Ghana Country Profile

Jhpiego in Ghana

Background Quick Facts One of the most politically and economically stable countries in West Africa, Estimated total population:1 Ghana is blessed with natural resources, including oil. In terms of health indicators, 24 million Ghana has made significant strides in health. Children under five were one-third Maternal mortality ratio:2 less likely to die in 2009 than they were in 2000. Contraceptive use in Ghana is the 541 per 100,000 live births highest in West Africa, although the contraceptive prevalence rate remains lower than most East African countries and elsewhere in the world. Despite the recent Infant mortality rate:2 gains in health, work remains to be done to ensure the health of the population, 50 per 1,000 live births particularly vulnerable groups such as children and women.

Under-five mortality rate:2 For two decades, Jhpiego has provided technical support to the Ministry of Health 80 per 1,000 live births (MOH), Ghana Health Service (GHS) and Nurses and Midwives Council (NMC), with funding from the U.S. Agency for International Development (USAID) and Total fertility rate:1 other donors. From 2001 to 2005, the MOH and Jhpiego conducted a cervical cancer 4.0 prevention project, funded by the Bill & Melinda Gates Foundation, to screen for cervical cancer, treat pre-cancerous lesions and refer women with cervical cancer. 1 Contraceptive prevalence: Other interventions over the last 10 years include: 1) teaming with local organization 17% (modern methods) Family Health Foundation to provide voluntary counseling and testing for HIV to 24% (all methods) high-risk, marginalized youth surrounding Agbogbloshie market; 2) strengthening HIV prevalence:3 Ghanaian capacity to train providers in intermittent preventive treatment of malaria in 1.8% pregnant women (IPTp); 3) developing IPTp information, education and communication materials for the National Malaria Control Program (NMCP); and Births with skilled provider:2 4) leveraging Jhpiego’s global partnerships with Intel®, the World Health Organization 59% (WHO) and the United Nations Population Fund (UNFPA) to place a free eLearning platform and learning materials in six midwifery schools. In addition, Jhpiego recently Sources: completed a three-year program, funded by the U.S. Department of Defense (DOD), 1 2010 Population and Housing Census, Ghana Statistical to support the Ghana Armed Forces (GAF) to provide high-quality HIV/AIDS Service; prevention and care services to members of the Ghana military, their families, 2 Ghana Demographic and Ministry of Defense civilian employees and the surrounding civilian communities. Health Survey 2008; 3 UNAIDS 2010 Report on the Global AIDS Epidemic. Currently, Jhpiego is implementing three programs in Ghana that are described in more detail below.

Current Program Highlights Maternal and Child Survival Program In Ghana, the USAID-funded Maternal and Child Survival Program (MCSP) builds on previous work from 2008 to 2015 under the Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Program and the Maternal and Child Health Integrated Program (MCHIP). The goal of MCSP in Ghana is to contribute to the improvement of health outcomes from HIV, malaria, nutrition, family planning (FP) and maternal, newborn and child health services.

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MCSP is working with the MOH, GHS and other USAID-funded partners (e.g., Systems for Health, Malaria Care and Evaluate for Health) to achieve the following objectives: 1. A better prepared midwifery and nursing workforce is equipped with the knowledge and skills to effectively provide services for HIV, malaria, nutrition, FP and maternal, newborn and child health. 2. The national Community-based Health Planning Service (CHPS)1 strategy, guidelines, training materials, tools and monitoring systems are standardized and approved. 3. USAID/MCSP-supported regions and districts have strengthened management and support systems to implement CHPS according to updated and harmonized policy and guidelines and provide high-quality HIV, malaria, FP, nutrition and maternal, newborn and child health services.

Jubilee Partners In 2011, Jhpiego received a five-year grant from Jubilee Partners (a consortium of Tullow Oil, Kosmos Energy, Anadarko Petroleum, Ghana National Petroleum Corporation and PetroSA) to implement the Supportive Technical Assistance for Revitalizing CHPS (STAR CHPS) project with the goal of increasing access to high-quality, basic primary health care in six coastal districts in the Western Region. Jhpiego is accomplishing this through an integrated, holistic approach to improve the quality of health care services including malaria control, antenatal care, FP, immunization, growth monitoring and basic outpatient care available via CHPS. This is being accomplished through the use of a Jhpiego-developed quality improvement approach known as Standards-Based Management and Recognition (SBM-R®) within a total of 62 CHPS zones, reaching all 321 Community Health Officers (CHOs) and 401 Community Health Volunteers (CHVs). In addition, 62 Community Management Health Committees have been formed with 413 members in total.

The Bill & Melinda Gates Foundation Under this award, Jhpiego is working to reduce newborn mortality in Ghana through low-dose, high-frequency (LDHF) training approaches aimed to supplement Project Fives Alive!—a project implemented by the Institute for Healthcare Improvement (IHI) and funded by the Bill & Melinda Gates Foundation. LDHF allows for facility-based practical training at low doses at two different time points followed by continued practice, reinforcement of lessons learned through SMS reminders and quizzes, and mobile mentoring (mMentoring) for continued support. Within IHI’s existing project framework, Jhpiego is providing this evidence-based, scalable approach to improve the competency of providers to reduce newborn mortality. Jhpiego’s project goal is to reduce the newborn mortality rate (in the first 24 hours) by 25% at 101 health facilities across four regions of Ghana over three and a half years. This goal will be achieved through two objectives: 1) ensure that 100 health facilities in four regions have competent health care providers and the basic supplies needed to provide high-quality, evidence-based maternal and newborn care services; and 2) develop, test and refine a sustainability model that enables the LDHF approach to be scaled up to additional facilities beyond the life of the project.

1 CHPS is an innovative primary health care service delivery system in Ghana that includes a health compound providing outreach and services to surrounding communities.

Key Accomplishments Under MCSP

 Pre-service education has been strengthened at 10 midwifery and two community health nursing schools through four eLearning modules (on exclusive breastfeeding, cord care, gender-based violence and prevention of mother-to-child transmission) and support to skills labs at the midwifery schools.  In collaboration with GHS, MCSP convened a national-level CHPS Best Practices Seminar with 136 participants to discuss implementation realities and challenges as well as share regional differences in implementing CHPS across the country. The seminar resulted in the decision to develop the national CHPS technical working group.  MCSP also supported GHS national and regional integrated planning meetings with a strong focus on CHPS implementation.

Under Jubilee

 A total of 366,857 outpatient department visits were made in the 62 STAR CHPS zones (155,663 with children under five), and there have been 45,079 FP acceptors. Of the 131,023 confirmed cases of malaria in the zones, 219,619 have been treated. In line with WHO recommendations, the percentage of malaria cases confirmed by rapid diagnostic tests or microscopy is increasing; in the final quarter of the project, 90% of suspected malaria cases presenting at the CHPS facilities are being confirmed before treatment— representing a best practice in managing malaria. Immunizations provided include: 33,155 BCG immunizations, 41,843 polio 3, 41,167 Penta 3, 42,435 measles and 46,625 yellow fever.  To ensure that communities are involved in decision-making regarding their health needs, the STAR CHPS project instituted a Community Decision-Making System that equips community members to identify their health problems, plan resources that will be needed to solve the identified problems and implement and evaluate health-related actions.

Under the Bill & Melinda Gates Foundation-supported work

 LDHF training has been rolled out to 38 sites in Central, Western and Upper West Regions and Greater Accra, including the training of 357 providers and 37 master mentors.  Thirty trained master mentors were shown to retain knowledge and skills as measured by an observed structural clinical exam (OSCE) at 95% one year post-intervention compared to 79% for knowledge and 56% for skills at baseline. Providers at 16 health facilities in Wave 1 sites maintained knowledge at 93% and skills at 71% one year post-intervention compared to 84% for knowledge and 47% for skills at baseline.

Under DOD work

 Jhpiego and GAF developed and validated GAF’s HIV/AIDS strategic plan, and improved the quality of HIV services at the 37 Military Hospital in Accra by implementing SBM-R. The lab at 37 Military Hospital was also improved and is on track for international accreditation.  Jhpiego also supported the development of Prevention with Positives (PWP) and HIV testing and counseling (HTC) training curricula and initiated and sustained a PWP support group. Jhpiego also trained 22 trainers in peer education and HTC who then trained 20 peer educators and 20 HTC counselors. Ghanaian women with insecticide-treated bed nets.  Finally, Jhpiego improved GAF's ability in strategic information, including procuring and distributing key hardware and software to all seven garrisons and training staff on data collection and management.

Partners and Donors

 Past and present donors for Jhpiego’s program in Ghana include USAID; DOD; the Bill & Melinda Gates Foundation; the Global Fund for AIDS, Tuberculosis and Malaria; WHO’s Roll Back Malaria; and Jubilee Partners.  Past and present in-country partners include national organizations such as the MOH, GHS, NMCP, NMC, National AIDS Control Program, Human Resources Development Division, GAF, pre-service education schools and Family Health Foundation. International partners include UNFPA, IHI, EngenderHealth, Population Council, NetMark and Ipas.

References Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010 Report on the Global AIDS Epidemic. 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. Ghana Statistical Service (GSS). 2011. 2010 Population and Housing Census Provisional Results. Accra, Ghana.