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ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF FAMILY PLANNING. Presented at the KNUST Annual Scientific Conference 26 TH AUGUST 2010 by Dr. Gloria J. Quansah Asare Director, Family Health Division. Content. MDGs Current Country Status (Health Related MDGs) FP

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addressing the millennium development goals the role of family planning

ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF FAMILY PLANNING.

Presented at the

KNUST Annual Scientific Conference

26TH AUGUST 2010

by Dr. Gloria J. QuansahAsare

Director, Family Health Division

content
Content
  • MDGs
  • Current Country Status (Health Related MDGs)
  • FP
  • FP & MDGs
  • Conclusion
  • Way Forward
  • References
millennium development goals
Millennium Development Goals
  • Millennium Development Goals are a UN framework for global development
  • There are a total of 8 MDGs and 4 goals are directly related to health:
  • End Poverty & Hunger
  • Universal Education
  • Gender Equality
  • Child Health
  • Maternal Health
  • Combat HIV/AIDS
  • Environmental Sustainability
  • Global Partnership
mdg 1 end poverty hunger
MDG 1: End Poverty & Hunger
  • Goal: eradicate extreme poverty & hunger
  • Target: to halve, between 1990-2015 the proportion of people who suffer from hunger
  • Indicators:

- prevalence of underweight children under five years of age

mdg 4 child health
MDG 4: Child Health
  • Goal: reduce child mortality
  • Target: to reduce, by 2/3, between 1990-2015 under-5 mortality rate
  • Indicators:

- Under-five mortality rate

- Infant mortality rate

- Proportion of 1 year-old children immunised against measles (increase by 2/3)

mdg 5 maternal health
MDG 5: Maternal Health
  • Goal: reduce maternal mortality
  • Target: to reduce by 3/4 between 1990-2015 maternal mortality ratio
  • Indicators:

- Maternal mortality ratio

- Adolescent birth rate

- Unmet need for family planning

(Increase)

- Proportion of births attended by skilled health personal

-Contraceptive prevalence rate

-Antenatal care coverage

mdg 6 combat hiv aids malaria and other diseases
MDG 6: Combat HIV/AIDS, Malaria and Other Diseases
  • Goal: combat HIV/AIDS, Malaria and other diseases
  • Target: have halted by 2015 and begun to reverse the spread of HIV/AIDS
  • Indicators:

- HIV prevalence among population aged 15-24 years

- Condom use at last high-risk sex

- Proportion of population aged 15-24 with comprehensive correct knowledge of HIV/AIDS

mdg 6 combat hiv aids malaria and other diseases cont
MDG 6: Combat HIV/AIDS, Malaria and Other Diseases cont.
  • Goal: combat HIV/AIDS, Malaria and other diseases
  • Target: achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
  • Indicators:

- Proportion of the population with advanced HIV infection with access to antiretroviral drugs

mdg 6 combat hiv aids malaria and other diseases cont1
MDG 6: Combat HIV/AIDS, Malaria and Other Diseases cont.
  • Goal: combat HIV/AIDS, Malaria and other diseases
  • Target:have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
  • Indicators:

- incidence and death rate associated with Malaria

- Proportion of children under five sleeping under insecticide-treated bed nets

- Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs

- Incidence, prevalence and death rates associated with tuberculosis

- Proportion of tuberculosis cases detected and cured under directly observed treatment short course (DOTS)

mdg 1 end poverty hunger1
MDG 1: End Poverty & Hunger

INTERVENTIONS

Prevalence of Underweight Children Under 5 years (weight-for-age -2 std. devs) 1998 - 2008

  • Nutrition education
  • Promotion of complementary feeding
  • Promotion of good eating habits
  • Promotion of exclusive breastfeeding
  • Rehabilitation of undernourished children
  • Food supplementation
mdg 4 child health interventions
MDG 4: Child Health Interventions
  • Promotion of exclusive breast feeding
  • Promotion of early introduction of complementary feeding + breastfeeding
  • School health services
  • Vitamin A supplementation
  • Immunisation
  • Growth promotion and nutrition
  • Curative care for minor ailments
  • IEC

Under-5 Mortality, 1993 - 2008

mdg 4 child health1
MDG 4: Child Health

Infant Mortality, 1993 - 2008

Proportion of 1 year-old children immunised against measles, 1993 - 2008

Source: DHS-Ghana, 1988, 1993, 1998, 2003 , 2008

mdg 4 child health2
MDG 4: Child Health
  • Challenges
    • High Neonatal mortality rate
    • Traditional/ Cultural practices
    • Limited access to services
    • Poor utilization of services
    • Health seeking behaviours
  • Way forward
    • Improve skills
    • Improve Community actions
    • Operatios Research
mdg 5 maternal health interventions
MDG 5: Maternal Health Interventions
  • Services being provided
    • nutrition education,
    • Iron folate supplementation
    • Tetanus immunisation
    • Education on breastfeeding and care of the new born
    • IPT
    • VCT and PMTCT
    • education to improve capacity of family and community members in home based, life saving skills
    • Family planning services
    • comprehensive abortion care services as permitted by law
  • Increased
    • access to Essential, comprehensive and basic obstetric care
    • access to blood transfusion services
    • coverage, content and quality of antenatal and post natal services
    • proportion of deliveries conducted by skilled attendants
  • Promote
    • the prevention of unsafe abortion and post abortion care
    • the prevention &management of reproductive tract infections
    • the prevention and management of harmful traditional practices e.g. FGM
    • The management of cancers of the reproductive system
package of services
Package of Services
  • Safe Motherhood
    • Emergency Obstetrics care
    • Essential Newborn Care
    • PMTCT
    • MIP
  • Family Planning
  • Comprehensive Abortion Care Services
  • IE &C
mdg 5 maternal health1
MDG 5: Maternal Health

Maternal Mortality Ratio, 1990 – 2015 Projections

GAP

Source: WHO, 2008

mdg 5 maternal health2
MDG 5: Maternal Health

Medically Assisted Deliveries 1993 – 2008

Antenatal Care (at least 1 visit) 1988 – 2008

Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008

mdg 5 maternal health3
MDG 5: Maternal Health

Age-Specific Fertility Rate: 15-19, 1993 – 2008

Contraceptive Use: Any Method 1988 – 2008

Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008

mdg 5 maternal health4
MDG 5: Maternal Health

Unmet Need for Family Planning, 1993 – 2008

Success!

* Unmet Need figures are derived from both the number of women who want to delay childbirth or have no more children and the number that are not using contraceptive methods.

Source: DHS-Ghana, 1988, 1993, 1998, 2003 ,2008

mdg 5 maternal health5
MDG 5: Maternal Health
  • Challenges
    • 3 Delays
      • Decision Taking, Reaching Facility, Receiving Care
    • Limited geographical access by some clients
    • Human resources; ageing midwives, and their numbers
    • Inadequate EmOC equipment
  • Way Forward
    • Collaboration with civil society organisations, NGOs, Communities and other MDAs
    • Training in midwifery
    • Improve communication (mobile telephony)
mdg 6 hiv interventions
MDG 6: HIV - Interventions
  • Counselling and testing services
  • Prevention of Mother to Child Transmission
  • Management of STIs
  • Condom Promotion: provision of condoms to Social marketing agents
  • Safe blood transfusion
    • Provision of HIV test kits for all health institutions
    • Screening of blood
  • HIV exposure prevention in health facilities
  • Health promotion and demand creation
  • Treatment care and support
    • Improve quality of treatment services
    • Increase access to ART
    • Strengthening care and support services for PLHIV
mdg 6 hiv
MDG 6: HIV

HIV Prevalence Rates, 2000 – 2008

General Population

Number of Persons on ART, 2003 – 2008

Ages 15-24

Source: NACP

mdg 6 hiv1
MDG 6: HIV

Condom use at last high-risk sex (with a non-marital, non-cohabitating partner), 2003 & 2008

Source: DHS-Ghana 2003 & draft 2008

mdg 6 hiv2
MDG 6: HIV

% of population (15-24 years) with comprehensive correct knowledge of HIV/AIDS, 2003

Source: DHS-Ghana 2003

mdg 6 malaria interventions
MDG 6: Malaria Interventions

Proportion of children under 5 sleeping under insecticide-treated bed nets, 2002 – 2008

  • Improvement of malaria case management in health facilities e.g. ACTs,
  • Promotion of home-based care of malaria with emphasis on symptoms detection and seeking early treatment
  • Promotion of the use of insecticide-treated nets for children under-five and pregnant women
  • Provision of intermittent preventive treatment for pregnant women
  • Promotion of indoor residual spraying (IRS)
  • Larviciding
mdg 6 malaria
MDG 6: Malaria

Malaria Case Fatality Rate Under 5, 2002 – 2008

Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs, 1998 – 2008

mdg 6 tb interventions
MDG 6: TB Interventions
  • DOTS quality expansion programme
    • Provision of infrastructure for supervised treatment in some district hospitals.
  • Public –Private Mix (PPM) DOTS
  • Integration of TB and HIV prevention, care and support activities
  • Community based TB Care
    • system of case holding and defaulter tracing with active community participation.
    • Enablers package
  • TB in prisons
  • Advocacy , communication, social mobilization
    • Promote behavioural change communication to support TB control
  • Monitoring, supervision and evaluation
tuberculosis case detection 1997 2008
Tuberculosis Case Detection 1997-2008

Tuberculosis Treatment Outcome: Treatment Success Vrs Adverse Outcome, 1997-2007

mdg 6 hiv aids
MDG 6: HIV/ AIDS
  • Challenges
    • Delays in reporting
    • Human Resource: Multi tasked personnel
    • Procurement delays
    • Delays in initiating care (CT,PMTCT and ART)
  • Way forward
    • All regions to be resourced to carry ART training to increase access to HAART
    • Increase access to CT, STI services
mdg 6 malaria1
MDG 6: Malaria
  • Challenges
    • Delay in in the approval of anti malaria drug policy
      • Some hospitals do not adhere to new anti malaria policy
      • Existence of several mono therapies in the system
    • Acceptability and utilisation of some brands of LLINs
    • Improvement in diagnosis and prescription
  • Way Forward
    • Improvement in drug regulation
    • Treatment of other materials other than bed nets
    • Scale up Indoor Residual Spraying
    • Improve diagnostic capacity of including laboratory support
      • Scale up use of rapid diagnostic test kits
mdg 6 tuberculosis
MDG 6: Tuberculosis
  • Challenge
    • Low case detection rate
  • Way Forward
    • Address reasons for low case detection rate through monitoring, supervision and research
    • Develop standard operating procedures for TB case detection
    • Conduct national TB prevalence survey to assess magnitude of TB problem
    • Involve ex TB patients in Tb control activities to improve case detection rate
    • PPM DOTS expansion
family planning
Family Planning
  • Family planning services include methods and practices to space births, limit family size and prevent unwanted pregnancies.
  • Fertility by choice, and not by chance is a basic requirement for women’s health.
  • Fertility regulation is also a major element in aiding safe motherhood strategy.
    • reduces the number of unwanted pregnancies
    • decrease in the total exposure to risk of pregnancy
    • decrease in the number of unsafe abortions.
slide34
Goal
  • The goal of family planning is to assist couples and individuals of all ages to achieve their reproductive goals and improve their general reproductive health.
eligibility
Eligibility
  • All individuals and couples including adolescents are eligible for family planning services.  
family planning methods available in ghana
Short term

Condoms (male and female)

Spermicides

Oral Contraceptive pills (Combined & Mini-pill)

Injectables – (3 monthly)

Injectable (Monthly)

Lactational Amenorrhoea Method (LAM)

Long Term

(Reversible)

Intra Uterine Device

Implants

Natural Family Planning Method

(Permanent /Irreversible)

Tubal Ligation ♀

Vasectomy ♂

Family planning methods available in Ghana
  • Emergency Contraception
slide37

“Planning for Progress and Development” 1969 Population Policy

“Population Growth in excess of 2 % per year is among the structural factors inhibiting the achievement of a wide range of development objectives” (UN Population Division)

Ghana Population Policy, 1969

  • FP was seen essentially as an instrument for
  • attaining specified demographic targets and
  • socio-economic development objectives.
post icpd 1994
Post –ICPD, 1994
  • Global Consensus that National Development aspirations were best achieved through Comprehensive Reproductive Health Programmes including FP.
  • Benefits of FP extend beyond slowing pace of Population Growth
    • National RH Service Policy & Standards
    • Adolescent Health & Development Programme
    • Road Map for Repositioning Family Planning etc.
unmet need for fp
Unmet Need for FP
  • Unmet need refers to women who do not want to get pregnant for the next two to three years (spacing) or women who do not want to have any more children (limiting) but are not using any method.
  • Unmet need is 34%
  • 10% higher in Rural area
some challenges
Some Challenges
  • Decreasing Contraceptive Prevalence rate
    • 19% to 17% (GDHS 2003, 2008)
  • Persistently High Unmet Need for FP 34-35%
  • Rumours, Myths & Misconceptions about contraceptives
  • Contraceptive Security issues
    • Reduced or Dwindling Funding
    • Procurement of contraceptives
    • Programme activities particularly demand generation (IE&C, BCC)
    • Sub optimal integration of FP with other services
a pivotal service in rh
A Pivotal Service in RH

Family Planning

  • A component of Reproductive Health
  • Also a component of Safe motherhood
  • Cuts across most components of RH
    • Post Abortion Care, Comprehensive Abortion Care
    • STI/HIV/AIDS Prevention and Management
    • Infertility Prevention and Management
    • Adolescent and Male Services
    • Gender-based Violence
fp benefits all
FP Benefits All!
  • Women
  • Children
  • Men
  • Families
  • Communities
  • Nations
  • The Earth
slide45

Evidence of longer birth intervals effects on health

Conde-Agudelo A., Effect of Birth Spacing on Maternal and Perinatal Health: A Systematic Review and Meta-Analysis. Rutstein, S. Johnson & Conde-Agudelo A. Systematic Literature Review and Meta-Analysis of the Relationship between Interpregnancyor Interbirth Intervals and Infant and Child Mortality. Reports submitted to CATALYST Consortium, October 2004, Conde-Agudelo, A. and Belizan, J.M. Maternal morbidity and mortality associated with interval: Cross sectional study. British Journal (Clinical Research Ed.) 321 (7271): 1255-1259. Nov. 18, 2000.

fp mdgs
FP & MDGs

MDG1: Poverty Eradication

MDG2&3: Education & Gender

# of school age children double every 20 years, undermining quality

Girls tend to have educ stopped or shortened

“If you educate a woman, you education a nation.”

Dr. J.K. Aggrey

  • With exception of a few oil rich states,no country has pulled itself out of poverty while maintaining high fertility
  • E.g. Thailand, South Korea and Taiwan all lowered fertility before achieving economic success
fp mdgs1
FP & MDGs

MDG4: Child Health

MDG5: Maternal Health

Risk of maternal death increases if woman is:

Too old, too young

Has many children or closely spaced children

# of maternal deaths averted if unmet need were met:

4000 over 10 years =

400 per year =

>1 per day

  • Closely spaced children lead to increase in child deaths
  • # of child deaths averted if unmet need for FP in Ghana were met:
    • 200,000 over 10 years =
    • 20,000 per year =
    • 55 child deaths per day
fp mdgs2
FP & MDGs

MDG6: Combat HIV/AIDS, Malaria and Other Diseases

MDG7: Environmental Sustainability

Rapid pop growth negatively pressures:

Forests, biodiversity

Coastal and marine ecosystems, fisheries

Surface water from agric and mining pressures

Flooding in urban areas due to rapid in-migration

  • Rapid pop growth negatively impacts overstretched health systems
  • Promotion and access of male and female condoms thru FP programs protect against HIV/AIDS & STIs
fp mdgs3
FP & MDGs

MDG 8: GLOBAL PARTNERSHIPS

  • Foster Partnerships at all levels
  • FP has the potential of fostering partnerships and also thrives in partnerships for Advocacy, Service Delivery, Research, IEC, Coordination, Integration, etc. at all levels.
    • Internaltional
    • National
    • Public Private Partnership
    • All Stakeholders – Men, women, youth, Religious Organizations, MDA.s , Private Sector,
  • FP should be Everybody’s Business!!!
way forward
Way Forward

Strengthened Partnerships in:

  • Repositioning Family Planning
  • Advocacy
  • Ensuring Increased Government Funding & Support for Contraceptive Commodities & Services
  • Improved Service Delivery
  • IE&C
    • Family Planning Week
    • Re Launch “Life Choices Campaign”
  • Media Support
  • Research and Dissemination of Information is Crucial!
conclusions
Conclusions
  • Ghana can do a lot more towards achieving the health MDGs by 2015 if resources are committed.
  • FP has the potential to hasten Ghana’s Development efforts.
  • Ensure FP is a centrally important component of the medium term health plan and features in all poverty reduction strategies in the country.
  • Ensure budget support.
  • Appeal to development partners for additional support to help buttress our efforts.
  • Reposition FP as a development tool and a choice in Life to attain goals.
references
References
  • UNFPA Fact Sheet. http://www.unfpa.org
  • ICF Macro. 2010. Ghana Trend Report: Trends in Demographic, Family Planning, and Health Indicators in Ghana. 1960-2008: Trend Analysis of Demographic and Health Surveys Data. Calverton, Maryland, USA: ICF Macro.
  • Report of Hearings by the All Party Parliamentary Group on Population, Development and Reproductive Health. January 2007. Return of Population Growth Factor: Its Impact upon the Millennium Development Goals.
  • USAID Health Policy Initiative. July 2009. “Achieving the MDGs: The contribution of family planning Ghana.” Futures Group International.
  • Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International. 2009. Ghana Maternal Health Survey 2007. Calverton, Maryland, USA: GSS, GHS, and Macro International.
  • The Case for Including Family Planning on the National Health Insurance Scheme (NHIS) and Increased Budgetary Allocation for Contraceptives by Government. Position Paper. PPAG and Partners Advocacy 2010  
  • Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. 2009. Ghana Demographic and Health Survey 2008. Accra, Ghana.
  • Vice President’s Keynote Address at Launching of Life Choices Campaign, Accra August 2010
thank you for your interest
Thank You for Your Interest!

Presented by:

Dr. Gloria QuansahAsare

( Director Family Health Division)

Ghana Health Service

“Family Planning for a Better Life”