Free family planning services in Upper East Region attract increased usage
In April 2012, the Upper East Regional Health Directorate of the Ghana Heath Service launched a pilot project in which all fees associated with contraceptive adoption and use were removed.
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The project was to test a new policy announced by the Ministry of Health (MOH) focused on removing financial barriers to contraceptive use.
The announcement was the ministry’s response to the increasing unmet need for family planning, resulting from various social, financial and programmatic constraints associated with contraceptive utilisation.
The low family planning usage led to high levels of fertility and unwanted pregnancy in the country often with dire consequences for women and children.
Upper East Regional Director of Health, Dr Koku Awoonor-Williams, said that although evidence exists on the social, programmatic, and financial constraints to family planning adoption and behaviour in the region, there was the need to determine ways in which monetary cost removal could interact with other factors that affected family planning utilisation.
As such, the free family planning project, which was an implementation research sought to provide the evidence for ways to implement free family planning services, particularly as the MOH did not provide any blue print for implementation of the free family planning policy announced.
It further aimed to identify the barriers and facilitators of implementing the cost-free family planning so as to address them to improve service uptake, and to share the lessons learnt on implementing with national programme planners, policymakers, and donors to influence policy and promote the scale up of free family planning across Ghana.
What did the Health Directorate do?
Implementation of the pilot Free Family Planning Services started in the then Talensi-Nabdam district, one of the districts with low family planning usage.
The health directorate started off by reviewing all facility data on family planning services, taking inventory of existing family planning devices at facilities, training in service delivery for staff and increasing clinical supervision.
A key activity, Dr Koku Awoonor-Williams said, was the holding of a series of community durbars, meetings and discussions.
Preliminary Study
Prior to the pilot project at Talensi Nabdam, Dr Awoonor-Williams said, the regional health directorate had, between January and March 2012, carried out a study in Kassena Nankana East and West to explore the link between family planning and their associated user fees.
“We approached healthcare providers and administrators at all levels of the system, as well as an array of community members and leaders from villages across the region,” said Dr, Awoonor-Williams.
The vast majority of respondent believed that expense is an important barrier to family planning usage.
According to Dr Awonoor-Williams both men and women alike highlighted fees as the deciding factor in women’s uptake. A young woman from Naaga explained,
“What is preventing us is money. It is money because if you want to go for family planning and you don’t have money, how can you do it?”
Another man drove home the point of pervasive poverty when he stated that “I think it is about money... Some women do not even have money to buy salt.”
Respondents also underscored that accessing family planning is difficult because payments are required on a frequent basis; and according to a Community Health Officer, “Some also say they cannot be paying every three months to do family planning.”
The frequency with which women must pay for methods was also highlighted as a reason why many users default. One woman shared her experience of stopping Family Planning usage for this reason: “I have done it (family Planning) and when the time came for me to go for the next one; I did not have the money to go for it.”
Dr Awonoor-Williams indicated that in addition to the widely held understanding that user fees stood in the way of family planning uptake, a large number of respondents acknowledged that part of the problem with payment related to the fact that many women felt uncomfortable asking their husbands for financial assistance for family planning.
As couples sometimes disagree over family planning, women’s lack of access to funds may be a hindrance to their utilisation of family planning because they are not able to seek funds from their husbands.
Given the frequency with which respondents pointed to finances and the negotiation thereof as the principal barrier to family planning usage, it comes as no surprise that many respondents suggested that reducing or altogether eliminating user fees would improve the uptake of such services, said Dr Awonoor-Williams.
Findings
The Regional Health Director said a significant finding from the implementation of the Free Family Planning pilot in Talensi Nabdam was that cost was a major barrier to the acceptance of family planning services.
The project resulted in the generation of significant data quality as a result of strict adherence to family planning service provision protocols, monitoring and supervision.
Furthermore, awareness of family planning issues improved and there was general acceptance of family planning services by the general public due to intensive education in communities known to be very strict with traditions, beliefs and culture.
It also clearly came out that the most preferred family planning method was the male condom and the injectable, Depo Provera.
Also glaring was the fact that the misconceptions affecting family planning still existed in the pilot district, Dr Awonoor-Williams indicated.
Scale up
Dr Awoonor-Williams emphasised that the pilot implementation research produced enough evidence that family planning services should be made free and readily available in the district.
“Based on the findings identified in the Talensi Nabdam district, we decided to scale up and pilot the removal of user fees in the five poorest performing districts in family planning districts in the Upper East Region, which are Talensi, Nabdam, Garu-Tempane, Builsa and Bongo,” he added.
By Rosemary Ardayfio/Daily Graphic/Ghana
Writer’s email: [email protected]