Project

DISASTER RISK REDUCTION
Narrative Summary  

Ghana Red Cross Society (GRCS), is currently working with the most vulnerable communities in Northern and Upper East Regions on the DRR/CCA project. The key approach for the DRR/CCA project is to create awareness, develop DRR community structures and systems, build their capacities and equip them to prepare and respond to disasters. The priority, therefore, is to ensure that vulnerable communities understand their inherent risks, hazards, and vulnerabilities, and to assist them identify their capacities to be able to protect them from disaster and other emergencies. GRCS implemented the first phase of DRR project in the Northern and Upper East Regions (2014 – 2017) mainly concentrating on the community led Vulnerability and Capacity Assessment VCA process in 45 communities, to identify the community risks, hazards their capacities to address them. The phase also developed the community disaster plans and later the Community Disaster Management Frameworks for the Northern and Upper East Regions. The Frameworks were adopted by the National Disaster Management Organization (NADMO) who also supported in their preparations and are the blueprints upon which all disaster management efforts within the communities are derived from. The previous phase of the project also implemented the recommendations of the Framework in 25 communities in the Northern Region in which the DRR structures were developed and currently active.

Geographical location / map   

The first project region, the Upper East Region covers 8,842 km2, occupying only 2.5% of the country’s total landmass, and inhabited by 4% (1,046,545 persons) of the national population. It has a population density of 118.4 people per sq. km. The region is 21.0% urban with an annual urban growth rate of 4.2%. The region is located in the north-eastern corner of the country, and is characterized by savannah woodland, scattered by drought resistant trees. With low annual rainfalls, low soil fertility and seasonal floods, living conditions are overall harsh.2 Poverty incidence is at 44.4%, the third highest regional poverty rate in Ghana.The adult literacy rate for the Upper East Region is 23.0%, less than half the national average of 53.4%. The main ethnic groups in the region are the Mole-Dagbon, Grusi, Mande-Busanga and Gurma. Locally, this ethnical distribution changes, as the different groups tend to settle within different districts.

The second project region, the Northern Region is the largest of the ten regions of the country in terms of landmass, accounting with 70,300 km2 for 30% of the total land area of the country4, while inhabited by only 10% (2.86 m) of the population5. The Northern Region is the less densely populated region of the country with a population density of only 35 people per km2. With a poverty incidence of 50.4% in 2013, the region ranks second in poverty incidence amongst the ten regions of the country6. The illiteracy rate in the Northern Region is only 22%. The main ethnic groups of the region are the Mole Dagbon, the Gurma, the Akan and the Guan. The region has four paramount chiefs, namely the Yaa Na based in Yendi; the Yagbon Wura in Damango; the Bimbila Naa in Bimbila; and the Nayiri in Nalerigu, each representing a major ethnic group. The indigenous languages spoken by the people vary from Region to Region and from district to district. The most common languages are Gonja, Dagbani and Kokomba. Both region experience pocket of chieftaincy tensions occasionally resulting in killings. However, these tensions do not emanate from any of the project communities.

MATERNAL AND NEOTENAL CHILD HEALTH

Narrative Summary

Mother and Child health is since decades among the top priorities of the Ministry of Health of Ghana and the multiple efforts are slowly recording considerable improvements. The mortality rate of children under-5 years of age reduced from 155 deaths per 1’000 live births in 1990 to 60 deaths per 1,000 live births in 2014. Regional data also shows that the deprived northern regions recorded significant reduction: The Upper East Region recorded a 68% reduction from 221.8 deaths per 1’000 live births in 1990 to 72 deaths per 1’000 live births in 2014; whilst the Northern Region recorded a 50% reduction from 221.8 deaths per 1’000 live births to 111 deaths per 1’000 live births. This notwithstanding, Ghana was still short of the 2015 MDG 4 target of 40 deaths per 1,000 live births. The leading causes of under-5 mortality are since year’s malaria (28.1%), Anaemia (6.1%) asphyxia (5.9%) and pneumonia (5.6%), though mostly preventable or treatable diseases.

For the Ministry of Health, one of the biggest concern among the under-5 mortality is the near-stagnant neonatal mortality rate around 32/1’000 live births. Which again is higher in the northern regions of Ghana, where the number increases to 35 (NNSAP, 2013). In Ghana, new-born deaths contribute to 50% of all infants’ deaths. 75% of these babies will die in their first week, and 50% in the first 24 hours. The main causes for new-born mortality are infections (31%), pre-term complications (24%) and intra partum related (27%). Contributing factors are low adoption of family planning methods (25%), high total fertility rate (4.3 children per woman), high adolescent birth rate (60/100 women giving birth are teenagers), low utilization of skilled delivery (68% on average, ranging between 37.3% in Northern region and 89.75 in Greater Accra).

The picture is similar for the national maternal mortality ratio, which fell from 760 deaths per 100,000 live births in 1990 to 319 deaths per 100,000 live births in 2015. The achievements still fell far short of the MDG 5 target of 190 deaths per 100,000 live births, and far from the SDG Goal of 70 deaths per 100’000. This shows that the risk for pregnant women in Ghana is still far too high. The situation is again particularly severe in the Northern Region with an MMR of 207.3 deaths per 100’000 live births in 2016. Haemorrhage (39%) continued to be the leading direct cause of maternal deaths, followed closely by hypertensive disorders (35%), unsafe abortion, obstructed labour/ruptured uterus, ectopic pregnancy and sepsis. The high haemorrhage is attributed to lack of facilities to store blood to facilitate blood transfusion in time of excessive bleeding during labour and or after labour. Also, lack of HB testing facilities in some hospitals, health centres and CHPS compounds leading to women having to seek testing services elsewhere without feedback to the requesting facilities. This makes it very difficult for midwives to know the HB levels of pregnant mothers before/during labour. Additionally, some women are required to make payment for the testing in private laboratories and this has the potential to reduce the number of pregnant women tested at ANC registration[. Mothers who deliver at remote facilities are always at danger of losing their lives through bleeding due to the above factors coupled of lack of regular transport system to facilitate referrals.

SRC’s presence and experience in the area of intervention


Map showing SRC intervention – themes and regions

In Ghana, the SRC in partnership with the GRCS is present in both project regions. In the NR, GRCS is running an eye health project ECS (2005-20) in close partnership with GHS and National Eye Care Unit NECU and in collaboration with Ghana Education Services across the region. The over 10 years’ experience in eye health project delivery with partner organisations gives the niche in quality project management and community health care and community mobilization in the Northern Region. A disaster risk reduction project DRR (2014-17 with new phase 2018-20) is implemented in both NR and UER region in collaboration with Regional and District Directorates of National Disaster Management Organisation (NADMO). The DRR intervention in the NR started earlier and is thus further advanced than in the UER. The actual MNCH is implemented in the UER, (2014-17) which with this new phase (2018-20) will also be expanded to NR. The DRR project started in the UER in some of the existing MNCH communities. Similarly, some of the DRR communities in the NR may differ from the MNCH communities due to possible differences in selection criteria that will be used in selecting beneficiary communities. Through the EHS project, the GRCS is present in the whole of NR and the actual DRR and upcoming MNCH communities in this region will see an overlapping activities with eye health community sensitization and screening activities in some of the communities. Two of the MNCH beneficiary districts (Kpandai and Zabzugu) in the NR do not have DRR intervention.

The experiences gained from the MNCH project in UER will guide the MNCH intervention in the NR and the two regional branches are already collaborating. The SRC in the recent past supported also a Cholera and Ebola Preparedness project nationwide and Cerebrospinal Meningitis (Response/Preparedness project) in the NR and UER. GRCS has gained considerable experience through the two projects where nationwide collaboration between all branches was crucial and where thousands of Red Cross volunteers have increased their knowledge in disease transmission, hygiene, behaviour change, communication strategies and community mobilization. The interactive radio discussion and social mobilisation approaches of this MNCH project for example, were influenced by these experiences and will be adapted to the new project.

Geographical location / map


Map of UER showing SRC intervention districts and projects

Map of NR showing SRC intervention districts and projects

The upcoming program phase will continue offering MNCH services in the four districts of the Upper East Region covered through the current program (Binduri, Nabdam, Bongo, Kassena-Nankana Municipal), and expand into two additional districts (Pusiga, Talensi). In addition to the two new districts in Upper East, four districts in the Northern Region will be added to the programme (Zabzugu-Tatale, West Gonja, West Mamprusi and Kpandai): The choice of the project districts were made during stakeholders’ meetings, planning meetings and engagement with the health authorities at both regional and district levels in the UER and NR. The Regional Directors of GHS in the two regions and District Directors of the selected districts made strong case for support based on the prevailing needs listed under 3.2 as the reasons for the support. The districts were selected by GHS and GRCS because they were classified as having highest hunger and poverty levels, longest distance travel (intra), worst roads and unreliable transportation systems in accessing health services as well as their susceptibility to natural disasters. As per GRCS strategy/principle, the interventions will continue to target most deprived communities and individuals. The key target groups will be mothers and children with extra emphasis on prenatal, childbirth and postnatal stages to enhance their survival and wellbeing.

In the previous project phase (2014-17), 10 communities were selected in each (4) district for project implementation. The ratio of 10 communities per district will be maintained for the new phase (2018-2020) and implementation will take place in total 120 communities in 10 districts:

  • 40 “existing” + 20 “new” communities in 4 “existing” districts of the UER which are already part of the program in its current phase
  • 20 “new” communities in 2 “new” districts in the UER
  • 40 “new” communities in 4 “new” districts in the NR

EYE HEALTH

Executive Summary

Eye health problems are high among the priority health needs of the people living in Ghana. According to a recent Blindness and Visual Impairment Study the prevalence of blindness in Ghana is 0.74% and 1.07% of the population has severe visual impairment. A large proportion of those with low vision (88.9%) and blindness (67.7%) are due to avoidable causes. The SRC started supporting eye care services in Ghana in collaboration with the Ministry of Health (MOH), Ghana Health Services (GHS) and Ghana Red Cross Society (GRCS) in 1991 expanding these services to the Upper West, the Brong-Ahafo and the Northern Region. It has offered outpatient department and community outreach attendance, school screenings and surgical operations and made significant impact on the eye health of the ordinary citizen of the Northern part of Ghana, considered as one of the poorest.

Project Context

Ghana is a democratic state and covers a land area of 238,000km2 and is host to an estimated population of 28’3 million people of which about 51% reside in urban centres. The country is divided into 10 Administrative Regions and operates a decentralized administrative system with 216 Districts.

Ghana Country Map

Ghana is endowed with a variety of natural resources which include gold, bauxite, manganese, limestone, timber, and oil and gas. The economy of Ghana depends largely on rain-fed agriculture, employing over 60% of the labour force mainly in subsistence agriculture. However, services and oil and gas sectors have emerged in recent times as economic forces. Ghana’s economy growth has steadily increased by 7% per year on average since 2005 and it is considered as a Lower Middle Income Country since 2010 and due to the discovery of offshore oil reserves, per capita growth in the country has remained relatively high. Despite the growth recorded, inequality has been increasing in the country and poverty remains prevalent in many areas. Households in urban areas continue to have a much lower average rate of poverty than those in rural areas (10.6% versus 37.9%). The gap between urban and rural areas has doubled – rural poverty is now almost 4 times as high as urban poverty compared to twice as high in the 1990s.

The Northern Region, the actual project region, is the largest of the ten regions of the country, accounting for 30% of the total land area of the country and has 2.86 m inhabitants (10 % of the total of Ghana’s 28.3 m population[). With a poverty incidence of 50.4% in 2013, it ranks as second region in poverty incidence of the country. Climatically, religiously, linguistically, and culturally, the region differs greatly from the politically and economically dominating regions of central and southern Ghana. The region has four paramount chiefs, (the Yaa Na, Yagbon Wura, Bimbila Naa and the Nayiri), each representing a major ethnic group. The main ethnic groups of the region are the Mole Dagbon (52%), the Gurma, (22%), and the Akan and the Guan (9%). There are no ethnic conflicts between these groups; when conflicts arise, these are usually disputes related to chieftaincy and land rights. The indigenous languages spoken by the people vary from district to district. With only 22 % of the population of 15 years and older classified as literate, the literacy rate in the Northern Region is low, with strong differences between districts.

While public health expenditure as percentage of GDP in Ghana has risen from 1.6% in 1990 to 3.8% in 2010, expenditure has now fallen to 2.1% in 2014. With this level of spending, Ghana belongs to the group of 20 countries in Africa with the lowest percentage of health per GDP expenditure, having reduced human and material resources available for the health sector. Ghana has an average of one physician per 10,000 people, lying beyond the lowest category of “low human development countries” (1.8), developing countries (10.3), sub-Saharan Africa (1.9) and the group of least developed countries.

Location of the Project

The Eye care program will cover all 14 district hospitals and their respective catchment areas in the whole Northern Region of Ghana. The program phase 2017-2020 will continue to support service delivery in 10 facilities (for OPD and surgical services) and districts (for outreach, screening and sensitization) established in earlier program phases (Bole, Damango, West Hospital Tamale, Walewale, Gambanga, Guschiegu, Yendi, Zabzugu, Bambila, Kpandae) and add new facilities (the district hospitals of Salaga, Savelugu and Saboba as well as the Tamale Central Hospital (TCH)) and their respective catchment areas. The following map shows the hospitals supported by the program, whereby new hospitals are marked in green


Location of hospitals in the Northern Region supported in the program phase 2017-2020 Equipment of 10 facilities in the past 2010-2016 (yellow), Equipment of 4 new facilities in this
project cycle (green). All 14 facilities will be supported during project
cycle (green+yellow)  

Beneficiaries

The Northern Region has a total population of 2.86 m, out of which specific sub-sectors will benefit from the different services of the programme:

  • 120.000 people as beneficiaries of community outreach activities
  • 175.000 school children as beneficiaries of school screening activities
  • 44,100 school children treated with drugs during eye health camps
  • 1,650 children provided with subsidized spectacles
  • 65,800 people reached through OPD services
  • 6.300 beneficiaries of subsidized cataract surgeries, (4,250 pro-poor patients).

140,000 people reached with eye health messages via radio programs