DEDICATION
This report
is dedicated to the Almighty God for His care and protection bestowed on me
throughout the period of attachment, to my family for their love and care, to
the members of staff of the Tumu district health administration especially
those at the accounts department for their patience and friendliness towards me
during my period of attachment, they actually made me feel as if I was one of
them. To my special mentor the principal accountant of the hospital, to my
friends and all those who contributed to the development of this report.
ACKNOWLEDGEMENT
I give glory
and honor to God Almighty for His protection, guidance and bountiful blessings
bestowed upon me throughout the period of attachment. My Sincere gratitude and appreciation goes to
the district medical director, the hospital administrator, the principal
accountant and the staff of the accounts department for their support.
A word of
appreciation also goes to the university authority for their invaluable support
and the opportunity given to me to go through this exercise.
PREFACE
This report
presents an account of a compulsory supervised industrial attachment at the
sissala east district health administration in Tumu . It covers the
introduction and main objectives underlying the implementation of the
compulsory supervised industrial attachment program for students.
The report
also seeks to highlight on the background of the Ghana health service, the
sissala east district hospital and the services rendered by the hospital as
well as the various activities carried out in the unit I was assigned to during
the period of the attachment. The
objectives and conclusions are not left out.
APPENDIX1:
ACRONYMS
GHS: Ghana Health Service
GoG: Government of Ghana
DHA: District Health Administration
TDH: Tumu District Hospital
PHO: Public Health Officer
CHN: Community Health Nurse
ACCT: Accounts
HRD: Human Resource Department
PROC: Procuremnt Officer
PNO: Principal Nursing Officer
LAB: Laboratory
TECH: Technician
DISP: Dispensary
DHMT: District Health Management Team
NHIS: National Health Insurance Scheme
NHIA: National Health Insurance Authority
ATF: Accounts, Treasury and Finance
BMC: Budget Management Centre
RHA: Regional Health Administration
CONTENT
DEDICATION
ACKNOWLEDGEMENT
PREFACE
APPNDIX1
CHAPTER ONE
Introduction
Objectives
of the industrial attachment
CHAPTER TWO
2.0
BACKGROUND TO GHANA HEALTH SERVICE
2.1
INTRODUCTION
2.2
RATIONALE FOR THE ESTABLISHMENT OF GHS
2.3 MANDATE
OF GHS
2.4
OBJECTIVES OF GHS
2.5
FUNCTIONS OF GHS
2.6
ORGANISATIONAL STRUCTURE OF GHS
CHAPTER THREE
3.0 HISTORY
OF THE SISSALA EAST DISTRICT HEALTH ADMINISTRATION
3.1
INTRODUCTION
3.2
SOCIO-CULTURAL
3.3
SOCIO-ECONOMIC ACTIVITIES
3.4
EDUCATION
3.5
COMMUNICATION
3.6
ELECTRICITY / POWER SUPPLY
3.7 WATER
3.8
POPULATION INDICES
3.9 MISSION
STATEMENT
3.10 VISION
STATEMENT
3.11
OBJECTIVES
CHAPTER FOUR
4.0 WORK
SCHEDULE AND ACTIVITIES
4.1WORK
SCHEDULE
4.2DESCRIPTION
OF MAJOR ACTIVITIES UNDERTAKEN
CHAPTER FIVE
5.0
KNOWLEDGE ACQUIRED, RECOMMENDATIONS AND CONCLUSION
5.1
KNOWLEDGE ACQUIRED
5.2
RECOMMENDATIONS
5.3
CONCLUSION
CHAPTER ONE
1.1 INTRODUCTION
Practical
training in industry (company, private co-operations and establishment) is an
essential component of the course structure in the University for Development
Studies. During this period, students
acquire additional practical experience to complement their course of study in
the University. The students are also exposed
to the world of work and experiences to prepare them for their future careers.
1.2 OBJECTIVES OF THE
INDUSTRIAL ATTACHMENT
1. To assess
the interest of the students in the occupation he or she plans to take.
2. To
provide the student an opportunity to apply his or her knowledge in real world
situation thereby bridging the gap between the University`s work and the actual
practice.
3. To expose
the students to work methods not taught in the University and provide access to
product equipment not normally available in the University environment.
4. To make a
transition from school to the world of work career and to enhance students
contact for job placement.
5. To
enhance industries’ satisfaction with graduates of the University.
6. To enlist
and strengthen employers involvement in institutional activities and in the
entire educational process if preparing the students for employment in
industries.
CHAPTER TWO
2.0 BACKGROUND TO GHANA
HEALTH SERVICE
2.1 INTRODUCTION
The Ghana
Health Service (GHS) is a Public Service body established under Act 525 of 1996
as required by the 1992 constitution. It is an autonomous Executive Agency
responsible for implementation of national policies under the control of the
Minister for Health through its governing Council - the Ghana Health Service
Council.
2.2 RATIONALE FOR THE
ESTABLISHMENT OF GHS
As an
essential part of key strategies identified in the Health Sector Reform process
outlined in the Medium Term Health Strategy (MTHS) which are necessary steps in
establishing a more equitable, efficient, accessible and responsive health care
system, the GHS was established. The reform builds on the reorganization of the MOH that began
in 1993, which was explicitly designed to set the scene for the establishment
of the Ghana Health Service. The reforms
also provide a sound organizational framework for the growing degree of
managerial responsibility that has already been delegated to districts and
hospitals. Themes that were central to
the reorganization of 1993 remain important today for the Ghana Health Service:
careful stewardship of scare resources, clear lines of responsibility and
control, decentralization, and accountability for performance rather than
inputs.
2.3 MANDATE OF GHS
The mandate
of GHS is to provide and prudently manage comprehensive and accessible health
service with special emphasis on primary health care at regional, district and
sub-district levels in accordance with approved national policies
2.4 OBJECTIVES OF GHS
The objects
of the Service are to:
· Implement approved national policies
for health delivery in the country.
· Increase access to good quality
health services.
· Manage prudently resources available
for the provision of the health services.
2.5 FUNCTIONS OF GHS
GHS performs
the following functions amongst others:
·
Provide
comprehensive health services at all levels directly and by contracting out to
other agencies. As part of this function, the GHS will:
·
Develop
appropriate strategies and set technical guidelines to achieve national policy
goals/objectives
·
Undertake
management and administration of the overall health resources within the
service
·
Promote
healthy mode of living and good health habits by people
·
Establish
effective mechanism for disease surveillance, prevention and control
·
Determine
charges for health services with the approval of the Minister of Health
·
Provide
in-service training and continuing education
·
Perform
any other functions relevant to the promotion, protection and restoration of
health.
2.6 ORGANISATIONAL
STRUCTURE OF GHS
GHS is
administratively organized at 3 levels:
v National level
v Regional level
v District Level
2.6.1 ADMINISTRATIVE
LEVEL STRUCTURES
National
Level
I.
Ghana Health
Service Council
II.
Office of the
Director General and Deputy Director General
III.
Eight National
Divisional Directors
Regional
Level
I.
Regions are
headed by 10 Regional Directors of Health Services
II.
Supported by
Regional Health Management Teams
III.
Regional Health
Committees
Districts
Level
I.
All 110 districts
are headed by District Directors of Health Services
II.
Supported by the
District Health Management Teams
III.
District Health
Committees
IV.
Sub District
Health Management Teams
2.6.2
GOVERNANCE OF GHANA HEALTH SERVICE
GHS
is governed by a 12-member Council-The Ghana Health Service Council.
Its
functions are:
I.
Ensure the
implementation of the functions of the Service
II.
Submit to the
Minister recommendations for health care delivery policies and programmes
III.
Promote
collaboration between the Ministry of Health, Teaching Hospitals and the
Service
IV.
Advise the
Minister on posts in the Service and other matters that the Minister may
request
2.6.3 BUDGET
MANAGEMENT CENTRES OR COST CENTRES OF THE GHS
The
administrative levels are organized as Budget and Management Centres (BMCs) or
Cost centres for purposes of administering Government of Ghana (GoG) and
Developmental Partner Funds. There are a total of 223 functional BMCs and 110
Sub-Districts BMCs of Record. A breakdown of the BMCs is as follows:
Ø The headquarters of the GHS is managed as one BMC
Ø 10 Regional Health Administration
Ø 10 Regional Hospitals
Ø 110 District Health Administrations and
Ø 95 District Hospitals.
2.6.4 STAFF
OF THE GHS
Act
525 mandates that the following categories of staff belong to the Ghana Health
Service:
o
Health personnel
in the employment of the MOH immediately before the coming into force of the ACT
525
o
All who will be
employed by GHS or seconded to it after the coming into force of GHS
2.6.5 REGIONAL
AND DISTRICT ADMINISTRATION
As
a result of decentralization and health sector reform, services are integrated
as one goes down the hierarchy of health structure from the national to the
sub-district.
2.6.6 STRUCTURE
OF DELIVERY OF SERVICES
At
the regional level, curative services are delivered at the regional hospitals
and public health services by the District Health Management Team (DHMT) as
well as the Public Health division of the regional hospital. The Regional Health Administration or
Directorate (RHA) provides supervision and management support to the districts
and sub-districts within each region.
At
the district level, curative services are provided by district hospitals many
of which are mission or faith based. Public health services are provided by the
DHMT and the Public Health unit of the district hospitals. The District Health Administration (DHA)
provides supervision and management support to their sub-districts.
At
the sub-district level both preventive and curative services are provided by
the health centers as well as out-reach services to the communities within
their catchment areas. Basic preventive
and curative services for minor ailments are being addressed at the community
and household level with the introduction of the Community-based Health
Planning and Services (CHPS). The role
played by the traditional birth attendants (TBAs) and the traditional healers
is also receiving national recognition.
2.6.7 HEALTH
CENTER
Functions and Roles
The
health center has traditionally been the first point of contact between the
formal health delivery system and the client.
It is headed by a Medical Assistant and staffed with program heads in
the areas of midwifery, laboratory services, public health, environmental, and
nutrition. Each health center serves a
population of approximately 20,000. They
provide basic curative and preventive medicine for adults and children as well
as reproductive health services. They
provide minor surgical services such as incision and drainage. They augment their service coverage with
outreach services and refer severe and complicated conditions to appropriate
levels. The polyclinic is the urban
version of the rural health center.
Polyclinics are usually larger, offer a more comprehensive array of
services, are manned by physicians, and can offer complicated surgical
services. They are mainly in
metropolitan areas.
2.6.8 DISTRICT
HOSPITALS
Functions and Roles
District
hospitals are the facilities for clinical care at the district level. District hospitals serve an average
population of 100,000–200,000 people in a clearly defined geographical
area. The number of beds in a district
hospital is usually between 50 and 60.
It is the first referral hospital and forms and integral part of the
district health system.
A
District Hospital should provide the following:
I.
Curative care,
preventive care, and promotion of heath of the people in the district
II.
Quality clinical
care by a more skilled and competent staff than those of the health centers and
polyclinics
III.
Treatment
techniques, such as surgery not available at health centers
IV.
Laboratory and
other diagnostic techniques appropriate to the medical, surgical, and
outpatient activities of the district hospital
V.
Outpatient and
in-patient
CHAPTER
THREE
3.0 HISTORY
OF THE SISSALA EAST DISTRICT HEALTH ADMINISTRATION
3.1 INTRODUCTION
The
Tumu District Hospital is the only referral Hospital in the Sissala East
District in the Upper West Region. It started as Health Centre in the early
fifties, and then upgraded to the status of a District Hospital in 1992.
The
district is bounded to the East by the Upper –East Region, South by Wa
East, West by Jirpa, lambussie &
Sissala West district and to the North by the Republic of Burkina Faso.
Being
a border town, the hospital’s catchments area extends beyond the Ghanaian
boundaries to Burkina Faso and the surround villages in the Jirpa/lambussie
District. It also extends its services to the neighbouring people of the Upper
East Region of Ghana.
The
district (Sissala East District where the BMC is located) covers an area of
approximately 4,600 km2 and has a rather low population density of about 12/
km2. All roads are in deplorable state. About 68% of the population are
subsistent farmers. Livestock and poultry are reared in small scale. Cotton is
the only cash crop grown by some farmers. Despite rearing of the livestock and
poultry, the people do not consume much of these, but rather transport them to
the south to sell for money to enable them buy other needs and pay their wards
school fees. The district has only one rainy season beginning from March to
September.
3.2 SOCIO-CULTURAL
The
district has 61 villages and communities, divided into 4 Area Councils and one
town council. The languages spoken are: Sissali, Grunni and Dagaari. However,
Akan, Hausa, and English are widely spoken particularly in the district
capital.
Islam,
Christianity and traditional African religion are religions practised in the
district. However, the effects of some religious beliefs have negative effects
on the health of the people, since some of these beliefs have seriously
undermined the acceptance of some health messages.
3.3 SOCIO-ECONOMIC
ACTIVITIES
The
main occupation of the people in the district is agriculture (both crops and
livestock rearing). A small number of people, especially women are involved in
trading. These people visit several markets within and outside the district to
buy and sell.
3.4 EDUCATION
Literacy
level in the district is low, but is higher in males than females. However,
interventions such as the government school feeding programme and Catholic
Relief Service (CRS) food for education, as well as the support of child
education programme by PLAN GHANA are strategies that are likely to improve
upon the literacy rate in the near future.
As
a result of high illiteracy rate in the district, local strategies for health
promotion and education have been developed to enable the Hospital and the
District Health Administration deliver messages that will improve upon the health
of the people.
3.5 COMMUNICATION
There
is one local radio station (RADFORD) in the district and two FM stations in the
regional capital, Wa. These radio stations enable the rural people to be
informed, educated and entertained on various issues of national importance
including health.
The
national TV network covers the district, however only GTV transmissions can be
received in the district. There are
internet facilities where people visit for internet services.
The
various health facilities in the district were network on GHS/MOH regional T.P.
radio programme. This used to allow health facilities to interact with the
District hospital and the DHA, especially on referral of patients. This network system broke down since 2005 and
all efforts to have it repaired proved futile.
3.6 ELECTRICITY
/ POWER SUPPLY
It
is only the district capital and two health facilities which are connected to
the national grid. The rest of the facilities are without electricity from the
national grid. They are supplied with solar panels which produce solar power
for them as an alternative.
3.7 WATER
The
main water supply system for both the major settlements and the small
communities in the district are from underground water sources. These are bore
holes and hand dug wells. Other sources of water are small- scale dams, dug
outs and seasonal streams. Though there have been major improvements over time,
water supply is still inadequate.
Due
to the poor water supply system, typhoid cases and other diarrhoeal diseases
are common in the district.
3.8 POPULATION
INDICES
The
BMC has a bed complement of 90 and total staff strength of 74. It operates with
one (1) Ghanaian Medical Officer with 6 practicing Midwives.
Indicator No.
Population
54,467
Bed
Complement 90
Wards 3
Sub-BMCs
5
Staff
Strength 74
3.9 MISSION
STATEMENT
The
Tumu district hospital will work in
collaboration with all partners to improve the health status of all people
living in the districts through the provision of quality health services which
are accessible, available and delivered by well motivated staff.
3.10 VISION
STATEMENT
Quality
of life improved through enhanced overall health status and reduced disease
burden of the people living in the Sissala districts.
3.11 OBJECTIVES
To Increase access to good quality
Health services
Implement approved national health
policies
Manage prudently resources available
for the provision of health services
CHAPTER FOUR
4.0
WORK SCHEDULE
AND ACTIVITIES
4.1 WORK
SCHEDULE
The
finance department of the sissala east district hospital was the unit I
underwent my attachment as a financial mathematics student. One is espected to
report daily from Monday to Friday at 8:00am. Below is the daily time schedule
for the department:
DAYS MONDAYS TO FRIDAYS
MORNING
SCHEDULE
8:00AM TO 12:00PM
LUNCH
BREAK
12:00PM TO 1:00PM
AFTERNOON
SCHEDULE 1:00PM TO 5:00PM
4.2 DESCRIPTION
OF MAJOR ACTIVITIES UNDERTAKEN
4.2.1
OBSERVATION
On
my first day at my place of attachment, my first and foremost activity was to
observe the schedules of the accounts staff and how each one of them undertakes
his schedule. This I did throughout the period of my attachment.
4.2.2
SORTING OF CLAIM
FORMS
After
being introduced to NHIS patients claim forms, I was made aware that the forms
are separated into the various service areas provided by the hospital. Some of
the various service areas include the in-patient and the outpatient, OPD, lab,
surgical, dental, pediatrics and antenatal. These services attract different
tariffs as recommended by NHIA for both children and adults. When claim forms
are brought to the finance department, they are sorted out into the various
service areas before any other action is taken on them. This enables easy
completion of the forms.
4.2.3
CODING OF CLAIM
FORMS
NHIA
has provided a list of codes that are used for the various service areas
covered under the NHIS with their respective tariffs. Claim forms are
completed with the appropriate code and tariff depending on the service area
rendered to clients by the hospital.
4.2.4
VETTING OF CLAIM
FORMS
All
claim forms are vetted for possible sources of queries and correction at the
finance department to reduce financial loss to the hospital.
4.2.5
ENDORSING OF
CLAIM FORMS
After
clients claim forms are completed and keyed in the only computer in the
department, they forms are bound in groups of fifty and then endorsed with the
stamp of the health facility insurance officer’s improvised rubber stamp that
has his name and signature before being dispatched to the district NHIS office.
4.2.6
COLLECTION OF
REVENUE
The
health facility generates revenue daily at the collection point from patients
for various services rendered to them by the facility. The revenue collector
in-charge reports to accounts department daily with the revenue collection book
where information on revenue generated is recorded in addition to the official
GHS receipt books and the total amount generated for the necessary action to be
taken by the officer scheduled to collect revenue.
4.2.7
SAVINGS OF
REVENUE AT BANK
After
receiving the daily revenue generated at the accounts department, a pay in slip
is prepared for the amount generated to be deposited at the facility’s IGF
current accounts at the Ghana commercial bank, Tumu branch. This is also done
daily.
CHAPTER FIVE
5.0
KNOWLEDGE ACQUIRED, RECOMMENDATIONS AND CONCLUSION
5.1
KNOWLEDGE ACQUIRED
Through
observation and active involvement in execution of some activities, I acquired
the following experience:
§ An in-depth knowledge into the
various services provided by the Tumu district hospital.
§ Vetting of NHIS clients claim forms.
§ The type of patients that visit the
hospital.
§ Some codes used under the NHIS.
§ Tariffs associated with some codes.
§ Revenue generation process.
§ Queries regarding NHIS client claim
forms.
§ Good record keeping.
§ Types of MOH’s books of accounts.
§ Measures to combat revenue leakages.
§ Some MOH’s ATF rules.
§ Improvisation of signature.
5.2 RECOMMENDATIONS
To improve
the quality of service and efficiency, the following personal suggestions would
be beneficial if considered:
·
A
database should be created for the hospital. This will enhance a fast and
easier way to access information and also reduce the amount of space required
for storing other documents either than electronic data.
·
More
computers should be provided to reduce the pressure on the only computer in the
office.
·
A
wireless internet connectivity should be provided for fast transfer of data
·
In
addition to the wireless internet connectivity, each unit of the hospital
should be provided with a computer so that patients records can be assess at
any unit of the hospital at the click of a button.
·
The
tariffs of NHIS clients should be automated to ensure easy completion of
clients forms.
·
For
the accounts department, a database should be created to replace the manual
book keeping of revenue collected as earlier information of revenue collected
is easily lost in the books.
·
An
active and effective electronic network should be established to link the
hospital to the district mutual health insurance office.
5.3 CONCLUSION
The development of every nation depends
largely on quality and accessible health care of the people in the
country. Though NHIS has made the
provision of quality health care possible, issues such as late release of funds
to health facilities need redress because it takes the hospital at least three
months or longer to receive funds from NHIS upon submission of claims.
The
attachment program also exposes students to the realities of the job market
since it equips them with a firsthand practical experience in the field of
work. The university alone cannot inculcate both academic and practical experience in the students hence
students should be encouraged to go on voluntary industrial attachment as well.
