Family Planning in Ghana:
Contraceptive Security is
still a work in progress
Yaa Osei Asante
Ghana Health Service
Background Information on Ghana
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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
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To improve availability of quality and 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
Why RH Commodity Security?
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Success of FP Programs
 Generated Demand for Contraceptive Commodities
 Unmet Need for FP still high
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Shift of resources to HIV/AIDS Programming
Inadequate Coordination among stakeholders
Weak Logistics Systems
Need to reinvigorate RHCS
Ghana: Family Planning Successes
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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
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.
Contraceptive
Security
Contraceptive
Security
Proposed Actions: Procurement
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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 resupply sometimes result in facility-level stockouts.
 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
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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 problemsolving in the system.
Promote CBD, CHOs provision of pills, condoms
and injectables and increase ease of referral for
other methods
FP data from 2008 identify challenges
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Prevalence rate for modern FP has declined
since last DHS in 2003, from 19% to 17% of
married women of reproductive age
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Use of long term methods in particular sharply
decreased, as did use among the more
educated, urban women
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Sales of social market products decreased – due
to temporary disruptions in supply
FP method use by source of method
100%
1.6
0.1
3
13
90%
19.9
17.8
80%
DK/other
70%
Private
60%
Public
85.7
50%
86.9
40%
77.4
79.2
30%
20%
10%
12.7
2.7
0%
Oral contraceptives
Injectables
Condoms
Norplant
Availability of Clinical Methods
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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.
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
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We must be engaged and
forceful in advocacy and
delivery of effective programs
for FP in Ghana
•Thank you!