Background

Ghana is currently one of the most politically and economically stable countries in West Africa. In terms of health indicators, contraceptive use in Ghana is the highest in West Africa, although the contraceptive prevalence rate remains lower than most East African countries and elsewhere in the world. The HIV prevalence rate is among the lowest on the continent; however, specific groups such as young, poor women are especially vulnerable to HIV infection. Despite recent gains in health, much work remains to be done to ensure the health of the population, particularly vulnerable groups such as children and young women.

For nearly two decades, Jhpiego has provided technical support to the Ministry of Health (MOH), Ghana Health Service (GHS) and Nurses and Midwives Council (NMC), with funding from the U.S. Agency for International Development (USAID) and other donors. After developing trainers and training materials in maternal and neonatal health (MNH) and family planning, Jhpiego strengthened pre-service education at 13 midwifery schools, five community health nursing schools and one rural health training school. From 2001 to 2005, the MOH and Jhpiego conducted a cervical cancer prevention project, funded by the Bill and Melinda Gates Foundation, to screen for cervical cancer, treat pre-cancerous lesions, and refer women with cervical cancer. Other interventions over the last six years include: 1) teaming with local organization Family Health Foundation to provide voluntary counseling and testing for HIV to high-risk, marginalized youth surrounding Agbogbloshie market; 2) strengthening Ghanaian capacity to train providers in intermittent preventive treatment of malaria in pregnant women (IPTp); 3) developing IPTp information, education and communication materials for the National Malaria Control Program (NMCP); and 4) working with 13 midwifery schools and one school of public health to update tutors using e-learning to shorten time away from work. Since 2004, Jhpiego has also been working in Ghana in human capacity development, reproductive health and child health as a key partner in the USAID-funded Quality Health Partners (QHP) Project. In addition, Jhpiego received private funding to improve skills of tutors in long-acting and permanent methods of family planning under the Reducing Maternal Mortality and Morbidity (R3M) project.

Current Program Highlights

Quality Health Partners (QHP) Project
As a partner to EngenderHealth under QHP, Jhpiego served as the technical lead on malaria, pre-service education, human resources management and family planning. Under this project, Jhpiego adapted its Standards-Based Management and Recognition (SBM-R) approach to measure and improve MNH services, and used Jhpiego resources to strengthen on-the-job training for supervision of family planning and integrated management of neonatal and childhood illnesses. In addition, Jhpiego led the process to revise the curricula of the following educational programs: 1) diplomas in registered nursing, midwifery, mental health and community health; 2) post-basic certificates in registered nursing, community health nursing and public health nursing; and 3) certificates in community health nursing.

“Repositioning Safe Motherhood” under ACCESS Program
With ACCESS core funds, Jhpiego piloted MNH work through the QHP Project by focusing on one district (Birim North) to improve service delivery in key emergency obstetric care skills by applying the SBM-R process. This district was highlighted by USAID as a model district for improvements in maternal morbidity and mortality, and Jhpiego was requested to use lessons learned in Birim North to strengthen pre-service education nationally. In collaboration with the NMC, Jhpiego is implementing the SBM-R approach used in Birim North to strengthen pre-service education at the country’s 13 midwifery schools. This process will support and strengthen the existing national accreditation process, but will need continued support in the coming years to be completed.

The President’s Malaria Initiative (PMI) under ACCESS
Since October 2008, Jhpiego has been working under ACCESS and in collaboration with QHP and NMCP to integrate standards into the existing on-the-job training process to improve the quality of malaria in pregnancy services in QHP-supported health facilities. In the area of pre-service education, Jhpiego also created and launched a supplement for the midwifery school curricula and trained school tutors and clinical preceptors to effectively teach students how to provide services for malaria in pregnancy.

Key Accomplishments

• Following Jhpiego’s initial work with the 13 midwifery schools in Ghana, a matched case-control evaluation conducted two years after graduation demonstrated that Jhpiego’s intervention had significantly improved the skills and knowledge of midwives in the areas of MNH and family planning.
• As a result of Jhpiego’s work integrating community health officer (CHO) skills training at five community health nursing schools and one rural health training school, an estimated 500 new students graduate annually ready to be posted as CHOs under the national Community-based Health Planning and Services initiative.
• Through the work of just eight nurse-midwives trained by Jhpiego in cervical cancer prevention, 17,662 women were screened between 2001 and 2005. Of those, 1,521 tested positive for pre-cancerous lesions, and 1,452 were provided with cryotherapy. By the end of the cervical cancer prevention project, Jhpiego had prepared two hospitals and two health centers to sustain these services.
• Under the 20-month project to provide HIV counseling and testing to youth around Agbogbloshie market in Accra, 4,189 clients—all between age 15 and 25 years—were provided with voluntary counseling and testing, and referrals if they were HIV-positive. HIV prevalence among these clients was higher than for their age group in the general population, and women were three times as likely to be positive than men.
• Through Jhpiego’s work with QHP, 350 district supervisors and managers in seven southern regions across the country have been trained to use staff performance improvement tools, and SBM-R has been introduced to enhance in-depth supervision and on-the-job training of providers and improve provider competencies, equipment and management of health facilities.
• Under ACCESS, implementation of the SBM-R process in Birim North District resulted in measurable improvements in basic emergency obstetric and neonatal care practices at 11 health facilities.
• Under R3M, Jhpiego initiated E-learning for 13 midwifery schools and one public health nursing school to improve skills of tutors in long-acting and permanent methods of family planning.
• Jhpiego conducted a national malaria needs assessment in Ghana under the National Malaria Control Program for the Roll Back Malaria (RBM) Initiative of the World Health Organization (WHO).
  
  

Partners and Donors

• Past and present donors for Jhpiego’s program in Ghana include USAID; the Bill and Melinda Gates Foundation; the Global Fund for AIDS, Tuberculosis and Malaria; WHO’s RBM; and an anonymous donor.
• Past and present in-country partners include: national partners such as the MOH, National AIDS Control Program, Human Resources in Health Development, NMCP and NMC; local partners such as Family Health Foundation and the pre-service education schools; and international partners such as EngenderHealth, Population Council, NetMark and Ipas.

References:
 
Population Reference Bureau. 2008. World Population Data Sheet. Washington, D.C.

Joint United Nations Programme on HIV/AIDS (UNAIDS). 2008. Report on the Global AIDS Epidemic.

World Health Organization (WHO) Statistical Information System. At: http://www.who.int/whosis/en/

Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro. 2009. Ghana Demographic and Health Survey 2008. Accra, Ghana: GSS, GHS, and ICF Macro.