District ownership in Akwapim North, Ghana

Mercy Ahun
GAVI’s Special Representative to GAVI Eligible Countries

Tuesday

17 April

2012

I was in Ghana last week, following up on preparations to introduce two new vaccines against diarrhoea and pneumonia. I had visited Akwapim North district, some 50km from the hustle and bustle of Accra. The view from the hills was serene and the air felt fresh after a light rain. Dr Joseph Opare, the District Director of Health Services (DDHS) and Rachel, the District Disease Control Officer took me round the district, visiting health facilities and outreach centres.

As we chatted between visits to villages I probed deeper to get a better understanding of why immunisation coverage is increasing in his district, (DTP3 >90%). I had attended the 2011 performance review meeting of senior health managers in Accra the previous day. The national DTP3 coverage is stagnating around 88% and there was general agreement that it was mainly due to late release of funds for service delivery.

He described how his team strategized to increase coverage:

• Better estimates of target population - The target population was re-estimated based on the most recent census data and monthly target populations was provided to each of the 8 sub districts.

• Revised outreach points - The number and frequency of outreach points was increased to cover the target population.

• Availability of funds - The DDHS used innovative approaches in raising funds for outreach activities: allowed use of OPD fees to cover transport costs. For health facilities without medical personnel, he organised special OPD sessions which attracted more patients and raised funds through the national health insurance scheme. The local parliamentarian and the district assembly (local government) also contributed to pay off some debts from previous outreach activities.

• Supervision - Regular visits by DHMT members to supervise outreach activities.

• Social Mobilisation - Volunteers were given incentives to help with social mobilisation.

• Monitoring - Performance was reviewed at monthly DHMT meetings. Peer reviews motivated staff to reach targets. Regular data quality checks done to address discrepancies.

What struck me was how the DDHS focused on his area of influence to improve service delivery and coverage without pointing fingers at others. He had other issues to deal with as we went round: suspected measles outbreak (5 cases), industrial action by some health workers, a cholera case, plus the fact that I had taken him away from other duties he had to perform that morning…

Much discussion has gone into the importance of country ownership in ensuring sustainability of programmes. District ownership is critical to increasing and maintaining high coverage. Districts like Akwapim North need to be encouraged to continue innovating to save lives.