The Municipal Health Directorate is headed by the Municipal Director of Health Services, assisted by Programme officers and Sub Municipal leaders who are Medical Assistants and Senior Nurses.

Health care in the municipality is provided through hospitals, health Centres,CHPS Compounds, private clinics and traditional healers.

Health Facilities

There are three Zonal Councils and twenty (20) electoral areas in the municipality with the following health facilities. In all there are twenty seven health facilities which include 9 CHPS compounds, 2 Hospitals 8 health centers and a Maternity Home. The remaining are functional CHPS without compounds.  See Table 14 for details on health facilities in the Municipality.

Table 27: Health facilities and type of ownership

SOURCE: MHD Records, 2017

Table 28: Human resource (health)

SOURCE: MHD Records, 2017

Clinical Care:

 Table 29:Trend of OPD attendance

There has being a significant increment in OPD attendance in 2016 (407449). This could be attributed to the increased in suspected malaria to 134,084 of total cases reported for the year under review compared from 114,476 in 2015. Generally the peak of OPD attendance was 466907 in 2012 and 484,174 in 2013.

The health of the general population of the municipality have improve quite significantly with a reduction in neonatal and child mortality rates

Malaria as usual is the leading cause of admission for all admitted at the health facilities contributing to 25.9%, 21.2% and 14.7% of all cases admitted in 2014, 2015 and 2016 respectively as shown on the Table 16. Other top causes of admission include URTI, diarrheal diseases, rheumatism and other joint pains etc. The pictorial view of the top ten causes of admission shows a steady increase of URTI from 10.3% in 2014 to 18.1 in 2016%. In the case of malaria, it has recorded and increase in 2016 over the previous years. 

With regard to top ten causes of death as displayed in Table 17, pneumonia, cirrhosis of the liver, malaria and anemia are on top. It must be noted that the top ten causes of death including HIV/AIDS and Tuberculosis are not part of the top ten cause of admission. It means that these diseases, though do not infect many people are very deadly. There is therefore the need for intensive education on the treatment of those diseases.

On the other hand, malaria eradication must be intensified. Malaria is among the top ten causes of admissions as well as the top ten causes of death in the Municipality.

Table 30: Top ten causes of OPD attendance 2014-2016

SOURCE: MHD Records, 2017

Figure 11: Top ten causes of OPD attendance

Table 31: Top ten causes of death in the Municipality

HIV/AIDS

Any intervention that is aimed at reducing HIV/AIDS in the Municipality is worth undertaking. The prevalence rate of the disease has seen a dramatic increase in 2015. As shown in Table 18, the prevalence rate in 2015 is 2.4 which is more than twice the 2014 prevalence rate of 1.1. It is sad to note that the Municipality in 2015 has contributed an increase in both the regional and national rates of 1.5 and 1.8 respectively.

Table 32: HIV prevalence rates 2013-2015

Sourec: MHD Records, 2017

Figure 12. HIV Prevalence Rate

SOURCE: MHD Records, 2017

Table 33: Mortality rates

SOURCE: MHD Records, 2017

Table 34: Malaria case fatality in children under 5 years

SOURCE: MHD Records, 2017

Statistics from the Municipal Health Directorate attested to the fact that maternal mortality and malaria case fatality in children under 5 year keep increasing from 2014 to 2016. The Municipality recorded a maternal mortality ratio of 129.6, 200 and 275/100,000 in 2014, 2015 and 2016 respectively. Antenatal Care and skilled delivery must be ensured in order to circumvent the situation. See Table19 & 20 as well as figure 14 for details. 

Figure 13: Mortality rates, 2014-2016

SOURCE: MHD Records, 2017

  Access to healthcare in the Municipality is limited in terms of financial, geographical and physical due to low incomes, bad roads and inadequate personnel and facilities.

Municipal Health Insurance

The Health Insurance Scheme became operational in the municipality on the 15^th November, 2005 and as at December, 10,794 people have registered. As of December, 2016 The Scheme has recorded an active membership of 146,058 comprising of 82,732 females and 63,326 males who were biometrically registered. The Office has also registered a total of 36, 335 indigenes in the Municipality during the year.

As a continuous process, the registration is still going on, however, there are certain challenges faced by the scheme in the municipality.  Some of them include; inadequate funds for administrative support, inadequate office accommodation, Frequent internet failure, Delay in paying claims to Service Providers, Facility shopping by Subscribers; People hop from facility to facility with the same ailments and end up getting the same treatment which is a waste of time and resources, Limited means of transport (motor bikes) and Difficulty in the identification of indigents.

The administration of the Municipal Health Insurance however, has devised some strategies to addressing the challenges. Some of the strategies include; running of shift system (working 16 hours a day), Door to door registration, operation of 6 zonal offices round the Municipality, stakeholder engagement (providers and clients) and conduct of clients satisfaction surveys

Generally, the sanitation situation of Bawku Municipality is bad. The Municipality is still lacking critical sanitation facilities that are necessary for improved sanitation. The poor sanitation situation of the Municipality is also exacerbated by the limited human resources in the sanitation sector.

Most households lack improved toilet facilities leading to high levels of open defecation. Out of about 120 communities in the Municipality, only 20 are Open Defecation Free (ODF). The drainage system in the Municipality is also poor always causing unpleasant scents and scenes. The detail of the sanitation facilities situation in the Municipality is indicated in the subsequent tables.

Table 35: solid waste disposal facilities 2017

SOURCE: EHSU, 2017

In Table 1 above, the Municipality required a Compactor Refuse Truck and 6 communal refuse containers in order to tackle its solid waste challenges.  The absence of the above facilities is affecting solid waste disposal in the Municipality.

Table 36: Liquid waste disposal facilities 2017

SOURCE: EHSU, 2017

In Table 2 above, a Cesspool Emptier and 20-seater 12 water closet toilets are required by the Municipality in order to deal with its liquid waste menace.

Table 37: Number and type of disposal sites 2017

SOURCE: EHSU, 2017

In Table 3 above, the Municipality required engineered waste disposal sites both liquid and solid. There are sites for the disposal of both solid and liquid, however, they are not developed. The situation is causing indiscriminate disposal of waste in the Municipality.

Table 38: Meat facilities 2017

Bawku Municipality is noted for animal rearing. These animals also serve as delicacies to the people both within and outside the Municipality. It is however unfortunate to note that there is no a well-developed abattoir in the Municipality where wholesome meat can be prepared.

NOTE:

• The drainage system needs to be developed in order to improve the sanitation situation of the Municipality.
• Feed the Future Ghana District Profile Series (2017) ranked the Municipality 24.1 % on improved sanitation which is an indication that all is not well with the Municipality when it comes to improved sanitation.
• Currently a lot of filth is doted all over the Municipality. This is as a result of the above challenges enumerated above. 

Water

The water supply system in the municipality can be classified into rural and urban, based on the location of the facilities and the technology of delivery. The rural water supply system consists of boreholes, hand-dug wells and other sources such as rivers, dams, ponds rainwater. It is important to note that sections of the population in Municipality are using unimproved sources which most often than not are unhygienic.

The urban water supply system consists mainly of a network of piped system that provides water to consumers. The Ghana Water Company Limited (GWCL) produces water for distribution within the Bawku Township. Although the quality of water supplied by GWCL can generally be considered good, the amount of water generated daily is woefully inadequate to meet the growing demand for potable water in the Municipality. This has resulted in intermittent supply of pipe borne water especially in high density areas. And therefore cannot be reliable upon to meet the water needs of the people of the Municipality.

Spatial distribution of Water Facilities

Considering that the settlement type of the Municipality is predominantly the dispersed type, efforts are being made to extend water facilities to all the communities even though this ambition is not yet met. Water facilities are being distributed in line with the settlement pattern of the people making it necessary to distribute the facilities across the entire Municipality. Generally, water facilities can be said to be evenly distributed across the Municipality with the Kuka Zabugu Zonal Council recording the highest number of boreholes of 105. Mognori and Bawku Zonal Councils have a total number of 64 and 52 boreholes respectively. According to the Community Water and Sanitation Agency, the Municipality has water coverage of 70%.

VULNERABILITY ANALYSISPoverty

According to Feed the Future Ghana District Profile Series (2017), poverty is prominent in the Municipality. The research shows that the poverty prevalence is 10.9%, with 51.9% of households suffering moderate to severe hunger.

Gender, orphans and vulnerable children

Of the 98,538 population (2010 population and housing census) 52.0 percent of the population is females. Fifty one and half percent (51.5%) of the total population constitute children and the youth 0-19 years. Fifty three (53) of these children suffer various forms of vulnerabilities; physically challenged visually impaired, dearf and dump etc. The economic fortunes of these people depend on Agric which is not sustainable enough in this respect.

In terms of their gender roles women take care of the house and the family, providing household chores and taking care of the children. They also do petty trading on behalf of the family. They take part in farming activities in the area of weeding, sewing, harvesting and processing of the farm produce. Men on the other hand are in charge of providing for the family. In this regard they do most of the farm work or any activity that will bring income to the family. Both men and women take care of the educational needs of their children but the ultimate responsibility lies on the man.

In terms of education and other services like access to decision making, men are more advantaged than women and thus you see many men being educated and in decision making positions like the District Assemblies than women. All these are as a result of socio-cultural factors

The traditional set up does not fever females in the households. Most households one headed by males who take most of the decisions that affect the fortunes of the households.  Many of these decisions go against the female. Male education for example is preferred to female education; females are withdrawn from school because of the lure of the dowry. High dowry system leads to broken homes and marriages.  Female contributions to the households are not recognized. There are traditional practices inimical to the female, e.g.  Female genital mutilation, widowhood rights etc. Below are a summary of issues that affect women, girls and children in the Municipality.

• Some women being ignorant about the existing laws protecting their rights.
• School dropout rate especially of the girl child is still high
• Some parents prefer educating their boy child to the detriment of the girl child
• Low representation of women in decision making process at the local level
• Difficulties experienced by women in getting access to farm land.
• High dowry system exposes women to slavery
• Limited financial support and high interest rates
• Negative /harmful cultural /traditional practices e.g. FGM, force marriage, not allowing people who fall sick to seek modern medical treatment
• Irresponsible parentage
• Children not involved in issues that affect them
• Low recognition given to contribution of women to Municipal Development.
• Household chores and caring of the children not regarded as part of any economic value.

Implementation of LEAP

There are ten (10) communities currently benefiting from the Livelihood Empowerment Against Poverty (LEAP) Programme. This covers a total household of 302 with a total number of 731 eligible beneficiaries, of whom about 80% are females. A total grant of GH₵19,482.00 is received bi-monthly and distributed among the eligible beneficiaries. They have been receiving cash payments since 2008 that LEAP was initiated in the Municipality. It must also be made clear that 35 new communities examined and included in the programme which also cover a total of 4999 households. The number of beneficiaries is not available due to the fact that the additional communities have not started benefiting. Success stories included beneficiaries being able to take care of the educational needs of their children, and also, their nutritional requirements. Some are also engaged in petty trading. These and others are contributing to alleviating poverty among the vulnerable in The Municipality.

The Department of Social Welfare and Community Development has also registered and renewed 1,251 NHIS cards of beneficiaries of the Livelihood Empowerment Against Poverty (LEAP) programme in ten (10) communities

Persons with disability (PWDs)

According to the 2010 Population and Housing Census, of the 98,538 total populations in the Municipality, 2,141 are with disability representing 2.2 percent of the total population in the Bawku Municipality. The Males constitutes 1,095 disabled persons and that of the Women is 1,043. Of the proportion of those who have disability, 52.8 percent are employed, 3.0 percent unemployed and 44.3 percent are economically not active.

Figures from the Department of Social Welfare and Community Development (2017) put the disability population at 900 of whom 590 were males and 320 were females. These figures are far below the 2010 Population and Housing Census figures. This could be attributed to several factors including under representation and disabled persons not willing to register with the department or improvement in the living standards of people leading to a reduction in the disability population. Table 27, depicts the number of registered Persons with Disabilities PWDs within Bawku Municipality.

Table 39: Persons with disabilities (PWDs)

SOURCE: DSW & Comm. Dev. (2017)

Causes of Vulnerability of PWDs

The causes of vulnerability of PWDs are multi-dimensional. They include;

• Family and community neglect
• Inadequate care and protection of persons with disabilities
• Inadequate access to some basic amenities and infrastructure due to stigmatization from family members as well as community members.
• Inadequate support and access to financial support due to lack of collateral securities that can enable persons with disabilities access funds to go into some income generating activities that are peculiar to their disability.
• Inadequate support from government especially from the two per cent (2%) of the District Assembly Common Fund (DACF) as a result of growing numbers of vulnerabilities ratio and the fixed nature of support allocated to Persons with Disabilities.

HIV/AIDS

HIV/AIDS remains a challenge in the Municipality. The 2016 annual report of the Municipal Health Directorate revealed that the HIV/AIDS menace is not getting better in the Municipality. The year 2015 recorded a prevalence rate of 2.4, a figure that is far higher than the 2014 prevalence rate of 1.1.

More interventions are still needed if HIV/AIDS incidence must be reduced in the Bawku Municipality. The Ghana AIDs Commission, the Ghana Health Service, Civil Society, Traditional Leaders, Religious Leaders and all stakeholders are entreated to act to the best of their capacity to curb HIV/AIDS menace in the Bawku Municipality.

Subsistence farming

Many people in the Municipality (60.9% of 15,012 household’s) depend on Agric as their dominant economic activity. Most of these people are located in the rural areas but output is low and many people are not able to meet their food requirements, not to talk of selling some to meet basic socio-economic needs. This is as a result of a short and erratic rainfall (dry spells and floods), declining soil fertility, inadequate fertilizer application, bush burning, indiscriminate tree felling, unfavorable market conditions, bad roads, migration of the youth, inadequate feed and water for animals during the dry season, prevalence of pests and diseases, etc. Most farmers therefore face greater food insecurity for the greater part of the year. This goes to affect the poverty levels of farmers and their dependents in the municipality.

Floods and other disasters

Floods are a perennial feature in the municipality. This occurs along the banks of the tributaries of the White Volta River that drain the municipality. The major flood prone areas include Mognori, Gentiga 1&2 and Bador. Climate changes resulting in more than expected rainfall also bring about flooding in the municipality. These destroy crops when they occur thus exacerbating the poverty levels of farmers. Wind storms, bush and domestic fires are other forms of disasters in the Municipality that destroy crops and other properties. All these bring untold hardships to the people.

In 2015 the Municipality recorded a number of natural disasters mainly windstorm and flood.  Windstorm disasters affected the following communities: Kuka, Bugri-Corner, Zabugu, Missiga, Sabon-Gari, South Natinga and Gingande.

The people affected included women, men and children totaling to 1,300. The breakdown is as follows; 320 adult male and 260 adult female, 260 male children and 340 female children.

Six schools were ripped off including Tampizua Primary, Winamzua Primary, Zabugu Primary and JHS, kuka JHS and Gozesi Primary.

All the communities along the White Volta tributaries were affected including Mognori, Gentiga, Tampizua, Bador, Gumakutari and Baribari. In all 800 farmers were affected with 3000 archers of farm lands with crops washed away. The affected persons include 300 male adults and 200 female adults as well as 160 male children and 140 female children.

The crops that were washed away included Maize, rice, millet, soyabeans and potatoes.

In 2016, there were no flood disasters; however windstorm disasters affected some schools and communities. The affected communities are Zabugu, Kuka, Bugri-Corner, Gingande, Sagabo and Wiidi. The disasters affected 700 people including 170 male adults and 200 female adults as well as 180 male children and 150 female children.

The affected schools are Zabugu Primary and JHS, Lalsaa Primary, Winamzua Primary Gozesi primary Primary and Bawku Senior High Technical School.

In 2017, some windstorm disasters were recorded on 25^th April and 30^th April, affected several communities and schools. The affected communities are Buabula, Baribari, North-Natinga, Sagabo, Sabon-Gari, Sabon-Zongo, Hausa-Zongo, Gingande, Daduri, Bawkzua, Kpalwega, Possum, Kariyama, Patelemi and Wiidi.

A total of 1,200 persons were affected including 250 male adults and 350 female adults. It also affected 250 male children and 300 female children.

Five schools were affected thus Buabula Primary, Gentiga Primary and JHS, Daduri Primary and Winamzua Primary.

It is clear that natural disasters are affecting almost all aspects of development in the Municipality including health, education agriculture etc. Disaster prevention and management should therefore be one of the priority areas if sustainable development must be ensured.

Interventions to address issues of vulnerability in the Municipality

Under the community care programme the Social Welfare Unit develops and coordinates Community Based Rehabilitation Programmes of Persons with Disabilities (PWDs). It aims at strengthening the relationships and promoting interactions between individuals with disabilities their families and the social organization in which they live.

 Promotion of access to social welfare services for the disadvantaged, vulnerable and excluded group of individuals through community mobilization and organization.

 Again opportunities for Non-Governmental Organizations (NGOs) are facilitated to develop social services in collaboration with the communities to ensure that services are meeting communities’ needs.

Also awareness is created on the prevention and provides care and support to orphans and vulnerable children and People Living with HIV/AIDS (PLWHIV/AIDS).

We income security among the disadvantaged, vulnerable and excluded is ensured as well as the facilitation of and coordination of programmes for the elderly including community based care services.

Spatial Analysis

This section seeks to present the spatial arrangement and distribution of population; infrastructure, Economic activities and settlement patterns.

The Municipality has a total projected population of 114,257 for the year 2017 disaggregated into 58,134 females and 56,123 males. The Bawku Zonal Council is the most densely populated as compared to the other two Zones thus Kuka-Zabugu and Mognori. Bawku being the Municipal capital with a lot of business prospects explains why the population is concentrated there. The other two Zones are mostly rural with lesser populations. This poses a problem for the provision of socio-economic facilities and services e.g electricity for those two Zones.

In terms of settlement pattern, the dispersed settlement will be the appropriate description for the Municipality. The settlements are not only far away from each other, but are also dotted across the entire Municipal land area. The only exceptions where settlements are quite nucleated are the Bawku Township and other smaller towns.

With regards to settlement hierarchy, the Municipality is made up of a mixture of settlement types comprising mainly towns and villages. Bawku is the largest town in the Municipality and provides most of the functions including commerce, education, health, security, administration etc.   The Bawku Township has also benefitted from the street naming and housing exercise with a number of its streets named and some houses numbered. This will help in easy identification of places for easy access for service provision e. g fire service in terms of emergency and will also help in revenue mobilization for the Municipal Assembly.