1. DR PATRICK KUMA-ABOAGYE – DEPUTY DIRECTOR FHD, GHANA HEALTH SERVICE 7 TH OCTOBER, 2013, SEOUL, SOUTH KOREA IMPLEMENTATION OF MDG ACCELERATION FRAMEWORK FOR MDG 5 The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20131

2. PRESENTATION OUTLINE WHY AND WHAT IS MAF FOR MDG 5 FOR GHANA IMPLEMENTATION STRATEGY KEY ACHIEVEMENTS AND OUTCOMES IMPLEMENTATION CHALLENGES WHAT WORKED WELL RECOMMENDATIONS The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20132

3. WHY MDG 5 IN NATIONAL DEVELOPMENT CONTEXT ? MAF Action Plan focus on MDG 5 because the progress in reducing maternal mortality ratio by 3/4 by 2015 is off-track. The 2010 MDG Report showed maternal mortality rate to be at 451 per 100,000 live births. The slow progress is a great concern to policy decision- makers to an extent that Maternal Mortality was declared National emergency in July 2008. Tackling MDG 5 will likely have positive impact on almost all MDGs and health systems Need to be focus to overcome bottlenecks in MDG 5 implementation The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20133

4. MAF has three priority areas and one cross-cutting are: 1. Family Planning 2. Skilled Delivery 3. Emergency Obstetric and Newborn Care 4. Crosscutting or Health Systems issues Three implementation phases: Phase I - National operational multi-year plan development Phase 2 – Preparation of regional plans etc Phase 3 – Full implementation Introduction - MDG Accelerated Framework (MAF) The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20134

5. Implementation Strategy. Governance To ensure better oversight of results and resources. Multidisciplinary implementation steering committee (National and development Partners) chaired by Minister of Health Establishment of sub-committees to work on key areas in MAF such as; Procurement IEC/BCC /advocacy Training and Human Resource M&E The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20135

6. Implementation Strategy. Advocacy Orientation meetings with stakeholders and groups to ensure adequate buying-in Maintenance of Free maternal health Service by incorporating it in the new Health Insurance Law Free family planning services to improve CPR and reduce unwanted pregnancy Task shifting - FP service policy reviewed to allow auxiliary nurses provide contraceptive implant services to improve access to services The President of Ghana is currently Championing Maternal Health and FP The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20136

7. Implementation Strategy. Partnership and Resource Mobilisation Government with strong support from the UNCT, under the remarkable leadership of RC and WHO has used MAF extensively to mobilize new partners and strengthened the existing relationships. Additional Resource mobilized so far includes; 52 Million Euro Grant from the European Union 23 million Euro (Grant and Loan) from the ORIO funds being concluded US$5.758 million from DANIDA $100,000 from Access bank (Private sector) Potential support from Dutch and Japanese Govt. The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20137

8. Family Planning – key achievement Smart phones/mobile phones procured and used in capturing FP logistics data to prevent stock-out District Health Information Management Systems (DHIMS 2) roll out completed. Available online in all districts GoG allocates $3,000,000 for contraceptive procurement in yearly, partners increase support for commodities (DFID) Institutionalization of National Family Planning week in September – 2 celebrated The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20138

9. Skilled Delivery key achievement Staffing norms using workload benchmarking on-going Increase production of Midwives, Policy reviewed and the country has re-introduced 2- year post basic and auxiliary midwifery course 8 new midwifery training institutions established commenced training in 2011/2012 academic year 60 midwifery tutors at university recruited between 2010 and 2011 (more than 100% increase over the previous years) Increased intake of students in 2010 – 2011. 1300 intake for 2011 and 2012 compared to 800 in 2010 Regional and national midwifery forums organised to allow sharing of experiences, provision of updates especially technological skills and boost their moral The Seoul Post - 2015 Conference: Implementation and Implications 7th October 20139

10. EmONC- key achievement Nationwide EmONC assessment conducted and disseminated and facility upgrades on-going Referral policy completed, 161 new ambulances deployed by the MOH. Engaged private transport unions with MOU to support transport of pregnant women in emergencies Upon request from MOH, UNDP is supporting the establishment of an M & E system through pilot monitoring system in two hard to reach areas (provision of ambulances and basic equipment). This will be scaled up Life Saving Skills training for midwives Scaled up maternal death and health surveillance system scaled up throughout the country The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201310

11. Cross-cutting Issues (Health Systems) Capacity building for the Family Health Division at national and regional levels Initiate regional and local level MOUs with mobile phone operators to support maternal health services especially emergency response National Health Account including preparation for Maternal and Child Health Sub-Accounts to track Maternal and child health expenditures Resource tracking system – for MAF implementation. Guidelines developed for use in 2013 Media and BCC activities intensified for demand generation and reduce myths and misconceptions about FP The Seoul Post - 2015 Conference: Implementation and Implications 7th October 2013 11

12. Key Outcomes- Trends in Maternal Health Indicators The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201312

13. Use of modern contraceptives increasing…. The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201313

14. The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201314

15. In the current WHO/UNFPA/WORLD BANK TRENDS IN MMR REPORT 2008 GHANAS MMR IS 350/100,000 LB AND CLASSIFIED AS MAKING PROGRESS AND MMR REDUCED 42% FROM THE 1990S Institutional maternal mortality has declined from 230/100,000LB in 2009 to 153/100,000 LB in 2012 The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201315

16. Implementation Challenges Creating attitudinal changes needed at the district and lower level for rapid implementation Road infrastructure: poor road networks particularly at the local levels were considered a huge limitation to health facility accessibility and coverage. Inadequate inter-sectoral coordination especially between health sector and the MMDAs Long time lag between the preparation phase and the full implementation Inadequate understanding of the MAF strategy by Key managers created initial conflicts The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201316

17. What Worked Well Implementing health systems and program interventions together encourages all to be involved yields better results Boosting the moral and capacity of service providers (MW) particular led to improved ownership at the implementation level Resource tracking systems improved compliance and adherence to plans The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201317

18. Recommendations Attention should also focus on key infrastructural and health systems challenges that greatly impact on maternal health Continue to reduce out of pocket payment for maternal health services for the poor has significantly reduced the equity gap in skilled delivery. Additional advocacy to get the private sector, CSO, domestic financial institutions and the MMDAs more involve in MAF implementation Strengthen donor coordination Institutionalization of accountability systems The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201318

19. Recommendations Post 2015 Momentum should not be lost by coming up with other new Goals, which may take several years to understand. Emphasis on access as well as quality issues Pay attention to equity issuesNational averages mask disparity between settings MDG 5 should be categorised as a development issue that is intertwined with infrastructure, ICT, Transportation etc. Clear funding for maternal health by Governments. The Seoul Post - 2015 Conference: Implementation and Implications 7th October 201319

20. THANK YOU The Seoul Post - 2015 Conference: Implementation and Implications 7th October 2013 20