Putting Women and Girls at the Centre of Primary Health Care (PHC) in Ghana
This initiative, funded by Co-Impact, will address the structural barriers that limit equitable access to quality health care from both the demand and supply sides of the health system. The initiative directly contributes to achieving the SDG targets of universal health coverage, gender equality, and women’s empowerment. It will also promote and strengthen the voice, agency, and power of women and girls, and women’s leadership towards transforming systemic barriers that discriminate against them and foster inequalities in health services delivery. It will also contribute to the generation equality agenda by creating platforms for young women and girls to participate in designing and building a gender-sensitive primary healthcare system that responds to their needs and aspirations.
Gender Transformative and Responsive Health Systems (ADOWA GTR) Project
The ADOWA project supported by the International Research Center, Canada, and the UK Medical Research Council aims to promote gender-transformative and responsive health systems for adolescent mental, sexual, and reproductive health in Ghana, Niger, and Burkina Faso— through the co-production of culturally relevant and appropriate interventions with adolescents, frontline health providers, and policymakers.
Reproductive Health Education for Adolescents and Young People Project
ARHR supported the 7th UNFPA/Government of Ghana country program from 2018 to 2022. The project, which was implemented in six (6) districts (Ashiedu Keteke, KEEA, Nzema East, South Dayi, Bosome Freho, Jirapa) across six (6) Regions (Greater Accra, Western, Volta, Ashanti, Central, Upper East) in Ghana sought to empower out-of-school adolescent girls through improved access to reproductive health education and responsive reproductive health services.
Over the project’s five-year implementation, ARHR trained 150 Adolescent Health Champions (ADH) across the six implementing districts to exercise leadership and leverage their influence within their respective communities to share critical health information with their peers to enable them to make well-informed SRH choices. Through health fairs and ADH-led peer network meetings, approximately 200,000 adolescent girls, including persons living with disabilities, have been reached with sexual and reproductive health and rights information and life skills to help them make decisions about their SRH. About 34, 000 of these people were referred or had access to adolescent-friendly healthcare facilities across all project implementation communities. As a result, more adolescent girls have been empowered to exercise their agency regarding sexual and reproductive health, and more health professionals have been enabled to provide quality youth-friendly and gender-sensitive SRH services to these adolescent girls.
The Primary Health Care Advocacy Project
With funding from Population Action International (PAI), ARHR implemented the Primary Health Care Advocacy initiative from 2017 to 2022. It engaged national-level decision-makers, and stakeholders on the need to use PHC as a medium of achieving UHC in Ghana. It engaged the government of Ghana and its representatives to develop, adopt, and finance a consolidated essential health services package as part of national efforts toward UHC attainment.
Using a series of stakeholder engagements, budget analysis, and media interviews, the following key outcomes were achieved: increased understanding of a critical mass of CSOs on emerging issues within the national PHC landscape; increased CSOs’ knowledge and enhanced CSO advocacy for a strengthened PHC; and increased CSO-State Actors engagements to demand accountability and responsiveness in health system strengthening.
Catalyzing leadership to improve reproductive, maternal, newborn, child and adolescent health outcomes in West Africa (WNCAW) project
To improve women’s and girls’ access to quality SRH services, the International Development Research Centre (IDRC) funded project sought to understand and document the experiences and perceptions of women and adolescent girls regarding access, quality, and affordability of sexual and reproductive health services across five (5) African countries—Ghana, Senegal, Sierra Leone, Cote D’Ivoire and Burkina Faso. ARHR, as an advocacy and research organization, led the scorecards assessment and multi-stakeholder policy dialogue processes of the project. Key outcomes of these processes included:
Utilization of evidence from score-card assessment by key decision makers to inform policy and practice. Service providers across implementing communities within the five implementing countries used and continue to use the results of the assessment to inform decision-making. For example, in terms of service delivery, facilities that did not have basic equipment like pediatric weighing scales and BP apparatuses have had these provided by the national and district health authorities.
There is also emerging evidence of improvement in provider-client relationships that have contributed to increased uptake of sexual and reproductive health services by women and girls across all five implementing countries.
Bridging Gaps: Innovate For Malaria (B4M) Project
The Bridging Gaps: Innovate for Malaria (B4M) Project commenced from 2017- 2021. It was implemented in four districts (Bodi, Juaboso, Mpohor, and Nzema East) in the Western Region, Ghana with funding from Comic Relief’s ‘Fighting Malaria, Improving Health’ in a partnership with Glaxo Smith and Klein (GSK) and sought to empower communities to demand better services and hold service providers accountable for improved malaria services towards better outcomes. Ultimately, the project was designed to improve the delivery of malaria within a stronger PHC system. Outcomes included enhanced knowledge by communities of their rights and the government’s responsibilities in malaria prevention, diagnosis, and treatment. Over the project period, notable changes occurred in the lives of about 64,800 pregnant women of reproductive age, children under five years, men, and adolescents. Results from an end-line survey showed that 50% of respondents knew that access to health care was a right and should be demanded compared to 20% before the commencement of the project in 2017; an improved provider-client relationship that increased uptake of malaria services by the target group. The end-line survey also noted an increase in the percentage of pregnant women who took medication for the prevention of malaria in pregnancy which increased by 42.91% from 45% in 2017 to 87.91% in 2020 and almost 80% knew the recommended number of times it should be taken as against 3% in 2017.
Integrating Gender Equality and Social Inclusion in National Health Policies, Programmes and Commitments (GESI) Project
The ARHR implemented the GESI project from 2017 to 2020 across three districts— (South Dayi, KEEA, Agona East) in two Regions (Volta and Central) of Ghana. The STAR Ghana-funded initiative aimed to ensure the systematic integration of gender equality and social inclusion into Universal Health Coverage in Ghana. Some major outcomes of the project included:
Recognition of and effective planning for gender and social differentials in UHC-related initiatives at the district and national levels. ARHR developed a GESI framework to track the impact of these development initiatives, policies, and programs on marginalized and vulnerable groups, aspects of which have since been integrated into the annual and action plans of implementing project districts and municipals— to ensure that activities are GESI compliant. At the national level, the Ghana Health Service (GHS) uses aspects of the framework to develop a Standard Operating Protocol for providing SRH services for PWDs.
Utilization of evidence from the GESI monitoring by non-state and state actors (policy and decision-makers, health providers) to ensure provisions of gender equality and social inclusion in the National Health Insurance Scheme (NHIS) and Community-Based Health Plan and Services (CHPS)—the two key operational strategies for achieving UHC in Ghana.
Enhanced capacity of socially excluded groups to demand accountable health care. In some communities, this resulted in the formation of committees championing GESI issues which translated to concrete actions. For PWDs’ convenience in accessing healthcare, the KEEA municipal, for instance, constructed a ramp at the Elmina Polyclinic.
Universal Access to HealthCare Campaign (UAHCC)
ARHR’s Universal Access to Healthcare Campaign, supported by Oxfam in Ghana and other CSOs, which was implemented from 2009 to 2022 advocated for the government of Ghana to legislate for quality and accessible universal healthcare for all, free at the point of use, with identified new sources of funding like tax and innovative finance mechanisms by 2030.
The Campaign was made up of local and international NGOs with a reach of over 500 members working on health-related issues across all the regions of Ghana. It employed strategies that included evidence generation, policy analysis, civil society mobilization, and media engagements to target the government.
The Campaign reviewed the National Health Insurance Scheme’s operations and recommendations were submitted to the Technical Review Committee set up by the Ministry of Health (MoH). Aspects of the recommendations made by the Campaign were considered in the final report submitted by the Technical Review Committee to the MoH for action.
Mitigating the spread and impact of covid 19 in Ashiedu Keteke (MISAICAK) Project
The MISAICAK project was a COVID-19 response initiative that supported mitigation efforts among residents of the Ashiedu Keteke sub-metropolitan assembly. It complemented two of the five objectives outlined by the Government of Ghana to mitigate the spread and impact of COVID-19 in Ghana.
Specifically, the project by the end of September 2020, intensified community education to ensure the prevention and spread of the virus among communities; strengthened and enhanced community knowledge and attitude towards physical distancing; and advocated against fear, discrimination and stigmatization of individuals and families infected and affected by the virus.
As part of actions toward implementing the project, hand washing, sanitation, and hygiene products were stationed at vantage points in the target community, and sanitary practices were enforced. The French Embassy funded the project.
Adolescent Health Empowerment Project (AHEP) Project
To provide adolescent girls, specifically head porters or ‘kayayei’ in Agbogbloshie, with access to reproductive health education and services amid Covid 19, ARHR with funding from the French Embassy initiated the Adolescent Health Empowerment Project, in partnership with the City of Hope.
The project empowered the target group through the provision of reproductive health education, and sexual and gender-based violence prevention information, and linked them to SRH services.
Contraceptive demand generation activities promoted head porters’ access to reproductive health and services. Partnerships at the national and community levels were strengthened to deliver reproductive health education and services to these groups of people.
Accountability Loop Budget Advocacy (ALBA) Project
The Accountability Loop Budget Advocacy Project (ALBA) was implemented in several African countries including Ghana by the WHO. ARHR was part of a Ghana Country Team constituted by WHO in January 2015, to implement the Project.
The project advocated for Members of Parliament to ring-fence a percentage of their National Health Insurance Scheme allocation to support maternal and newborn health. To provide the evidence base for advocacy, an assessment was conducted in a main health facility (one that receives the highest number of clients for maternal and child healthcare) in each of the 10 deprived districts selected for the project. The assessment identified gaps in the provision of quality maternal and newborn health care, including emergency care, and these were used for advocacy for improved maternal and newborn health.
Members of Parliament in whose districts the assessment was done were engaged with the results of the assessment and elicited their unflinching commitment to seek redress to the gaps. To address the gaps, these MPs resorted to using part of their NHIS fund to provide at least one basic equipment or supplies for maternal and newborn care in a health facility within their constituencies.