Bolgatanga Municipal is located in the center of the Upper East Region and also the Regional Capital. It has a total land area of 729 sq. km and is bordered to the North by the Bongo District, South and East by Talensi, and Kassena-Nankana Municipality to the West. The municipality was established by LI 1797 (2004). The Municipality has been divided into nine (9) sub-municipalities namely; Bolga Central, Bolga North, Bolga South, Kalbeo, Sherigu, Sumbrungu East, Sumbrungu West, Plaza and Zaare.

Figure 1: Map of Bolgatanga Municipality

1.1.2 Occupation

The people are mainly peasant farmers with few farming vegetables like tomatoes in commercial quantities during the tomato farming season. A handful of women also deal in basketry and this accounts for as much as 57% of the labor force, trade and commerce 19%, manufacturing (mainly handicrafts) 11.92%, community/social services 7.4%, and others like mining, construction and utility service.

1.1.3 Climate and Vegetation

The climate is classified as tropical and has two distinct seasons – rainy season that runs from May to October and a long dry season that stretches from October to April; with hardly any rains. Mean annual rainfall is 950mm while the maximum temperature is 45°C in March and April with a minimum of 12°C in December. The natural vegetation is that of guinea savannah woodland consisting of short deciduous trees widely spaced and a ground flora, which gets burnt by fire or scorched by the sun during the long dry season. The most common economic trees are the shea nut, “dawadawa”, baobab, and acacia. The municipality has a forest reserve, which primarily protects most of the water bodies in the area.

1.1.4 Transport

The municipality depends solely on road transport to link up with the other parts of the country. Bolgatanga town, the capital of the Upper East Region is about 820 km from Accra, 540 km and 160 km from Kumasi and Tamale respectively. Bolgatanga is the pivot of road transportation in the Upper East Region with all three major roads to the other districts radiating from it.

1.1.5 Telecommunications

Telecel Ghana Telecommunication has its regional headquarters in the Bolgatanga Post office block. The company offers telephone, telegram, mobile, fax, and telex services both at the domestic and international levels. The other mobile service providers include MTN and Airteltigo.

1.1.6 Educational Institutions

There are about 200 educational institutions in the municipality ranging from pre-schools to a Technical University. In addition to these educational institutions under the GES, there are two Health Training institutions for the training of Diploma nurses and midwives.

1.1.7 Water and Sanitation

The municipality is vulnerable in terms of adequate water supply. During the dry season, most of the existing water bodies dry up whilst boreholes and wells virtually become non-functional due to fall in the water table. The water supply system in the municipality can be classified into rural and urban, based on the location of the facilities and the technology of delivery.

The rural water supply system consists of boreholes, hand-dug wells, and other natural water sources such as rivers, dams, ponds dugouts, rainwater, etc. Even though the other water sources are not hygienic, about 40% of the rural population still depend on them.

Urban water supply system consists mainly of a network of piped systems that provide water to consumers. One of the most important challenges facing the Municipality is the disposal of solid and liquid waste. Most houses do not have bathhouse drains and where they exist there are no feeder drains to link them to major drains. This results in the stagnation of wastewater from houses, which not only breeds mosquitoes but is also an eyesore in most areas. About 15% of the total waste generated is collected for disposal. There are about 40 refuse sites in the town and only 22 refuse containers are provided with two skip loaders. This results in high dumps serving as breeding grounds for rodents.

1.1.8 Population

The capital of the Municipality is Bolgatanga which is cosmopolitan. The major tribe is Frafra with significant tribes from within the Upper East Region as well as other neighboring regions in the country.

Table 1: Population Indices 2024

Population for 2024

1.1.9 Health Facilities

Bolgatanga Municipality has a total of 54 health facilities delivering various levels of health care to residents and neighboring districts. The health system is a mix of public health facilities, private as well as CHAG. Also, there are few well-established herbal practitioners whilst the majority of them are not engrained within the municipality and perhaps not licensed.

Table 2: Distribution of Health Facilities by Type

1.2.0 Overview of Municipal Health System

The Municipal Health Directorate (MHD) implements national policies with emphasis on expanding primary health care services at sub-district levels under the guidance of its administrative offices. We provide technical, administrative and logistical support to not only Ghana Health Service facilities but also to all Private, CHAG and Quasi government Service providers.

1.2.1. Governance Structure and Functions

Administratively, the Municipal Health Service delivery is at three (3) levels. The Municipal Health Directorate, Sub-Municipal Health Management Teams, and CHPS at the community level.

The Municipal Director of Health Service is supported by the Municipal Health Management Team and the Sub-Municipal Health Management Team. There is a Municipal Health Committee that advices the Municipal Director of Health Service.

The Municipal Directorate is composed of a finance Unit, Stores, Supply and Drugs, Reproductive and Child Health Unit (RCH), Internal Audit, Administration Unit (including Transport, Estates and procurement), Disease Control Unit, Nutrition Unit, Health Information Unit, and Health Promotion Unit.

The Municipal Health Directorate with its partners directly and indirectly provides comprehensive health services at all levels to:

• Develop strategies and technical guidelines to implement national policies
• Undertake management and administration of the health resources within the Service
• Promote healthy mode of living and good health habits by people
• Establish effective mechanisms for disease surveillance, prevention, and control
• Provide in-service training and continuing education, and
• Perform other relevant functions that promote, protect, and restore population health

1.2.2 Mission of the GHS/Municipal Health Directorate (MHD)

The mission of the GHS is to provide and prudently manage comprehensive and accessible health service with special emphasis on primary health care at National, Regional, Municipal/District, and Sub-Municipal/district levels following approved national policies.

1.2.3 Vision of GHS/ GHS/Municipal Health Directorate (MHD)

To increase access to good quality health services, and manage prudently resources available for the provision of the health services.

1.2.4 Core Values

People-Centered, Professionalism, Teamwork, Innovation, Discipline and Integrity

Highlights of key challenges/constraints

• Shortage of vaccines especially BCG, Measles and Yellow Fever. There were shortages of vaccines and syringes especially during the first quarter of the year 2023. This has affected the coverage for BCG and measles for the year under review.
• Low EPI performance especially PENTA 3 and MR 2. Though PENTA 3 coverage increased from 83.2% to 88.4% in 2023, target of 95% was not met. This could partly be attributed low follow ups made on defaulters by staff in the various health facilities.
• Inadequate laptops available for units in the Municipal Health Directorate. Few of the units at the Directorate have official laptops while the rest are using their personal laptops.
• Inadequate quantities of medications and medical consumables from the Regional Medical Store to health facilities. There are also delays in supply and this has affected OPD attendance for the period under review.
• Inadequate motorbikes for routine activities at the MHD and some health facilities. Thirty per cent (30%) of units in the MHA and thirty-four (34%) of health facilities have official motorbikes for service delivery.
• Delay reimbursement of CLAIMS by NHIS. Delays in reimbursement of claims have been an issue affecting the Municipality. Reimbursement from the NHIS has been slow and erratic
• Late report submission and poor record-keeping practices in some health facilities within the municipality. Data entry into DHIMS is done late
• Apathy or Low capacity for Nutrition activities
• Low Community sensitization and engagement
• Poor attitude towards radio discussion. Staff at the health facilities fail to comply with the schedule for radio discursion. They often give excuses which disrupts the program in most cases
• Low male involvement in health promotion activities like durbars and home visits. Men in this part of the world are the key decision makers in our homes yet majority of them do not participate in health promotion activities.
• Late submission of claims from the facility
• High TB treatment undesirables i.e. deaths and treatment failures
• Low reporting on weekly IDSR 1 by some facilities
• Lack of accommodation at most of our facilities thereby impacting services at night
• Lack of data collection tools-registers, maternal record booklets
• Inadequate logistics/resources for service delivery
• High teenage pregnancy in the Municipality
• Inadequate Logistics/equipment (scales, height boards, registers, etc.)

1.4.0 Summary of Key Priorities from previous year

1.4.1 HO1: Universal access to better and efficiently managed quality health care services

• Increase OPD per capita from 1.9 to 2.0 at the end of December 2023
• Conduct four (4) monitoring and supervisory visits to all Sub-municipals by the end December, 2023
• Achieve 95% completeness and 90% timeliness of data in DHIMS for the year 2023.
• Intensify home visits to help identify and manage the both Non-Communicable Diseases (NCD) and Communicable Diseases (CD) that may go undetected.
• To provide on-the-job coaching for staff on Health Promotion activities and also; carry out Radio discussion effectively.
• Carry out more medical outreach services. Organize at least 2 health screening session for staff and community members for the year 2023
• Increase family planning uptake from 30% in 2023 to 40% in 2023. Intensify health education and promotion of the use of long-term contraceptives and also encourage staff to continue the re-registration of family planning clients for the year 2023

1.4.2 HO2: Reduce avoidable maternal, adolescent and child deaths and disabilities

Revamp all adolescent health clubs in all the nine (9) sub municipal within the Municipality

• Sensitize adolescents on adolescent health issues.
• Intensify health education on maternal health issues within the district. A series of radio programs as well as community durbars were organized to sensitize the community on maternal and child health issues
• Straighten the referral system in the district to ensure prompt referrals within and outside the municipality.
• Liaise with RHD for maternal health record booklets to enhance proper record keeping practices and promote continuity care of the clients
• Encourage planning and budgeting by sub-municipals for key logistics ahead of the ensuing year to avoid shortages.
• Liaising with the Municipal and the Member of Parliament for the construction of accommodation facilities for staff
• To intensify follow-up and monitoring at all levels.
• To reactivate pregnancy schools.
• To engage community members on first-trimester registration.

1.4.2 HO2: Reduce avoidable maternal, adolescent and child deaths and disabilities

• To reduce TB undesirables from 3.8% in 2021 to 2.5% in 2022 cohort
• To ensure timely submission of weekly IDSR 1 by all reporting sites
• To achieve 95% of all EPI antigens
• To attain 100% uptake of eMTCT services among pregnant women
• To detect two (2) cases each of epidemic-prone diseases to meet national target
• Sensitize Community on COVID-19, HIV/AIDS, and other STIs. Carry out Durbars and radio talk shows on COVID-19, HIV/AIDS, and other STIs.
• Intensify EPI Services by providing Monthly Performance analysis of service indicators and feedback shared with all stakeholders within the municipality

1.5.0 Summary of Key Activities Planned and Implemented

A wide range of services were planned and implemented towards achieving the objectives of the health sector. These included: clinical services at the outpatient department, consulting rooms, laboratory, and dispensary. Also, preventive/public health which included: immunizations, case detection and notifications, antenatal, deliveries, and postnatal services as well as administration and managerial services were carried out at both health facilities and communities as well.

The key specific activities planned for the year 2023 and implemented is summarized below:

Table 3: Activities Planned and Implemented.

2.1.0 Service Delivery Performance

2.1.1 Health Status

There are three (3) major health problems in the Bolgatanga Municipality. These health conditions include Malaria, Upper Respiratory Tract Infection (URTI), and Typhoid fever. Among these three health issues of concern, Malaria has been the chief cause of OPD attendance in the Municipality. Malaria alone constituted 13.2% in 2023 of all cases seen at the OPD. Despite the numerous interventions to control malaria like the periodic Point Mass Distribution campaign activities, Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine, and Seasonal Malaria Chemo-prevention among others, the problem persists.

Moreover, Upper Respiratory tract infection (URTI) contributed to 7.9% while Typhoid fever, 6.7% of all the cases seen at the OPD. One other key disease condition to look out for is anaemia which ranks 4th on the causes of OPD attendance. It is increasingly becoming a problem and needs drastic intervention to prevent it from causing more harm.

Table 4: Top Ten (10) causes of OPD attendance, 2021 to 2023

2.1.2 Top Ten Causes of Admissions

Septicaemia, Pneumonia, and liver diseases were the three major causes of admissions within the municipality. These three (3) conditions alone accounted for 59.29% of all the top causes of admissions within the municipality for the year 2023. Most interventions should be directed towards eradicating these conditions thereby solving 59% of the causes and reducing the rate of admission in our health facilities.

Figure 2: Top Causes of Admissions 2022 and 2023

2.1.3 Top Ten Causes of Deaths

The death rate has increased by 14% (874 persons) in the year 2023. The chief causes of these deaths included septicemia, followed by pneumonia, and liver disease. Interestingly, out of a total of 17,023 admissions recorded, 63.4% were females while 36.6% were males; yet, the death toll for males was higher (56%), than for females (44%).

The under-five mortality rate has also, increased by 8.75%, and the maternal mortality ratio increased from 175/100,000 live births in 2022 to 194.9/100,000 live births in 2023 within the municipality.

2.1.3 Top Ten Causes of Deaths

The death rate has increased by 14% (874 persons) in the year 2023. The chief causes of these deaths included septicemia, followed by pneumonia, and liver disease. Interestingly, out of a total of 17,023 admissions recorded, 63.4% were females while 36.6% were males; yet, the death toll for males was higher (56%), than for females (44%).

The under-five mortality rate has also, increased by 8.75%, and the maternal mortality ratio increased from 175/100,000 live births in 2022 to 194.9/100,000 live births in 2023 within the municipality.

Figure 4: Top 10 Causes of Death

2.2.0 Outpatient Department (OPD) Services

2.2.1 Emergency service (Ambulance utilization)

The municipality has two (2) ambulances (1 for the regional hospital and the other National Ambulance). Apart from the two (2), there are also five (5) tricycle ambulances placed at selected CHPS compounds to augment referral service within the municipality.

2.2.2 OPD Attendance Clinical Care (OPD)

Data for OPD attendance is collated from the OPD register or the consulting room by records officers, nurses as well as the other cadre of staff. Below is a figure showing OPD per capita from the year 2021 to 2023.