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Presentation on theme: "ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF FAMILY PLANNING. Presented at the KNUST Annual Scientific Conference 26 TH AUGUST 2010 by Dr."— Presentation transcript:


2 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

3 Content MDGs Current Country Status (Health Related MDGs) FP FP & MDGs Conclusion Way Forward References

4 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 & Hunger 2.Universal Education 3.Gender Equality 4.Child Health 5.Maternal Health 6.Combat HIV/AIDS 7.Environmental Sustainability 8.Global Partnership

5 MDG 1: End Poverty & Hunger Goal: eradicate extreme poverty & hunger Target: to halve, between the proportion of people who suffer from hunger Indicators: - prevalence of underweight children under five years of age

6 MDG 4: Child Health Goal: reduce child mortality Target: to reduce, by 2/3, between 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)

7 MDG 5: Maternal Health Goal: reduce maternal mortality Target: to reduce by 3/4 between 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

8 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 years - Condom use at last high-risk sex - Proportion of population aged with comprehensive correct knowledge of HIV/AIDS

9 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

10 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)


12 MDG 1: End Poverty & Hunger INTERVENTIONS Nutrition education Promotion of complementary feeding Promotion of good eating habits Promotion of exclusive breastfeeding Rehabilitation of undernourished children Food supplementation Prevalence of Underweight Children Under 5 years (weight-for-age -2 std. devs)

13 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,

14 MDG 4: Child Health Infant Mortality, Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008 Proportion of 1 year-old children immunised against measles,

15 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

16 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

17 Package of Services – Safe Motherhood Emergency Obstetrics care Essential Newborn Care PMTCT MIP – Family Planning – Comprehensive Abortion Care Services – IE &C

18 MDG 5: Maternal Health Maternal Mortality Ratio, 1990 – 2015 Projections Source: WHO, 2008 GAP

19 MDG 5: Maternal Health Medically Assisted Deliveries 1993 – 2008 Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008 Antenatal Care (at least 1 visit) 1988 – 2008

20 MDG 5: Maternal Health Age-Specific Fertility Rate: , 1993 – 2008 Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008 Contraceptive Use: Any Method 1988 – 2008

21 MDG 5: Maternal Health Unmet Need for Family Planning, 1993 – 2008 Success! 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.

22 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)

23 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

24 MDG 6: HIV General Population Ages HIV Prevalence Rates, 2000 – 2008 Source: NACP Number of Persons on ART, 2003 – 2008

25 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

26 MDG 6: HIV % of population (15-24 years) with comprehensive correct knowledge of HIV/AIDS, 2003 Source: DHS-Ghana 2003

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

28 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

29 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

30 Tuberculosis Case Detection Tuberculosis Treatment Outcome: Treatment Success Vrs Adverse Outcome,

31 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

32 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

33 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

34 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 womens 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.

35 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.

36 Eligibility All individuals and couples including adolescents are eligible for family planning services.

37 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

38 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

39 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.

40 Population Targets & Performance YearTFRCPR ProjectedAchievedProjectedAchieved 1988 (DHS) % 1993 (DHS) % 1998 (DHS) % 2003 (DHS) % 2008 (DHS) % % % %

41 TFR and use of any and modern contraceptive methods, Ghana

42 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

43 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

44 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

45 FP Benefits All! Women Children Men Families Communities Nations The Earth

46 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 Mother Lower 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): Nov. 18, Evidence of longer birth intervals effects on health

47 Family Planning is Pivotal to SRH & Relevant in All 8 MDGs!

48 FP and MDGs FP 1. Poverty 2 Education 3 Gender 4 Child Health 5 Maternal Health 6 HIV, Malaria, Other 7 Environment 8 Partnership

49 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. Educatio n 3. Gender 4. Child Health 5. Maternal Health 6. HIV, Malaria, Other 7. Environm ent 8. Partnersh ip

50 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. Educatio n 3. Gender 4. Child Health 5. Maternal Health 6. HIV, Malaria, Other 7. Environm ent 8. Partnersh ip

51 FP & MDGs MDG6: 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. Educatio n 3. Gender 4. Child Health 5. Maternal Health 6. HIV, Malaria, Other 7. Environm ent 8. Partnersh ip

52 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 Everybodys Business!!! FP 1. Poverty 2. Educatio n 3. Gender 4. Child Health 5. Maternal Health 6. HIV, Malaria, Other 7. Environm ent 8. Partnersh ip

53 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!

54 Conclusions Ghana can do a lot more towards achieving the health MDGs by 2015 if resources are committed. FP has the potential to hasten Ghanas 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

55 References UNFPA Fact Sheet. ICF Macro Ghana Trend Report: Trends in Demographic, Family Planning, and Health Indicators in Ghana : 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 Return of Population Growth Factor: Its Impact upon the Millennium Development Goals. USAID Health Policy Initiative. July Achieving the MDGs: The contribution of family planning Ghana. Futures Group International. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International Ghana Maternal Health Survey 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 Ghana Demographic and Health Survey Accra, Ghana. Vice Presidents Keynote Address at Launching of Life Choices Campaign, Accra August 2010

56 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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