Priority Setting in Ghanas Reforms: Where is sexualreproductive health

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Priority Setting in Ghanas Reforms Where is
sexual-reproductive health?

• Susannah H. Mayhew
• Samuel Adjei

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Team members

• Study design analysis
• Susannah Mayhew, LSHTM
• Sam Adjei, Deputy Director General Ghana Health
  Service
• Henrietta Odoi-Agyarko, Director Reproductive
  Child Health Unit, MoH
• Further interviews conducted by
• Alex Nassar, Policy Unit, MoH
• Mercy Abbey, Health Research Unit, MoH

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Methods

• Key informant interviews at national, regional
  and district level
• 33 in 2003 (current situation)
• 98 in 1996-8 (historical perspectives)
• Document analysis of national, regional and
  district policy documents and reports, donor
  documents and relevant independent research.
  1992-2003.

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Research analysis questions

• In Ghanas health reforms
• What priority setting tools used which actors
  involved?
• How far are SRH priorities reflected?
• Whose priorities are reflected?
• Can SRH sensitive priority setting be developed?

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SRH reform actors development
USAID, UNFPA, UNICEF RCH Unit, NCP, NACP
NACP UNAIDS, NGOs, UNICEF
MoH, MoF, MoLG WB, DFID, DANIDA, Dutch
MoH DANIDA, DFID, World Bank
MoH Strg Grp World Bank, WHO
GoG-PPME World Bank, DFID, EU donors
Decentralisation
EP
SWAp I
EP/ SWAp II
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Priority setting for reforms

• Key SRH stakeholders not involved
• In the early versions of the Programme of Work
  RH was not there at all. HIV was there but even
  safe motherhood had been left out the RMCH Unit
  is not part of the MoH systems group so it was
  completely out of the loop
• SRH donor, 2003

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Is SRH in reform priority indicators?
Focuses on cross-cutting effectiveness and
system efficiency
Indicators are very broad, very haphazard
basically disease control EPI related to
disease patterns
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Whose priorities? Where is Cairo?
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Can future priority setting in Ghana better
reflect Cairo SRH goals?

• Direct attention measures (what is known)
• Process attention measures (what is happening)
• Political attention measures (what level of
  commitment)
• (after Reichenbach 2002)

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What is known about SRH?

• Continuing low uptake of FP and supervised
  deliveries WHY?
• Abortion role in high maternal mortality?
• Reproductive cancers
• Gender Based Violence Female Genital Mutilation
• Unmet needs of adolescents for SRH services
• Costs of RH services/interventions

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What is happening to support SRH?

• No longer possible to disaggregate SRH costs and
  spending.
• SWAp funds meet c.50 requests
• SRH service delivery relies on earmarked funding
• Policies and training on full range of Cairo SRH
  goals is limited

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What commitment to SRH?

• My battle here in this office is not to let HIV
  cloud everything - yes its an important issue,
  but abortion kills more people here than HIV.
• SRH donor, 2003
• HIV/AIDS has pushed FP to the background because
  funds are diverted to AIDS. We should re-launch
  our FP programme in the country.
• District Director, 2003

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What commitment to SRH?

• Government/SWAp donors still biased to MDGs (HIV,
  SM).
• Research institutions some NGOs beginning work
  on extent of FGM, GBV, unsafe abortion,
  reproductive cancers
• need ADVOCACY

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Conclusions present

• No clear tools were used to set priorities,
  process ad hoc and following individual
  preferences
• Many Cairo priorities are not reflected in reform
  indicators
• SRH stakeholders are little involved in reform
  negotiations

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Conclusions future

• We can develop SRH sensitive priority setting
  tools/mechanisms if we
• Generate data on all SRH components costs
• Avoid polarisation of SRH donors
• Shift political commitment towards Cairo SRH
  goals
• SRH Stakeholders must engage with be involved
  in reform processes

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