Countdown to 2030 is working in 25 countries in Africa and Asia including Ghana through collaboration with the Global Financing Facility (GFF). The GFF partnership in Ghana is supporting the implementation of a roadmap for Universal Health Coverage (UHC) through the development of a Prioritized Operational Plan and Costing (POP-C) that serves as Ghana’s investment case. The GFF catalytic role provides details on the GFF support for Ghana’s Reproductive, Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH-N) agenda. It focuses on support provided in the areas of the Investment Case (IC), health financing and systems reforms, the country platform, partner alignment, and data use for decision-making. These aim to generate evidence and strengthen countries' capacity to measure progress and performance of RMNCAH+N programs. They are also to inform the country’s annual and mid-term review plans and GFF investment cases.
Ghana is developing the Global Financing Facility (GFF) investment case and results framework. Its investment case will be adopted to national priorities, most notably a new roadmap to universal health coverage, with an associated national monitoring, learning, and evaluation (MLE) framework in which RMNCAH+N is prominent. The Ghana Health Service, which is responsible for the reporting of health sector indicators to the Ministry of Health, is leading development of the MLE framework.
In Ghana, routine reporting from the health system occurs through a district information management system (DHIMS2). Improving the quality data collected through DHIMS2 is an ongoing effort. Another key area identified in need of strengthening is the estimates of the population at risk (denominators) to produce subnational RMNACH+N and other health system indicators at district and sub-district levels. This will be one aspect of the Ghana country collaboration.
Ghana’s Integrated Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAHN) Strategic Plan
Ghana has launched a comprehensive Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAHN) Strategic Plan aimed at ensuring increased and equitable access to high quality RMNCAHN services for all by 2030. The five-year RMNCAHN prioritized strategic framework provides strategic direction for health and relevant non health stakeholders towards ending preventable deaths of women, newborns, children, and adolescents and ensuring their health and wellbeing. It is also aligned with the Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016 – 2030) and envisions a world in which every woman, child, and adolescent in every setting, realizes their rights to physical and mental health and well-being, has social and economic opportunities, and can participate fully in shaping prosperous and sustainable societies.
Nevertheless, over the past decade and according to the Maternal Health Survey reports in 2007 and 2017, Ghana has reduced the number of mothers who die from pregnancy related causes from 378 to 310 for every 100,000 live births. The under-five mortality was reduced from 82 to 52 per 1,000 live births. Infant mortality went down from 50 to 37 per 1,000 live births. Out of every 1,000 live births, newborn deaths declined from 29 to 25. And stunting decreased from 6.8% to 4.8%.
In spite of the progress made for every 1,000 children born alive in Ghana, 52 die between birth and their fifth birthday, 37 do not make it before reaching their first birthday, and 25 die between birth and 28 days. Only half of newborns are put to their mother’s breast within the first hour of birth and only four out of ten children under six months are exclusively breastfed with close to one in every five children under five years, stunted. https://www.afro.who.int/news/ghana-develops-integrated-reproductive-maternal-newborn-child-adolescent-health-and-nutrition
CD2030 Phase III – Ghana Collaboration
The Ghana country collaboration under CD2030 Phase III is focusing on the following key areas during the 2023 – 2025 years:
- Analysis of institutional maternal mortality in a specific period using multiple data sources i.e., DHIMS2, EmONC, DHS, Death audits
- Trend analysis of access to family planning among adolescents in Ghana. Geospatial analysis at the district level across the country/Number of pregnancies that occurred in girls aged 10 to 19 per 1000 women in that age group per year.
- Analysis of the continuum of care (ANC1, ANC4, IPTp3, SBA & PNC) from pregnancy to 40 days of life of newborns in Ghana. Analysis of the multiple survey data such as DHS, MICS and MHS.
- Tracking of deaths among neonates, children under 1, children under 5 / deaths due to malaria among children under 5/ using routine data and National Survey Data.
- Track the family planning accepters- Profile and inequalities of family planning counselling and acceptance using routine health facility data and National Survey
- Improving population estimates for immunization coverages: Analytical comparison of DHIS, routine coverage denominator and gridded population (Census and HDSS).
- Health financing profile of Ghana from 2000 to date with a focus on Reproductive health and Maternal conditions using data from the World Data bank and Ghana Ministry of Health.
- Analysis of the trend and factors and inequalities of immunization coverages (Penta1 and Penta3) using multiple Routine data, DHS, and MICS data
Planned Research 2023 – 2025
The Countdown to 2030 has instituted a Fellowship Program which is a multilateral collaboration to strengthen analytical capacities for monitoring and tracking the progress of life-saving interventions for reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) in Africa. Every year beginning in 2023, Countdown to 2030 selects 10 fellows from countries with an ongoing Countdown collaboration. During the 12-month fellowship, the selected researchers to work on a specific research project related to RMNCAH+N with mentorship from other Countdown researchers. Akua Amponsaa Obeng from the University of Ghana was selected as a Countdown Fellow for 2023. Akua’s fellowship project is titled "Equity Analysis of Demand for Family Planning Satisfied by Modern Methods in Ghana" with the aim of assessing the inequalities in the demand for family planning satisfied by modern methods across different regions, urban and rural areas, and socio-economic groups in Ghana from 2013-2017.
Outputs, Products, Programs
The Ghana country collaboration contributed to the following key areas during the 2020-2022 years:
Capacity Building Workshop - To improve data utilization at the district levels (Ga South and Nzema East Districts). The objectives of the training workshop are to strengthen the capacity of the district to improve data utilization, and reporting using multiple data sources to measure health sector performance. The specific objectives build the capacity of districts and sub-districts on the following areas:
- Narrative and analytical report writing
- DHIMS2 GIS Module
- Improving data quality and strengthening M & E structures at the districts level and
- Annual Performance Review presentation
2022 Countdown GFF Multi-Country Analysis Workshop in Nairobi Kenya
The African Population and Health Research Centre (APHRC), the Global Health Financing Facility (GFF) and the Countdown to 2030 consortium, invited participants from Ghana and 15 other African Countries to a Health Facility Data Analysis workshop for the West and East Africa regions from 13th to 17th June 2022 in Nairobi, Kenya. The key objectives of the workshop included:
- Strengthen the skills of the country teams in the analysis of health facilities and related national and subnational data.
- Develop and share different ways of communicating results from health facilities and related data analysis.
- Enrich country-led monitoring of progress by supporting the development and implementation of comparable methods to estimate coverage from health facility data and other sources.
- Support country analysts to develop a set of national and subnational estimates for key RMNCAH and nutrition indicators.
Model Annual Reports (2021) Authored by Beneficiary Districts – Ga South and Nzema East Municipal health directorates. These reports were products of the annual report review conducted for the districts to identify the gaps in their reports and the consequent capacity building on analytical and narrative report writing by CD2030 team of experts. These reports serve as model district Annual Reports as they provide the structure and layout of the elements of a good district annual report.
Journal Articles on Critical Topics for Submission to a Peer-Reviewed Journal
- Health service utilization during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multi-country empirical assessment with a focus on maternal, newborn and child health services. BMJ global health, 7(5), p.e008069.(Published)
- Impact of urban slum residence on coverage of maternal, neonatal and child health service indicators in the Greater Accra Region of Ghana: an ecological time-series analysis, 2018-2021 (Submitted for publication)
- Assessing Inequalities in Reproductive, Maternal, New-born and Child Health Coverage Indicators in Ghana - Analysis of Nationwide Complex Surveys, 2003-2018 (Under Review)
- Mapping the levels of inequalities in vaccination coverage within regions in Ghana: Routine health facility data analysis from 2017 to 2021. (Under Review)
- Building the capacity of district health staffs on data use, analytical and narrative reporting: Implementation research in two rural districts in Ghana (Draft Zero)
Population Modelling and Mapping for Health Workshop
The aim of this training is to respond to the need to strengthen estimates of the population at risk (denominators) to produce subnational health system indicators at sub-district levels. Four core team members of countdown from the Ministry of Health, Ghana Health Service and the University of Ghana, School of Public Health have received training in Population Modelling and Mapping for Health from the University of Southampton.
Geospatial Data (QGIS) Training
Countdown Geospatial data (QGIS) Training was organized for Health Management Information Officers and some ICT managers to improve the capacity of health managers in data analysis for health service delivery and provide evidence-based recommendations for policy interventions. The specific objectives of the training were as follows:
- To improve the capacity of health managers in data analysis for health service delivery and provide evidence-based recommendations for policy interventions.
- To train health managers to be experts in the use of the QGIS tool.