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September 2012

GAP
RESOURCE
REQUIREMENTS FOR
FAMILY PLANNING
IN GHANA

Brief

Status of Family Planning


Population pressures constitute important constraints Subsequent national policy documents also address FP
on future economic growth and the ability of a country issues. For example, A Road Map for Repositioning Family
to provide for the welfare of its citizens and achieve its Planning in Ghana (20062010) calls for an increase in
national development objectives. From 20002010, the (1) political commitment, (2) public awareness and
population of Ghana increased by 30 percentfrom acceptance of family planning as important to national
18.9 million in 2000 to 24.6 million in 2010.1 Recognising health and socio-economic development, and (3) funding
the link between rapid population growth and social and for FP commodities and services.2
economic development, the government has worked to
build a positive policy environment for family planning These policies are further supported by the current
(FP). The National Population Policy (Revised Edition, 1994) national blueprint for development, Ghana Shared Growth
sets clear targets regarding fertility and contraceptive use. and Development Agenda (20102013), which recognises
These are to family planning as a top priority for inclusion in national
development plans and activities at all levels.
Reduce the total fertility rate (TFR) from 5.5. to 5.0
by 2000 and then to 3.0 by 2020; As a result of this positive policy environment, Ghana
has made some progress toward achieving its National
Achieve a contraceptive prevalence rate (CPR) of Population Policy targets. The latest census indicates
15 percent for modern FP methods by 2000 and 50 that the annual population growth rate has dropped
percent by 2020; and to 2.5 percent.3 In addition, according to the 2008
Demographic and Health Survey (DHS), the countrys
Reduce the current annual population growth rate total fertility rate lowered to an average of 4 children
of about 3 percent to 1.5 percent by 2020.

Photo by: Jeannine Harvey

H E A LT H
POLICY
P R O J E C T
Reduce the total fertility rate (TFR) from 5.5. to 5.0 by 2000 and then to 3.0 by 2020;
Achieve a contraceptive prevalence rate (CPR) of 15 percent for modern FP methods by 2000 and 50 percent by
2020; and

September
Reduce2012
the current annual population growth rate of about 3 percent to 1.5 percent by 2020.

Subsequent national policy documents also address FP issues. For example, A Road Map for Repositioning Family
Planning in Ghana (20062010) calls for an increase in (1) political commitment, (2) public awareness and acceptance
of family planning as important to national health and socio-economic development, and (3) funding for FP commodities
and services. 2

These policies are further supported by the current national blueprint for development, Ghana Shared Growth and

Estimated Resources
Development Agenda (20102013), which recognises family planning as a top priority for inclusion in national
Figure
development 1: activities
plans and Historical Trends in Fertility
at all levels.
and Contraceptive Use
Required
As a result of this positive policy
environment, Ghana has made some progress
7 25
toward achieving its National Population
6 Policy targets. The latest census indicates
20 that the annual To fully appreciate
population growth rate hasthe investment needed to attain
5 dropped to 2.5 percent. 3 In addition,
the2008
targets, the National Population Council and

CPR (%)
according to the Demographic and
15
TFR

4 Health Surveyits partnersin


(DHS), collaboration with the USAID-
the countrys total
fertility rate lowered to an average of 4
3 10
funded
children per woman and Health Policy Projectreviewed data on
use of modern

2
family planning demographic patterns,
methods among married
women ages 1549 increased to 17 percent. 4
family planning costs, and
5 It is interstingprojected funding
to note, however, that for 20102015 and conducted an
1 historical trends in fertility and contraceptive
application of the GAP (Gather, Analyze, and Plan)
use reveal a mismatch (see Figure 1); while
0 0 the TFR has beenTool. Thedeclining,
steadily tool isthere
designed to project the contraceptive,
1988 1993 1998 2003 2008 has not always been a corresponding
service provision, and program support funding
increase in CPR. Furthermore, fertility rates
TFR CPR (All) CPR (Modern)
continue to varygaps in inor
births
widely a the
country
do country,
not wantto ultimately
any
rising helpbutpolicymakers,
more children are not using contraception (defined as u
from 2.5 childrenprogress
per woman is in
necessary to achieve the population policys ambitious targets, as well as
the Greater
Accra region to 6.8 children in the Northern Region. Moreover, 35 percent of married women decisionmakers,
securitywhich
either want to space and
theirdevelopment
exists partners
when people are able understand
to choose, obtain, and use high-quality
per woman and use of modern family planning thethem.
costs involved in reaching national family planning
methods
1
among
Ghana Statistical Service married
(GSS). 2012. women
Population &ages 1549
Housing increased
Census 2010. goalsAccra:
Summary Report of Final Results. andGSS.addressing challenges to progress.
2
Ghana Health Service. The Reproductive Health Commodity Security Strategy (20122016) 5 identifies seve
4 2006. A Road Map for Repositioning Family Planning in Ghana. Accra: Ghana Health Service.
toGhana
3 17 percent. It (GSS).
Statistical Service is interesting to&note,
2012. Population Housing however, that Report of Final Results.
Census 2010. Summary set targets and ensuring the sustainability of the FP programme, including (1) inadeq
Accra: GSS.
4
historical trends inMacro.
fertility and contraceptive use Meeting
Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. 2009. Ghana Demographic the
and Health
reproductive unmet
Survey need for family
2008. commodities
health Accra, and (2) aplanning (35%)on donors for commodi
high dependence
Ghana: GSS, GHS, and ICF
reveal a mismatch (see Figure 1); while the TFR has will enable Ghana to reach the target CPR of to50address these challenges an
by government and development partners is necessary

been steadily declining, there has not always been percent for modern FP methods by 2020. Based on
Estimated Resources Required
a corresponding increase in CPR. Furthermore, the projected increase in contraceptive prevalence (see
To fully
Figure 2),appreciate
the totalthenumber
investment
of needed
userstowillattain the targets,
increase fromthe National Populati
fertility rates continue to vary widely in the country, collaboration with the USAID-funded Health Policy Projectreviewed data on dem
rising from 2.5 children per woman in the Greater 1.6costs,
million womenfunding
and projected in 2010forto more than
20102015 2.8 million
and conducted an application of the GA
Accra region to 6.8 children in the Northern Region. women
The tool in is2015 and
designed toalmost 4.3
project the million women
contraceptive, service in 2020. and program sup
provision,
ultimately help policymakers, decisionmakers, and development partners understand
Moreover, 35 percent of married women either national family planning goals and addressing challenges to progress.
want to space their births or do not want any more Figure 2: Projected CPR
Meeting the unmet n
children but are not using contraception (defined as 35% enable Ghana to reac
unmet need). Thus, accelerated progress is necessary 30%
modern FP methods
increase in contracep
to achieve the population policys ambitious targets, total number of users
as well as the related goal of contraceptive security 25%
women in 2010 to m
which exists when people are able to choose, obtain, and almost 4.3 millio
20%
and use high-quality contraceptives whenever they Premised on a genera
15%
want them. anticipated that there
10% methods, with greate
The Reproductive Health Commodity Security Strategy (non-permanent and
5% multiple DHS reports
(20122016)5 identifies several major challenges to prevalence increases
achieving the set targets and ensuring the sustainability 0% methods also increas
2010 2011 2012 2013 2014 2015 country.
of the FP programme, including (1) inadequate public
funding for FP and reproductive health commodities The Ghana GAP application projects increases in the share of pills, implants, injecta
and (2) a high dependence on donors for commodity Premised on aand
between 2010 general understanding
2020. These increases willamong partners,
occur primarily at
the expense of traditional methods and condoms (although the
procurement. Greater investment by government and it isshare
anticipated that there will be an increase in the use
of condoms will remain relatively high).
development partners is necessary to address these of all methods, with greater emphasis on long-acting
challenges and accelerate progress. methods (non-permanent
The private and active
sector is already highly permanent). A review
in the distribution of
supply methods of contraception: condoms and pills.
of Although
data from multiple DHS reports shows that
there may be a movement towards the private sector as
Figure 3. Progr
contraceptive
for long-actingprevalence increases,
methods, for the thethisproportion
purposes of analysis, we of Committed Fun
assumed that
long-acting clients continued
methods to receive their
also increases as a contraceptives
share of the
from the same source.
method mix in the country.
Results
The total cost of delivering family planning in Ghana
(commodities plus programme costs) is estimated to be about
US$41 million in 2010. To reach the National Population Policy
Resource Requirements for Family Planning in Ghana

The Ghana GAP application projects increases in the


share of pills, implants, injectables, and intrauterine
devices (IUDs) between 2010 and 2020. These Increased investment in family
increases will occur primarily at the expense of
traditional methods and condoms (although the share planning will also help to promote
of condoms will remain relatively high). gender equality, achieve
The private sector is already highly active in the universal access to reproductive
distribution of supply methods of contraception: health, and reduce maternal
condoms and pills. Although there may be a and child mortality (Millennium
movement towards the private sector for long-acting
methods, for the purposes of this analysis, we assumed Development Goals 3, 4, and 5)
that clients continued to receive their contraceptives
from the same source.

Results
The total cost of delivering family planning in Ghana
(commodities plus programme costs) is estimated to
be about US$41 million in 2010. To reach the National
Population Policy goal by 2020, CPR in 2015 will need
to be about 33 percent, which will require resources
to almost double to US$78 million. The total funding
gap is projected to be almost US$15 million by 2015
(see Figure 3 ). However, this funding gap may be
understated due to several reasons: (1) a large portion
of the programme costs, especially commodities, are
currently covered by development partners whose

Figure 3: Resource Needs and


Commitments (US$)
$90
$78.3
$80
$69.7
$70
$61.6 Gap $63.8
$58.7
$60 $54.2
$54
$47.2
$50
Millions

$40.8
$40

$30

$20

$10

$0
2010 2011 2012 2013 2014 2015

UK Department for United States Agency United Nations Internationall


International for International Population Fund Planned Parenthood
Development (DfID) Development (USAID) (UNFPA) Federation (IPPF)
National European Union (EU) Other private Requirements
government

Photo by: Allison Stillwell


Resource Requirements for Family Planning in Ghana

projected funding may or may not be fulfilled; and (2) Review policies, standards, and procedures to
there are difficulties in separating donor support for increase and expand the cadre of FP service
family planning from overall reproductive and maternal providers, thus enabling lower level health workers
health support. In addition, although the commodity to provide clinical methods of family planning
costs were based on Ghanaian data, costs for service
delivery, programme support, and overhead were based Make family planning free and accessible to all
on default global values. Inadequate Ghana-specific cost
data is a significant hindrance to fully understanding Development partners should
resource needs for family planning in the country. Support the training, logistics, and supervision

Furthermore, to provide more preferred, long-acting costs associated with FP delivery
methods (injectables and implants) to hard-to-reach Support the implementation of the Reproductive

communities, the Ghana Health Service will have to Health Commodities Strategy
explore and invest in task shifting and cover the related
training, logistics, and supervision costs associated with Contribute to the procurement of FP commodities
the new cadre of service providers.

Although donor contributions have been crucial to References


closing the gap in the past, the Government of
Ghana must increase its support of FP commodities 1. Ghana Statistical Service (GSS). 2012. Population &
Housing Census 2010. Summary Report of Final Results.
to ensure contraceptive security. Without new sources
Accra: GSS.
of commodities, stockouts may continue to affect the
availability and quality of FP service delivery. More 2. Ghana Health Service. 2006. A Road Map for Repositioning
importantly, all donor projections need to be viewed in Family Planning in Ghana. Accra: Ghana Health Service.
the context of the overall economic crisis, which may in
turn affect the realisation of these projections. 3. Ghana Statistical Service (GSS). 2012. Population &
Housing Census 2010. Summary Report of Final Results.
Accra: GSS.
Recommendations 4. Ghana Statistical Service (GSS), Ghana Health Service
(GHS), and ICF Macro. 2009. Ghana Demographic and
Based on the results, if Ghana is to achieve its family
Health Survey 2008. Accra, Ghana: GSS, GHS, and ICF
planning targets and thereby realise its national Macro.
development goals, the government and development
partners should take action to increase investments for 5. Ministry of Health, 2011. Meeting the Commodity Challenge:
family planning. The Ghana National Reproductive Health Commodity Security
Strategy 20112016. Accra: Ministry of Health.
Government should
Increase budget and expenditure for family
planning commodities

Strengthen coordination for the family planning


programme

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Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. It is implemented
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