Att_19_National_MICS_Presentation_to_Health_Summit_-_23_April_2012.pptx

Preliminary findings from the 2011 National MICS to the Health Summit

Is Ghana reducing Disparities and Improving Equity on key Health Outcomes?

Presentation

Background of the National MICS Survey Putting the National MICS results into the context of the HSMTDP Key Findings:

Maternal Health Child Health Nutrition

NHIS

Water and Sanitation Conclusions

Background

The Ghana National MICS (with an enhanced Malaria module and biomarker) was conducted by the Ghana Statistical Service with financial and technical support from:

National Malaria Control Programme/GHS Navrongo Research Centre

USAID/CDC/ICF-MACRO

UNICEF

Government of Japan

UNFPA

A lot of technical support from other DPs, UN Agencies and MDAs

Background

2010 Census Sampling Frame was used, and a total of 12,250 Households were sampled;

4 Regions (Upper East, Upper West, Northern and Central) were oversampled to provide more precise data 4 Questionnaires were used: HH, Women 15-49 yrs, Children 0-5 yrs, and Men 15-59 years;

Anthropometry, Malaria/Anaemia testing for children under-5 yrs, and salt was tested (Rapid test kits, and titration);

Survey methodology similar to that of Demographic and Health Survey (DHS), therefore, data is comparable;

Presentation only captures a few core indicators, and additional results will be available in the next one month.

Objectives of the mics

Provide more current information for assessing the situation of children and women, and reporting on country progress on achieving the GSGDA goals/targets, the MDGs and the reporting requirements of other local and international development declarations and agenda;

Provide much-needed data on practices used to treat malaria among children under-five and the use of specific anti-malarial medications, bednet coverage and use, coverage of IPTP for pregnant women, treatment practices for childhood fever, and prevalence of malaria and anaemia among children age 6-59 months;

Provide baseline data for the new United Nations Development Framework (UNDAF) (2012-2016).

National MICS in the context of HSMTDP MICS 2011 provides a mid-term snapshot on progress on key HSMTDP 2010-2013 strategic objectives

HO1: Bridge equity gaps in access to health care and ensure sustainable financing arrangements that protect the poor HO3: Improve access to quality maternal, neonatal, child and adolescent health and nutrition services

MICS 2011 provides nationally representative data that can inform development of next health sector medium term plan.

MATERNAL HEALTH

In aggregate, positive trends in maternal care indicators, although disparities exist……..

Target is 80% for 2013

Maternal Care Indicators

GDHS 1988

Per Cent

Skilled deliveries still a challenges to many women in the northern region….

Northern 37% Volta 64% Ashanti 74% Brong Ahafo 64% Western 65% Eastern 78% Upper West 60% Central 63% Upper East 67% Greater Accra 90%

27% Volta 54% Ashanti 73% Brong Ahafo 66% Western 62% Eastern 61% Upper West 46% Central 54% Upper East 47% Greater Accra 84%

Ratio of highest to lowest is 1:2.43 Target: 1:1.8 (2011) Was: 1:3.1 (2008)

The richer, educated and urban residents benefiting more from skilled deliveries…

Rural Urban RESIDENCE None Primary Middle/JSS Secondary + MOTHER EDUCATION Poorest Second Middle Fourth Richest WEALTH QUINTILE NATIONAL 53.858177892832764 88.2 54.476641373568391 66.180307507920872 79.446938885613648 98.121564834913471 40.233015587647934 55.019937745149008 70.193054058195884 86.033795221752342 98.34667397093645 68.400000000000006

Assistance by TBAs during delivery reducing, but still high in some regions…

33% Volta 11% Ashanti 12% Brong Ahafo 11% Western 25% Eastern 12% Upper West 13% Central 30% Upper East 4% Greater Accra 5%

Assistance during Delivery 2008 DHS Doctor Nurse/midwife Auxiliary midwife Community health officer/nurse TBA Relative/other No one 11 44 2.4 1.5 30.299999999999997 8 3 2011 MICS Doctor Nurse/midwife Auxiliary midwife Community health officer/nurse TBA Relative/other No one 13 54 1 1 16 12 3

PNC for mother and child fairly high, although not uniform across regions…

PNC for the newborn Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Total 88.368198941014342 91.658516524744059 96.948217073508545 76.046934841706843 87.516698360316909 87.364281268962884 79.473588195508654 75.368772320972582 82.640987367758882 84.804839301148192 86.2 Number of last births in the two years preceding the survey Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Total PNC for the mother Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Total 87.685539964357162 88.234129604952059 94.520525192210329 71.808931325773528 87.725859861336886 86.537731262546615 71.781335905700473 63.100870229308221 73.1377099941663 76.693906700258268 82.3

The richer, educated and urban residents benefiting more from PNC…

PNC for the newborn Urban Rural RESIDENCE None Primary Middle/JSS Secondary + MOTHER'S EDUCATION Poorest Second Middle Fourth Richest WEALTH QUINTILE TOTAL 93.071808188196869 81.250335927291061 79.385421350483284 86.921031994940193 91.462794083991724 95.676819209961252 74.744662723707506 78.372257329168988 87.631321069089509 96.054856994771868 97.933190874266742 86.2 PNC for the mother Urban Rural RESIDENCE None Primary Middle/JSS Secondary + MOTHER'S EDUCATION Poorest Second Middle Fourth Richest WEALTH QUINTILE TOTAL 91.880833622591695 75.323869575538566 72.351306911978298 83.966489087256406 89.408483721947619 96.442851297340553 64.147625641589187 76.529337508567195 84.37723554589536 93.61271404832064 97.496189293638921 82.319262391589177

Progress seen over time in prevention of malaria in pregnant women…

% of pregnant women receiving at least 2 doses of IPTp MICS 2006 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West National 31 16.100000000000001 37.299999999999997 25 18.100000000000001 21.9 34.200000000000003 27.7 40.299999999999997 43.7 27.5 DHS 2008 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West National 45.5 45.7 29.4 59.8 40.799999999999997 50.8 63.7 27.9 26 52.5 43.7 MICS 2011 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West National 62.966040998951541 67.755263912986834 62.542963585488764 40.465722012335014 74.119157745827593 76.110371800142545 63.839078820537161 74.092839686100163 70.17036176092455 70.245416189789154 67.090194199683864

Use of modern contraceptives increasing….

Use of modern methods 2008 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Total 13 17 22 21 17 16 22 6 14 21 17 2011 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Total 23.9 29 26.5 15.8 26.2 23.3 27 13.1 18.7 22.4 23 1 in 4 women in Ghana has unmet need for Contraception

Unmet need for Contraception Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Total 2008 Total 2011 25.080413679792613 22.610671512093869 19.682840234951307 37.86063233898934 22.378600738694132 29.791481330653976 27.275383703298541 30.39101448044023 26.263889995521954 28.010607195914105 35.299999999999997 26.433686037142504

CHILD HEALTH

Some gains made in immunization, but nearly 1 in 4 children missing out on vital immunization by age 1

Target for Penta by age 1yr is 91% by 2013

% of Children fully immunized by age 1

MICS 2006

Increased no. of children sleeping under ITNs, but well below the national target of 70% by 2013

LLIN Campaigns took place in these Regions

% of Children under-5 yrs who slept under an ITN MICS 2006 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Total 11.5 19.8 16.3 21.5 24.9 21.8 25.7 21.9 39.299999999999997 37.1 21.8 DHS 2008 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Total 35.5 18.899999999999999 17.2 40.4 35.700000000000003 25.3 50 11.2 36.799999999999997 34 28.2 MICS 2011 Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Total 32.674456492770062 27.725308201939082 22.138739242473584 70.670163805988651 60.168645911739887 31.248169178290208 41.345283903620469 41.76302889392047 45.009630232235317 46.932141074792568 39.033817185212179

NUTRITION

Concerted efforts required to promote breastfeeding…..

Exclusive Breastfeeding Target is 70% by 2012

Target for Underweight is 8% for 2013

Nutritional Status of Children under-5 yrs

Per Cent

Wide disparities in malnutrition across regions and poverty quintiles - Stunting

32% Volta 27% Ashanti 27% Brong Ahafo 25% Western 27% Eastern 38% Upper West 25% Central 34% Upper East 36% Greater Accra 14%

37% Volta 22% Ashanti 22% Brong Ahafo 19% Western 23% Eastern 21% Upper West 23% Central 23% Upper East 32% Greater Accra 14% Increase in Stunting in Northern Region

NATIONAL HEALTH INSURANCE

At least 60% of children have NHIS in Ghana…

NHIS Membership for Children under-5 yrs Yes, card seen Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 52.513966480446925 36.585365853658537 36.363636363636367 48.066298342541437 55.932203389830505 60.137457044673539 53.784860557768923 37.878787878787875 51.874062968515744 65.856777493606131 50.039277297721917 49.802087081684057 48.560135516657255 49.432534678436319 46.619217081850536 56.607495069033533 52.505966587112169 40.231948087808917 Yes card not seen Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 18.994413407821231 32.24932249322493 32.121212121212125 12.707182320441989 20.338983050847457 17.52577319587629 17.92828685258964 18.383838383838384 14.09295352323838 16.112531969309462 23.095051060487037 16.876574307304786 14.003387916431395 19.546027742749054 24.021352313167259 22.485207100591715 26.491646778042959 19.204749413226562

NHIS for women 15-49 yrs…

Yes, card seen Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 39.018087855297161 22.676991150442479 27.044025157232703 38.265306122448976 39.808153477218227 54.689984101748806 42.452830188679243 32.61562998405104 44.933078393881452 55.095277547638773 39.585422935473083 40.686735653809968 39.018197206940329 41.379310344827587 36.589545844044558 40.719542109566639 44.550173010380625 40.231948087808917 Yes card not seen Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 16.795865633074936 29.20353982300885 28.721174004192871 16.581632653061224 21.342925659472421 17.806041335453099 14.716981132075471 16.905901116427433 13.862332695984703 18.558409279204639 22.801738548980275 16.674506114769521 15.107913669064748 15.817091454272864 20.308483290488432 24.938675388389207 24.307958477508649 19.204749413226562

NHIS for men 15-59 yrs…

Yes, card seen Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 35.652173913043477 21.649484536082475 19.642857142857142 23.958333333333332 39.603960396039604 42.236024844720497 43.18181818181818 26.666666666666668 31.481481481481481 47.256097560975611 32.689655172413794 34.470377019748653 29.109589041095891 38.659793814432987 29.277566539923953 38.831615120274911 35.463258785942493 33.768352365415986 Yes card not seen Western Central Greater Accra Volta Eastern Asante Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest Total 26.956521739130434 32.989690721649481 44.642857142857146 21.875 23.762376237623762 23.602484472049689 15.151515151515152 14.848484848484848 19.25925925925926 24.695121951219512 28.827586206896552 19.838420107719926 19.69178082191781 16.75257731958763 24.714828897338403 24.742268041237114 36.102236421725237 23.382272974442632

WATER, SANITATION AND HYGIENE

UNICEF, Country Status Overview on Water Supply and Sanitation for Ghana, internal report, 2010.

Percentage of population with Improved Source of Drinking Water National average is 80%, also the Target for 2013

4 regions fall below the National average

Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Urban Rural Poorest Second Middle Fourth Richest 71.531245989130511 80.454828256898324 85.590564319966191 61.795308909946449 76.487101107546067 90.529432028844667 80.434363284041069 68.435035896428474 78.34455721596845 88.631233685172518 90.744386706106283 68.589828014725782 56.437622899961774 69.849101904463666 85.990663470872278 92.043987639551958 92.13393966905808

Access to improved sanitation still a challenge, with wide disparities across regions…….

Sanitation Target is 21% by 2013

% of Population with access to improved sanitary facilities 1990 Open defecation Unimproved facilities Shared facilities Improved facilities 22 43 29 6 2008 Open defecation Unimproved facilities Shared facilities Improved facilities 20 13 54 13 2011 Open defecation Unimproved facilities Shared facilities Improved facilities 23 16 46 15

72% Volta 25% Ashanti 10% Brong Ahafo 16% Western 12% Eastern 6% Upper West 71% Central 15% Upper East 87% Greater Accra 9%

Population with NO sanitation facilities quite high in the north…….

Majority of the unserved are the poorest, and those living in rural areas…….

Water Rural Urban Poorest Second Middle Fourth Richest Total 68.599999999999994 90.7 56.4 69.8 86 92 92 79.3 Sanitation Rural Urban Poorest Second Middle Fourth Richest Total 9.1135557852711866 21.244874372787113 5.1755959552090784 7.8472136353721957 9.0734300815570297 15.169551129075883 37.594820764770063 14.973849875218326 Progress has been made overall, but worrying geographic and socio-economic disparities persist.

Current increased focus on deprived regions should continue while watching out for other regions that may also be vulnerable.

MDG4

Coverage of key child survival interventions show improvement-immunization, malaria prevention, undernutrition However more efforts are needed to enable equitable attainment of MDG 4 for all children in Ghana

Conclusions

MDG5

Progress on coverage of key interventions- family planning and skilled delivery

However MDG target unlikely to be achieved at current pace and without strategic focus on structural bottlenecks

MAF-operational plan currently under development presents a huge opportunity to address these bottlenecks.

NHIS

Important tool for MDG attainment that needs further scale-up in coverage for all but particularly for the poorest populations.

‘All hands on deck’ needed for the last lap to MDG 4 and 5 goals

Conclusions (contd.)

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