Family Planning in Ghana: Contraceptive Security is still a work in progress Yaa Osei Asante Ghana Health Service

Background Information on Ghana  Situated in West Africa  Independence on 6 th 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 Financial Sustainability Plan  Repositioning Family Planning- A Road Map for Repositioning Family Planning

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 quality  To improve availability of quality and affordable contraceptive products and services partnerships  To strengthen public-private partnerships in the supply and delivery of contraceptive products and services efficient  To implement reliable and efficient systems for the supply of contraceptive products and services financing  To achieve sustainable financing of contraceptive products and services monitor and evaluate  To ensure a national capacity to monitor 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 (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

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  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

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

 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!