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National Coordination Mechanisms for Managing Contraceptive Commodity Security: The Case of Ghana Presented at the 7 th Semi-Annual Membership Meeting of the RH Supplies Coalition April 27-28, 2007 London

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TFR and use of any and modern contraceptive methods (1988-2003) & Unmet need in 2003 - Ghana Inter Agency Committee on Contraceptive Security (2002) Development of the National CS strategic plan (2004 -2010) Financial Sustainability Plan supports the National CS strategy plan.(2007-2011)

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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

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Method Mix

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Provision of Family Planning Three major programs provide family planning -MOH / GHS -PPAG (IPPF Affiliate) -GSMF (Ghana Social Marketing Foundation) and others

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Why RH Commodity Security? Success of FP Programs Generated Demand for Contraceptive Commodities Unmet Need for FP still high Shift of resources to HIV/AIDS Programming Inadequate Donor Coordination Donor Fatigue Weak Logistics Systems Need to go beyond Contraceptives to RHCS

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Strategic Planning Process GoG Policy Decision to Address CS Sogakope CS Workshop (May 2002) ICC/CS (August 2002) Core Technical Group (Oct. 2003) Ghana National Contraceptive Security Strategy (April 2004)

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Mandate to Ensure CS ICPD+5 Programme of Action - mandated access to contraceptives and ratified by Ghana Ghana: Vision 2020 - Improve quality of life Ghana Poverty Reduction Strategy Revised Population Policy - TFR and CPR targets 5 Year Programme of work and Annual Health Sector Programme Provide vision, policy framework and mandate to achieve contraceptive securityProvide vision, policy framework and mandate to achieve contraceptive security

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Inter Agency Coordinating Committee on Contraceptive Security (ICC/CS) Representation includes Government MOH, Ghana Health Service, National Population Council, Food & Drugs Board, Customs Excise and Preventive Service (CEPS), Ghana AIDS Commission, National AIDS Control Programme), others Donors and Partners USAID, JSI DELIVER (TA), DFID, UNFPA, World Bank, EU, The Royal Netherlands Embassy, DANIDA, JICA others NGOs/Civil Society PPAG, GRMA Private Sector Organizations GSMF, Society of Private Medical & Dental Practitioners, Representative of Private Pharmaceutical Firm Individuals

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MEETING THE COMMODITY CHALLENGE : T he Ghana National Contraceptive Security Strategy 2004 -2010

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Contraceptive Security (CS) in Ghana Definition : Contraceptive Security is achieved when: every woman, man and youth can choose, obtain and use contraceptives.

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CS Strategic Framework Contraceptive Security Package of Health Interventions M & E Quality Efficiency Partnerships Financing M & E

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Strategic Objectives quality To improve availability of quality and affordable contraceptive products and services partnerships To strengthen public-private partnerships in the supply and delivery of contraceptive products and services efficient To implement reliable and efficient systems for the supply of contraceptive products and services financing To achieve sustainable financing of contraceptive products and services monitor and evaluate To ensure a national capacity to monitor and evaluate the progress on the attainment of CS targets

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- STRATEGY INSTITUTIONAL FRAMEWORK The consensus achieved regarding the institutional framework were as follows ( from April 26, 2004 CS Conference): MOH : Coordinating role ICC/CS :Advocacy role Ghana Health Service (PHD, RCHU) : implementation role.

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Funding Commitments 2004 MOH (Health Funds)===>$1.5 million MOH (GoG) ==>$280,000 Partners (USAID, DFID)===>$4.9 million (USAID added $2.8 million to the 2003 balance for 2004/2005)

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YearTotal Requirement (US $) Commitment (US $) Funding Gap (US $) 20076.01.8 (DFID $0.7m, USAID $1.1m) 4.2 20086.50.2 (DFID) 6.3 20097.70 20108.10 20118.30 TOTAL$36.6$2.0 $34.6 2007-2011 Funding requirements, commitments & Gap

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Needs, Commitments and Gaps (2007 2011) Total requirements = $36.6 Total commitments = $2.0 Total funding gap = $34.6million

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Recommendations at Adoption Meeting 2004 Integrate the strategy into the 2005 Programme of Work Resource allocation between health partners need to begin Advocacy to increase MOH commitment to financing contraceptives Advocacy to include contraceptives and Family Planning services in the National Health Insurance

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- Financial Resources to implement the CS Strategy No specific commitments were made Two primary sources identified: - Public Health Division -Health Funds.

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Ghana RHCS Strengths Planning within health sector program of work National coordinating body Strong partnerships with social and private sector IEC/BCC Advocacy Increasing Government Contribution to Procurement of Commodities

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CS Experience has contributed to Development of HIV/AIDS Commodity Security (HACS) in 2005 Definition of HACS Ensuring a secure supply and choice of quality commodities to meet the need of PLWHAs at the right time and the right place and at affordable cost. Contribution to RHCS for West African Region Facilitated by WAHO

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General CS Challenges High Donor dependence for procurement Develop sub national LMIS capacity Public private partnership Funding to implement strategy Limited support for demand creation & sustainability e.g. IEC/BCC, training New integrated logistics system User fee pressure FP commodities not included in NHIS and pro poor schemes e.g. exemptions Representation at meetings

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Way Forward Funding to fully implement strategy Continued coordination Addressing unmet need Implement Repositioning Family Planning Road Map (2006 2010) Operationalize new LMIS Finalize and Implement Financial Sustainabilty Plan Further advocacy Commitment at all levels

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Advocacy ICC/CS will initiate high-level advocacy discussions to determine start and rate of phase-down of donor funding Raise profile of Family Planning Advocate for FP through collaborating with the MOH/GAC/NPC as one voice for funds outside of the MoH budget Create a contraceptive development fund within the MoH Repositioning Family Planning (multi-sectoral response) National Health Insurance Cover all FP commodities and condom for STI and HIV prevention In-country partnerships Engage District Assemblies and others in seeking additional funds for contraceptives and condom for STI and HIV prevention Diversification of Funding Sources Self Procurement Monitoring & Evaluation

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Conclusion NO MONEY, NO PRODUCT ? NO PROGRAM Slogan by DELIVER JSI Integration of programmes likely to improve efficiency and funding !

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Thank You Presented by Dr. Gloria J. Quansah Asare Family Planning Programme Manager