Evaluation of A.I.D. family planning programs : Ghana case study

Assistance fell into two distinct phases -- 1969-1982 and 1985-1991 -- with assistance suspended from April 1983 to July 1984. This report assesses the impact of this assistance in light of the country setting and the national FP program which it supported, with specific attention to that program's overall efficiency, cost-effectiveness, sustainability, and long-term development impact. According to the assessment, progress was practically negligible in the initial period of USAID assistance, but improved during the second phase: the number of FP delivery points increased dramatically; nearly all of the clinics distributing contraceptives were reporting regularly; the Ghana Social Marketing Program made significant progress in expanding the number of delivery points for commercial sector condoms; and during the period 1987-91, couple years of protection nearly tripled, from 75,000 to 223,000. Nonetheless, FP has made only limited gains in Ghana in terms of fertility rate (6.8% in 1965 vs. 6.4% in 1988) and contraceptive prevalence rate, which is the most reliable measure of the impact of any FP program. While the latter rate did increase from 9.5% in 1979 to 12.9% in 1988, the increase was largely in traditional methods; use of modern methods actually dropped slightly, from 5.5% to 5.2% during the period, although it rose to 8%-10% by 1991 and seems to be rising still. One factor behind Ghana's weak demand for modern contraceptives has been the severe economic crisis of the late 1970s and early 1980s, which led to a deterioration of both public and private health services. This situation was compounded by a mass exodus of Ghanaian professionals, including doctors, and the suspension of USAID assistance. Three additional factors explaining poor program progress have been: lack of political commitment; cultural attitudes (especially among men) favoring large families; and the fact that in many instances, contraceptives and FP counseling were not regularly available from a convenient and trusted source which ensured clients' privacy.