Estimating the Resources Required

to Achieve Family Planning Targets

in Ghana

September 2012

National Population Council

Photo credit: Barry Williams

Outline

Overview of the GAP Tool

GAP Application in Ghana

Challenges

Results

Conclusions Photo credit: http://w

ww

.bigfoto.com/afria/ghana/

Outline

Overview of the GAP Tool Why What How Results

GAP Application in Ghana

Challenges

Results

Conclusions Photo credit: H

uismus

Why the GAP Tool? FP stakeholders met in Istanbul (2001) to review the Global Donor Gap Analysis (updated 2009) and commit to closing the resource gap for reproductive health supplies

Newly established Reproductive Health Supplies Coalition called for a tool to estimate FP resource requirements at the country level

GAP Tool was developed to provide in-country stakeholders with timely, relevant data on the

Costs of delivering FP services and impact of projected changes in FP method mix and contraceptive prevalence

Resources needed to achieve FP programme goals for contraceptive prevalence or fertility

What Is It?

1. Gather

2. Analyse

3. Plan

FP Programme $$ Gap

Contraceptive $$ Gap

1. Gather Required Data Current and target contraceptive prevalence rates

Distribution of FP methods by method and source

Commodity costs by method

Labour costs of service delivery

Overhead costs

Programme support costs

Current and projected funding for FP by source

2. Analyse Results Projected funding gap for FP

Projected funding gap for contraceptives

Source mix changes

Shift in method mix

Expected changes in funding source for FP

3. Plan Collectively Build consensus on assumptions and other data inputs

Use to promote dialogue on resources required

Reach agreement on results to inform policy and financial planning

Phot

o b

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ietm

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How Can GAP Be Used? Determine whether national targets are achievable with existing funding

Foster policy dialogue on method mix and private sector involvement in FP

Advocate for longer term commitments for FP

Evaluate gaps in data on costs and resource allocation

Examine the effect of interaction between the public and private sector on the FP gap

Outline

Overview of the GAP Tool

GAP Application in Ghana Background Inputs

Challenges

Results

Conclusions

Photo credit: w

alter.org

Background: Process Initial data collection and document review (December 2011–January 2012)

Model development (January) Initial model preparation

Initial consensus-building exercise

Review of necessary inputs

Discussion/decision on inputs and targets

Presentation/discussion of preliminary results

Model finalisation (February)

Background: FP/RH Programme in Ghana Relevant policies and plans

National Population Policy (Revised 1994)

Roadmap for Repositioning Family Planning in Ghana (2006–2010)

National Health Policy (2007)

National Reproductive Health Policy and Service Standards (Revised 2003)

National Reproductive Health and Commodity Security Strategy (2011–2016)

MDG Acceleration Framework for MDG 5 (2012)—Prioritised Acceleration Solution: Develop proposal and mobilise the international community to ensure adequate funding for the procurement of commodities

Ghana Shared Growth and Development Agenda (2010–2013)

Background: FP/RH Programme in Ghana (cont.) Providers Clinics/community-based nurses

Private and NGO sector providers

Products Short- and long-acting methods (non-permanent and permanent):

condoms, pills, implants, injectables, intrauterine devices (IUDs)

Inputs Targets Contraceptive prevalence (National Population Policy, 1994)

Future method mix plan (consensus based on review of Demographic and Health Surveys, various years)

Current status Ghana Demographic and Health Survey (GDHS 2008)

Ghana Health Service Reproductive and Child Health (RCH) Unit Institutional Report

Couple-years of protection (CYP) conversion factors Factors currently in use in Ghana

In the future, may need to review CYP conversion factors based on latest guidance

Inputs (cont.) Costs and resources Ghana 2011 Contraceptive Procurement Table (CPT) Memo

(USAID | DELIVER PROJECT, Ghana Health Service)

Partner contributions (donors, NGOs)

Labour, programme support, and overhead—global defaults (Vlassoff et al. 2004. “Assessing the Costs and Benefits of Sexual and Reproductive Health Interventions.” Occasional Report No. 11.)

Commodities—actual costs (USAID | DELIVER PROJECT)

Outline

Overview of the GAP Tool

GAP Application in Ghana

Challenges

Results

Conclusions

Photo credit: H

uismus

Challenges Cost calculations are based on international estimates. Labour costs of service delivery

Overhead costs

Programme support costs

Ghana-specific data are needed to gain a better understanding of costs associated with FP service delivery.

Estimated funding gaps could be understated. Difficult to separate FP from other RH and MCH funding (integrated

programmes) for both the Government of Ghana and development partners

Projected funding for FP by source uncertain (although goal of GAP)

Outline

Overview of the GAP Tool

GAP Application in Ghana

Challenges

Results

Conclusions

Photo credit: International Institute for C

omm

unication and Developm

ent

CPR Targets Base CPR from 2008 GDHS: 13.5% for modern methods

Target for 2020 50% for modern methods (meets

most unmet need)

Projected CPR 19% to 33% for modern methods

in 5 years (2010–2015)

3 percentage point annual increase

Eligible Users 1.6 million women in 2010 to 2.8

million by 2015

19% 22%

24% 27%

30% 33%

0%

5%

10%

15%

20%

25%

30%

35%

Contraceptive Prevalence Rate (modern methods)

Note: Data refers to all women of reproductive age (ages 15–49)

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%0–10% 10–20% 20–30% 30–40% 40–50% 50–60% 60–70% 70–80% 80–90%

TraditionalMethods

Long-acting andPermanentMethods

xiho

d M

teM

Short-actingMethods

Contraceptive Prevalence Rate

Source: Stover, J., E. Weissman, and J. Ross. 2010. “Global Resources Required to Expand Family Planning Services in Low-and Middle-Income Countries.” Washington, DC: Futures Group, USAID | Health Policy Initiative, Task Order 1.

Method Mix Target: Move to Long-Acting Methods (based on policy and evidence)

Source of FP Services

100%

80%

60%

40%

20%

0%

2010

Public Private

100%

80%

60%

40%

20%

0%

2020

Public Private

Source: GDHS 2008 and projections.

Note: Analysis assumed no change in FP market source

Methods… Moving Towards a More Robust Mix

2010

19% 28%

5%

4%

19% 23%

1%

2015

13% 17%

6%

7%

27%

27%

2%

Condom

Female Sterilisation

Implants

Injectables

IUDs

Pills

Traditional

Sources: GHDS 2008 and consensus targets for 2010 and 2015.

Methods… Moving Towards a More Robust Mix

2010

19% 28%

5%

4%

19% 23%

1%

2015

13% 17%

6%

7%

27%

27%

2%

2020

8% 9%

7%

10%

33%

30%

3%

Condom Female SterilisationImplants InjectablesIUDs PillsTraditional

Sources: GHDS 2008 and consensus targets for 2010 and 2015.

Costs of Achieving CPR Targets by 2015

Almost $80 million required to achieve 33% modern CPR in 2015

Government share Labour, overhead, and some

commodity costs

Does not include capital investments and investment in education

Donor share Programme support and most

commodity costs

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

2010 2011 2012 2013 2014 2015

Milli

ons

Total Costs by Component (US$)

Commodities PersonnelOverhead Support

Source: GAP Tool projections.

What Is the Total FP Funding Gap?

$47.2

$40.8

Resource Needs and Commitments (US$) $90

$78.3 $80

$69.7 $70

$61.6

sn $60$54.2

ioill $50M

$40

$30

$20

$10

$02010 2011 2012 2013 2014 2015

Other private

EU

DfID

IPPF

UNFPA

USAID

Nationalgovernment

Requirements

Gap

$54

$63.8

$58.7

Source: GAP Tool projections. EU = European Union; DfID = UK Department for International Development; IPPF = International Planned Parenthood Federation; UNFPA = United Nations Population Fund; USAID = United States Agency for International Development

What Is the Total FP Funding Gap?

Year Requirements (‘000)

Commitments (‘000)

Gap (‘000)

2011 $47,233 $46,478 $755 2012 $54,233 $50,983 $3,188 2013 $61,645 $53,956 $7,689 2014 $69,691 $58,674 $11,016 2015 $78,342 $63,791 $14,551

Source: GAP Tool projections.

What Is the Contraceptive Funding Gap?

Commodity Resource Requirements and Commitments (US$) $14 $13.1

$12.0 $12

$10.9

$9.8 $10 s $8.7 n

ioill $7.7 $8

M

$6

$4

$2

$02010 2011 2012 2013 2014 2015

Global Fund

Other private

EU

DfID

IPPF

UNFPA

USAID

Nationalgovernment

Gap

Requirements

$8.7 $8.4 $8.5

Outline

Overview of the GAP Tool

GAP Application in Ghana

Challenges

Results

Conclusions

Photo credit: A

dam Jones

Conclusions Greater government support for FP/RH

Sustained donor funding for FP/RH

Better coordination of the overall FP programme

Additional data collection to better understand costs of delivering FP services

Thank you!

This presentation was prepared by the National Population Council (NPC) with support from the U.S. Agency for International Development (USAID) through Health Policy Project (HPP).

National Population Council