family planning in ghana: contraceptive security is still a work in progress yaa osei asante ghana...
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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!