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Health Facilities   
Generally there are several levels and categories of health facilities but for the sake of this presentation this has been categorised into 4 and the levels into three. The categories are government, quasi-government, mission and private. The levels include Hospitals, Health Centres/Health Post and others.

Concentration of Health Facilities in the Six Sub-Metros of Accra




  Fig. % Fig % Fig % Fig %
Okaikoi   2  0.9      19 8.7  6 2.8 27 12.4
Osu Clottey   3 1.4       27 12.4  7 3.2 37 17.0
Kpeshie   7 3.2       19 8.7 11 5.0 37 17.0
Awawaso   9 4.1       33 15.1 15 6.9 57 26.1
Ashiedu Keteke   1 0.5       19 8.7 7 3.2 27 12.4
Ablekuma   6 2.8       13 6.0 14 6.2 33 15.1
Metro 28 28     130 59.6 60 27.5 218 100

Ayawaso Sub-metro has the highest concentration of Health facilities among the six Sub-Metros in Accra. It has 9 hospitals; 33 health Centres/Posts and 15 other health facilities. Okaikoi and Ashiedu Keteke Sub-Metro have the lowest concentration. Both have 27 each. 

There are 28 Hospitals in Accra. One of such hospital is a teaching hospital, which is Korle-bu Teaching Hospital. Categories of such facilities range from pure government ownership to NGO ownership.    Private Sector participation in health delivery in Accra is very high. About 85.8% of all health care facilities are private proprietorship. Government owns a little over 9%.

Categories of Health Facilities




Fig. % Fig. % Fig. % Fig. % Fig
20 9.2    7 3.2    4 1.8 187 85.8 218

Incidence of Diseases
The major health problems of AMA are essentially communicable diseases due to poor environmental sanitation, ignorance, and poverty.  Malaria has been the number one disease in AMA, claiming about 53 per cent of all the OPD cases in 2001. The major communicable diseases (Top 5 communicable diseases in 2001) are malaria, Sexually Transmitted Infection, Diarrhoea, Chicken Pox and Enteric Fever.

Since the introduction of cholera in the country in 1970, the disease has become endemic with seasonal outbreaks that coincide with the onset of the rainy season.  The figures for 1999 were 1,671 cases and 42 deaths; most of the cases were in Accra.

Among the 10 leading diseases treated at out-patient visits, malaria ranked highest with an average incidence of 53% of OPD.  In contrast, the next two most frequent diagnoses were for upper respiratory infections and diarrhoea disease at 11% and 6% respectively.  Obviously, malaria is key to any consideration of health status improvements, nationally and in AMA.

Infant Health Status
In AMA, the major causes of death in infancy are low birth weight and other diseases of the newborn such as infections, malnutrition and anaemia.  Lung disorders contribute significantly to infant deaths, as do infant pneumonia, birth injury, congenital malformations, and infections.

Nationally, three-fourths of children’s deaths in the one-to four age group are caused by malaria, bronchopneumonia, diarrhoea disease, measles, meningitis, septicaemia and typhoid.  Only about 20 per cent of Ghanaian children under two years of age have received fully immunised coverage.  Accra has one of the highest coverage.

New Vaccine

The WHO has presently added three more childhood killer diseases to the EPI, making it now the Nine Childhood Killer Diseases. The additions are Yellow fever, Hepatitis B and Haemophilus influenza. The new vaccine, known as the Pentavalent vaccine is to replace DPT vaccine and be given according to the DPT schedule.

This new vaccine was formally launched at the Accra Sports Stadium on the 15th December, 2001 through a collaborated effort of the Ministries of Health, Education and Youth and Sports with financial, material and technical support from international bodies like WHO, UNICEF, USAID, JICA, Olympic AID, the Vaccine Fund etc. 

Sub-Metro 1st Dose 2nd Dose 3rd Dose Total
Ayawaso      123      152     205    480
Ashiedu Keteke        90        70       66    226
Ablekuma      149      159     162    470
Kpeshie      114      204     196    514
Osu Clottey      107      144       49    300
Okaikoi      220      190     109    519
Accra Metro      803      919     797 2 509

Coverage of Immunization in Accra
The coverage figures for the Accra Metropolis attest to the fact of its success. During the first round lowest coverage was 96% while in the second, the lowest was 102% and the highest 120%.  The 2001 coverage is indicated below for the six Sub-Metros.

Table 19: 2001 NID performance in Accra Metro
     1st Round

    2nd Round
  1mm % COV 1mm % COV
kpeshie  76022     117     66657     102
Ayawaso 54249     105     59134     114
okaikoi 69459     104     69789     105
Osu Clottey 48725     108     49344     110
Ablekuma 97053     112 1011871     118
Ashiedu Keteke 33964     109      37457     120
Accra Metro 330747       96    384252     111
Source: AMA Health Directorate

The Coverage of The Vitamin A Supplementation Programme.
The coverage for Vitamin A supplementation carried out in 2000 and 2001.  The results were as follows: - January 2000 – July – 96.2, November 2000 – June – 76.3, November 2001 79.4. Comparison of performance in Vitamin A supplementation in 2000 and 2001 shows a general improvement over 2000.

The coverage for the vitamin A Supplementation Programme which was carried out in 2000 – 2001 for the six sub-metros of Accra are shown in Table 21.

Sub-District Jan. 2000 July 2000 Nov. 2000 June 2000 Nov. 2001
Ashiedu Keteke 95.0 41.5 14.8 101.2 79.4
Ablekuma 68 41.5 92.5 81.1 102.9
Okaikoi 78 64.4 91.9 99.2    98
Ayawaso 89 17.8 113.3 74.8   108.8
Kpeshie 79 59.4 78.0 72.8 91.0
Osu Clottey 86 74.8 96.9 87.5 98
District Coverage 82.5 47.8 94.3 86.1 96.4

The NIDs performance in Ashiedu Keteke has revealed that the population of that sub-metro is higher than what is attributed to it.  If the NIDs coverage in Accra should be taken as a reflection of the population of Accra, then the Accra Metro Director for Health’s stand that the 2000 census did not reflect the population of Accra is justified.

Achievements of The Disease Control Unit of The Metro Health Directorate
The Disease Control Unit of the Accra Metropolitan Health Directorate had a commendable achievement during the year 2001. Some are:
  1. Remarkable increase in the EPI coverage in all antigens
  2. High cure and low defaulter rate in TB management.
  3. High number of training facilitated and participated.

It is however recommended that additional staff should be provided to assist with the Metropolitan Disease Control work at the Metropolitan level. There is the need to involve Disease Control Officers in training workshops related to diseases and their control as much as possible to ensure a more effective disease control activities in the health facilities.  Attention of Disease Control Officers should be drawn early enough to noticeable communicable disease situation to ensure prompt action to avoid unnecessary epidemic occurrence.

A minimum of two Disease Control Officers are needed in each institution to allow some to be sent to the record office for prompt recognition and notification of epidemic prone communicable diseases to the appropriate quarters for early action.  This is because Records Officers, sometimes, find it difficult to read and understand some medical terminology used on the OPD forms by prescribers.

To avoid forgery in the EPI figures in order to portray a realistic EPI coverage, it is suggested that the Disease Control Officers prepare the immunization returns, since they are not directly involve in the routine immunization exercise.  They should also be permitted to fully take control over the Cold Chain Management and its facilities in the health institutions to avoid a brake in the chain system.

The disease surveillance system in the Metropolis should be strengthened in the form of community based disease Surveillance system to pick disease incidence early enough for prompt control measures.  Repeated and regular education of the public on epidemic prone diseases should be encouraged by the metro health institutions.

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