Achieving MDG 5 In 2015…Some Measures To Take

The Ministry of Health (MoH) and the Ghana Health Service (GHS) have prioritised maternal health as an important focus area for the country in 2015. This is because of the current high maternal mortality rates (MMR) and lack of progress in reducing maternal deaths in the country.

In furtherance of this agenda, MoH) has met with its Millennium Development Goal Accelerated Framework (MAF) implementation agencies and development (donor) partners to firm up the Ghana Millennium Development Goals (MDGs) Operational Plan of activities and their funding scenarios for effective implementation in 2015.

Opening a two-day meeting last Wednesday, in Accra, the Coordinator of the Ghana MDG Acceleration Framework (MAF) of the Policy, Planning, Monitoring and Evaluation Directorate of the MOH, Dr. Emmanuel Odame, said that even though there are elaborate activities for the attainment of the MDG 5, the MOH’s Government of Ghana (GOG) budgetary allocations for these activities over the past years have been woefully inadequate, and therefore the need for development partners to fill the funding gaps to enable Ghana attain the MDG by the end of 2015 as required by the United Nations (UN).

He noted that even though the MOH has invested in both maternal and reproductive health services since 1990, these investments have fallen short of putting the country on tract to reach the 75% reduction of the MMR required by MDG 5 as a result of funding challenges among others.

Whilst the implementation agencies represented at the meeting were the Ghana Health Service (GHS), the four public Teaching Hospitals, the Christian Health Association of Ghana (CHAG) and Non Governmental Organizations (NGOs) in health, the development partners present were UNFPA, UNICEF, DANIDA, JICA, European Union USAID and World Health Organization.

The individual MAF implementation agencies have developed their agency specific implementation plans under four high priority areas -Training, Procurement, Service Delivery and Governance- that have been put together in the MAF 2015 operational plan to allow for better coordination and performance based MAF programme financing mechanism.

The development/donor partners on the other hand took turns to update the MOH and the other implementation agencies on activities they have undertaken in the regions across the country as their contribution towards reducing the maternal mortality ratio and any additional funding to support the operational plans of the implementation agencies.

The eight United Nations MDGs are a framework agreed upon by all leaders and development institutions to meet the needs of the world’s poorest population by 2015. These development challenges were set for a framework of 20 years where all member nations are suppose to achieve the targets set for each of the goals.

Ghana has only a year or 24 months left to achieve the health-related MDG 5 which focuses on reducing maternal mortality from the unacceptably high levels currently found in developing countries.

Specifically, MDG 5 aims to firstly reduce by three quarters, between 1990 and 2015, the Maternal Mortality Ratio (MMR); and secondly achieve, by 2015 universal access to reproductive health by increasing access and coverage of antenatal care, skilled delivery, and family planning and reduce adolescent birth rate.

According to the latest estimates by the Maternal Mortality Estimation on Inter-Agency Group (MMEIG), the MMR in Ghana was 380 per 100,000 live births in 2013. If it continues to reduce at the current pace by 2015 MMR will only reach 358 per 100,000 live births. In this scenario Ghana will attain its 2015 MDG 5 target in 2037.

Dr. Odame therefore noted that the slow progress in reducing MMR has been of great concern to policy and decision makers to the extent that Maternal Mortality was declared a national emergency in July 2008.

He explained that, in response to these concerns, Ghana’s MDG framework was developed by the MOH and the Ghana Health Service (GHS) in collaboration with development partners, particularly the UN Country Team and other stakeholders in Ghana in 2010, aimed to augment implementation of the Maternal and Child Health programme with the objective of attaining the MDG indicators and targets.

In a follow up to the above, he posited, a costed Operational Plan was developed in 2011 to guide implementation of the MAF, but it did not become operational until mid-2013 when the European Union committed 52 million euros to MAF and released the first tranche of 10 million euros towards its implementation.

This resulted in the training of over 1,800 health care workers between 2013 and 2014 in District Health Management Systems (DHMIS2) software to help improve monitoring and evaluation of the maternal and neonatal health programmes as well as their planning. Additionally, about 1, 900 midwives and nurses were also trained in comprehensive Family Planning services provision, over 1,000 of them in the use of the pantograph while obstetric facilities in 15 district hospitals were upgraded to provide full range of comprehensive Emergency Obstetric Neonatal Care (EmONC) services.

Dr. Odame disclosed that despite the progress made towards achieving Ghana MDG MAF targets, a number of challenges including financing, implementation, uncoordinated monitoring and evaluation as well as reporting have been a headache to the MOH.

The meeting was therefore timely and in an effort to address these challenges especially that of financing and the way forward even after 2015.

Under financing the 2015 operational plan, two high level scenarios were identified namely high level and medium level funding.

For high level funding, maximum funding is available from all donors to support MAF activities and there is strong coordination amongst donor partners funding specific commodities and regional activities which are broadly linked to MAF.

Under the medium term funding, continued concerns over the macro-economic position of Ghana mean there are further delays to the release of EU funds into 2015 and MAF is required to rely on funding from DANIDA to support a range of more targeted activities centering on procurement of EmONC and life saving equipment, training and service delivery to support their use in clinical practice and many of the other activities in the original MAF plan would remain unfunded. There will be the need to identify other donors to support other activities.

The UN estimates that the annual rate in reduction of the MMR is 3.4%, suggesting that even though Ghana is making progress, it is insufficient to attain the national MDG target of 185 per 100,000 by 2015.

It would be recalled that in 2010, the MOH/GHS and development partners together developed the MDG5 Accelerated Framework to identify the constraints to implementation of existing plans and strategies and to explore the reasons why pregnant women continue to die in Ghana.

When the MAF identified and prioritize the bottlenecks to effective implementation of the most important interventions to reduce maternal deaths, the MAF also showed that additional investment focusing on skilled attendance at birth, emergency obstetrics care and family planning would accelerate Ghana’s steps towards achieving MDG5.

Since all proposed MAF interventions well known to all the development partners and are evidence-based, cost effective and aligned to national plans and strategies, the UN agencies, other development partners and Civil Society Organizations should as a matter of urgency support the MOH and all its MAF implementing agencies with the required financial and material resources to enable Ghana achieve MDG 5 by the end of 2015.