Brong Ahafo, The District Health Directorate, Tano North, the District Health Insurance Scheme, the Christian Health Association of Ghana (CHAG) and the National Catholic Secretariat (NCS).

External

The hospital has good relationship with the St. John Foundation of Maastricht and AstraZeneca in the Netherlands who sponsor many of our constructional works in the hospital, including the Guest/Staff Houses, Equipment, Logistics, Relative Kitchen and part of the construction of the ground floor of the Administration block.

The hospital also maintained good relation with Friends of Ghana Foundation in the Netherlands, who support the hospital with equipment, logistics and constructional works in the hospital as well as in the town.

VISION: the vision of the hospital is to continue Christ Healing Ministry.

MISSION: to provide high quality care in the most effective, efficient and innovative manner to our clients.

CORE VALUES:

  • Holistic quality service
  • People centeredness
  • Professionalism
  • Integrity
  • Empathy

Supportive visits

The Diocesan Executive Director and Deputy paid supportive visits to the facility. They interacted with Management Team and staff as well as all professional groups.

AUDIT:

The Audit Unit did its best in ensuring that departments take documentation of their activities properly at all times for future references. Internal Audit verified drugs and non-drugs that were purchased within the period to make sure they met the standards and requirements intended to serve its purposes.  Pre-and post-audit of payments were done accordingly to ensure control procedures are followed and reviewed to prevent future breach of it.

The government audit from Sunyani visited the facility for payroll audit. All shortfalls were identified and rectified. The diocesan external auditors also visited the institution to carry out the yearly audit of the facility. It was successful and the audit report was sent through the diocesan Health Service to the Bishop. 

FINANCE:

During the year under review, the hospital had some difficulties so far as our finances are concerned as a result of non-regular reimbursement of claims by the National Health Insurance Authority (NHIA).

(A) (B) ( C )
  ACTUALS ACTUALS BUDGET 2016
INCOME NOTE JAN – DEC. 2016 JAN-DEC. 2015  
PATIENT FEES 1 4,696,611.77 3,641,394.70 3,616,205.00
GOVERNMENT SUBVENTION 4                4,785,350.52 3,681,702.93 4,255,565.00
MORTUARY FEES   133,891.40 103,698.00 107,784.88
OTHER INCOME 2 226,244.56 150,330.95 195,611.20
GIFTS AND DONATION 3 48,546.00 316,812.00 130,370.00
  9,890,644.25 7,893,938.58 8,305,536.08
 
 
EXPENDITURE  
COMPENSATION 5 5,841,916.63 4,654,277.74 5,392,816.70
PURCHASES AND SUPPLIES 6 2,081,927.13 1,670,118.28 1,473,891.05
REPAIRS AND MAINTENANCE 7 149,678.41 190,711.67 111,100.10
GENERAL ADMINISTRATION 8 1,475,848.99 1,163,791.81 1,128,984.88
9,549,371.16 7,678,899.50 8,106,792.73
EXCESS OF INCOME OVER EXPENDITURE 341,273.09
LESS CAPITAL EXPENDITURE -248,505.65
SURPLUS 92,767.44

HUMAN RESOURCE

The Human Resource Policy is aimed at recruiting, retaining and motivating health professionals to deliver maximum quality care to all clients in our catchment area and beyond.

RECRUITMENT:  44 new staffs (44) were recruited within the period under review. They are (1) IT Manager, (2) Accountants, (1) Biostatistics officer, (11) registered general nurses, (3) community health nurses, (8) Midwives, (12) Enrolled Nurses, (2) Medical Officers.

SEPARATIONS: one staff passed on to glory whiles two staff retired during the year.

TRANSFER OUT: During the period, four staff (4) were released to other facilities; (1) Snr. Staff Midwife, (2) Snr. Staff Nurse and (1) Medical Officer.

TRANSFER IN: (1) Technical Officer (Disease Control) and (1) Enrolled Nurse were transferred from Global Evang. Pope John Clinic Hospital respectively.

PROMOTIONS: Fifty-two (52) staff applied for promotion, all of them were promoted.

Nine (9) Senior Staff Nurses who successfully completed BSC Nursing from various Universities were upgraded to Nursing Officers.

EDUCATION AND TRAINING (SPONSORING SERVING OFFICERS):  As at 31st December 2016, eleven (11) serving nurses and two (2) Medical Officers were in school to pursue various approved programs fully sponsored by the Hospital whilst five (5) Para-medical staffs were also on study leave.

EXTERNAL WORKSHOPS

STAFF STRNGHT

PROFESSION TOTAL NUMBER OF EMPLOYEES(2015) TOTAL NUMBER OF EMPLOYEES(2016)
Doctors 7                   8
Orth/Trau. Doctors(specialist) 1                   1
Optometrist 1                   1
Physician Assistants 5                   4
SRN, RGN/Diploma 39 49
Midwives 18 25
Community Health Nurses 5 9
Enrolled Nurses 16 29
Health Assistants 31 30
Pharmacist 2 2
Pharmacy Technician 4 4
Dispensing Assistant 2 2
Laboratory Technicians 3 3
Biomedical Scientist 2 2
Lab. Assistants 1 1
Physiotherapists 2 2
Occupational Therapist 1 1
Field Technician 1 2
Physiotherapy Assistants 6 6
Radiographer 1 1
X-ray Technicians 1 1
X-ray Technical Assist 1 1
Supply Manager/Supply Officer 2 2
Human Resource Manager 1 1
Internal Auditor 2 2
I.T. Technical Assist 1 1
 I. T. Officer 1 1
IT Manager 1 1
Records Officers 1 2
Typist 1 1
Stenographer 1 1
Accountant 2 4
Accounts/Finance Officers 3 3
Administrator 1 1
Orderlies/Mortuary 23 23
Security 8 8
Biostatistics Officer 1 3
Health Educator 2 2
Technical Officer 1 1
BiostatAsst/Records Officer/Asst 5 5
Tech. Officer (Engineering)/Electricals 1 1
Driver 3 3
Occupational Therapist Assistant 2 2
Disease Control Officer 1 1
Junior/ Foreman/Artisans 5 5
Laundryman 4 3
Environ. Health Officer 1 1
Nutritionist 3 3
Technologist (Clinical Engineering) 1 1
TOTAL 232 263

 

EMERGENCY SERVICES

The hospital runs 24hour emergency services daily.

TABLE 1:   EMERGENCY SERVICE OUTPUT

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Attendance 4162 3308 5194 4961 4.5 Decline
Death 88 71 60 66 10 Increase

Comparing 2015 and 2016, emergency attendance saw a 4.5% decrease; there was also a 10% increase in emergency deaths.

MENTAL HEALTH

Mental Health Unit started at St John of God Hospital in November, 2014. The unit was established to create awareness on mental health services and its related disease conditions, to ensure people living with psychiatric problems and most especially epilepsy within the district and its surroundings have access to prescribed drugs, to prevent relapse of mental clients, to ease clients from travelling long distance to the psychiatric hospital for treatment and to help trace defaulters and visit clients frequently.

A total of twenty-eight (28) ward cases were attended to at the various wards and the emergency unit. Seventy-two (72) houses and saloon were visited and health education on mental health and mental illness were given. Twelve (12) outreach clinics / program were conducted on several occasions at Bomaa and Buokrukruwa.

At the end of the period under review (2016), one hundred and nine (109) clients were visited with regards to home visits.

TABLE 2:   MENTAL HEALTH STATISTICS

ATTENDANCE 2015 2016 % Change in 2YRS Performance
% Change Performance
New 167 161 3.6 Decline
Old 428              631 47.4 Increase
Total 595               792 33.1 Increase

Mental health attendance increased by 33.1% in 2016 as compared to 2015.

LABORATORY

St John of God has a well-equipped medical laboratory which provides a high quality and client centered services to the hospital and other health facilities in the Tano-North district as well as other neighboring districts. The department provides services in clinical chemistry, clinical microbiology, haematology, serology and blood banking.

We had one successful outreach program on protein urine examination at Duayaw-Nkwanta (Koforidua) in the last quarter of the year.

The department carried out 223, 268 investigations in 2016 representing a 280.2 % as compared to 58724 investigations carried out in 2015. The increase can be attributed to the fact that evidence based diagnosis was highly encouraged and practiced by the prescribers. Most of the diagnosis is lab confirmed before the patients are treated. The department also had a Chemistry Analyzer during the year under review.

TABLE3:   LABORATORY INVESTIGATIONS

Investigations 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Haematology 46223 41884 198159 373.1 Increase
Biochemistry 4256 3551 9178 158.5 Increase
Microbiology 8925 8474 10332 21.9 Increase
Serology 4168 4815 5599 16.3 Increase
Total 63572 58724 223268 280.2 Increase

 

 

MORTUARY

The unit was managed by 2 staffs in 2016.We received bodies from different Regions and Districts.

TABLE4:   MORTUARY STATISTICS

Indicator 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Bodies from the Hospital 107 130 98 24.6 Decline
Bodies from outside the hospital 118 175 154 12.0 Decline
Total 225 305 252 17.4 Decline

Total bodies decreased by 17.4% comparing 2015 and 2016.

PHARMACY

Notwithstanding the challenge of supply of some medicines in the period under review, the department provided quality pharmaceutical care to all patients at the hospital.

  • Education of clinical staff on medication through presentations at clinical meetings.
  • General education of clients on medicines at the various clinics and OPD units.
  • Comprehensive adherence counseling prior to initiation of antiretroviral medication.
  • Production of effective and quality extemporaneous preparations for the use of the institution.

PHARMACY DEPARTMENT REPORT

TABLE 5:  PHARMACY REPORT

PHARMACY DEPARTMENT
INDICATOR WHO REGIONAL TARGET ACHIEVEMENT
  TARGET 2015 2016 2015 2016
Average No. of Drugs Prescribed 2 <3 <3 3.1 3.3
% Generic 100 >90 >90 95 80
% Antibiotic <20 <30 <30 35 42
% Injection <20 <20 <20 10 15
% EML 100 100 100 94 90
Diagnosis 100 100 100 100            100
Review Date 100 100 100 90 83
PHARMACY IN HOUSE PRODUCTION
2015 2016
SYRUP PARACETAMOL 9800 bottles 8321
MIXT MAGNESIUM TRISILACATE 2100 bottles 1901
SYRUP EXPECT SED 1800 bottles 1832
SOLN BLEACH 12480 bottles 13350
H and SANITIZER 20 Liters 42
SOLN RUBBING ALCOHOL 90 bottles 650

 

OPERATIONAL RESEARCH

Client Satisfaction Survey          

The survey was conducted to assess the level of satisfaction of clients in health care delivery at St John of God Hospital in the last eleven months (January to November 2016).

The survey used descriptive study with cross sectional study design. The sample size used was 131 clients. Simple random sampling was used for the selection of clients. Descriptive statistics was used for the analysis (frequencies and graphs). The data was entered, edited and analyzed with the help of Statistical Package for Social Sciences (SPSS).

At the end of the survey, we realized that 74% of the clients revealed services delivered at the facility to be quality. Clients were satisfied with the services rendered to them. The survey also revealed good environmental conditions, privacy, and confidentiality at the facility.

 

Staff Satisfaction Survey

The survey was conducted to assess the level of staffs’ Satisfaction at St John of God Hospital in Duayaw- Nkwanta. The research was conducted in the last eleven months (January to November 2016).

The survey used descriptive study design. Purposive sampling technique was used to select a sample size of 100 staffs. Questionnaires were designed and sent to various departments for response. Descriptive statistics was used for the analysis (frequencies and graphs). The data was entered, edited and analyzed with the help of Statistical Package for Social Sciences (SPSS).

The survey revealed that staffs are given the opportunity to improve their personal skills, staffs have clear performance expectations, and staffs have reasonable workload and good physical environment to ensure health and safety at work. Staffs are also satisfied with the benefit package (leave, sick off, etc.) that the hospital offers.

REPRODUCTIVE AND CHILD HEALTH (RCH)

The RCH Department consist of eight (8) sub units which comprises antenatal, post-natal, child welfare, under five, disease control, HIV/ AIDS, Eye and adolescent health unit.

CHILD WELFARE CLINIC

The unit embarked on both static and outreach services. The outreach services were done in 13communities in our catchment area by the midwives, community health nurses, nutrition officers, disease control officer, field technicians, community health officers, and community based surveillance volunteers.

TABLE 6: COVERAGE OF ANTIGENS

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
BCG 2687 2697 1961 1434 26.9 Decline
OPV1/QUINVAXEMI 984 1235 1156 1163 0.6 Increase
OPV3/QUINVAXEM3 890 955 1202 1126 6.3 Decline
YELLOW FEVER 1127 1274 1261 1210 4.0 Decline
MEASLES 1253 1274 1261 1210 4.0 Decline

 

ANTENATALANDPOSTNATAL

The midwives and other associated staffs continued to offer dedicated services to the people of Tano-north and beyond by giving them quality of care as shown below:

TABLE 7:   STATISTICS ON ANTENATAL AND POSTNATAL INDICATORS

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
ANC

 

Registrants 1320 1110 1155 1212 4.9 Increase
Attendance 7737 7449 6173 5041 18.3 Decline
IPT

 

IPT 1 314 31 652 490 24.8 Decline
IPT 2 212 22 721 442 38.7 Decline
IPT 3 121 10 321 329 2.5 Increase
IPT 4 166
IPT 5 79
TD2+ 1680 1887 864 1171 35.5 Increase
PNC 891 1010 1213 1479 21.9 Increase

 

Figure 1: a line graph showing the trend of IPT Coverage (2012-2016)

 

Figure 2: a line graph showing the trend of TD2+ Coverage

35.5%↑

Comparing 2015 and 2016, TD2+ saw a 35.5% increase.

 

CHILD HEALTH

Table 8:   Child health statistics

YEAR 2014 2015 2016 % Change in 2Years Performance
% Change Performance
0-11 Months 2096 6559 7869 20 Increase
12-23 Months 1267 4726 6364 34.7 Increase
24-59 Months 951 3266 5664 73.2 Increase
TOTAL 4314 14551 19897 36.7 Increase

SCHOOL HEALTH

We also embarked on school health activities. The School Health service is one of the KEY services rendered for school children to improve their physical, social and mental development.

Duayaw Nkwanta Sub District team comprises of a Counselor, Community Health Nurses, Disease Control Officer, Field Technician and a Shep Coordinator from Ghana Education Service.

17 schools were visited throughout the year (Pre-School, Primary and J.H.S); those with common problems were referred appropriately.

TABLE 9: SCHOOL HEALTH STATISTICS

Pre-School Children(KG) Primary 1&2 JHS TOTAL
Number enrolled

 

1059 839 183 2081
Number examined

 

958 1000 195 2153
Number of school children referred with common problems 24 31 0 55

 

ADOLESCENT HEALTH

The hospital renders Adolescent Health Services to the Adolescents within the District. Meetings are held fortnightly for health education and sharing of individual views.  In all, 40 interested pupils from various schools have been put together to form a club in the District.

TABLE 10:   ADOLESCENT HEALTH COVERAGE

Indicator Males Females Total
Pregnant Cases 6 6
STI’s 4 3 7
Menstrual Disorders 9 9
Induce Abortion 2 2
Total Attendance 4 20 24

HEALTH PROMOTION

The RCH department also embarked on health promotion activities throughout the year; both static and outreach clinical sessions, (General OPD, Wards, Radio) were also part to improve the wellbeing of people. The department collaborates with the nutrition department in some of their outreach programs.

TABLE 11: SURVEILLANCE REPORT

Indicator Number suspected Number confirmed Death
Polio 11 0 0
Measles 0 0 0
Yellow Fever 0 0 0
Guinea worm 0 0 0
Buruli Ulcer 0 0 0
Cholera 0 0 0
Meningitis 0 0 0
Yaws 0 0 0
Syphilis 1043(tested) 7(positive) 0

TABLE 12:  TUBERCULOSIS SURVEILLANCE REPORT

Indicator Total number of cases
Total no. screened 1616
Eligible 572
Confirmed 60
Case Detection (all forms) 33
Case Detection(SM+) 17
Cure Rate 4(23.5%)
Completed Treatment 8
Defaulters 0
Death Rate 0
 Treatment Success 12
Treatment failure 0
Referred out 27

ANTI-RETROVIRAL TREATMENT/COUNSELING UNIT

The unit continues to render services to the people of Tano-North and beyond. Activities such as PMTCT clinic, ART clinic and Counseling and lab tests are performed.  ART Clinic attendance increased from 547 in 2015, to 665 in 2016.

TABLE 13:   OLD AND NEW CLIENTS FOR ART CLINIC (2016)

Indicator Males Females Total
Old Patients 153 425 578
New Patients 22 65 87
Total 175 490 665

 

TABLE14: HIV REPORT

INDICATOR 2012 2013 2014 2015 2016
CT

 

 

Counseled 165 454 749 531 538
Tested 184 454 749 531 538
Positive 51 (27.7%) 98 (21.6%) 167(22.3%) 100(18.8%) 97(18%)
PMTCT

 

 

Counseled 636 1106 924 1295 1286
Tested 636 1106 924 1295 1286
Positive 15 (2.4%) 18 (1.6%) 27 (2.9%) 24 (1.9%) 21(1.6%)
All other HIV/AIDS Tested Positive 194 119 70 24 61
Number on ARV Treatment 94 126 143 66 92

 

STATISTICS (SERVICE DELIVERY OUTPUT)

THEATRE

TABLE 15: STATISTICS ON OPERATIONS PERFORMED

Year Major cases Minor cases Total
2012 1565 442 2007
2013 1516 464 1980
2014 1470 434 1904
2015 1310 665 1975
2016 1225(6.5%↓) 613(7.8%↓) 1838

Comparing 2015 and 2016, theater saw a decrease of 6.5% and 7.8% in major cases and minor cases respectively.

7.8%↓

ANAESTHESIA GIVEN

TABLE16: STATISTICS ON ANAESTHESIA GIVEN

Year Spinal GA/Spinal LA GA TOTAL
2015 946 316 317 64 1643
2016 1073 310 324 48 1755

Total anaesthesia given in 2016 was 1755 as against 1643 in 2015 giving an increase of6.1% 

NUTRITION UNIT

 (REGISTRANTS)

TABLE 17:  INCIDENCE OF MALNUTRITION (0-59 MONTHS)

AGE(MONTHS) CHILDREN WEIGHED SEVERE UNDERWEIGHT MODERATE UNDERWEIGHT NORMAL POSSIBLY OVER WEIGHT POSSIBLY OBESE
0-11   1199 0     19   1169 8 3
12-23   597 3     26   558 10 0
24-59   451 5     33   409 3 1
TOTAL   2247 8 (0.4%)    78 (3.5%)   2136 (95%) 21 (0.9%) 4(0.2%)

 

(ATTENDANTS)

TABLE 18:  PREVALENCE OF MALNUTRITION (0-59 MONTHS)

AGE(MONTHS) CHILDREN WEIGHED SEVERE UNDERWEIGHT MODERATE UNDERWEIGHT NORMAL POSSIBLY OVER WEIGHT POSSIBLY OBESE
0-11   7782 1    39   7729 10 3
12-23   6319 5   47   6256 9 2
24-59  5807 7   70  5723 6 1
TOTAL  19908 13(0.06%)  156(0.8%)  19708(99%) 25(0.1%) 6(0.03%)

 

EYE CLINIC

TABLE 19: EYE CLINIC TOP TEN CAUSES OF OPD ATTENDANCE

TOP TEN CAUSES OF MORBIDITY 2014 TOP TEN CAUSES OF MORBIDITY 2015 TOP TEN CAUSES OF MORBIDITY 2016
DISEASE CASES % DISEASE CASES % DISEASE CASES %
Allergic Conjunctivitis 6219 52.5 Allergic Conjunctivitis 6413 44.8 Allergic Conjunctivitis 6092 51.3
Cataract 2074 17.5 Cataract 2599 18.2 Cataract 2336 19.7
Cornea Diseases 788 6.7 Cornea Diseases 1772 12.4 Glaucoma 862 7.3
Glaucoma 753 6.4 Glaucoma 1086 7.6 Pseudophakia 716 6.0
Pterygium 569 4.8 Pseudophakia 554 3.9 Pterygium 442 3.7
Refractive Error 442 3.7 Pterygium 439 3.2 Kerato Conjunctivitis 370 3.1
Pseudophakia 299 2.5 Refractive Error 457 3.1 Refractive Error 353 3.0
Retinopathy 218 1.8 Retina Diseases 290 2.0 Cornea Diseases 219 1.8
Preseptal Cellulitis 98 0.8 Uvietis 156 1.1 Retinopathy 181 1.5
Painful Blind Eye 93 0.8 Preseptal Cellulitis 79 0.6 Uvietis 99 0.8
TOTAL 11553 97.6 TOTAL 13845 96.7 TOTAL 11670 98.3
ALL OTHERS 286 2.4 ALL OTHERS 467 3.3 ALL OTHERS 202 1.7
GRAND TOTAL 11839 100.0 GRAND TOTAL 14312 100.0 GRAND TOTAL 11872 100.0

 

Figure 3: A Line Graph Eye Clinic Attendance

Eye clinic attendance saw a decrease of 0.45% comparing 2015 and 2016.

PHYSIOTHERAPY SERVICE REPORT

TABLE 20: PHYSIOTHERAPY CASES

TOP TEN CAUSES 2015 TOP TEN CAUSES 2016
DISEASE CASES % DISEASE CASES %
Low Back Pain/Sciatica/Scoliosis 1437 30.1 Low Back Pain/Sciatica/Scoliosis 1648 35.9
STROKE(CVA) 992 20.8 STROKE(CVA) 729 15.9
Osteoarthritis/Arthritis 556 11.6 Cerebral Palsy 496 10.8
Cerebral Palsy 536 11.2 Osteoarthritis/Arthritis 491 10.7
Cervical,Thoracic,Lumbar Spondylosis 320 6.7 Cervical,Thoracic,Lumbar Spondylosis 320 6.9
Erb’s Palsy 266 5.6 Erb’s Palsy 287 6.2
Post-fractures(Rehab) 262 5.5 Post-fractures(Rehab) 142 3.1
Facial/Bell’s Palsy 159 3.3 Facial/Bell’s Palsy 122 2.7
Frozen Shoulder/Adhesive Capsulitis 106 2.2 Frozen Shoulder/Adhesive Capsulitis 107 2.3
Contractures/Contusion 30 0.6 Spinal Cord Injury (Rehab) 30 0.7
TOTAL 4664 97.7 TOTAL 4372 95.2
ALL OTHERS 109 2.3 ALL OTHERS 220 4.8
GRAND TOTAL 4773 100 GRAND TOTAL 4592 100.0

Table 21: club foot clinic statistics

YEAR 2010 2011 2012 2013 2014 2015 2016 % Change in 2yrs Performance
% Change Performance
TOTAL CASES 218 702 950 1103 905 981 859 12.4 Decline
FOLLOW UP 14 187 342 325 362 247 180 27.1 Decline
BRACES 80 108 132 150 112 143 131 8.4 Decline
TENOTOMY 55 49 34 46 26 61 33 45.9 Decline

Table 22:   Out Patient Service Output

Attendance 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Main OPD 69379 69355 67101 56409 15.9 Decline
< 5 Clinic 17891 17093 16856 11787 30.1 Decline
ANC 7737 7449 6173 6253 1.3 Increase
Post Natal 891 1010 1213 1479 21.9 Increase
Total 95898 94907 91343 75928 16.9 Decline

TABLE23:   OPD ATTENDANCE BY INSURED AND NON-INSURED PATIENTS

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Insured 91812 87926 85355 70642 17.2 Decline
Non-Insured 4086 6981 5988 5286 11.7 Decline
Total 95898 94907 91343 75928 16.9 Decline

TABLE 24:   TOP TEN (10) OPD MORBIDITY

No 2014   2015   2016  
1 Malaria 15284 Malaria 15986 Malaria 10829
2 Orthopaedics 10996 Orthopaedics 8278 Diarrhoea diseases 8079
3 Diarrhoea diseases 8952 ARTI 6562 Orthopaedics 7444
4 URTI 5562 Diarrhoea diseases 5292 ARTI 6940
5 Acute Eye Infection 3525 Acute Eye Infection 4296 Skin Diseases and Ulcers 4569
6 Skin Diseases and Ulcers 2132 Skin Diseases and Ulcers 3306 Acute Eye Infection 3968
7 UTI 1493 UTI 2866 UTI 3819
8 Pregnancy and Related Complications 1096 Septicaemia 1835 Anaemia 3152
9 Home /occupational Accidents 781 Abscess /Cellulitis 1538 Septicaemia 2666
10 Sepsis 677 Anaemia 1416 Gynaecological Conditions 889

FIGURE 4: A BAR GRAPH SHOWING TOP TEN (10) OPD MORBIDITY 2016

FIGURE 5: MALARIA CASES 2012-2016

TABLE 25:   IN-PATIENT SERVICE OUTPUT STATISTICS

INDICATORS 2012 2013 2014 2015 2016
Admissions 6036 6500 6099 6024 6623
Discharges 5945 6365 6012 5905 6505
Death(Rate) 115(1.9%) 118(1.8%) 105(1.7%) 121(2.0%) 117(1.8%)
Patient Days 36275 34772 31585 29214 26725
Occupancy Rate 75.7% 72.7% 66.1% 61.10% 53.7%
Average Length of Stay 6.0 days 5.4 days 5.2 days 4.85 days 4.04 days
Turnover Per Bed 46 pts 50 pts 47 pts 46 pts 49 pts
Turnover Interval 1.9 days 2.0 days 2.7 days 3.10 days 3.48 days
Bed Capacity 131 131 131 131 136

 

INTERPRETATION OF STATISTICS

Occupancy Rate = 53.7%

No. of Active Beds                           =          53.7% * 136   = 73.0 ≈ 73 beds

                                                           100

This means that, out of 136 beds, 73 beds were active or used in the year 2016.

Average Length of Stay = 4.04 days

This indicates that, averagely a patient spent at least 4 days, 1 hour at the ward.

Turnover per Bed       = 49.0

                                   = 49 patients

This means that an active bed was used by 49 Patients during the year 2016.

Turnover Interval                   = 3.48

This implies that, it took 3 Days; 12 Hours for an empty bed to become occupied by patients in 2016.

TABLE 26:   ADMISSION BY INSURED AND NON-INSURED PATIENTS

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Insured 6160 5574 5496 5994 9.1 Increase
Non-Insured 340 525 528 629 19.1 Increase
Total 6500 6099 6024 6623 9.9 Increase

Total admissions saw a 9.9% increase in 2016 when compared to that of 2015.

FIGURE 6:   TOP TEN CAUSES OF ADMISSION

TABLE 27:   PERFORMANCE BY WARDS 2016

WARDS ADMISSION DISCHARGE DEATH PATIENT DAYS OCCUPANCY RATE AVERAGE LENGTH OF STAY TURN- OVER PER BED TURN OVER INTERVAL BED CAPACITY
Children’s 1935 1915 12 5007 52.62% 2.60 74.12 2.34 26
General 1836 1740 90 7107 62.64% 3.88 59.03 2.34 31
Orthopaedic 566 578 3 9087 49.66% 15.64 11.62 15.86 50
Maternity 2140 2138 2 4895 55.73% 2.29 89.2 1.82 24
NICU 146 134 10 649 35.46% 4.51 28.8 8.20 5

FIGURE 7:   TOP TEN CAUSES OF MORTALITY

TABLE 28:   MATERNAL REPORT

INDICATORS 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Deliveries (Mothers) 1325 1270 1317 1331 1.1 Increase
Deliveries (Babies) 1358 1312

 

1353 1387 2.5 Increase
Caesarean Section

(Rate)

349

 

 

292

 

 

324

 

 

403 24.4 Increase
Live Births 1336 1299 1330 1377 3.5 Increase
Still Birth (Rate) 22

 

13

 

23

 

10 56.5 Decline
Fresh (%) 10 7 11 3 72.7 Decline
Macerated (%) 12 6 13 7 46.2 Decline
Maternal Death

Ratio

2 4 3 2 33.3 Decline
150/100,000LBs 308/100,0000 LBs 226/100,000 LBs 145/100,000LBs 35.8 Decline

FIGURE 8:   LINE GRAPH OF MATERNAL MORTALITY

35.8%

 

 

 

 

 

 

 

 

 

 

 

5%%

Comparing 2015 and 2016, maternal mortality saw a 35.8% decrease.

TABLE 29:   OBSTETRICAL REPORT

INDICATOR 2013 2014 2015 2016 %change in 2yrs performance
% Change Performance
Episiotomy 259 185 195 113 42.1 Decrease
Vacuum Extraction 5 2 5 6 20.0 Increase
Caesarean Section 349 300 324 403 24.4 Increase
Operation for Ruptured Uterus 0 1 1 1 100 Constant

FIGURE 30:  TABLE SHOWING EVACUATION OF THE UTERUS

INDICATORS 2013 2014 2015 2016
EVACUATION OF THE UTERUS 130 149 126 108
14.3%↓

FIGURE 9:   LINE GRAPH OF EVACUATION OF UTERUS In figure 10, evacuation of the uterus decreased by 14.3% comparing 2015 and that of 2016.

TABLE 31:  ANALYSIS OF MODE OF DELIVERY.

INDICATOR No. of Mothers No. of Babies Born Alive Still Birth
Single 866 866 861 5
Twins 56 112 109 3
Caesarean Section 403 403 401 2
Vacuum Delivery 6 6 6 0
Triplet 0 0 0 0
Total       1331 1387 1377 10

 

TABLE 32:   INSTITUTIONAL INFANT/NEONATAL MORTALITY RATE

INDICATOR 2012 2013 2014 2015 2016
Neonatal Mortality

Ratio

4 2 1 1 10
(3/1000 LBs) (2/1000 LBS) (1/1000 LBS) (1/1000 LBS) (7/1000LBS)
Infant Mortality

 Ratio

11 10 4 5 4
(16/1000adm) (14/1000adm) (7/1000adm) (10/1000adm) (2/1000adm)
1-4 Years 4 15 19 9 13
(6/1000 adm) (7/1000 adm) (9/1000 adm) (6/1000adm) (9/1000adm)
Under Five Mortality

Ratio

24 27 24 15 27
(6/1000 adm+LBs) (6/1000 adm+LBs) (6/1000 adm+LBs) 4/1000adm+LBs) (12/1000adm+LBs)

TABLE 33:   SPECIALIZED SERVICES

Indicator 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Eye Clinic 6344 6676 7305 7272 0.5 Decline
Mental 595 792 33.1 Increase
 Orthopaedics Nsawam 725 511 407 356 12.5 Decline
Orthopaedics 10391 10996 8278 7444 10.1 Decline
Diabetes 2432 2203 2931 3562 21.5 Increase
Hypertension 3998 4242 8663 10867 25.4 Increase
O & G 79

TABLE 34:   DIAGNOSTIC SERVICES

INDICATOR 2013 2014 2015 2016 % Change in 2YRS Performance
% Change Performance
Ultra Sound 2972 2832 2953 3203 8.5 Increase
X-RAY 3825 4097 4774 4769 0.1 Decline
 

Lab

 

OPD 21588 23486 17010 18343 7.8 Increase
IPD 9278 10574 10891 11259 3.4 Increase
Total 37663 40989 35628 37574 5.5 Increase

ORTHOPAEDICS SERVICES

TABLE 35: COMPARATIVE ANALYSIS OF ORTHOPAEDIC SURGERIES PER MAJOR SURGERIES PERFORMED

Indicators 2012 2013 2014 2015 2016
Total Surgery 2007 1980 1904 1975 1838
Orthopaedics 1269 1050 1007 767 665
% of Total 63.2 53.03 52.89 38.8 36.2

From table 35, orthopaedic surgery was reduced from 38.8% to 36.2% giving a difference of 2.6%.

TABLE36:   COMPARATIVE ANALYSIS OF ORTHOPAEDIC OPD ATTENDANCE PER TOTAL OPDATTENDANCE

Indicators 2012 2013 2014 2015 2016
Total OPD 88025 95898 94907 91343 75928
Orthopaedics 9407 10391 10996 8278 7444
% of Total 10.7 10.8 11.6 9.1 9.8

From table 36, comparing 2015 and 2016, orthopaedic OPD attendance was decreased fom 8278 to 7444 giving a 10.1% decrease.

TABLE 37:   COMPARATIVE ANALYSIS OF ORTHOPAEDIC IPD PER TOTAL IPD

Indicators 2012 2013 2014 2015 2016
Total IPD 6036 6500 6099 6024 6623
Orthopaedics 726 721 672 655 566
% of Total 12.03 11.09 11.02 10.87 8.55

Table 37 depicts a reduction in percentages when comparing orthopaedics inpatients and that of total in-patients (2015 and 2016) recorded by the facility representing a percentage difference of 2.32%.

TABLE 38:   PERFORMANCE INDICATORS

INDICATOR EXPECTATION 2014 2015 2016
Percentage Bed Occupancy Rate 75% 66.1% 61.1% 53.7%
Facility Admission Rate 6.4% 6.6% 8.7%
Facility Death Rate 1% 1.7% 2.1% 1.8%
OPD Insurance Coverage 80% 93% 93.4% 93%
In-Patient Insurance 80% 91% 90.3% 90.5%
Deliveries at Facility 37.5% 36.7% 36.3%
Under Five Mortality Rate 40/1000 6/1000 4/1000 12/1000
Infant Mortality Rate 39/1000 7/1000 10/1000 2/1000
Neonatal Mortality 1/1000 1/1000 7/1000
Antenatal Coverage 31.7% 32.2% 27.5%
Low Birth Weight Rate 5% 16% 19.5% 15.9%
Maternal Mortality Rate 100/100000LBs 308/100000 225/100000 145/100000
Still Birth Rate 1% 1.0% 1.7% 0.8%
CT Positive Rate 22% 18.8% 18%
PMTCT Positive Rate 2.9% 1.9% 1.6%
Rate of surgical cases per admission 31.2% 25.3% 27.8%
Caesarean Section Rate 15% 23.0% 23.9% 30.3%
Doctor to Patient Ratio 1:13558 1:10149 1:10847
OPD Attendance per Capital 1.1 1.1 0.8
Average Daily OPD Attendance 260 250 207
Average Daily Admissions (In-patient 17 16 18

 

  • The number of active beds during 2016 decreased from 80 active beds to 73 active beds used by the facility. This indicates that 73 active beds out of the total 136 beds were used within 2016. The admission rate was also increased from 6.6% to 8.7%. Death rate at the hospital also decreased from 2.1% recorded in 2015 to 1.8% recorded in 2016.
  • OPD insurance coverage was decreased from 93.4% to 93.0% whiles IPD insurance coverage rate was increased from 90.3% to 90.5 %. However, the facility covered high insurance coverage rate when comparing to the WHO standard (80%). Overall under five mortality rate increased to 12/1000 admissions and live births. This means that out of every 1000 live births and admissions recorded at the hospital including emergency cases, the facility recorded 12 under five death cases.
  • Infant mortality rate decreased from 10/1000admissions to 2/1000 admissions meaning that 2 out of every 1000 admissions and emergency detentions died. Neonatal deaths increased from 1/1000 live births to 7/1000 live births. The neonatal deaths increased due to the creation of the NICU ward as more neonates are referred to the hospital. However, there is more to be done in order to sustain the MDG 5. In view of that, there is a recommendation to the clinical department to audit every under-five death recorded at the facility level.
  • PMTCT Positive Rate, Antenatal coverage, low birth weight, stillbirth rate saw a decrease. The decrease in antenatal coverage is a negative shift. The decrease in the stillbirth rate shows a positive sign towards the MDG 4. Moreover, the C/S rate recorded at the facility is greater than the standard required by WHO (10-15%). Maternal mortality rate showed a decrease which indicates a shift to the positive direction. However, the rate still remains as a hindrance to MDG5 sustainability. Meanwhile, 2 out of the maternal deaths recorded at the facility came as transferred into the facility from different district with a worst condition.

ACHIEVEMENTS

  • We successfully recruited 44 new employees during the year.
  • Four (4) staff completed their courses successfully
  • We successfully constructed and installed an ultramodern X-ray machine.
  • Five (5) year strategic plan developed
  • We provided various logistics to the hospital.
  • Sponsorship/training of staff in school
  • We carried out renovation of staff quarters.
  • We procured a clocking device to monitor staff attendance and this has improved staff attendance significantly.
  • We ensured effective safety and security of staff, patients and their relatives.

CHALLENGES

  • Inadequate specialists.
  • Old and obsolete equipment
  • Difficulty in paying staff allowances.
  • Difficulties in paying suppliers.
  • Inability to mechanize our non-mechanized staff.
  • Non-reimbursement of NHIS Claims
  • Inadequate staff accommodation
  • Shortage/inadequate logistics
  • Poor referral system (from district facilities and outside district facilities)
  • Poor documentation
  • No surgical ward, and small Neonatal Intensive Care Unit (NICU)

WAY FORWARD

Ø  To increase our market share of client in the district.

Ø  To expand the scope of specialized services.

Ø  To ensure prudent financial management.

Ø  Expand hospital’s infrastructural capacity and continue renovations

Ø  To establish a unique corporate identity and image for all staffs.

Ø  Enhance welfare, safety and security of all staffs.

  • Appeal for funds for the construction of NICU and Surgical ward
  • Appeal for support to purchase equipment
  • Train two specialists
  • Continue in-service training for staff
  • Continue the Administration block.

                                               SIGNATORIES

……………………………….                                             …………………………………

Rev. Sr. Rosina Fosu Ntiwaa                                                           Dr. Prosper A. K. Moh

(Administrator)                                                                                    (Medical Director)

……………………………………                                      ………………………………………

Ms. Mary Bibiana Naaeke                                                                Rev. Fr. Theophilus A. Pepra

(Nursing Manager)                                                                           (Hospital Chaplain)