Donor Withdrawal versus Maternal, Child Health and Nutrition Programs in Northern Ghana: A Three‑Parts Study of Implications

Abstract

Background: Transitions of donors create threats to health systems in low- and middle-income countries that depend on external financing. In Northern Ghana, this study evaluated the financial, operational, and policy implications of USAID’s withdrawal from maternal, child health, and nutrition (MCHN) programs. Methods: We used a mixed-methods design, integrating quantitative data from eight districts with qualitative inputs from key informant interviews and focus group discussions, triangulating financial records, service utilization indicators, and community perspectives. Findings: Donor withdrawal resulted in fiscal shortfalls, with health directors at district level reporting budget cuts of 35–45% and NGOs noting that 42%–100% of their programs were halted. Metrics on service use including antenatal care (92%), skilled delivery (76%), and child immunization (84%) continued to be stable but under strain. Supply chain disruption is widespread: vaccine delays have been recorded in 75% of districts, 88% of districts have experienced shortages of Ready-to-Use Therapeutic Food (RUTF), and all districts faced logistical constraints, including cold-chain equipment and transport fuel. Policy Implications. Donor departure influenced reforms. The President of Ghana mandated that the Minister of Finance to swiftly fill funding gaps, NGOs fostered innovations by the private sector, and local governments with Members of Parliament supported efforts sustain gains and progress in the health sector into the future. Conclusion: Donor withdrawal revealed weaknesses but also launched responsive measures, like emphasis on basic services, resource innovations, and reinforced community ownership. Both risks of dependency on donors and opportunities for resilience when local systems re-calibrate are emphasized by these findings.