Q&A: Krachi East District disease control officer talks maternal health on islands, malaria prevention amid late NHIS reimbursements
- On November 5, 2018
Luke Ofori Asuah is the Krachi East District disease control officer. His district lies on the eastern bank of Volta Lake and includes several island communities. Asuah spoke with People for Health (P4H) about the unique health challenges facing his district after participating in our first-ever Volta Region forum to collate citizen input into the national budget. The interview has been edited for clarity and brevity.
Tell me about yourself: who you are, where you work and the role you play on the district citizens monitoring committee (DCMC).
My name is Luke Ofori Asuah. I work as a disease control at the Krachi East Municipal Health Directorate. I am also the community-based health planning services coordinator for the municipality. As a member of the DCMC, I provide health information and play a lead role when matters of health are being discussed during meetings.
In your district, what is the most deprived health issue among the five P4H thematic health areas?
HIV and AIDS, family planning as well as maternal and child health care are the most common health problems. However, I will go for maternal and child health issues as the most widespread in the municipality.
What are the specific maternal and child health challenges?
Our municipality has 30% of about 140,000 of the population living on the islands. We do not have health facilities on the islands. This means that more than 40,000 of the population find it difficult to access health care, especially in the area of maternal health. We also have only 13 midwives in the municipality to serve a population with an expected delivery rate of 6,000 per year. You can imagine the stress. Some of the facilities we have that provide maternal health care also have very poor road networks, making them inaccessible to many people. The municipal health directorate sometimes organizes outreach programs by conveying the services of midwives and clinical nurses to island communities. It is, however, difficult to maintain such programs due to the high cost. As such, outreach interventions may only be carried out once a year. What happens when we are not there? Recently we were provided with an ambulance boat, but it is difficult to procure oil for the two-stroke engine.
How do you fund your outreach programs?
We do not generate funds as a health directorate, so we write proposals to NGOs and the assembly for support. The municipal assembly can only support as and when they receive the District AIDS Common Fund. The whole of last year we did not receive any support from the assembly. Currently, we have a big challenge when it comes to financing. We are only able to serve about 1,500 to 2,000 out of the estimated 6,000 deliveries per year due to lack of financing, so we have low coverage of antenatal care and the Expanded Programme on Immunisation. We also have not met half of our target for family planning because of the island population’s low access to health care.
What was discussed during the forum to make inputs into the national budget? Were any recommendations made?
My group discussed nutrition and malaria. Our recommendation was indoor and outdoor residual spraying alongside the use of the treated bed nets so that people who stay outside for longer hours are protected. We also discussed the issue of late reimbursement by the National Health Insurance Scheme (NHIS). This makes it impossible to procure antimalarial drugs on time.
Can you share some of your experiences with NHIS reimbursement?
In 2016, the NHIS paid just 2 months of claims to facilities in the municipality. Sometimes there are also issues of health facilities reimbursed just the drug component at the neglect of the service component, and other times vice versa. This has been the major challenge for repayment. I recommend that the NHIS ensure that in every ensuing month reimbursement for the previous month is fully paid so that health facilities can procure drugs and restock.
How will the forum impact your work at the district health management team, on the DCMC and in the municipality?
We selected pressing issues in malaria and nutrition that need attention and made recommendations. I will be glad if discussions we had here today will be reflected in the 2019 national budget. I am optimistic that what we have done today will go a long way to help the health sector in my municipality and other areas in the country.