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

1. Family Planning in Ghana: Contraceptive Security isstill a work in progressYaa Osei AsanteGhana Health Service

2. 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

3. 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

4. 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

5. Strategic Objectives • To improve availability of qualityand affordable contraceptive products and services • To strengthen public-private partnerships in the supply and delivery of contraceptive products and services • To implement reliable and efficient systems for the supply of contraceptive products and services • To achieve sustainable financing of contraceptive products and services • To ensure a national capacity to monitor and evaluate the progress on the attainment of CS targets

6. 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

7. 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

8. Contraceptive Security 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

9. 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.

10. 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.

11. 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

12. 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

13. FP method use by source of method

14. Availability of Clinical Methods • 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.

15. 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

16. We must be engaged andforceful in advocacy and delivery of effective programs for FP in Ghana • Thank you!