Sustaining the gains of MDGs beyond 2015: The Upper East Special initiative

A Feature, Samuel Adadi Akapule, Bolgataga

It was historic when in September 2000, one hundred and eighty nine countries, including one hundred and forty-seven heads of State and Governments, of which Ghana was among, met for the inauguration of the UN Millennium Declaration, dubbed “ the Millennium Development Goals (MDGs)” . it is very important to note that this laudable initiative was crafted under the tutelage of Ghana’s illustrious Son, Mr. Kofi Annan ,the former United Nation (UN) Secretary General.

The goals represent a partnership between the developed countries and the developing countries "to create an environment - at the national and global levels alike -which is conducive to development and the elimination of poverty”. This is what has become known as the eight Millennium Development Goals (MDGs), including 21 time bound targets and 60 indicators.

Among the eight MDGs include: 1. Eradicate Extreme Hunger and Poverty 2. Achieve Universal Primary Education 3. Promote Gender Equality and Empower of Women 4. Reduce Child Mortality 5. Improve Maternal Health 6. Combat HIV/AIDS Malaria and other diseases 7. Ensure Environmental Sustainability 8. Develop a Global Partnership for Development.

It is also very important to note that the MDGs were time-bound. With quantitative and qualitative goals of core human values , the goals were expected to be met over a 15 year period. Thus, beginning from the year 2000 to 2015. Barely some few months left to meet the deadline, we are far behind in meeting many of the targets set by the UN. The achievement of the goals are hinged on core human values, investment in human capital, emancipation of women, reversing despoliation of the fragile environment, improving living standards and the quality of life for the majority poor, engender regional cooperation and collaboration among nations, eradication of diseases, and the achievement of high levels of literacy.

It is crucial to note that since Ghana begun the process, the MDGs have been mainstreamed into the country’s successive medium term development plans. Ghana has so far made some significant progress towards the attainment of some of the targets. For some other targets however, progress has not been steady. From all indications it is showing that Ghana is wobbling in achieving goal four and five due to the slow progress in improving child and maternal health. Between 1990 and 2011, the under-five mortality rate decreased by only 36 per cent.

That was insufficient to meet MDG 4, which requires that a decrease of 66 per cent has to be achieved in under-five mortality by 2015.Under-five child mortality in the country reduced from 121 deaths in 1,000 births in 1990 to 78 deaths in 1,000 births in 2011.Maternal mortality also decreased by 40 per cent between 1990 and 2010, showing some progress towards reaching MDG 5.

It improved by reducing from 580 deaths in every 1,000,000 births in 1990 to 350 deaths in every 1,000,000 births in 2010. Malnutrition is still a major obstacle. The MDG 4 demands governments to reduce by two-thirds the under-five mortality rate by 2015 and to achieve this goal, the country must cut under-five mortality to less than 50 deaths per 1,000 live births, but the ratio is currently above 70 per 1,000.

There is need to consolidate some of the gains the country has chalked, particularly in the area of the MDGs four and five. Comparatively, in terms of health performance indicators of the MDGs four and five and even six, statistics show that among the ten regions across the country, the Upper East Region performs best despite its meager resources in terms of the allocation of health budget. Both the Minister of Health and the Director- General of the Ghana Health Service , Dr Kwaku Agyeman-Mensah and Dr Ebenezer Appiah Denkyre, lauded the efforts of the Upper East Regional Director of Health Services, Dr Koku-Awoonor-Williams and his contingents at the just ended Annual General Conference of District Directors of Health.

On a sideline interview to find out how he managed to score such high marks in goals four and five including the sixth one, he told me that the Upper East region has thirteen districts, ninety sub-districts, one thousand three hundred and eighteen communities with a population of 1,097,692 with 302 health facilities, two hundred and six (68%) of which are CHPS compounds. He noted that only five out of the thirteen districts have a district hospital and indicated that the region is synonymous to CHPS.

“CHPS, for us is an essential intervention that we continue to hold on to and guide religiously; it is a strategy to save lives in our remote and rural communities. CHPS has been introduced to make health care easily accessible to communities, a close to client strategy. In this region, we have seen tremendous CHPS roll-out while at the same time the region is obviously the best performing region in the country in CHPS implementation. Functional CHPS zones have increased from 203 in 2013 to 212 in 2014 and we continue to recognize the tremendous support of Municipal/District Assemblies to CHPS roll out. Recently to improve maternal and newborn health services at the CHPS level, we have posted 62 Midwives to CHPS zones while we distributed over 133 midwifery delivery kits and infant weighing scales to 133 CHPS zones.”, Dr Awoonor-Williams told me and the District Directors of Health Services.

He pointed out that as a region, the key health indicators had consistently seen positive trends over the past five years and is the best performing in the country in many critical indicators, stressing, “this is clearly referenced in both the 2011 and 2013 Ministry of Health Holistic Assessment Review report. Upper East Region has the best maternal health indicator in Ghana, our institutional maternal mortality ratio reduced consistently from 141/100,000LB in 2010 to 111/100,000LB in 2013. (Maternal deaths reduced from 37 in 2012 to 34 in 2013), alongside consistently high antenatal and postnatal coverages. We have the best indicator for supervised delivery in Ghana (68%), the best in terms of consistently lowest indicators in newborn deaths and overall child mortality significantly reducing neonatal deaths, 95/1000LB in 2012 to 52/1000LB in 2014”

To address survival and emergency referral of mothers and newborns, he explained that “motorking” ambulances were procured and deployed to Bongo and Builsa districts under a Regional Sustainable Emergency Referral Care Initiative in July last year and mentioned that preliminary assessment had shown that the concept saved many lives both newborns and mothers. “Our region is one of the best performing regions in terms of Preventive Mother to Child Transmission performance indicators and indeed one of our districts, Bongo for three years running has 100% Anti Retroviral Therapy (ART) client retention, the only district in Ghana to achieve this”, he added.

”Our Regional HIV prevalence rate dropped from 2.4 in 2010 to 1.7 in 2013. TB cure rate has improved over the years, (from 83% in 2011 to 87% in 2012). We also have best nurse-population ratio in Ghana, due to our prudent Human Resource Management practices. The region’s many health initiatives largely explain our success story. These initiatives and innovations are largely community-based, thinking outside the box: the legendary Zorko maternal and newborn care initiative, the pregnancy school initiative for pregnant mothers, community-engaged maternal and newborn referral system, the training and deployment of midwives to CHPS zones and to support domiciliary deliveries, scheduled health commodity delivery and availability to all service delivery points including CHPS zones initiative, regular Community Health Officer (CHO) and midwives capacity building on safe motherhood and newborn health, kangaroo mother care and other high impact community-based interventions, Community-Integrated Management Childhood Illnesses (C-IMCI), Community-based Management of Severe Acute Malnutrition (CMAM ), neonatal resuscitation, cord care and other infection prevention practices are being scaled up in all districts”.

The Regional Director disclosed that building partnerships with local and community stakeholders was also key to the overall health improvement, working with local collaborators and health development partners helped a lot.

To quote him, “the pivotal role of the District Director of Health Services in the attainment of our health development goals can never be overemphasized. If the wise axiom ‘leadership is cause and all others is the effect’ is anything to go by, then the level of success of the health sector correlates directly to the quality and productivity of the leadership at all the levels particularly the primary care level notably the community, sub-district and district”.

The Conference was on the theme, “Sustaining the gains of MDGs 4, 5 & 6 beyond 2015: The Role of CHPS. I think there is more to that taking into consideration the lessons that can be learned from the good initiatives of the Upper East Health Directorate, hence the proposed theme, “Sustaining the gains of MDGs 4, 5 & 6 beyond 2015: The Upper East Special initiatives”. There is no doubt if the lessons are put into practice by being replicated in the various Regions and Districts, it would improve upon and consolidate the gains of the MDGs four, five and six.

The Regional Director could be rewarded by the Ministry of Health and the Ghana Health Service. To all the District and Regional Directors of Health, I challenge them to re-examine their leadership drive, initiatives and innovations in dealing effectively with the nagging and common issues particularly the poor staff attitude towards clients, work and productivity. It is in doing this that we can together as a country propel the sector to attain the MDG targets, most importantly goals 4, 5 and 6 and consolidate the gains beyond 2015.

samuelakapule@yahoo.com