ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF
FAMILY PLANNING.
Presented at the KNUST Annual Scientific Conference
26TH AUGUST 2010 by Dr. Gloria J. Quansah AsareDirector, Family Health Division
Content
• MDGs• Current Country Status (Health Related MDGs)• FP• FP & MDGs• Conclusion• Way Forward• References
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:
1. End Poverty & Hunger2. Universal Education3. Gender Equality4. Child Health5. Maternal Health6. Combat HIV/AIDS7. Environmental Sustainability8. Global Partnership
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
• 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
• 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
• 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.
• 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 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)
INTERVENTIONS & CURRENT STATUS
MDG 1: End Poverty & HungerINTERVENTIONS
• Nutrition education • Promotion of
complementary feeding• Promotion of good eating
habits• Promotion of exclusive
breastfeeding• Rehabilitation of
undernourished children• Food supplementation
15.4
12.4
25.4
22.324.3
21.4
0
5
10
15
20
25
30
1998 2003 2008
year
% o
f u
nd
er 5
ch
ildre
n
Prevalence of Underweight Children Under 5 years (weight-for-age -2 std.
devs) 1998 - 2008
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
119.4107.6 111.2
8070.8
39.88
0
20
40
60
80
100
120
140
1993 1998 2003 2008 2015
year
Deat
hs/1
,000
Under-5 Mortality, 1993 - 2008
MDG 4: Child HealthInfant Mortality, 1993 - 2008
66.4
56.7
64.3
50
0
20
40
60
80
1993 1998 2003 2008
year
Dea
ths/
1,00
0
Source: DHS-Ghana, 1988, 1993, 1998, 2003 , 2008
50.6
60.9
68.8
79.9
0
10
20
30
40
50
60
70
80
90
1993 1998 2003 2008
year
pro
po
rtio
n o
f ch
ild
ren
1-y
r
Proportion of 1 year-old children immunised against
measles, 1993 - 2008
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
• 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
– Safe Motherhood• Emergency Obstetrics
care• Essential Newborn Care• PMTCT• MIP
– Family Planning– Comprehensive Abortion
Care Services– IE &C
MDG 5: Maternal Health
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
0
100
200
300
400
500
600
700
800
740
590540 560
483451
185
YEAR
PE
R 1
00 0
00 L
B
Maternal Mortality Ratio, 1990 – 2015 Projections
Source: WHO, 2008
GAP
MDG 5: Maternal HealthMedically Assisted Deliveries
1993 – 2008
44 44.347.1
57
0
10
20
30
40
50
60
1993 1998 2003 2008
year
% o
f del
iver
ies
Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008
Antenatal Care (at least 1 visit) 1988 – 2008
87.5
91.9
95.4
82
84
86
88
90
92
94
96
1998 2003 2008
year
% o
f w
om
en r
ecei
vin
g a
t le
ast
1 vi
sit
(fro
m h
lth
pro
f)
MDG 5: Maternal HealthAge-Specific Fertility Rate: 15-
19, 1993 – 2008
Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008
2022
2524
0
5
10
15
20
25
30
1993 1998 2003 2008
year
% o
f m
arri
ed w
om
en u
sin
g a
ny
met
ho
d
Contraceptive Use: Any Method 1988 – 2008
116
88
74
66
0
20
40
60
80
100
120
140
1993 1998 2003 2008
birth
s/1,
000 w
omen
ages
15-1
9
year
MDG 5: Maternal HealthUnmet Need for Family Planning, 1993 – 2008
Success!
38.6
33.534 34
30
31
32
33
34
35
36
37
38
39
1993 1998 2003 2008
year
% o
f w
om
en w
ith
un
met
nee
d
Source: DHS-Ghana, 1988, 1993, 1998, 2003 ,2008
* 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.
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• 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
2.3
2.9
3.43.6
3.1
2.7
3.2
2.6
2.2
2.6
1.9
2.5 2.6
1.9
0
0.5
1
1.5
2
2.5
3
3.5
4
2000 2001 2002 2003 2004 2005 2006 2007 2008year
Pre
vale
nce
Rat
e
General Population
Ages 15-24
HIV Prevalence Rates, 2000 – 2008
Source: NACP
3156
13,249
23,614
197
1804 1913
0
5000
10000
15000
20000
25000
2003 2004 2005 2006 2007 2008year
# of
per
sons
on
AR
T
Number of Persons on ART, 2003 – 2008
MDG 6: HIVCondom use at last high-risk sex (with a non-marital,
non-cohabitating partner), 2003 & 2008
43.9
44
28.1
25.4
0 5 10 15 20 25 30 35 40 45
percentage
Male
Female
2008
2003
2003
2008
Source: DHS-Ghana 2003 & draft 2008
MDG 6: HIV% of population (15-24 years) with comprehensive correct
knowledge of HIV/AIDS, 2003
45.45
38.15
34 36 38 40 42 44 46
Percentage of persons
Male
Female
Source: DHS-Ghana 2003
MDG 6: Malaria Interventions
• 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
3.5
21.8
41.1
0
5
10
15
20
25
30
35
40
45
2003 2006 2008
year
% o
f chi
ldre
n
Proportion of children under 5 sleeping under insecticide-
treated bed nets, 2002 – 2008
MDG 6: MalariaMalaria Case Fatality Rate Under 5,
2002 – 2008
60.762.8
60.8
43
0
10
20
30
40
50
60
70
1998 2003 2006 2008
year
% o
f chi
ldre
n
Proportion of children under 5 with fever who are treated
with appropriate anti-malarial drugs, 1998 – 2008
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
02000400060008000
10000120001400016000
Year
No.
of c
ase
Tuberculosis Case Detection 1997-2008
45.850.6
55.350.3
5660.5
66.971.7 72.6
76.1
84.7
54.249.4
44.749.7
4439.5
33.128.3 27.4
23.919.3
0102030405060708090
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Rat
e (%
)Treatment Success Adverse outcome
Tuberculosis Treatment Outcome: Treatment Success Vrs Adverse Outcome, 1997-
2007
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: 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 • 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 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.
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
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 ♂
• Emergency Contraception
“Planning for Progress and Development” 1969 Population Policy
FP was seen essentially as an instrument for
•attaining specified demographic targets and •socio-economic development objectives.
“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
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.
Population Targets & Performance
Year TFR CPR
Projected Achieved Projected Achieved
1988(DHS) 6.7 5.0%1993(DHS) 5.5 10.5%
1998(DHS) 4.4 13.0%
2003(DHS) 4.4 19.0%
2008(DHS) 4.0 17.0%
2000 5.0 15%
2010 4.0 28%
2020 3.0 50%
TFR and use of any and modern contraceptive methods, Ghana 1988-2008
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
Unmet Need for FP
1113 12
16
25
22
34
38
27
0
5
10
15
20
25
30
35
40
Urban Rural National
% U
nmet
Nee
d
total
limiting
spacing
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
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!
• Women• Children• Men• Families• Communities• Nations• The Earth
For Children Lower risk of:• Child death• Infant death• Neonatal death• Fetal death• Stunting and underweight• Small for gestational age• Low birth weight• Preterm birth
For MotherLower risk of :• Maternal death• Puerperal endometritis• Premature rupture
membranes• Anemia• Third trimester bleeding
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.
Evidence of longer birth intervals effects on health
Family Planning is Pivotal to SRH&
Relevant in All 8 MDGs!
FP and MDG’s
FP
1. Poverty
2 Education
3Gender
4 Child Health5
Maternal Health
6 HIV, Malaria,
Other
7Environment
8 Partnership
FP & MDGs
MDG1: Poverty Eradication• 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
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
FP
1. Poverty
2. Education
3. Gender
4. Child Health
5. Maternal Health
6. HIV, Malaria,
Other
7. Environment
8. Partnership
FP & MDGs
MDG4: Child Health• 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
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
FP
1. Poverty
2. Education
3. Gender
4. Child Health
5. Maternal Health
6. HIV, Malaria,
Other
7. Environment
8. Partnership
FP & MDGsMDG6: Combat HIV/AIDS, Malaria and Other Diseases
• Rapid pop growth negatively impacts overstretched health systems
• Promotion and access of male and female condoms thru FP programs protect against HIV/AIDS & STIs
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
FP
1. Poverty
2. Education
3. Gender
4. Child Health
5. Maternal Health
6. HIV, Malaria,
Other
7. Environment
8. Partnership
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!!!
FP
1. Poverty
2. Education
3. Gender
4. Child Health
5. Maternal Health
6. HIV, Malaria,
Other
7. Environment
8. Partnership
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
• 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.1. Ensure FP is a centrally important component of the
medium term health plan and features in all poverty reduction strategies in the country.
2. Ensure budget support.3. 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.
53
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!
Presented by:Dr. Gloria Quansah Asare
( Director Family Health Division)Ghana Health Service
“Family Planning for a Better Life”
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