RH STRATEGIC PLAN Dr P. K. Aboagye

Rationale Ghanas revised population policy was first developed in the early 1990s Ghanas revised population policy was first developed in the early 1990s RH service Policy and Standards 1996, RH service Policy and Standards 1996, A revised 2nd edition was published in A revised 2nd edition was published in Gap between statements and documents on national RH and population policies and implementation plans Gap between statements and documents on national RH and population policies and implementation plans National strategic direction in RH services not clear National strategic direction in RH services not clear

SITUATION ANALYSIS

Trends in Antenatal Care Coverage (at least one)

Utilisation of services ANC

Utilisation of services Supervised Delivery

Utilisation of services Postnatal

Miles N > 40% 30-39% 20-29% < 20% Fig… Regional distribution of TBA deliveries, Upper East – 27% Upper West 44% KEY Northern - 50% Volta Brong Ahafo – 25% 4.5% Ashanti – 26.7% Eastern – 50% Western 9.7% 35.8% Central Greater Accra 32.7%

TFR and use of any and modern contraceptive methods, Ghana

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% higher in Rural area

WHAT IS GHANAS MMR? National Sisterhood Survey (1993): 214/100,000 National Sisterhood Survey (1993): 214/100,000 WHO/Hill Estimates (1995): 586/100,000 WHO/Hill Estimates (1995): 586/100,000 UNICEF Estimates (1996): 740/100,000 UNICEF Estimates (1996): 740/100,000 WHO/UNICEF/UNFPA(2000): 540/100,000 ( ) WHO/UNICEF/UNFPA(2000): 540/100,000 ( ) Health Institutions 2005: 196/100,000 Health Institutions 2005: 196/100,000

Trend in Institutional MMR: GHANA

CAUSES OF MATERNAL DEATH

Regional Trends of Institutional Maternal Mortality in Ghana

Trends in Ghanas childhood mortality rates for the five year periods preceding the DHS: CMR (12 – 59 months), Post-NMR (1 – 11 months) and NMR (< 1 month) Source: 1988, 1993, 1998 and 2003 DHS

NEONATAL & INFANT MORTALITY RATES BY REGIONS

MAJOR CAUSES OF NEWBORN DEATHS

Situation Analysis Reproductive health indices suggest that Ghana has made substantial progress in the priority areas of reproductive health. Reproductive health indices suggest that Ghana has made substantial progress in the priority areas of reproductive health. Levels of awareness of both modern, and any, contraceptive methods is almost universal. Levels of awareness of both modern, and any, contraceptive methods is almost universal. The desire to limit the number of children and to increase the time period between births has both increased. The desire to limit the number of children and to increase the time period between births has both increased. Prenatal care services are very well attended. Prenatal care services are very well attended. The substantial majority of infants are breastfed for some period of time, and most infants are breastfed within the first hours of birth. The substantial majority of infants are breastfed for some period of time, and most infants are breastfed within the first hours of birth. A majority of infants receive their first vaccinations during the neonatal period, and the majority are adherent to a full program of vaccination, leading to immunization status. A majority of infants receive their first vaccinations during the neonatal period, and the majority are adherent to a full program of vaccination, leading to immunization status.

Situation Analysis knowledge of modern family planning methods is very widespread knowledge of modern family planning methods is very widespread A large unmet need for family planning services. A large unmet need for family planning services. slowing of the pace of decline in the total fertility rate slowing of the pace of decline in the total fertility rate urban and rural differences in fertility demonstrate marked differences. urban and rural differences in fertility demonstrate marked differences. Skilled attendance at childbirth and facility-based delivery is not available to all citizens in all regions. Skilled attendance at childbirth and facility-based delivery is not available to all citizens in all regions. The maternal mortality rate remains high; The maternal mortality rate remains high; The pace of decline in the infant mortality rate has slowed overall; neonatal mortality represents a substantial proportion (nearly two-thirds) of these deaths. Mortality rates are considerably and consistently higher in rural areas. The pace of decline in the infant mortality rate has slowed overall; neonatal mortality represents a substantial proportion (nearly two-thirds) of these deaths. Mortality rates are considerably and consistently higher in rural areas.

PURPOSE OF STRATEGIC PLAN To provide the framework for a programme of action and defines and clarifies the national strategic direction in RH services and activities for the next five years. To provide the framework for a programme of action and defines and clarifies the national strategic direction in RH services and activities for the next five years. To bridge the gap between statements and documents on national reproductive health (RH) and population policies on the one hand, and implementation plans at the operational level To bridge the gap between statements and documents on national reproductive health (RH) and population policies on the one hand, and implementation plans at the operational level To serve as an reference document for RH service providers, collaborative public and private sector stakeholders, and interested community members. To serve as an reference document for RH service providers, collaborative public and private sector stakeholders, and interested community members. Accelerate Ghanas progress towards achieving the MDGs Accelerate Ghanas progress towards achieving the MDGs

Strategic Objective 1: Reduce maternal morbidity and mortality Intermediate Objectives Intermediate Objectives 1a: Improve access to comprehensive and basic essential obstetric care 1a: Improve access to comprehensive and basic essential obstetric care 1b: Improve the capacity of family and community members in home-based life-saving skills 1b: Improve the capacity of family and community members in home-based life-saving skills 1c:Increase the proportion of deliveries conducted by skilled attendants 1c:Increase the proportion of deliveries conducted by skilled attendants 1d:Increase ANC and PNC coverage, content and quality of services 1d:Increase ANC and PNC coverage, content and quality of services 1e:Ensure the availability of comprehensive abortion care services as permitted by law 1e:Ensure the availability of comprehensive abortion care services as permitted by law

Strategic Objective 2: Reduce neonatal morbidity and mortality Intermediate Objectives Intermediate Objectives 2a:Increase knowledge of family and community members concerning care of the neonate, recognition of danger signs, and early care seeking 2a:Increase knowledge of family and community members concerning care of the neonate, recognition of danger signs, and early care seeking 2b:Increase capacity of neonatal care providers to implement appropriate measures for neonatal resuscitation 2b:Increase capacity of neonatal care providers to implement appropriate measures for neonatal resuscitation 2c:Increase the capacity of the service provider to manage the sick child and neonatal complications 2c:Increase the capacity of the service provider to manage the sick child and neonatal complications 2d:Promote early initiation and continuation of exclusive breast feeding, and infant nutrition 2d:Promote early initiation and continuation of exclusive breast feeding, and infant nutrition 2e:Promote appropriate infant feeding for children with special needs 2e:Promote appropriate infant feeding for children with special needs 2f:Promote the initiation of and adherence to a program of infant immunization and growth promotion 2f:Promote the initiation of and adherence to a program of infant immunization and growth promotion

Strategic Objective 3: Enhance and promote reproductive health Intermediate Objectives Intermediate Objectives 3a:Reduce the incidence and improve management of reproductive tract infections including STI/HIV/AIDS including PMTCT of HIV 3a:Reduce the incidence and improve management of reproductive tract infections including STI/HIV/AIDS including PMTCT of HIV 3b:Promote and enhance sexual and reproductive health knowledge and healthy sexual and reproductive health behaviours for adolescents and vulnerable groups and communities 3b:Promote and enhance sexual and reproductive health knowledge and healthy sexual and reproductive health behaviours for adolescents and vulnerable groups and communities 3c:Ensure the availability of services for assessment, screening, and management of conditions related to the reproductive system 3c:Ensure the availability of services for assessment, screening, and management of conditions related to the reproductive system 3d:Reduce the incidence and manage the effects of harmful traditional practices that relate to reproductive health 3d:Reduce the incidence and manage the effects of harmful traditional practices that relate to reproductive health 3e:Promote sensitivity to adolescent and gender issues within reproductive health 3e:Promote sensitivity to adolescent and gender issues within reproductive health

Strategic Objective 4: Increase contraceptive prevalence through promotion of access to, and quality of family planning services Intermediate Objectives Intermediate Objectives 4a: Promote and enhance knowledge and use of modern family planning methods by community members. 4a: Promote and enhance knowledge and use of modern family planning methods by community members. 4b: Develop and expand the cadres of family planning service providers 4b: Develop and expand the cadres of family planning service providers 4c: Ensure access to and availability of the full range of quality family planning commodities and services 4c: Ensure access to and availability of the full range of quality family planning commodities and services

Strategic Objective 5: Develop and implement cross-cutting measures to ensure access and quality of reproductive health services Intermediate Objectives 5a:Sustain and expand a program of continuous performance and quality improvement activities 5a:Sustain and expand a program of continuous performance and quality improvement activities 5b:Ensure intra- and inter-sectoral coordination and collaboration at all levels 5b:Ensure intra- and inter-sectoral coordination and collaboration at all levels 5c:Promote collaboration between the public and private sector institutions and service providers 5c:Promote collaboration between the public and private sector institutions and service providers 5d:Reinforce management and health information systems pertaining to RH services within an integrated health information management system 5d:Reinforce management and health information systems pertaining to RH services within an integrated health information management system

Strategic Objective 5 (contd): Develop and implement cross-cutting measures to ensure access and quality of reproductive health services Intermediate Objectives Intermediate Objectives 5e:Promote the appropriate legal environment to support RH services 5e:Promote the appropriate legal environment to support RH services 5f:Develop and implement policies and practices that enhance access to quality RH services for all sectors of the population 5f:Develop and implement policies and practices that enhance access to quality RH services for all sectors of the population 5g:Develop a reproductive health research agenda 5g:Develop a reproductive health research agenda

Strategic Objective 6: Enhance and promote community and family activities and values that improve reproductive health Intermediate Objectives 6a:Promote strategies that enhance a wide range of community activities that promote RH. 6a:Promote strategies that enhance a wide range of community activities that promote RH. 6b:Expand community partnership and resources for RH 6b:Expand community partnership and resources for RH 6c:Promote community participation in RH service delivery 6c:Promote community participation in RH service delivery

DetailedDetailed Plans and Costing Detailed