Transcript Document

IMPLEMENTATION OF MDG ACCELERATION
FRAMEWORK FOR MDG 5
DR PATRICK KUMA-ABOAGYE – DEPUTY DIRECTOR FHD, GHANA HEALTH SERVICE
7TH OCTOBER, 2013,
SEOUL, SOUTH KOREA
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Implementation and Implications 7th October
2013
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PRESENTATION OUTLINE
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WHY AND WHAT IS MAF FOR MDG 5 FOR GHANA
IMPLEMENTATION STRATEGY
KEY ACHIEVEMENTS AND OUTCOMES
IMPLEMENTATION CHALLENGES
WHAT WORKED WELL
RECOMMENDATIONS
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WHY MDG 5 IN NATIONAL DEVELOPMENT
CONTEXT ?
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MAF Action Plan focus on MDG 5 because the progress
in reducing maternal mortality ratio by 3/4 by 2015 is
off-track. The 2010 MDG Report showed maternal
mortality rate to be at 451 per 100,000 live births.
The slow progress is a great concern to policy decisionmakers to an extent that Maternal Mortality was
declared National emergency in July 2008.
Tackling MDG 5 will likely have positive impact on
almost all MDGs and health systems
Need to be focus to overcome bottlenecks in MDG 5
implementation
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Introduction - MDG Accelerated Framework
(MAF)
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MAF has three priority areas and one cross-cutting are:
1. Family Planning
2. Skilled Delivery
3. Emergency Obstetric and Newborn Care
4. Crosscutting or Health Systems issues
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Three implementation phases:
 Phase I - National operational multi-year plan
development
 Phase 2 – Preparation of regional plans etc
 Phase 3 – Full implementation
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Implementation Strategy.
Governance
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To ensure better oversight of results and resources.
 Multidisciplinary implementation steering committee
(National and development Partners) chaired by Minister
of Health
 Establishment of sub-committees to work on key areas
in MAF such as;
 Procurement
 IEC/BCC /advocacy
 Training and Human Resource
 M&E
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Implementation Strategy.
Advocacy
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Orientation meetings with stakeholders and groups to
ensure adequate buying-in
 Maintenance of Free maternal health Service by
incorporating it in the new Health Insurance Law
 Free family planning services to improve CPR and
reduce unwanted pregnancy
 Task shifting - FP service policy reviewed to allow
auxiliary nurses provide contraceptive implant
services to improve access to services
 The President of Ghana is currently Championing
Maternal Health and FP
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Implementation Strategy.
Partnership and Resource Mobilisation
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Government with strong support from the UNCT, under the
remarkable leadership of RC and WHO has used MAF
extensively to mobilize new partners and strengthened the
existing relationships.
Additional Resource mobilized so far includes;
 52 Million Euro Grant from the European Union
 23 million Euro (Grant and Loan) from the ORIO funds
being concluded
 US$5.758 million from DANIDA
 $100,000 from Access bank (Private sector)
 Potential support from Dutch and Japanese Govt.
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Family Planning –
key achievement
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Smart phones/mobile phones procured and used in
capturing FP logistics data to prevent stock-out
District Health Information Management Systems (DHIMS
2) roll out completed. Available online in all districts
GoG allocates $3,000,000 for contraceptive procurement
in yearly, partners increase support for commodities
(DFID)
Institutionalization of National Family Planning week in
September – 2 celebrated
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Skilled Delivery
key achievement
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Staffing norms using workload benchmarking on-going
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Increase production of Midwives,
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Policy reviewed and the country has re-introduced 2year post basic and auxiliary midwifery course
8 new midwifery training institutions established
commenced training in 2011/2012 academic year
60 midwifery tutors at university recruited between
2010 and 2011 (more than 100% increase over the
previous years)
Increased intake of students in 2010 – 2011. 1300
intake for 2011 and 2012 compared to 800 in 2010
Regional and national midwifery forums organised to
allow sharing of experiences, provision of updates
especially technological
boost their moral
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EmONC- key achievement
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Nationwide EmONC assessment conducted and
disseminated and facility upgrades on-going
Referral policy completed, 161 new ambulances deployed
by the MOH.
Engaged private transport unions with MOU to support
transport of pregnant women in emergencies
Upon request from MOH, UNDP is supporting the
establishment of an M & E system through pilot monitoring
system in two hard to reach areas (provision of ambulances
and basic equipment). This will be scaled up
Life Saving Skills training for midwives
Scaled up maternal death and health surveillance system
The
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scaled up throughout the
country
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Cross-cutting Issues (Health Systems)
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Capacity building for the Family Health Division at national
and regional levels
Initiate regional and local level MOUs with mobile phone
operators to support maternal health services especially
emergency response
National Health Account including preparation for Maternal
and Child Health Sub-Accounts to track Maternal and child
health expenditures
Resource tracking system – for MAF implementation.
Guidelines developed for use in 2013
Media and BCC activities intensified for demand generation
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and reduce myths and misconceptions
about FP
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Key OutcomesTrends in Maternal Health Indicators
120
Maternal Care Indicators
100
Per Cent
80
82
86
89
92
95 96.7
78.2
84.7
69.4
58.9
60
68.4
62.3
59
40
40
44
44
47
20
0
ANC from health
professional, at least one
visit
GDHS 1988
GDHS 1993
ANC from health
professional, 4 or more
visits
Skilled assistance at
delivery
GDHS 1998
GDHS
GDHS 2008
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Conference:
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Use of modern contraceptives increasing….
Use of modern methods
50
45
40
35
30
29
25
20
24
15
10
5
0
13
17
27
22
26
21
16
17
23
27
22
16
13
19
14
2122
23
17
2008
2011
6
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Trend in Couple Year Protection 2008 - 2012
2500000
1988892.69
2012807.253
2000000
1424584.6
1500000
1000000
796134
635652.2
500000
0
2008
2009
2010
2011
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Trends in Maternal Mortality Ratio in Ghana and MDG Target
Maternal Mortality
740
590
540
451
350
185
1990
1996
2000
2007
2008
2015
In the current WHO/UNFPA/WORLD BANK TRENDS IN MMR REPORT 2008 GHANA‘S MMR IS 350/100,000 LB AND
CLASSIFIED AS MAKING PROGRESS AND MMR REDUCED 42% FROM THE 1990’S
Institutional maternal mortality has declined from 230/100,000LB in 2009 to 153/100,000 LB in
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Implementation Challenges
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Creating attitudinal changes needed at the district and
lower level for rapid implementation
Road infrastructure: poor road networks particularly at the
local levels were considered a huge limitation to health
facility accessibility and coverage.
Inadequate inter-sectoral coordination especially between
health sector and the MMDAs
Long time lag between the preparation phase and the full
implementation
Inadequate understanding of the MAF strategy by Key
managers created initial conflicts
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What Worked Well
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Implementing health systems and program interventions
together encourages all to be involved yields better
results
Boosting the moral and capacity of service providers
(MW) particular led to improved ownership at the
implementation level
Resource tracking systems improved compliance and
adherence to plans
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Recommendations
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Attention should also focus on key infrastructural and health
systems challenges that greatly impact on maternal health
Continue to reduce out of pocket payment for maternal
health services for the poor has significantly reduced the
equity gap in skilled delivery.
Additional advocacy to get the private sector, CSO, domestic
financial institutions and the MMDAs more involve in MAF
implementation
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Strengthen donor coordination
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Institutionalization of accountability systems
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Recommendations Post 2015
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Momentum should not be lost by coming up with
other new Goals, which may take several years to
understand.
Emphasis on access as well as quality issues
Pay attention to equity issues—National averages
mask disparity between settings
MDG 5 should be categorised as a development issue
that is intertwined with infrastructure, ICT,
Transportation etc.
Clear funding for maternal health by Governments.
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Implementation and Implications 7th October
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THANK YOU
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and Implications 7th October 2013
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