Estimating the Resources Required to Achieve Family Planning Targets in Ghana September 2012 Photo credit: Barry Williams National Population Council
Outline Overview of the GAP Tool GAP Application in Ghana Challenges Results Photo credit: http://www.bigfoto.com/afria/ghana/ Conclusions
Outline Photo credit: Huismus Overview of the GAP Tool Why What How Results GAP Application in Ghana Challenges Results Conclusions
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 Photo by Dietmar Temps
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: walter.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) 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) National Reproductive Health and Commodity Security Strategy (2011 2016)
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: Huismus
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 Photo credit: International Institute for Communication and Development Challenges Results Conclusions
CPR Targets 35% 30% 25% 20% 15% Contraceptive Prevalence Rate (modern methods) 19% 22% 24% 27% 30% 33% Base CPR from 2008 GDHS: 13.5% for modern methods Target for 2020 50% for modern methods (meets most unmet need) Projected CPR 10% 5% 19% to 33% for modern methods in 5 years (2010 2015) 0% 3 percentage point annual increase Note: Data refers to all women of reproductive age (ages 15 49) Eligible Users 1.6 million women in 2010 to 2.8 million by 2015
Method Mix Target: Move to Long-Acting Methods (based on policy and evidence) 100% 90% Method Mix 80% 70% 60% 50% 40% 30% 20% 10% Traditional Methods Long-acting and Permanent Methods Short-acting Methods 0% 0 10% 10 20% 20 30% 30 40% 40 50% 50 60% 60 70% 70 80% 80 90% 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.
Source of FP Services 2010 2020 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% Public Private Public Private Note: Analysis assumed no change in FP market source Source: GDHS 2008 and projections.
Methods Moving Towards a More Robust Mix 2010 2015 28% 19% 17% 13% 6% Condom Female Sterilisation 5% 4% 27% 7% Implants Injectables IUDs 19% 23% 27% Pills Traditional 1% 2% Sources: GHDS 2008 and consensus targets for 2010 and 2015.
Methods Moving Towards a More Robust Mix 2010 2015 2020 28% 19% 17% 13% 6% 8% 9% 7% 5% 4% 7% 33% 10% 27% 19% 23% 27% 30% 1% 2% 3% Condom Implants IUDs Traditional Female Sterilisation Injectables Pills Sources: GHDS 2008 and consensus targets for 2010 and 2015.
Costs of Achieving CPR Targets by 2015 Millions $90 $80 $70 $60 $50 $40 $30 $20 $10 $0 Total Costs by Component (US$) 2010 2011 2012 2013 2014 2015 Commodities Personnel Overhead Support 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 Source: GAP Tool projections.
What Is the Total FP Funding Gap? ns illio M $90 $80 $70 $60 $50 $40 $40.8 Resource Needs and Commitments (US$) $69.7 $61.6 $54.2 $54 $58.7 $47.2 Gap $78.3 $63.8 Other private EU DfID IPPF UNFPA $30 USAID $20 $10 National government $0 2010 2011 2012 2013 2014 2015 Requirements 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? $14 Commodity Resource Requirements and Commitments (US$) $13.1 s illion M $12 $10 $8 $7.7 $8.7 $9.8 $10.9 $12.0 $8.4 $8.5 Gap $8.7 Global Fund Other private EU DfID $6 IPPF UNFPA $4 USAID $2 National government Requirements $0 2010 2011 2012 2013 2014 2015
Outline Overview of the GAP Tool GAP Application in Ghana Challenges Results Conclusions Photo credit: Adam 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! National Population Council 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).