CHAPTER SIX
Date - 14/Sep/2016
CHAPTER SIX
6.0. Social Services
6.1. Education
6.1.1. Number of Schools
The Nandom District currently has a total of 107 schools comprising of 38 pre-schools, 36 primary schools,27 Junior High Schools, 2 vocational and technical schools and 2 Senior High Schools. A midwifery training school has newly been established in the district. The Table below presents the number of educational institutions in the district by their levels and ownership.
Table 16: Educational Institutions in Nandom District
| Level of Education | Number of Schools | |
|---|---|---|
| Type of School | 2012 | 2013 |
| Kindergarten | ||
| Public | 35 | 36 |
| Private | 2 | 2 |
| Total | 37 | 38 |
| Primary | ||
| Public | 34 | 34 |
| Private | 1 | 2 |
| Total | 35 | 36 |
| Junior High School | ||
| Public | 26 | 26 |
| Private | 0 | 1 |
| Total | 26 | 27 |
| Technical & Vocational | ||
| Public | 2 | 2 |
| Private | 2 | 2 |
| Total | 4 | 4 |
| Senior High School | ||
| Public | 2 | 2 |
| Grant Total | 104 | 107 |
Source: Nandom District GES
From the table it is evident the District has about 107 educational institutions for a projected child population of 17,172 (2013). Clearly more classrooms are needed to accommodate the increasing number children of school-going age. The provision of more classrooms will create a sound environment for teaching and learning which will impact positively on the performance of students in their exams.
6.1.2. Enrolment and Teaching Staff Situations
Total enrolment in the district is currently 18,899 pupils consisting of 3,704 Pre-School students, 8,454 Primary students, 3,777 Junior High students, 1,450 Senior High students and 1,520 Technical/Vocational students. Administratively, enrolment in the Nandom Central circuit is about twice that of any of the remaining four circuits with 6,812 students. The enrolment levels in the various levels of education in the district are summarized in Table 18
Table 17: Education Enrolment
| Name of Circuit | TYPE OF INSTITUTION | |||||
|---|---|---|---|---|---|---|
| Type of School | Pre -School | Primary School | JHS | SHS | TVET | TOTAL |
| Nandom Central | 1005 | 2561 | 1101 | 700 | 1445 | 6,812 |
| Nandom North | 749 | 1263 | 389 | - | - | 2401 |
| Nandom South | 480 | 1374 | 820 | 750 | 75 | 3,499 |
| Nandom West | 914 | 2112 | 737 | - | - | 3,763 |
| Puffien | 556 | 1144 | 724 | - | - | 2424 |
| Total | 3704 | 8454 | 3771 | 1,450 | 1,520 | 18,899 |
Source GES Nandom
The Current Enrolment in The Basic Schools Has Shown a remarkable improvement as from 2012 to 2014.This is attributed to government interventions including the School Feeding Programme, Capitation Grant, Free exercise books uniforms together with the efforts of some development partners. The GER for Primary Schools as at 2011/2012 was87% and an increase to 99.3% in 2013. Gender Parity Index shows an increase from the previous years. This stands at 1:1.02 indication that, there are slightly more girls in School over the period than their male counterparts (Source GES Nandom District).
6.1.3. Gross School Enrolment, Completion and Transition Rates
Table 19: Gross School Enrolment, Completion and Transition Rates
| Indicator | 2011/12 | 2012/13 | 2013/14 |
|---|---|---|---|
| Gross Enrolment Rate | 90.70 | 90.20 | 97.70 |
| JHS Completion Rate | 60.7 | 72.3 | 72.10 |
| SHS Completion Rate | 92.0 | 92.7 | 84.5 |
| Transition rate from Primary to JHS | 98.90 | 96.1 | 108.50 |
| Transition rate from JHS to SHS | 49.40 | 62.00 |
Source: GES-Nandom
6.1.4. District Teaching Staff situation
Table 20: District Teaching Staff situation
| LEVEL | 20012/13 | ||
|---|---|---|---|
| Trained | Untrained | Total | |
| Pre-School | 6 | 68 | 74 |
| Primary | 124 | 45 | 169 |
| JHS | 78 | 35 | 103 |
| TVET | 23 | 17 | 40 |
| SHS | 57 | 23 | 80 |
| Grand Total | 288 | 188 | 466 |
6.1.5. Teaching and Learning Materials
Table 21: Teaching and Learning Materials
| LEVEL | 20012/13 | ||
|---|---|---|---|
| Classrooms | Furniture | Text Books | |
| Pre-School | 76 | 1000 | Nil |
| Primary | 274 | 3500 | 1:2 |
| JHS | 75 | 2000 | 1:3 |
| TVET | 15 | 1400 | Not available |
| SHS | 30 | 800 | 2:1 |
| Grand Total | 470 | 8700 |
6.1.6. Information and Communication Technology (ICT)
Being a largely rural district, knowledge in Information Communication Technology is limited in the Nandom District. The district can boast of an ICT infrastructure at the Nandom town and a yet to be completed ICT centre at Baseble. There are no commercial internet cafe facilities. Schools and communities lack ICT centres.
However, with the existence of telecommunication networks, many people access the internet using their phones. The major challenge still has to do with the application of ICT in manufacturing and service provision. Efforts are therefore required to deepen ICT knowledge in the district, especially in hardware, and software development and its application.
6.2. Health
6.2.1. Health Infrastructure
The District Health Administration serves at the highest implementing agency and the headship of the Ghana Health Services in the District. The District is zoned into 5 Sub-Districts which offers comprehensive Public Health Services.
All of the 5 sub-Districts are being served by 4 Health Centres and one polyclinic. The St. Theresa’s hospital is a CHAG institution which serves as the District hospital.
With the inauguration of the CHPs concept to enhance access to health care services, the District has six (6) CHPS compounds in operation.
There are 108 trained TBAs, 81 community based surveillance volunteers and 178 CBAs. There are 8 chemical sellers in the District predominantly located at the urban points and a private maternity home located in Nandom.
Health service is made accessible to the population through 6 static health facilities and 59 outreach points.
6.2.2. Health Staff Situation
It is an undisputable fact that human resource is the single most valuable resource in the health sector which also accounts for the greatest engagement of health sector funds. The health human resource situation in the district is a real concern. The challenges range from inadequate staff, inequitable distribution of staff especially to the deprived areas and staff retention.
The human resources situation in the district can be aptly described as inadequate for all cadres of health staff but inexcusably critical for critical clinical staff all through the stages of service delivery points in the district.
The role of midwives as a single category in improving the health indicators and attaining the MDGs 4 and 5 cannot be over emphasized. The need to post midwives to hospitals, health centres and reproductive health services points is frustrated due to the inadequacies in their numbers which therefore compromises the efforts to provide quality reproductive health services.
The Situation of the Medical Doctors is far more bizarre. The entire District made up of one hospital as at the time of compilation of this report has no resident doctor.
The situation is not different for the general nurses and other professional categories. That of the general nurses is virtually threatening the provision of 24 hours services especially at the referral hospital. One other intriguing situation is that a gross of the available staff especially the midwives are aged 50 years and above.
The current situation has led to the engagement of locum services and the reliance on health extension workers of the National Youth Employment Programme to assist the professional nurses to salvage the situation.
The DA, in collaboration with health sector management is putting in every effort to attract and retain health professionals including the offer of sponsorship. Lobbying is an alternative that is currently being explored with relevant stakeholders.
A clearer picture of the deficiencies in the numbers is captured in the table below:
Table 22: Staff Norm for Nandom Hospital/DHA/Sub-District/CHPS (2013)
| Category | Nandom Hospital | DHA/Sub-District/CHPS | |||||
|---|---|---|---|---|---|---|---|
| Norm | # at Post | Deficit | Norm | # at Post | Deficit | Total Deficit | |
| Medical Officer | 2 | 0 | 0 | 0 | - | - | 0 |
| Midwives | 16 | 5 | 11 | 16 | 5 | 11 | 22 |
| General Nurses | 30 | 34 | +3 | - | - | - | 38 |
| Laboratory Technologist | 2 | 1 | 1 | - | - | - | 2 |
| Medical Assistant | 5 | 1 | 4 | 8 | 2 | 6 | 10 |
| X-Ray Technician | 2 | 1 | 1 | - | - | - | 3 |
| Lab. Technician | 3 | 0 | 3 | - | - | - | 6 |
| Theatre Nurse | 2 | 1 | 1 | - | - | - | 3 |
| Ophthalmic Nurse | 2 | 1 | 1 | - | - | - | 2 |
| Dispensing Technicians | 5 | 1 | 4 | 10 | 0 | 10 | 16 |
| Anesthetist | 2 | 1 | 1 | - | - | - | 2 |
| Public Health Nurse | 1 | - | - | 4 | 2 | 2 | 4 |
| Dental Technologist | 1 | 1 | 1 | - | - | - | 2 |
| Blood Donor Organizer | 2 | 1 | 1 | - | - | - | 3 |
| Technical Officer (Nut) | - | - | - | 11 | 2 | 9 | 9 |
| Field Technicians | - | - | - | 11 | 2 | 9 | 9 |
Source: District Health Directorate, 2014
Assessing the magnitude of this problem, there is the need for a concerted effort to resolve the problem. There is the need to institute a more sustained sponsorship scheme in the district to cater for middle level man power training. Some incentive package should also be instituted to attract and retain medical doctors and other high level medical professionals. One other factor is the suitable environment such as staff accommodation, availability of essential logistics and a good working environment.
6.2.4. Top Ten Causes of Morbidity
1.3.6.2.4.1. Disease Burden of Nandom District
The disease burden of the District is summarily displayed in the table below. The table encapsulates Out- Patient attendance for a three year period. It is worth of note that the table captures institutional attendance. All other medications and ailments not reported to health facilities in the district are not captured.
| 2011 | 2012 | 2013 | ||||||
|---|---|---|---|---|---|---|---|---|
| Disease | Total Cases | % | Disease | Total Cases | % | Disease | Total Cases | % |
| Malaria | 25618 | 34.5 | Malaria | 34323 | 43.9 | Malaria | 35801 | 47.3 |
| Rheumatism & Joint Pains | 5208 | 7.0 | Acute Resp. Tract Infection | 5352 | 6.8 | Acute Resp. Tract Infection | 22 | 11.8 |
| Skin Diseases & Ulcers | 4742 | 6.4 | Skin Diseases & Ulcers | 3896 | 4.9 | Rheumatism & Joint Pains | 3738 | 4.9 |
| Acute Respiratory Tract Infection | 4457 | 6.0 | Rheumatism & Other Joint Pains | 3333 | 4.3 | Skin Diseases & Ulcers | 3624 | 4.8 |
| Acute Urinary Tract Infection | 2876 | 3.9 | Acute Urinary Tract Infection | 3322 | 4.3 | Acute Eye Infection | 2859 | 3.8 |
| Acute Eye Infection | 2704 | 3.6 | Acute Eye Infection | 2369 | 3.0 | Acute Urinary Tract Infection | 2410 | 3.2 |
| Pneumonia | 1962 | 2.6 | Diarrhoea Diseases | 2354 | 3.0 | Diarrhoea Diseases | 1807 | 2.4 |
| Diarrhoea Disease | 1831 | 2.4 | Pneumonia | 1787 | 2.3 | Acute Ear Infection | 1308 | 1.7 |
| Hypertension | 1534 | 2.1 | Hypertension | 1252 | 1.6 | Hypertension | 1282 | 1.7 |
| Intestinal Worms | 1049 | 1.4 | Acute Ear Infection | 988 | 1.3 | Intestinal Worms | 1132 | 1.5 |
| All other Conditions | 22233 | 29.9 | All other Conditions | 19181 | 24.5 | All other Conditions | 12787 | 16.9 |
| Total Conditions | 74214 | 100 | Total Conditions | 78157 | 100 | Total Conditions | 75638 | 100 |
Source: Nandom District Health Directorate (2014)
As indicated in the table, malaria has been the main cause of OPD attendance followed by URTI, skin diseases, eye infection and pneumonia over the period under review. The contribution of malaria cases in total OPD attendance increased from 43.9% in 2012 to 47.3% in 2013. Despite numerous interventions, the relativity and absolute attendance are increasing. The interface remains that the interventions are either not effective or there are other factors such as syptomic diagnoses or the enhanced access to health care as a result of the NHIS. Skin diseases, Acute Eye Infection, Pneumonia, Hypertension and Diarrhoea have maintained their positions over the period, hence, continued to be regular conditions among the top 10 causes of OPD attendances.
6.2.4.2. Other Diseases of Public Health Importance
The focus of this sub-section is to examine the HIV/AIDS and Tuberculosis situation in the District. The choice is compelled by the public health importance attached to these ailments. They have very debilitating effects on the populace.
Table25: District HIV/AIDS Situation
| CLINICAL CASES | NANDOM DISTRICT | ||||
|---|---|---|---|---|---|
| 2009 | 2010 | 2011 | 2012 | 2013 | |
| Screened | 106 | 831 | 155 | 457 | 543 |
| Positive | 34 | 149 | 27 | 44 | 88 |
| Prevalent Rate | 32.1 | 18 | 17.4 | 9.6 | 16.2 |
| DONORS | 4457 | 6.0 | Rheumatism & Other Joint Pains | 3333 | 4.3 |
| Screened | 453 | 1340 | 1510 | 2496 | |
| Positive Cases | 63 | 165 | 223 | 465 | |
| Prevalent Rate | 13.9 | 12.0 | 14.7 | 18.6 |
The distinction between donor prevalence and clinical prevalence is very necessary because the donor prevalence is more of an indication of the prevalence in the District.Clinical cases are suspect cases screened from those who are present at health facilities with clinical signs.This does not represent the prevalence rate of HIV in the District. However, this rate is a cause for concern and interventions are being scaled up to tackle the situation.
It is also worthy of note from the relevant statistics that, the prevalence is more dominant among the age bracket 15-44. This has a telling implication on productivity in the District as this group also forms the productive age. The effect on the further transmission of the disease is high because the group is also the most sexually active among the populace.
6.2.4.3. Key Health Sector Problems
- High maternal, neonatal and still birth rate
- Increasing burden of communicable and non-communicable diseases
- Staff attitude and indiscipline
- Accommodation for both office and staff
- Basic office furniture and equipment
- Office consumables are more pressing
- No toilet facility in Ketuo Health Centre
- Deteriorating facilities eg. Tuopare, Baseble, Puffien
- Gap in construction of CHPS compounds to meet MDG 2015
- One completed CHPS compound at Tom but not launched
- Two CHPS compounds not furnished at Sonne and Tankyara
- Lack of funds from central government to support programs
- Nandom Hospital needs an emergency ward
- An inadequate number of key staff in the hospital eg. Doctors, Physician Assistant, midwives Dispensary tech.
- No electricity and water at the permanent Midwifery Training site
The water and sanitation sector is one of the focal areas of the Nandom District Assembly. The goal of the District in this area is to provide improved access to potable water and decent sanitation service in the District with the view to ultimately achieving an improved health status of the people.
6.3.1. Water
Currently, there is one (1) mechanized small town water systems in Nandom, the district capital. There are also 452 boreholes in the District out of which 39 are for schools and clinics, 29 are private and used privately, 19 are low yielding and hardly produce water during the dry season and 24 of them are bad wells and cannot produce potable water. Thirty nine (39) of these are also in Nandom.
The District based on the available functioning water facilities has calculated water coverage of 87%. It is the intension of the Nandom District to attain a hundred percent water coverage. This will be achieved by drilling more boreholes and construction of smaller town water supply systems.
| Source | Total | % | Urban | Rural |
|---|---|---|---|---|
| Total | 8,551 | 100 | 100 | 100 |
| Pipe-borne | 1,796 | 21 | 64.7 | 12.2 |
| Bore-hole/Pump/Tube well | 6,165 | 72.1 | 30.7 | 80.6 |
| Protected well | 265 | 3.1 | 3.4 | 3.1 |
| Rain water | 0 | 0.0 | 0.0 | 0.0 |
| Protected spring | 17 | 0.2 | 0.2 | 0.2 |
| Bottled water | 2 | 0.0 | 0.1 | 0.0 |
| Satchet water | 2 | 0.0 | 0.0 | 0.0 |
| Tanker supply/Vendor provided | 9 | 0.1 | 0.0 | 0.1 |
| Unprotected well | 162 | 1.9 | 0.3 | 2.2 |
| Unprotected spring | 9 | 0.1 | 0.0 | 0.1 |
| River/Stream | 1.3 | 1.2 | 0.6 | 0.6 |
| Dugout/Pond/Lake/Dam/Canal | 9 | 0.1 | 0.0 | 0.0 |
| Other | 0 | 0.0 | 0.0 | 0.0 |
Source: GSS-Nandom District (2014)
Currently, plans are in place to construct a small town water system in Ko and Zimuopareand expand the Nandom Town water system. Several other projects including Global Water initiative by CRS and CARE International, Japan Embassy Water Project and the GoG Priority Water Project have all contributed to the drilling of boreholes and also rehabilitation of malfunctioning ones. With the proposed drilling of new additional boreholes under the Sustainable Rural Water and Sanitation Project, the water situation in the District will be further improved.
Though the water coverage looks remarkable, much is still expected since people still scramble for water in most communities especially in the dry season. Several other new settlements have no access to potable water. This emanates from the fact that, the settlement pattern is dispersed whiles other water facilities have become dysfunctional. Drying up of borehole especially during the dry season also accounts for the inadequacy of potable water.
6.3.2. Sanitation
The District has a sanitation coverage of just 47% which underscores the high incidence of open defecation and the occurrence of waste (excreta) related diseases in the District. Of the ten top causes of OPD attendance, a good number are sanitation related illnesses.
There are 132 public KVIP/institutional latrines. Out of a total of 8,551 households in the District, only 2,052 households have household latrines representing 24%. About 6,071 households practice open defecation, whilst the rest of the population is supposed to be served by the 132 public latrines.
Table 27: Toilet facility used by household
| Facility | Total | % | Urban | Rural |
|---|---|---|---|---|
| Total | 8,551 | 100 | 1,454 | 7,097 |
| No facilities (Open defecation) | 6,071 | 71 | 658 | 5,803 |
| W.C. | 171 | 2 | 84 | 79 |
| Pit latrine | 1,283 | 15 | 181 | 1,138 |
| KVIP | 7 | 599 | 341 | 257 |
| Bucket/Pan | 9 | 0.1 | - | 5 |
| Public toilet (WCKVIPPitPanetc) | 428 | 5 | 183 | 294 |
| Other | 17 | 0.2 | 2 | 13 |
Source: GSS-Nandom District (2014)
Source: GSS-Nandom District (2014)
Maintenance of public toilets in the District is nothing to write home about. The toilets mostly get so filthy that, community members can no more access them resulting in majority of them resorting to open defecation. Mechanisms such as hiring of conservatory labourers to take care of the toilets has become cumbersome as people refuse to take up such jobs because of social ridicule from family members and the general public.
The District Assembly at a point in time hired out the facilities to be run by private individuals who will clean the toilets and take care of them. The token that people are to pay drives them away, resulting in the usage of the bush. There is therefore the need to encourage community-led sanitation practices to sensitize people on the need to provide and use household latrines. The construction of household latrines will eliminate the difficulties in managing public latrines and indiscriminate disposal of human excreta in the District.