Ghana, a small lower middle-income country with a vibrant health sector, enjoys a long history of cooperation with the U.S. on health. Ambitious national plans and concrete strategies in the areas of newborn health, family planning, and child health have made reproductive, maternal, newborn and child health (RMNCH) topics of national importance and high-level political attention.
Despite the recent progress in RMNCH, Ghana still faces considerable challenges when it comes to protecting women’s and children’s health. Thanks, in part, to support from Gavi, the Vaccine Alliance, Ghana has developed a strong national immunization program, which has contributed to reductions in child mortality. However, over the next five years Ghana will need to assume full financing for those vaccine purchases as its economic status mandates the country begin to transition away from Gavi support. Additionally, maternal and neonatal mortality rates continue to be high, the contraceptive prevalence rate is low, and the government faces difficulties reaching remote populations with health services.
Photo credit: Kate Holt for Jhpiego/MCSP
To examine U.S.-Ghana bilateral cooperation on reproductive, maternal, neonatal, and child health (RMNCH) issues as well as how U.S. bilateral assistance on immunization programs complements support provided to Ghana by Gavi, the Vaccine Alliance, a delegation from the CSIS Task Force on Women’s and Family Health traveled to Ghana in late May, 2016.
Photo credit: USAID
The Task Force believed that there might be lessons from Ghana that could be relevant for other lower middle income countries where the U.S. is engaged on maternal and child health for several reasons:
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Ghana is one of 24 priority countries for U.S. engagement on MCH, as well as family planning.
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Ghana’s ongoing economic growth and transition to lower middle income country (LMIC) status have implications for the country’s continued eligibility for some forms of health-related development assistance, including from Gavi.
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The United States has developed a robust government-to-government engagement in Ghana, with direct financial support for sub-national government entities, as well as the country’s National Health Insurance Scheme (NHIS).
Photo credit: AFP
We identified several areas where the United States can enhance its engagement on RMNCH in Ghana and offer lessons for continued work in other countries:
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As Ghana moves towards full self-financing for all vaccines currently procured with funds from Gavi, the U.S. should reinforce its support for Ghana’s immunization programs, use its role on the Gavi Board to advocate for extending the period of time during which LMIC countries, like Ghana, have access to Gavi prices following the transition; and facilitate discussions about ways for the government to take on new and expensive vaccines once Gavi support is phased out.
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The United States should couple its support for the extension and strengthening of health services at the community level with reinforced emphasis on activities that increase the access of women and children to RMNCH services at all levels of care. The United States should also continue to support the integration of family planning services into the NHIS, which has been approved but has not yet been implemented.
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Lessons learned from the successful integration of HIV/AIDS or malaria services with maternal and child health activities should be shared with — and extended to — other sectors, particularly reproductive health and family planning. Given the low contraceptive prevalence rates in Ghana, high rates of maternal mortality, and Ghana’s stated goals of increasing access to and uptake of family planning by 2020, it is also important to maintain a special focus on family planning to address unmet need, as well as to improve maternal and newborn health outcomes.
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As the government-to-government support for health, agriculture and nutrition programs moves forward, the U.S. should carefully document the financial and human resource costs of the government-to-government programs, analyze carefully the needs with respect to oversight and sustaining progress following the program’s conclusion, and use the experience in Ghana as a model for government-to-government and multi-sectoral engagement in other contexts.
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