Puta, Chilunga
Resolving the Denominator Dilemma within the Ghana Health Service
The generation of some of the service indicators depends on the use of population data. This population data is derived from the census published by the Ghana Statistical Service (GSS). The age groups population data from the population census is often used as the denominator in generating some of the service coverage indicators.
From the 2000 census and now the latest 2010 census for Ghana, the use of the age group segments as provided by the GSS results in generation of coverage often above 100% especially for the EPI.
To address this anomaly the EPI programme from data gathered from the various NIDs started using 4% as the proportion for the children less than one year and by extension expected pregnancy for all the Regions to generate the coverage indicators. This results in acceptable coverage figures below 100%. It however also results in some very low figures for some districts whose under one population was far below the 4% that was used.
From the recent census of Ghana, the average proportion of children less than one year out of the total population was given as 3.1%. It however ranges from 2.7 to 3.2. Using these proportions for children less than one year give Penta 3 coverage ranging from 121% to 96%, although in the various districts you will from coverage surveys find children who have not been vaccinated.
From the recent NID, (2010 and 2014) the proportions for the regions are higher than from the 2010 census, using these proportions also give more realistic coverage.
A decision was made by GHS to use the 4% and going forward the Ghana Health Service-Policy Planning Monitoring and Evaluation Division is implementing the DHIS2 e-Tracker as a child (immunization and growth promotion) and mother (ANC delivery, PNC and FP) registry for Child and Maternal Health Services. The e-Tracker does the following and is currently deployed in some districts in Ghana:
· Collect transactional data - set up automated aggregation queries - populate the aggregated data warehouse directly - all in one system!
· Enrol individuals into longitudinal and chronic programs - schedule visits - set up automated SMS reminders - track missed appointments - improve retention.
· Define your own programs with stages - decide what to collect at each stage - all through the user interface.
· Generate daily or weekly visit schedules (work plans) for your facility or community health workers.
· Tools for tracking and following up children and mothers who do not come to scheduled visits.
· Set up detailed maternal or neonatal death audits - analyse your data using the tabular reports with both case-based data and ad-hoc aggregation.
· Collect data using mobile phones - online in web browser or offline with java clients
The results we are getting are interesting as children registered so far in the phase one districts are more than what the Ghana Statistical Service have published , we are documenting all this and the service can then make a strong case to local and political authorities to resolve the denominator dilemma.
Dominic K Atweam