ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF FAMILY PLANNING. Presented at the KNUST Annual Scientific Conference 26TH AUGUST 2010 by Dr.
Download ReportTranscript ADDRESSING THE MILLENNIUM DEVELOPMENT GOALS - THE ROLE OF FAMILY PLANNING. Presented at the KNUST Annual Scientific Conference 26TH AUGUST 2010 by Dr.
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
Content
• • • • • • • MDGs Current Country Status (Health Related MDGs) FP FP & MDGs Conclusion Way Forward References
Millennium Development Goals
• •
1.
2.
3.
4.
5.
6.
7.
8.
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:
End Poverty & Hunger Universal Education Gender Equality Child Health Maternal Health Combat HIV/AIDS Environmental Sustainability Global Partnership
MDG 1: End Poverty & Hunger
• • •
Goal: eradicate extreme poverty & hunger
Target: to halve, between 1990-2015
the proportion of people who suffer from hunger
Indicators:
- prevalence of underweight children under five years of age
MDG 4: Child Health
• • •
Goal: reduce child mortality Target: to reduce, by 2/3, between 1990-2015
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)
MDG 5: Maternal Health
•
Goal: reduce maternal mortality
Target:
to reduce by 3/4 between 1990-2015 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
•
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 15-24 years - Condom use at last high-risk sex - Proportion of population aged 15-24 with comprehensive correct knowledge of HIV/AIDS
•
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
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)
INTERVENTIONS & CURRENT STATUS
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 5 0 15 10 30 25 20 Prevalence of Underweight Children Under 5 years (weight-for-age -2 std. devs) 1998 - 2008
25.4
24.3
1998 21.4
22.3
2003 year 2008 15.4
12.4
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, 1993 - 2008 140 120 100 80 60 40 20 0
1993 119.4
1998 107.6
2003 year 111.2
2008 80 2015 70.8
39.88
20 0 60 40 80
MDG 4: Child Health
Infant Mortality, 1993 - 2008
66.4
56.7
64.3
50
Proportion of 1 year-old children immunised against measles, 1993 - 2008
1993 1998 year 2003 2008
90 40 30 20 10 80 70 60 50 0
50.6
60.9
68.8
79.9
1993 1998 year 2003 2008
Source: DHS-Ghana, 1988, 1993, 1998, 2003 , 2008
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
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
Package of Services
– – – – Safe Motherhood • Emergency Obstetrics care • Essential Newborn Care • PMTCT • MIP Family Planning Comprehensive Abortion Care Services IE &C
800 700 600 500 400 300 200 100 0
MDG 5: Maternal Health
Maternal Mortality Ratio, 1990 – 2015 Projections 740 590 540 560 451 483 185 GAP YEAR
Source: WHO, 2008
20 10 0 40 30 60 50
MDG 5: Maternal Health
Medically Assisted Deliveries 1993 – 2008
1993 44 44.3
1998 year 2003 47.1
2008 57
90 88 86 84 82 96 94 92 Antenatal Care (at least 1 visit) 1988 – 2008
87.5
91.9
95.4
1998 2003 year 2008
Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008
MDG 5: Maternal Health
20 0 60 40 120 100 80 140 Age-Specific Fertility Rate: 15 19, 1993 – 2008
116 88 74 66 1993 1998 2003 2008 year
30 25 20 Contraceptive Use: Any Method 1988 – 2008
20 22 25 24
15 10 5 0
1993 1998 2003 2008
Source: DHS-Ghana, 1988, 1993, 1998, 2003, 2008
year
39 38 37 36 35 34 33 32 31 30
MDG 5: Maternal Health
Unmet Need for Family Planning, 1993 – 2008 38.6
34 33.5
Success!
delay childbirth or have no more children and the number that are not using contraceptive methods.
34 1993 1998 2003 2008 year
Source: DHS-Ghana, 1988, 1993, 1998, 2003 ,2008
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)
• • • • • • • •
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
MDG 6: HIV
0 0.5
1 4 3.5
3 2.5
2 1.5
HIV Prevalence Rates, 2000 – 2008
2.3
General Population 3.6
3.4
3.1
2.9
2.6
2.7
1.9
3.2
2.5
2.2
1.9
Ages 15-24
Number of Persons on ART, 2003 – 2008 25000
2000 2001 2002 2003 2004 year 2005 2006 2007 2008
20000 15000
13,249
10000 Source: NACP 5000
1913 1804 3156
0
197 2003 2004 2005 year 2006 2007 2008 23,614
Female
MDG 6: HIV
Condom use at last high-risk sex (with a non-marital, non-cohabitating partner), 2003 & 2008 2003 2008 25.4
28.1
Male 2003 2008 0 5 10
Source: DHS-Ghana 2003 & draft 2008
15 20 percentage 25 30 35 40 45 44 43.9
MDG 6: HIV
% of population (15-24 years) with comprehensive correct knowledge of HIV/AIDS, 2003 38.15
Female Male 34
Source: DHS-Ghana 2003
36 38 40 Percentage of persons 42 44 46 45.45
• • • • • •
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 25 20 5 0 15 10 45 40 35 30 Proportion of children under 5 sleeping under insecticide treated bed nets, 2002 – 2008
41.1
3.5
21.8
2003 2006 year 2008
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 10 0 30 20 50 40 70 60
60.7
62.8
60.8
43 1998 2003 2006 2008 year
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
Tuberculosis Case Detection 1997-2008
16000 14000 12000 10000 8000 6000 4000 2000 0 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 Year 20 06 20 07 20 08 90 80 70 60 50 40 30 20 10 0 54.2
45.8
Tuberculosis Treatment Outcome: Treatment Success Vrs Adverse Outcome, 1997-2007
Treatment Success 55.3
44.7
Adverse outcome 60.5
66.9
71.7
72.6
76.1
84.7
56 44 39.5
33.1
28.3
27.4
23.9
19.3
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year
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
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
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
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 women’s 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.
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.
Eligibility
All individuals and couples including adolescents are eligible for family planning services.
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
“Planning for Progress and Development”
1969 Population Policy
“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
FP was seen essentially as an instrument for • attaining specified demographic • socio-economic development objectives.
targets and
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.
Population Targets & Performance
Year TFR CPR 1988 (DHS) 1993 (DHS) 1998 (DHS) 2003 (DHS) 2008 (DHS) 2000 2010 2020 Projected 5.0
4.0
3.0
Achieved 6.7
5.5
4.4
4.4
4.0
Projected 15% 28% 50% Achieved 5.0% 10.5% 13.0% 19.0% 17.0%
TFR and use of any and modern contraceptive methods, Ghana 1988-2008
Unmet Need for FP
Unmet Need for FP 40 35 38 34 30 25 27 25 22 20 16 15 10 5 11 13 12 0 Urban Rural National total limiting spacing
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
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
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
FP Benefits All!
• • • • • • • Women Children Men Families Communities Nations The Earth
Evidence of longer birth intervals effects on health
For Children For Mother
Lower risk of:
•
Child death
•
Infant death
•
Neonatal death
•
Fetal death
•
Stunting and underweight
•
Small for gestational age
•
Low birth weight
•
Preterm birth
• • • • •
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): 1255-1259. Nov. 18, 2000.
Family Planning is Pivotal to SRH & Relevant in All 8 MDGs!
FP and MDG’s
1.
Poverty 8 Partnership 2 Education 7 Environment 6 HIV, Malaria, Other
FP
Gender 5 Maternal Health 4 Child Health 3
8. Partnersh ip 1. Poverty 2. Educatio n 7. Environm ent FP 3. Gender 6. HIV, Malaria, Other 5. Maternal Health 4. Child Health
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
8. Partnersh ip 1. Poverty 2. Educatio n 7. Environm ent FP 3. Gender 6. HIV, Malaria, Other 5. Maternal Health 4. Child Health
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
8. Partnersh ip 1. Poverty 2. Educatio n 7. Environm ent FP 3. Gender 6. HIV, Malaria, Other 5. Maternal Health 4. Child Health
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
8. Partnersh ip 1. Poverty 2. Educatio n 7. Environm ent FP 3. Gender 6. HIV, Malaria, Other 5. Maternal Health 4. Child Health
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 Everybody’s Business!!!
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!
Conclusions
• Ghana can do a lot more towards achieving the health MDGs by 2015 if resources are committed.
• FP has the potential to hasten Ghana’s 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
References
• • • • • • • • UNFPA Fact Sheet. http://www.unfpa.org
ICF Macro. 2010. Ghana Trend Report: Trends in Demographic, Family Planning,
and Health Indicators in Ghana. 1960-2008: 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 2007. Return of Population
Growth Factor: Its Impact upon the Millennium Development Goals.
USAID Health Policy Initiative. July 2009. “Achieving the MDGs: The contribution of family planning Ghana.” Futures Group International. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International. 2009. Ghana Maternal Health Survey 2007. 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. 2009. Ghana Demographic and Health Survey 2008. Accra, Ghana. Vice President’s Keynote Address at Launching of Life Choices Campaign, Accra August 2010
Thank You for Your Interest!
Presented by: Dr. Gloria Quansah Asare ( Director Family Health Division) Ghana Health Service