The Birim South District Health Directorate has the primary mandate to ensure that the people living in the district are healthy by providing quality healthcare services to all people living everywhere in district. This is a priority achieved through a continuous access to health service from community level to the district level.
Health delivery in the district include disease control activities such as EPI, Disease Surveillance, TB control, Malaria control and HIV control. Other services provided are Family planning, antenatal care and child immunization. The directorate also provides support services such as Health Information and Human resource.
Health delivery in the district is also generally skewed towards the urban centers with few facilities in the rural areas. To increase geographical access to health services more CHPS compounds with accommodation facilities should be provided to rural areas.
There is the urgent need for stakeholders including religious organizations and non-governmental organizations to promote and rejuvenate functional literacy among adults since illiteracy is high among persons who are 25 years and older. Children who form about 41 percent of the district’s population must be considered for provision of adequate school infrastructural buildings
Health Facilities
According to Table1.34 presents the distribution of health facilities in the district. Health delivery in the district is carried out by 7 government institutions, and One (1) mission institution. The district has maternity home and a proposed government hospital, currently ongoing. Community based Health Planning Services Compounds (CHPS Compound) are 11 representing 73.3 percent of health facilities while health centers and clinics are three (3) and one (1) respectively.
Distribution of Health Facilities by Sub-Districts
| Sub-District | Population | Type | |||
| CHP | Health Center | Clinic | Total | ||
| Aduasa | 4 | 0 | 4 | ||
| Apoli | 2 | 1 | 0 | 3 | |
| Swedru | 5 | 2 | 1 | 8 | |
| Total | 58,672 | 11 | 3 | 1 | 15 |
Source: BSD DHA, 2021
Health Personnel
The District Administration has staff strength of 165 health officers with different skills set; however, additional 57 health officers are required for efficient health service delivery in the district. Table 1.35 presents the distribution of health professionals in the district. Community health nurses recruited under the Youth Employment Programme represents 43.6 percent of health personnel in the district. Community health nurses is the second largest number of health workers constituting 30.1 percent, followed by enrolled nurses (8.5%), midwives (4.2%) and disease control officers. Clearly, the district does not have a medical doctor, this could be explained by the fact the district does not have a hospital. In addition to these orthodox institutions, the district has trained Traditional Birth Attendances (TBAs) who provide maternal service in various communities. There are also traditional herbal practitioners (THPs) who also contribute towards the health needs of the people in one way or the other.
Number of health personnel in the district
| Category | Number | Percentage |
| Medical Doctor | 0 | 0.0 |
| Technical Officers (Dip. Disease Control) | 2 | 1.9 |
| Field Technicians ( Cert. Disease Control) | 2 | 1.9 |
| Midwives | 12 | 11.4 |
| Community Health Nurses | 50 | 47.6 |
| Enroll Nurses ( Cert. Nurses In Green) | 22 | 21.0 |
| Registered Community Health Nurses ( Diploma) | 8 | 7.6 |
| Community Health Workers ( Youth Employment) | 0 | 0.0 |
| Psychiatric Nurses | 4 | 3.8 |
| Nutrition Officer | 2 | 1.9 |
| Orderlies | 3 | 2.9 |
| Administrative Staffs (Others) | 10 | 8.7 |
| Total | 115 | 100 |
Source: DHA BSDA, 2021
Despite the Assembly effort in providing adequate health facilities in the district, the district health administration still battles with the problems of limited number of health personnel to man these facilities.
Top Ten Diseases
Malaria continues to top the ten (10) diseases and causes of OPD attendance in the District followed by Upper Respiratory Tract Infection, Rheumatism and Diarrhoea over the past two years (2019-2020) as shown in the table below. This situation calls for pragmatic steps to be taken by all stakeholders to control mosquitoes and improve the sanitation situation in order to reduce the incidence of the disease to the barest minimum. Apart from malaria,
Non-communicable diseases such as CVA, Hypertension, anaemia, diabetes mellitus and HIV/AIDS are the leading causes of death among adults.
Top 10 causes of OPD attendance in 2019-2020
| NUMBER | CONDITION | 2019 | 2020 |
| 1 | Malaria | 12,787 | 13,979 |
| 2 | URTI | 9,957 | 7,075 |
| 3 | Diarrhoea | 4,160 | 4,306 |
| 4 | Rheumatism | 3,405 | 2,526 |
| 5 | Skin Diseases | 2,238 | 1,833 |
| 6 | Intestinal Worms | 2,668 | 1,810 |
| 7 | Anaemia | 2,110 | 1,588 |
| 8 | Acute Urinary Tract Infection | 1,340 | 780 |
| 9 | Typhoid Fever | 205 | 186 |
| 10 | Hypertension | 54 | 23 |
Source: BSD Health Administration, 2021
HIV and AIDS
The District AIDS Committee (DAC) and District Response Management Team (DRMT) are the Multi sectoral and technical response bodies respectively mandated for the management of HIV response programme in the district. Service provided in the district includes HTC, PMTCT, Condom Distribution, Behavioural Change Communication, and care and support for persons living with HIV.
HIV Testing and Counseling
Available statistics from the District Directorate of Health indicates that 1,226 (including 949 females) persons were counseled and tested for HIV. Thirty-three (33) females and three (3) males tested positive in 2020.
Trend of HIV Testing and counselling
| Indicators | SEX | 2020 | 2021 |
| # Pretest Counseled | M | 277 | 132 |
| F | 949 | 460 | |
| # Tested | M | 277 | 132 |
| F | 949 | 460 | |
| # Receiving Positive Test Results | M | 3 | 4 |
| F | 33 | 35 | |
| # Receiving Posttest Counseling | M | 277 | 132 |
| F | 949 | 460 |
Source: BSD Health Administration, 2021
1.3.26.10 Prevention of Mother to Child Transmission (PMTCT)
Prevention of Mother to Child Transmission of HIV (PMTCT) is a service provided at antenatal care clinics to all pregnant women to know their HIV status. Every pregnant woman is to be tested for HIV and if positive, given the right treatment to prevent the mother from infecting the baby. The target for this service is pregnant women. All health facilities in the district provide PMTCT services
According to Table 1.38, out of the 913 ANC registrant that were counseled and tested five (5) tested positive. Proportionately, the 2020 figures are improvement over 2019.
Trend of PMTCT performance in Birim South
| Indicators | 2018 | 2019 | 2020 | 2021 |
| # Of ANC Registrants | 4,871 | 4,897 | 2,311 | 524 |
| # Tested | 1,275 | 1,033 | 913 | 503 |
| # Receiving Posttest Counseling | 1,275 | 1,033 | 913 | 503 |
| # Positive | 5 | 20 | 5 | 12 |
| Number on Treatment | 5 | 20 | 5 | 12 |
Source: BSD Health Administration, 2021
Determinants of HIV and AIDS in the District
The key determinants in the district include mining, transport, unemployment and underemployment and social functions. Mining plays a key role in the economic life of the people as well as the spread of HIV/AIDS epidemic in two major ways. Migrant labour especially the youth travels in and outside the district to engage in mining activities either in the few mining companies or engage in small scale (galamsey) mining activities in search of “quick” money. Other also travels outside the district to the nearby district such as nearby mining communities. These men frequently move to and from the district sometimes as often as weekly.
The strategic location of the district is another key determinant point for many long haulage drivers especially those carrying timber for processing at sawmill located in the district. Nearly all such drivers pass at least one might in the district and often having just receive their wages engages in high-risk behaviours such as alcohol consumption and casual sex.
Other determinants include social functions such as funerals, festivals and other social gathering which are on weekly and annual basis. Many people who patronize these functions meet sexual partners and engage in casual sex promoting the spread of the virus. Additionally, unemployment and underdevelopment cannot be left out as a determinant. While the district attracts those working for skilled and semi-skilled job in the mines and sawmills. It similarly attracts on increasing number of low or unskilled labourers seeking employment. However, jobs in these areas are few and this growing number of young people are often forced to adopt survival strategies to meet their basic needs. Such strategies increase their vulnerability and frequently promoting high rise behaviours.
The key vulnerable and high-risk groups therefore are as follows.
Key Vulnerable and High-Risk Groups in The District
| Vulnerable Groups | High Risk Groups |
| Apprentices | Miners |
| Students | Drivers |
| Street Children | Commercial sex workers |
| Domestic aid | Business executives, porters |
Source: BSD Health Administration, 2021
Issues
- Periodic Shortage and inadequate supply of vaccines, RDT kits for malaria, Syphilis and HIV and AIDS
- Inadequate trained counselors for PMTCT services
- Frequent breakdown of motor bikes and vehicles resulting in high cost and frequency of maintenance
- Poor data capture at facility level (e.g., EPI, PMTCT, HTC, malaria, etc.)
- Lack of vaccine refrigerator in some facilities (10 facilities work without major cold chain equipment)
- Inadequate vehicles and motor bikes
- Late reporting of pregnant women to health facilities for ANC services
- Use of chemoprophylaxis by some chemical sellers in treating malaria patients
- Inadequate CHPS infrastructure
Sanitation and Waste Management
There are 9 public toilets in the district. These facilities are spread around Swedru and Awisa. Communities like Apoli and Akortekrom do not have any public toilet. The collection, transportation and disposal of solid and liquid waste are the sole responsibility of the District Assembly which operates through the Zoomlion Company limited. Solid waste collection is done in three ways: door to door, dumping at refuse site and communal container system. Door to door services is usually provided to middle class in communities such as Swedru and Awisa. District Assembly uses 11 refuse containers for the communal collection. The District Environmental Health unit in collaboration with Zoomlion regularly administered refuse collection for onward disposal from markets, lorry parks and other public centres.
The district has a landfill site at Aduasa. In an attempt to improve the general waste management, the district acquired six (6) acres of land at Aduasa which has been developed by the Zoomlion Ghana limited. Three (3) acres are being used for solid waste management and the rest for liquid waste management.
Inventory of Public Toilets in Birim South District
| No | Community | Type | Number of facilities |
| 1. | Swedrusekunde | 20 Seater WC | 1 |
| 2. | SwedruZongo | 20 Seater Vault Chamber toilet | 1 |
| 3. | Suame | 10 Seater Septic Tank Latrine | 1 |
| 4. | Salem | 20 Seater Septic Tank Latrine | 1 |
| 5. | Salem | 12 Seater Septic Aqua privy | 1 |
| 6. | Awisa Methodist Area | 10 Seater Septic Tank Latrine (Abandoned ) | 1 |
| 7. | Awisa Chief Palace | 12 Seater Septic Tank Latrine | 1 |
| 8. | Awisa Refuse Dump | 20 Seater Septic Tank Latrine | 1 |
| 9. | Awisa Market | 2 Seater WC (Not Functioning) | 1 |
Source: District Environmental Health Unit 2021
Map showing Health facilities in the District, DPCU 2021
Locational map of toilet facilities in Birim South District