Prioritising sexual and reproductive health in Ghana

Many countries are making major changes to their health sectors.  But are populations' needs for sexual and reproductive health services being overlooked? In Ghana, curative health care policies are prioritised over longer term strategies to prevent ill health. There is a clear need for expert analysis and involvement to support effective resource allocation within Ghana's health sector.

The London School of Hygieneand Tropical Medicine, together with the Ghana Health Service, looked at howhealth reforms are being carried out in Ghana, and how these have affected sexualand reproductive health (SRH) services. The study took place at national leveland in the Upper East region of Ghana which is predominantly poor and rural. 35people were interviewed over a three month period in 2003. These includedofficials from the Ministry of Health (MoH), districtand regional health managers, donors, and members of non-governmental organisations.The study also looked at official documents for the preceding 10 years in orderto analyse the reform process. The study found that:

• Decisions on how to allocate resources were basedprimarily on mortality rates and the prevalence of certain illnesses suchas diarrhoea and malaria.
• Preventative services, such as family planning,were neglected in system-wide planning and targets.
• An early health plan did not budget for condoms:crucial in preventing the spread of HIV as well as preventing unwantedpregnancies.
• Decision-making was not systematic and often dependedon the enthusiasm and involvement of particular individuals.

At present funding is beingtargeted inappropriately. HIV treatment receives high priority despite its relativelylow prevalence (four percent) in Ghana. Expensive drugs are available to treatpeople with AIDS although there are no tests available to discover whether theyare HIV positive in the first place. Meanwhile, more pressing concerns, such assafe abortion, family planning and teenage sexual health, are comparatively neglected.

One reason why SRH has beenoverlooked by Ghana's MoH is because the country has astrong independent SRH programme funded by international donors. While this programmemay appear beneficial in the short term, in the long run sexual andreproductive health services need to be an integral part of the health service.International funding for these services will not last forever.

The report suggests that:

• Decision-making must be based on a healthsystem-wide approach with closer involvement from the SRH programme, aswell as other specialist programmes.
• In the short term, policymakers should listen tothe priorities set down by specialists in the field of sexual andreproductive health.
• Experts in sexual health need to be moreproactively engaged in making crucial decisions about spending limited healthcare resources.
• The longer term benefits of investing inpreventative health care policies should not be neglected for shorter termcurative options.

Decisions based primarily onthe prevalence of disease do not measure the benefits that investing in SRHprevention and care can bring. Meeting SRH service needs requires that SRHspecialists are included in decision-making processes about allocations ofresources and health systems functioning.