Family Planning in Ghana: Contraceptive Security is

still a work in progress

Yaa Osei AsanteGhana Health Service

Background Information on Ghana

Situated in West Africa Independence on 6th

March 1957 Population of 20 million at

last Census 2000 Population Growth Rate

2.7% 10 Administrative

Regions 138 Districts Capital City Accra

Contraceptive Security

MEETING THE COMMODITY SECURITY CHALLENGE IN GHANA

The Ghana National Contraceptive Security Strategy 2004 -2010

-Financial Sustainability Plan Repositioning Family Planning- A Road

Map for Repositioning Family Planning 2006-2010

Contraceptive Security

The Inter Agency Coordinating Committee on Contraceptive Security(ICC/CS)

Representation includes: Government

MOH, Ghana Health Service, National Population Council, Food and Drugs Board, Customs Excise and Preventive Service,Ghana Aids Commission, National Aids Control Programme, others

Development Partners

USAID, JSI DELIVER(TA), DFID, UNFPA, World Bank, EU, The Royal Netherlands Embassy, DANIDA, JICA and others

NGOs/Civil Society

-PPAG Private Sector Organizations

GSMF, Society of Private Medical and Dental Practitioners, Representatives of Private Pharmaceutical Firms

Strategic Objectives

To improve availability of qualityquality and affordable contraceptive products and services

To strengthen public-private partnershipspartnerships in the supply and delivery of contraceptive products and services

To implement reliable and efficientefficient systems for the supply of contraceptive products and services

To achieve sustainable financingfinancing of contraceptive products and services

To ensure a national capacity to monitor and evaluatemonitor and evaluate the progress on the attainment of CS targets

Why RH Commodity Security?

Success of FP Programs Generated Demand for Contraceptive Commodities Unmet Need for FP still high

Shift of resources to HIV/AIDS Programming Inadequate Coordination among stakeholders Weak Logistics Systems Need to reinvigorate RHCS

Ghana: Family Planning Successes

Early political awareness and support (1960’s) Strong U.S. and other donor support for family

planning over the past four decades Contraceptive Security Strategy with a Financial

Sustainability Plan adopted for 2004-2010 (due for review)

Highest contraceptive prevalence in West Africa: in 2008, 17% of married women used modern methods of FP

Sharp fertility decline, from 6.4 in 1988 to 4.0 in 2008

Procurement of contraceptives: Status MOH has a line item for contraceptives. Sector budget support is allocated for this. The funds eventually released by the MOFEP are

considerably less than the budgeted amount. Process of obtaining funding and approval for

purchase is complex and causes major delays. USAID, UNFPA provide some commodities ( and

DFID in the past). UNFPA is used as a purchasing agent except

MOH procures condoms directly. No framework contracts in place.

Distribution Large systemic problems result in facility-level

stock-outs Recent study of the flow of products and funds

across the levels of the system called for change

Contraceptive Security

Contraceptive Security

Proposed Actions: Procurement

Advocate to have the national health insurance system cover clinical FP services.

Strengthen MOH/GHS management of procurement processes; and explore use of pooled procurement mechanisms

Development partners to help with support for public and social marketing products through 2014.

Explore whether some support should flow through the health insurance system.

Contraceptive Security

Distribution: Current Status An integrated, scheduled delivery system was

initiated in 2003 but is still not fully functional Systemic problems in transport, reporting and re-

supply sometimes result in facility-level stock-outs.

The process of collecting fees from clients and accounting for them at different levels complicates regular distribution of contraceptives.

Recent study of the flow of products and funds across the levels of the system called for change.

Contraceptive Security

Contraceptive Security

Proposed Actions: Distribution

Revise current system for collection and distribution of fees to increase efficiency and timeliness in flow of products to lower levels.

Post all prices, and test the possibility of providing some methods at no cost to the client.

Closely monitor progress and do active problem-solving in the system.

Promote CBD, CHOs provision of pills, condoms and injectables and increase ease of referral for other methods

Contraceptive Security

FP data from 2008 identify challenges

Prevalence rate for modern FP has declined since last DHS in 2003, from 19% to 17% of married women of reproductive age

Use of long term methods in particular sharply decreased, as did use among the more educated, urban women

Sales of social market products decreased – due to temporary disruptions in supply

FP method use by source of method

12.7

86.9

2.7

79.2

85.7

13

77.4

17.8

1.6 0.1

19.9

3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oral contraceptives Injectables Condoms Norplant

DK/other

Private

Public

Limited access to voluntary sterilization, implants and IUDs has resulted in lower use of these methods in recent years Train nurses and midwives in use of clinical

methods including implants – use On The Job Training wherever possible

Ensure quality assurance and supportive supervision

Make a particular effort in areas where use is well below unmet need, including some urban areas.

Availability of Clinical Methods

Goal: Family Planning Revitalized

More women and men choose to use FP Health care workers responsive to their

needs, with a range of products and services

Easy access to ST methods throughout Ghana

Program on more solid footing Tangible results in increased CYP and

contraceptive prevalence

We must be engaged and

forceful in advocacy and delivery of effective programs for FP in

Ghana

•Thank you!