Aim and Objectives

The MOH (Ministry of Health) of Ghana plan and supports national policy of health, and is accountable of evaluating and monitoring advancements towards its intended results. GHS (Ghana Health Service) is an independent government organization associated with the ministry of health for delivery of service. GHS collaborate with governmental representatives and with district and regional management teams of health to deploy and derive the human and financial resources needed to conduct a harmonized work program such as the health service delivery (Osei-Akoto & Adamba, 2017). The RCHD (Reproductive and Child Health Department) collaborate with the GHS public Health Directorate. RCHD and GHS collaborate with a wide association of private and public segments communities and collaborators with the purpose of boosting the status of health and increasing the healthy life years of all people residing in Ghana, for instance, making sure that sexual and reproductive rights improve. The elements of the RH (Reproductive Health) program controlled by the RCHD comprises of:

• Family planning
• Treatment and prevention of reproductive tract infections such as HIV/AIDS and STIs (Sexually transmitted infections)
• Control of reproductive systems cancers such as prostatic and testicular cancers and breast cancer
• Discouragement of unsafe traditional methods that influence the RH of women and men including FGM (female genital mutilation
• Safe motherhood such as women and infant health, antenatal and post-natal care, and safe delivery
• Management of post-abortion care and prevention of unsafe abortion
• Treatment and prevention of infertility
• Addressing menopause concerns
• Offering advice on responsible sexual behavior, pre-conception care, human sexuality, responsible parenthood and sexual health.

Ghana has developed a detailed reproductive health standards and policy. The strategic plan is developed to offer the foundation of action program and plans the future national strategic direction in RH activities and services. It is purposed to connect the difference between documents and statements on national RH and Policies of population on one hand, and comprehensive plans of implementations including work programs for RH services at the functional level, on the other (Ayanore, Pavlova & Groot, 2015). It mirrors the general policy and commitment of Ghana to RH.

The Reproductive Health Strategic Plan (RHSP) consist of six strategic objectives that offer the foundation for the action program. It is purposed to benefit all shareholders and will be interpreted into a comprehensive plan of implementation at the regional, national or district levers by budgeting, programming and executing the activities of implementation that are expressed at every strategic level (Nyonator, 2015). The plan is meant to act as an instructional reference record for cooperative private and public segment interest groups, RH service providers, and concerned community members.

The International Conference on Population and Development (ICPD) developed an action program. The program was established to guarantee rights and RH for everyone as a vital contribution to poverty minimization and global sustainable development. RH is a vital element and a comprehensive concept of general health. RH affects all individuals since it is powerfully intermixed throughout the lifecycle. It mirrors pre-birth health from infancy, the completeness of sexual and reproductive health throughout the years of productions, and establishes the health care stage past the years or reproduction for both men and women (Mumuni, et al., 2016). RH is affected and affects the wider contexts of individuals lives, their education, living standards, gender and social relationships, economic circumstances, employment, family environments, and the legal and traditional structures in which they reside.

The basic RH principle and action agenda of ICPD are included within various United Nations’ and other global documents, resolutions and treaties such as the MDGs (Millennium Development Goals) developed by United Nations. The MDGs comprises of particular objectives connected to the enhancement of child and maternal health, and other objectives that offer the context of promotion of gender equity, minimization of disease burden, poverty minimization, and women empowerment. ICPD specific objectives connected to RH comprise of reduction of:

• Maternal mortality, with a particular concentration on the provision of important obstetric care and maximizing experienced attendance at child birth
• HIV/AIDS transmission
• Childhood mortality
• The unaddressed need for RH services and family planning

Proposed Action Plan

The first international RH strategy of WHO (World Health Organization) was adopted by the World Health Assembly. The objective of the strategy was to speed up progress towards achieving the RH and MDGs objectives of the ICPD. The strategy acknowledges five major aspect of sexual and reproductive health.

• Boosting delivery, newborn, antenatal and postpartum care
• Eradicating unsafe abortion
• Improving sexual health
• Offering top-level services for family planning
• Fighting STIs

It is within the above context that the Ghana government has established its poverty minimization strategy and national population policy and where ministry of health expresses its strategic mission. The RH strategic plan was formulated as a foundation to guide the implementation and planning of a work program that abides by these national and international values and goals.

This research will adopt the qualitative approach, using both secondary and primary data. Secondary data will be collected from the international and national-level documents and the primary data through observation and key informant interviews (KII).

One hundred key informants were interviewed which was made up of sixty-four women and thirty-six girls. All were of age fourteen and above. The informants will be made up of various categories of women including professionals. Ten of the informants would be selected from the ministry of health, central monitoring and evaluation, policy and planning department, and reproductive health departments. Additionally, some of the KIIs will be selected from tertiary levels of quality control divisions in Ghana. Interviews will also be carried out at the district level with twenty-two family planning service providers, family planning coordinators, HMIS officers, data clerks, and health surveillance assistance (Swatz, 2018). The major private sector actors in Ghana are for-profit providers, non-profit providers, and professional associations. In this research, professional associations will be excluded and more focus will be on non-profits, public, and for-profit reproductive health providers including pharmacies (Lower, et al., 2014). The research will be carried out in the Central, northern, and southern region with the goal of getting deeper insights about reproductive health planning. This is to enable proper comparison of both institutional and regional practices.

Data collection is one key factor in the research. The primary data collection technique is interview which will involve utilizing semi-structured interview guidelines that reflects on the objectives of the research. The interview questions are divided into two sections: one for service providers and one for policy makers. The interviews will be face-to-face and the interview session will be recorded and later translated through transcribed verbatim (Lavranos & Vassou, 2016). The questions will concentrate on understanding how reproduction planning or family planning practices can be adopted and implemented, key interest being best practices.

The research will also carry out field observation to review the reproduction planning strategies that have been adopted by the service providers in Ghana and comparing them against the results obtained. Additionally, data integration tools will be reviewed and the training of field data collectors will be carried out before the actual data collection process (Fledderjohann, 2012). During training, more emphasis will be on ethical conduct, interview techniques, and getting to learn the various data collection tools.

Collection of secondary data will be conducted via desk review of all the data and national documents and policies associated with reproduction and family planning. The documents include Ghana sexual and reproductive health policy, HMIS national strategy and implementation plan, Ghana national health information system, and Ghana’s annual track 20 progress report (Covan, E. K. (2017). A deeper understanding can be gained through review of the policy documents and the process of integration of the data from national and private institutions.

Sampling Strategy and Study Population

The data primary data collected from the filed observation and key informant interviews will be compared to identify the opportunities, weaknesses, and strengths of improving the reproduction and family planning between the public and private health facilities.

Review and analysis of the transcripts were done manually and electronically for the topics related to the research objectives. The content was examined for major topics and used to code the data. Two analysts were selected to analyze the data in order to ensure reliability of inter-coder. The data was analyzed iteratively to deduce emerging topics and subtopics to determine differences and consistencies and synthesize them according to the objectives of the study (Darteh, Doku & Esia-Donkoh, 2014).

the study will be submitted to the Ghana Health Science commission for approval. The informants voluntarily participated in the study and a written consent was given to all the participants detailing the purpose of the study and how the research data will be used (Buor, 2008).

At the end of the research, the team anticipates to achieve the following:

Provide recommendations on the best practices to boost the health of the adolescents to because of their several psychological and physical changes in their reproductive systems and their tender age. The project seeks to give them ways on how to better understand themselves and accept the changes that are happening in their bodies. In order to maintain their health, it is necessary to give them proper guidance and advice (Edward, 2013).

Provide the necessary steps that should be taken in order to prevent adolescents from first and repeat pregnancies. The providing contraceptives and counselling the teenagers have less impact on pregnancy prevention. As such, it is necessary to provide sex education, holiday support, and sport activities and this approach may cut the risk of pregnancies by more the fifty percent (Adah, 2015). The study will also propose the best practices in parental care to help the young women and teenagers who already have children.

Propose better health practices such as birth spacing. The study will carry out a research on the and recommend appropriate birth spacing timeline in order to maintain good health. Additionally, recommend reproductive planning after abortion which women often do after getting unwanted pregnancies (Derbile, 2007). For those women who look for after abortion services which often have a positive influence to them. It reduces the risk of getting unplanned pregnancies and trauma to those who seek help.

Recommend the best and appropriate age bracket that is safe to conceive and get pregnant without any health-related complications. Several studies that have been carried out suggest that 20-35-year bracket is the best time to get pregnant. These studies have argued that conceiving at the age more than 35 years bring more risks of contracting health complications.

The expected outcome will have some major significance to the concerned party. Contraceptives have been regarded as one of the main methods to enhance women reproductive health (Jameson, 2012). However, in Ghana many women are of low income and thus cannot afford to or access modern contraceptives. Additionally, many women have insufficient knowledge on how to use such contraceptives and this proposal will bring forth the strategies on how to educate the women on the various contraceptive available for them and what best suites their needs and how to use them. There are many aspects that have slowed the efforts for ensuring proper and good reproductive health in women. They include cultural practices that are still practiced in Ghana such as female genital mutilation, forced pregnancies, and unprotected sex among the young girls. Many girls and boys below the age of twenty tend to engage in sexual intercourse according to statistics from early research and this leaves most of the teenagers at a risk of getting pregnant (Panjalipour, Khalesi & Mirhaghjoo, 2017).

Data Collection

The proposal and recommendation made in the research will ensure that women and young girls who get unplanned pregnancies will get medical services to reduce the health complications and risks that the unborn baby or the mother may face. Women pre-pregnancy health is improved by providing support and engaging them in activities that will occupy their minds and keep them away from sexual thoughts. If the proposal is implemented then contraceptive services will be available to all women and girls across Ghana.

The various development programs that have been proposed will empower the youth who are idle most of the time and this will reduce teenage pregnancies by more than 65 percent (Ameyaw, 2018). Complications associated with late or early pregnancies will be reduced by maintaining the appropriate pregnancy intervals.  

The anticipated growth in Ghana’s population by 2050 is 39.5 million (Ramashwar, 2010). The national population policy of Ghana developed various policy objectives that would assist in improving life quality of the citizens of Ghana and reduce poverty (Shahhosseini & Abedian, 2015). The proposal has recommended various strategies that will reduce total fertility rate to 3.0, attain the minimum birth interval of two years, reduce infant mortality rate, promote reproductive and sexual health amongst adolescents, reduce the rate of HIV infection and increase support and care for the women that have already been infected, and promote women empowerment and gender equality by the year 2020.

It is essential to evaluate the outcomes of the programs in order to determine if it was successful, provide ways to refine it, and offer continuous support to the program (Alubo, 2011). Evaluating the results will not only determine the appropriateness of the program to the target audience but also provide feedback on its effectiveness, any concerns that need to be addresses, or issues with its execution (Susmita, 2014). This section will discuss the strategies that will be used to evaluate the outcomes of reproductive planning program.

This is the first stage that is normally carried out to plan on how the evaluation process will be carried out. Determine the evaluation criteria for the various programs and define the objectives of the evaluation process. In addition, identify the various evaluation method that will be used. A well-planned, complete, and properly executed program is easier to evaluate than inconsistent ones. Proposed reproduction plan programs should be implemented alongside the evaluation framework (Allen, 2016). Moreover, it is essential to collect baseline measures prior implementation of the intervention so as to facilitate gauging of the changes that may occur to such measures. The objectives of the program and the evaluation aims are the are the factors affecting the evaluation process.

The aim of the evaluation is to determine the level to which the objectives of the program have been addressed. In this case, the objective of the program is to improve delivery services, eradicate unsafe abortion, improve sexual and reproductive health, increase the availability of family planning services and contraceptives, and reduce the rate of STI infections (Svanemyr, Guijarro, Riveros & Chandra-Mouli, 2017). Evaluation is carried out to assess if these objectives have been met. Other objectives of the evaluation process include determining if the concerned parties and stakeholders accept the proposal.  

There exist several types of evaluation. They include: process evaluation which examines if the program was executed as planned. This entails coming up with a list of indicators that requires evaluation. The outcome will be to determine the weaknesses, strengths, and opportunities associated with the programs (Akhouri, 2017). Impact assessment is another type of evaluation that is focused on determining if the program has brought about desired changes. The effect or impact of the program refers to the change in the target audience as a result of the program, that is, the change would not have occurred without the program.

After determining the evaluation objectives, choose the most appropriate evaluation method(s) that will best meet the objectives. There exists various method that can be employed in the evaluation process. Every type of evaluation requires different method and can use both quantitative and qualitative approaches. Qualitative approach may be used in process and formative evaluations such as questionnaires and focus groups (Titiloye & Ajuwon, 2017). Quantitative methods can be used to evaluate outcomes and impacts of the program. Process and formative evaluations entail in-depth verbal characteristic descriptions to expound on the different patterns of behaviors.

Interviews and focus groups will be used to get feedback on the impact and influence the program has had on the target population. The feedback will be assessed and determine the areas that may need improvement. It is necessary to have a hierarchy of study designs that is well-structured to assess program effectiveness such as uncontrolled before-after studies and randomized control trials (RCT). Randomized control trial provides evidence of the highest quality of the success of the program (Aikins & Koram, 2017). A cluster of the target population is selected randomly to take part in the program. RCT requires more resources and this may not be achieved within a limited budget even though it is an effective method for evaluating the outcome of a project or program.

Economic evaluation will also be conducted to demonstrate the possible cost effectiveness and value for money. This type of evaluation seeks to evaluate of the program utilizes the resources available effectively (Agyepong, et al., 2015). It is dependent on the comparison of the alternatives with regards to their consequences and costs. Cost effectiveness analysis will be employed in economic evaluation which includes the total cost of the intervention together with defined outcome which results in production of cost-effectiveness ratio.

This project is expected to run for 363 days beginning 10^th October, 2018 and expected end date 28^th September, 2019.

Table 1: Timeline

Table 2: Budget Summary

The above budget will be able to facilitate the completion of the project and an its activities. It addresses each cost aspect as well as any other categories that may arise. It will allow the project team to outsource services (professional, consulting, and fundraising), occupancy (utilities, rent, maintenance), training and professional development, travel expenses, supplies, insurances, evaluation, and media publications.

More attention should be focused on the cross-cutting effect that gender equality has on monitoring responsibility and strategic performance areas in attaining the strategic plan. This proposal should be adopted because it provides strategies to minimize maternal mortality and morbidity. Many women and young girls in Ghana suffer from disabilities and illnesses associated with childbearing. Many of these injurie and deaths could have been prevented by making care services readily available for them before, during, and after pregnancy.

In order to promote and improve reproductive health it is important to focus major conditions that lead to young girls engaging in premature sex which increases the risks of contacting STIs and early pregnancies. It is necessary to adopt family planning method and use of contraceptives child and maternal health should be provided including control of sexually transmitted infection such as HIV.

More emphasis should be placed on reproductive health and sexual education across the country. More attention should be drawn to women rights, gender issues in reproductive health and sex, and equal decision making among the partners concerning sex and reproductive health. Prevalence of contraceptives should be increased by promoting and enhancing access to quality family planning services.

Conclusion

The Reproductive Health Strategic Plan (RHSP) seeks to benefit all shareholders and will be interpreted into a comprehensive plan of implementation at the regional, national or district levers by budgeting, programming and executing the activities of implementation that are expressed at every strategic level. The plan is meant to act as an instructional reference record for cooperative private and public segment interest groups, RH service providers, and concerned community members.

It is within the above context that the Ghana government has established its poverty minimization strategy and national population policy and where ministry of health expresses its strategic mission. The RH strategic plan was formulated as a foundation to guide the implementation and planning of a work program that abides by these national and international values and goals.

Data collection is one key factor in the research. The primary data collection technique is interview which will involve utilizing semi-structured interview guidelines that reflects on the objectives of the research. The interview questions are divided into two sections: one for service providers and one for policy makers. The interviews will be face-to-face and the interview session will be recorded and later translated through transcribed verbatim. The questions will concentrate on understanding how reproduction planning or family planning practices can be adopted and implemented, key interest being best practices.

The project aims to provide recommendations on the best practices to boost the health of the adolescents to because of their several psychological and physical changes in their reproductive systems and their tender age. Provide the necessary steps that should be taken in order to prevent adolescents from first and repeat pregnancies. Propose better health practices such as birth spacing. The study will carry out a research on the and recommend appropriate birth spacing timeline in order to maintain good health. Recommend the best and appropriate age bracket that is safe to conceive and get pregnant without any health-related complications.

The various development programs that have been proposed will empower the youth who are idle most of the time and this will reduce teenage pregnancies by more than 65 percent. Complications associated with late or early pregnancies will be reduced by maintaining the appropriate pregnancy intervals.

It is essential to evaluate the outcomes of the programs in order to determine if it was successful, provide ways to refine it, and offer continuous support to the program. Evaluating the results will not only determine the appropriateness of the program to the target audience but also provide feedback on its effectiveness, any concerns that need to be addresses, or issues with its execution. This section will discuss the strategies that will be used to evaluate the outcomes of reproductive planning program.

References

Adah, H., (2016). Advances in Sexual and Reproductive Rights of Adolescents. Journal of Womans Reproductive Health,1(3), 38-48. doi:10.14302/issn.2381-862x.jwrh-16-1294

Agyepong, I., Anniah, K., Aikins, M., Akweongo, P., Esena, R., & Mirzoev, T. (2015). Health policy, health systems research and analysis capacity assessment of the school of public health, University of Ghana. Ghana Medical Journal,49(3), 200. doi:10.4314/gmj.v49i3.12

Aikins, A. D., & Koram, K. (2017). Health and Healthcare in Ghana, 1957–2017. The Economy of Ghana Sixty Years after Independence,365-384. doi:10.1093/acprof:oso/9780198753438.003.0022

Akhouri, D. (2017). Impact of Reproductive Health Education Intervention On Reproductive Health Practice In Rural Literate Sarna Tribal Women. Psychology and Behavioral Science International Journal,6(1). doi:10.19080/pbsij.2017.06.555678

Allen, C. F. (2016). Commentary on ‘Transnational connections of health professionals: Medicoscapes and assisted reproduction in Ghana and Uganda, by Viola Hörbst and Trudie Gerrits. Ethnicity & Health,21(4), 375-378. doi:10.1080/13557858.2016.1151696

Alubo, O. (2011). Adolescent Reproductive Health Practices in Nigeria. African Journal of Reproductive Health,5(3), 109. doi:10.2307/3583329

Ameyaw, E. K. (2018). Prevalence and correlates of unintended pregnancy in Ghana: Analysis of 2014 Ghana Demographic and Health Survey. Maternal Health, Neonatology and Perinatology,4(1). doi:10.1186/s40748-018-0085-1

Ayanore, M. A., Pavlova, M., & Groot, W. (2015). Unmet reproductive health needs among women in some West African countries: A systematic review of outcome measures and determinants. Reproductive Health,13(1). doi:10.1186/s12978-015-0104-x

Buor, D. (2008). Factors Influencing Child Health at the Periphery of the Kumasi Metropolis, Ghana. Journal of Science and Technology (Ghana),28(1). doi:10.4314/just.v28i1.33076

Covan, E. K. (2017). Reproductive health issues. Health Care for Women International,38(10), 997-998. doi:10.1080/07399332.2017.1372556

Darteh, E. K., Doku, D. T., & Esia-Donkoh, K. (2014). Reproductive health decision making among Ghanaian women. Reproductive Health,11(1). doi:10.1186/1742-4755-11-23

Derbile, E. (2007). Traditional birth attendants and health service delivery in northwest Ghana-operational dynamics and new frontiers. Ghana Journal of Development Studies,4(1). doi:10.4314/gjds.v4i1.35054

Edward, J., (2013). Ghana – Ghana hosts first African meeting on strengthening health systems.. International Journal of Health Care Quality Assurance,26(5). doi:10.1108/ijhcqa.2013.06226eaa.012

Fledderjohann, J. J. (2012). Zero is not good for me: Implications of infertility in Ghana. Human Reproduction,27(5), 1383-1390. doi:10.1093/humrep/des035

Jameson, T., (2012). Introduction to the Psychology of Reproductive Health. Reproductive Health Psychology,3-16. doi:10.1002/9781119968382.ch1

Lavranos, G., & Vassou, P. (2016). Promoting reproductive health in adolescents: Implementation of the Health Belief Model. European Journal of Public Health,26(Suppl_1). doi:10.1093/eurpub/ckw172.036

Lower, R., Wilson, J., Medin, E., Corlett, E., Turner, R., Wheeler, K., & Fowler, D. (2014). Evaluating an early intervention in psychosis service for ‘high-risk’ adolescents: Symptomatic and social recovery outcomes. Early Intervention in Psychiatry,9(3), 260-267. doi:10.1111/eip.12139

Mumuni, M. Z., Soghaier, M. A., Zankawah, K. B., Musah, B., Kubio, C., Mahamadu, T., & Goodstaff, A. (2016). Knowledge and Skills of Mothers/Care Givers of Children Under Five Years in Communities with Home Based Management of Malaria in Tamale, Northern Region, Ghana, 2013. AIMS Public Health,3(4), 923-932. doi:10.3934/publichealth.2016.4.923

Nyonator, F. (2015). Coverage of the poor—innovative health financing in Ghana. Oxford Medicine Online. doi:10.1093/med/9780198703327.003.0019

Osei-Akoto, I., & Adamba, C. (2017). Social Health Insurance in Ghana. The Economy of Ghana Sixty Years after Independence,385-399. doi:10.1093/acprof:oso/9780198753438.003.0023

Panjalipour, S., Khalesi, Z. B., & Mirhaghjoo, S. N. (2017). Female Adolescents’ Reproductive Health Needs: A Systematic Review. International Journal of Womens Health and Reproduction Sciences,6(3), 226-232. doi:10.15296/ijwhr.2018.39

Ramashwar, S. (2010). Adolescents May Not Always Receive Essential Reproductive Health Services from Their Pediatrician. Perspectives on Sexual and Reproductive Health,42(3), 217-217. doi:10.1363/4221710

Shahhosseini, Z., & Abedian, K. (2015). Female Adolescents Reproductive Health Education Needs: Perspectives of Health Care Providers. European Psychiatry,30, 579. doi:10.1016/s0924-9338(15)30460-0

Susmita, B. (2014). Chapter-01 Reproductive Health of Women: The Challenges. Manual of Reproductive Health Care,1-2. doi:10.5005/jp/books/12360_1

Svanemyr, J., Guijarro, S., Riveros, B. B., & Chandra-Mouli, V. (2017). The health status of adolescents in Ecuador and the country’s response to the need for differentiated healthcare for adolescents. Reproductive Health,14(1). doi:10.1186/s12978-017-0294-5

Swatz, A., (2018). Reproductive Health: Reproductive Education Advocating Client Vaginal Health (REACH). Journal of Midwifery, Women’s Health and Nursing Practice,21-23. doi:10.29199/2637-9260/mwnp-101013

Titiloye, M. A., & Ajuwon, A. J. (2017). Knowledge and quality of adolescents reproductive health communication between parents and their adolescents children. Journal of Public Health in Africa,8(1). doi:10.4081/jphia.2017.688.