Adolescent- friendly health services are services specifically designed to improve

ADOLESCENT HEALTH AND DEVELOPMENT
Definition
Adolescent- friendly health services are services specifically designed to improve
the quality of existing health services including reproductive health for young
people. This means the health services provided for young people should be
acceptable, appropriate, accessible, equitable, efficient and effective.
Therefore, adolescent-friendly health services are services tailored to meet the
peculiar needs of young people.
GHS Working Definition.
NB: Pre-adolescents and Young People are the target groups of the National ADHD Programme
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Background Information
Introduction
Adolescence literally means to ―grow up‖. It is a term given to one phase or stage
in the growth and development of human beings. Adolescence is a new cultural
invention since it was only recently regarded as a separate period of life- a period
different from childhood and adulthood.
Adolescence is generally accepted as a period of transition from childhood to
adulthood. It is the formative period when significant, physical, psychological and
behavioural changes take place in young people. It is a time of preparation for
undertaking greater responsibilities; a time of exploration, experimentation and
widening horizons. It is a time to ensure healthy all-round development for the
adolescent.
It is characterized by a growing self-confidence as adolescents transit from
childhood dependency, asserting their independence and moving towards
adulthood inter-dependence.
Adolescence is a cross-road in life and is also the gateway to health promotion.
Adolescence is a period of development when young people acquire new
capacities and are faced with two new situations that create opportunities for
progress and also risks to health and well-being. It is a time when growth is
accelerated and major physical changes take place and differences between boys
and girls increase.
This period is labelled as a period of opportunities, physically, psychologically
and socially.
A universally accepted definition categorizes those belonging to 10 and 19years
of age as adolescents. This period is further staged into younger adolescents (1014years) and older adolescents (15-19 years).
Again, the period of adolescence is staged into early (10-13 years), mid (14-16)
and late (17-19) adolescence.
Pre-adolescents refer to people aged 5 to 9 years. This is the period when the
physiological changes begin to manifest. Adolescent development continues into
young adulthood (20 – 24yrs).
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Adolescents go through a number of adaptation processes and so are vulnerable and at risk of
ill health and death as they are exposed to various health problems and challenges associated
with their stage of development. The health problems of adolescents are usually caused by
unhealthy environment, inadequate support systems for promoting healthy lifestyle, lack of
accurate information and inadequate or inappropriate health services. As a result, adolescents
are exposed to sexual and reproductive health problems, nutrition and substance abuse
related problems and injuries. Certain hereditary mental health problems may manifest for
the first time in adolescence.
The health of adolescents is determined to a large extent by family environment that provide
immediate basic needs for shelter, food, education, healthcare and spiritual values necessary
for character building as well as by schools and work environment. The influence of peers
and the wider community can promote health and well-being in the adolescent or create
unsafe and hostile conditions detrimental to health and development.
Preventive health interventions and actions to promote adolescent development can build the
adolescent’s capacity to develop individual, social and life skills and competencies to offset
negative social influences. The best interventions are those that help young people feel
appreciated, have belief in their own worth, know their rights and responsibilities and have a
sense of belonging as well as hope in the future. Provision of accurate information and
quality health care contribute to promoting adolescent health.
The adolescent health and development programme is an integral part of the Reproductive
and Child Health Programme of the Public Health Division of the Ghana Health Service.
The programme aims at promoting the health of young people, preventing and responding to
health problems from early, unprotected and unwanted sex, use and misuse of drugs
including cigarettes and alcohol, poor nutrition, endemic diseases, violence and injuries.
The major interventions include creating safe and supportive environment, providing
accurate information, building self-care, life and livelihood skills, providing counselling
services and improved health services including reproductive health.
Priority Interventions include advocacy and awareness creation, enhanced opportunities to
grow and develop, youth and community involvement, capacity-building in terms of human
resources and infrastructure, youth-friendly service delivery, protection from harmful
practices and resource mobilization.
The main areas of programme implementation are adolescent health promotion, prevention of
peculiar health problems and provision of youth-friendly health services including curative
and rehabilitative healthcare.
Vision:
To have a well-informed adolescent adopting healthy lifestyle physically,
psychologically, socially and supported by a responsive health system.
Mission
To make available appropriate information on young people’s health and provide
comprehensive adolescent health services including reproductive health. These
services will be delivered in a humane, efficient and effective manner by – trained,
friendly, highly motivated and client oriented personnel
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Goal of Adolescent Health and Development Programme
To contribute to improved adolescent health through the provision of adequate health
information, knowledge and quality healthcare which will ensure behavioural change and
increased utilization of health services including reproductive health in both public and
private health delivery systems in Ghana.
Strategic Objectives of Adolescent Health and Development
1. To promote the generation and use of evidence for decision-making, programme
development, resource management through research and health information
management in adolescent health programming.
2. To strengthen human resource capacity-building to include young people and
stakeholders at all levels.
3. To strengthen the capacity of service delivery points to provide a well-defined service
package for pre-adolescents and young people.
4. To ensure effective partnership and collaboration with stakeholders in managing
adolescent health programmes in public and private health sectors.
5. To promote healthy lifestyles and appropriate health seeking behaviour among young
people.
6. To increase access to youth-friendly health services in the health delivery system
including family/household and community.
Specific Objectives of Adolescent Health and Development Programme
1. To increase young people’s access to general health services including sexual and
reproductive healthcare in 25% of health facilities and outreach points by the end of the year
2006, 50% by end of the 2008 and 100% by end of the year 2009.
2. To promote understanding of the concept of adolescent health and development
programming at all levels of the health delivery system to meet needs and build
competencies of all stakeholders as an on-going process.
3. To identify available resources for adolescent health programming in catchments areas by
end of the year 2007.
4. To integrate youth-friendly services into existing health services on incremental basis; 25%
by 2006 and 100% by the year 2015.
5. To establish and use indicators to track quality and coverage of adolescent friendly health
services by end of the year 2007.
6. To integrate ADHD programming into existing monitoring and evaluation systems by end of
the year 2010
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Adolescent Health and Development Program Components
-
Identification and management of common health problems affecting preadolescents and young people
Provision of adolescent-focused services including counselling, information,
education and communication (IE&C) and reproductive health in general
Referrals
Key Elements of the Adolescent health and Development Programme
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Adolescent Rights and Responsibilities
Pre-adolescent and Adolescent Development
Health promotion for adolescents
Adolescent Nutrition
Counselling Adolescents towards Behaviour Change
Parenting adolescents
Adolescents and family planning
Adolescent Pregnancy, Childbearing and parenting
Adolescents and Sexually Transmitted Infections
Adolescents and HIV/AIDS
Peculiar Reproductive Health Problems affecting adolescent boys and girls
Adolescent Mental Health and Substance Abuse
Harmful Practices that affect Adolescent Development
Social Mobilization for Adolescent Reproductive Health
Appropriate teaching methodologies in ADHD programming
Key Strategies for Implementation of ADHD Programme
All management strategies are used in the implementation of the ADHD programme, the focus has
been on the following:a. Research
b. Capacity-building
c. Health Promotion
d. Service Delivery
e. Policy and Planning
f. Monitoring and Evaluation
Minimum Adolescent Health Service Package
Young people like all people living in Ghana are entitled to a full range of health services. However,
for the peculiar needs of young people a minimum package has been proposed in line with
WHO/AFRO’S suggestion. The minimum package of health services for young people includes the
following:
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1. General Health Service Package (programme level)
1.1 Adolescent Health Promotion (BCC in ADHD Programmes)
-
IEC on adolescent health and development including sexual and reproductive health
(SRH) issues with focus on sexuality education, STIs and HIV/AIDS
Self-care, life and livelihood skills education
I & E on basic health and lifestyle (individual and group counselling included)
Social mobilisation for adolescent health and development
1.2 Health and Lifestyle
-
General health services including mental health.
Referral system (family, community including school and facility levels)
Contraceptive services (appropriate for young people and must include primary and
secondary abstinence)
STI management and HIV related services including client/provider initiated counselling
and testing.
Maternal health services focussing on safe motherhood.
Management of physical, psychological and sexual violence and other types as may
affect young people.
Lifestyle programmes that address healthy ways of drinking, eating, dressing and
entertainment, personal and environmental hygiene, healthy relationships at family and
community levels including school, exercise, rest and recreation.
1.3 Recreation Services
-
Sports (healthful activities)
Games (local and foreign games that entertain and educate)
Audio – visual (teaching, music, etc)
2. Specific Levels Health Service Package
2.1 Health Facility Level Service Package
- Promotive health services (Services that enhance healthy growth and development)
- Preventive health services (Services that promote primary, secondary and tertiary
prevention of pregnancy, diseases and unhealthy behaviours)
- Curative health services (Services that address the negative outcome of risky behaviours,
minor ailments and reproductive illness)
- Rehabilitative health services (Services that rehabilitate adolescent parents, adolescents
using drugs, adolescent mental patients, adolescent victims of all forms of abuse.)
2.2 Community Level
- Community – based education on adolescent health issues targeting young people,
parents/guardians, teachers, opinion leaders and significant others using festivals,
celebrations, sports events and media as entry points.
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- In – school education focusing on age – appropriate family life education with emphasis
on delaying early initiation of sex and pregnancy, prevention of STI’s, unsafe abortion
and use of substances.
- Technical support to community groups such as parent groups, youth clubs and religious
organisations to do community mobilisation and other programmes that enhance the
health and development of young people and stakeholders
- Use home visiting, festivals, ceremonies and meetings to reach young people with
focused health services.
Characteristics of Youth-Friendliness (ADHD Service Delivery Policy)


Community Support
- Community well informed about YFS and acknowledges its value and are supportive
Youth Participation
- Youth are meaningfully involved in management of programmes

Youth Friendly Policies
- Guarantees privacy and confidentiality
- Provides a full range of services for all young people without any discrimination

Youth Friendly Environment
- No stigma and discrimination
- Convenient location
- Comfortable and appealing surroundings
- Age-appropriate information and availability of educational materials
- Privacy and confidentiality assured

Youth Friendly Procedures
- Services readily available
- Reasonably short waiting time
- Comprehensive services
- Appropriate referral services
- Reduced cost of services/free services

Youth Friendly Staff
- Technically competent
- Understanding and considerate
- Trustworthy and ready for repeat visit
Selected Indicators for Measuring Quality Adolescent Health Care
 Accessibility and Equity.
All adolescents are able to use the services if they want to. All the essential health services that
adolescents need are being provided in ways that make it possible for all adolescents to use them.
 Acceptability.
Adolescents are willing to use the services that are available. The health facility staff is trained to
provide services to young people in a respectful manner that ensures privacy and confidentiality.
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 Appropriate.
Health services at the point of delivery meet needs of the adolescent clients. For example, if an
adolescent client seeks help for the management of sexually transmitted infection and these services
are not being provided, the point of service delivery is not meeting his/her needs.
 Effective.
The services make a difference in improving the health of adolescents. The necessary skills,
equipment and supplies are in place to provide quality services for adolescents.
Expected Behavioural Outcomes



Reduction in risky sexual behaviour such as early initiation of sex, serial monogamy,
multiple sexual partners and unprotected sex.
Reduction in substance use/abuse (alcohol, cigarettes, marijuana, and cocaine)
Reduction in violence (physical, psychological and sexual)
Expected Health Outcomes







Healthy growth and development (physical, social, emotional and intellectual)
Knowledge about ASRH Skills (self – care, life and livelihood) and Rights and
Responsibilities will translate into minimization of early initiation of sexual activities thereby
contributing to reduced incidence of sexually transmitted infections including HIV/AIDS,
unplanned pregnancies, abortions, early births and birth injuries.
Reduced unwanted/unplanned pregnancies will contribute extensively to:
- Reduced incidence of abortions and its related complications
- Reduced birth injuries
- Reduced deaths among adolescent mothers
Reduced levels of malnutrition (under and over nutrition)
Reduced levels of misuse of substances including alcohol, cigarettes and hard drugs.
Reduced levels of mental health problems such as depression.
Reduced levels of injuries (intentional and unintentional)
Planned Activities for the Year 2007
Policy and Planning
1. Provide technical support in the management of the ADHD programme in the regions,
districts and institutions in the public and private health sectors
- sensitization and orientation meetings as part of advocacy programme
- monitoring visits
- material development
- research into adolescent health issues.
- evaluation of programme
Capacity-building
2. Complete draft adolescent health and development (ADHD) documents
- teaching materials(flipcharts, job aids, etc)
- parenting adolescents brochure
- lay counsellors manual
- second edition manual on counselling adolescents towards behaviour change
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Adolescent Health Promotion
3. Conduct a three (3) day refresher course in Counselling Adolescents Towards Behaviour
Change for regional ADHD resource teams.
4. Produce a documentary on adolescent health focussing on the following issues:
- concepts of Adolescent Health and Development (ADHD)
- adolescent sexual and reproductive health
 early initiation of sex
 unprotected sex
 adolescents and STIs including HIV/AIDS
 abortion
 care in adolescent pregnancy
 adolescent pregnancy with good outcome
 adolescent pregnancy with a negative outcome
 parental and community support
- Adolescent mental health
 substance abuse
 drop-out
 crime
 parental and community support
- Adolescent nutrition
 Eating the right food at the right time (making healthy choices)
5. Review and develop adolescent health promotional materials
 script writing on adolescent health and development programme Issues for
print media
 develop IEC messages to be put on posters, leaflets and billboards
 review existing IEC materials to reflect current information
6. Initiate a sustained national health promotion campaign, using every available opportunity to
address ADHD issues with focus on sexuality reproductive health and substance abuse.
Research
- Provide support to adolescent health – related research activities at all levels.
Monitoring and Evaluation
7. Conduct monitoring visits to assess level of integration of youth-friendly services into the
health delivery system
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Major Achievements for the Year 2007
 Policy and planning

The process for the development of the ADHD strategic plan (2007-2011) has commenced

A monitoring plan for visiting the forty (40) GOG/UNFPA districts was prepared. The aim
of the visit was to assess the level of implementation of the adolescent health and
development programme. However, the visits did not come off due to financial constraints.

A proposal on introducing Mapping Adolescent Programming and Measurement (MAPM) to
stakeholders in Ghana was developed in collaboration with the WHO Office in Accra.
(MAPM) is a WHO/UNICEF framework for measuring health outcomes, behaviours,
determinants and interventions for adolescent health and development programmes in that
order of decendancy. The meeting came off from 8th – 12th October, 2007. Seventy four (74)
stakeholders from both public and private institutions and UN agencies attended. Participants
were introduced to the MAPM framework and the 4S approach. MAPM is a programme
management tool that determines what health outcome is expected, what behaviours
may/may not contribute to its achievement, what protective factors will lead to the
achievement of positive behaviours and how risk factors can be minimized and what
interventions will contribute to achieving the protective factors that will enhance positive
behaviours to contribute to the achievement of health outcomes. The 4S stands for strategic
planning, services and supplies, supportive policies and support to other stakeholders.
The participants were given an insight into the expected Health Sector response to adolescent
health issues with details of the 4S. The 4S approach uses four (4) strategies to address
adolescent health needs. Strategic planning is based on use of strategic information, such as
age and sex disaggregated data. Appropriate services with adequate supplies of
equipment and commodities enhance service delivery for young people. Supportive
policies at all levels enhance the quality of care for young people. Providing technical
support to other stakeholders helps achieve adolescent health and development goals.
From the discussions, participants expressed the desire to have more information on gender
issues, sexual abuse, adolescent nutrition, privacy and confidentiality as a mark of quality of
care and data on community adolescent health activities. Suggestions for follow-up activities
indicated the need to strengthen the health sector so it can respond appropriately to the needs
of young people in terms of improved documentation, improved and expanded youth-friendly
health services, improved networking and expanded resource mobilization base.
 Capacity-building
 No capacity-building activities were carried out at headquarters level
 In the regions eleven (11).new adolescent health corners have been established thus Eastern
region (1),Upper East region (4), Upper West region (1) Northern region (2) and Volta region
(2).
In the Upper West Region, a five (5) day refresher course was organized for thirty-three (33) regional resource
persons, and three hundred and fifty (350) frontline health workers were sensitized on adolescent health issues.
In the Upper East Region, forty – eight (48) frontline health workers trained in providing youth – friendly health
services and refresher training was held for fifty (50) trained health workers.
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CAPACITY – BUILDING
Table: 3-2. Trained frontline health workers and peer educators.
Year Number of Trained
Frontline Health Workers
2001
2002
2003
2004
506
2005
614
2006
433
2007
48
Number of Trained Peer
Educators
30
426
194
Comment
Table: 3-3. Number of Functioning ADH Corners 2006 and 2007
Regions/Institutions
Greater Accra
Ashanti
Eastern
2006
10
17
35
2007
10
17
36
Central
Brong-Ahafo
20
4
20
5
Western
Upper West
9
3
9
5
Northern
3
5
Volta
-
2
Upper East
-
4
CHAG
PPAG
Total
10
4
108
10
4
127
Comment
All 10 ADH Corners are functioning
All 17 ADH Corners are functioning
New ADH Corners is located in Birim South
district
All 20 ADH Corners are functioning
New ADH corner located at Kenyasi Health
Center in the Asutifi district
All 9 ADH Corners are functioning
New ADH Corners are located in Wechau and
Jirapa Districts
New ADH Corners are located in Tamale and
Bole districts
Adaklu – Anyigbe and Hohoe districts
established an ADH corner each
Location:- Bolga, Navrongo, Bongo, and
Bawku districts
All 10 ADH Corners are functioning
All 4 Youth Centers are functioning
 Adolescent Health Promotion
 On 4th January, 2007, a presentation on the overview of the National Adolescent Health And
Development Programme was done at a School Mental Health training of trainers’ workshop
carried out at Tadoma Hotel, Accra. The session was very interactive.
Participants testified they benefited as individuals and also as a group. Factual information on
the health risks and interventions put in place for young people in Ghana was provided The
concepts, of health and development issues and interventions were discussed extensively in
between presentations. Experiences in sub-sahara Africa were shared.

From 5th -7th February 2007, an International Adolescent Reproductive Health workshop was
held at the Akosombo Hotel for the Gates Institute and Partners in Sub-Sahara Africa.
The John Hopkins University in the United States provided technical support. Trends in
adolescent reproductive health and development in Africa were discussed in different
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modules. For example, adolescent nutrition, sexual and reproductive health, mental health,
substance abuse and injuries were discussed. Adolescent behaviours and relationships were
also discussed. Ghana and Nigeria shared experiences.
Highlights of issues in adolescent reproductive health and development research were
presented at the meeting. Issues and interventions were discussed extensively.

As part of the advocacy programme, a sensitization and orientation meeting was held with
the Ashanti Regional Preventive Health Nurses Group on the 16th June, 2007 at the
conference room of the Ashanti Regional Health Directorate. The meeting was attended by
one hundred and thirteen (113) participants including the Regional Public Health Nurse,
District Public Health Nurses and a District Director of Health Services.
A detailed overview of the programme was presented highlighting the concepts, adolescent
health profile and programme outline.
Discussions were held on the role of health workers in promoting Adolescent Health and
Development. The issue of providing a standard format for collecting data on adolescent health
activities was also discussed.

A Youth Forum organised by Planned Parenthood Association of Ghana was attended on 11 th
July, 2007 at Teachers Hall, Accra. The theme was ―Male Youth Support, Participation and
Utilization of Sexual and Reproductive Health Services‖ Presentations were made and group
work was done. Recommendations made for youth programme enhancement included
Promoting virginity among boys and girls, Positive parenting, Male focused health services,
Responsible media and Gender mainstreaming.

On the 4th of September, 2007, the Ghana Health Service monthly health promotion topic
discussed was Adolescent Pregnancy: a Problem of Concern. The venue was Teshie
Community Clinic. Discussions focused on the magnitude of the problem of adolescent
pregnancy in Ghana, the biological, socio-cultural economic and emotional reasons, the risk
and protective factors that influence adolescent pregnancy, the four (4) levels of preventing
adolescent pregnancy and stakeholders needed for preventing adolescent pregnancy at all
levels. The media and community were involved in the discussions

During the year, three (3) virgin clubs were formed in the North Tongu district in the Volta
Region, with the collaboration of two (2) NGOs. (Po – Linksimavi and Village Exchange
Ghana. Kadjebi and Ho districts are promoting adolescent health. Pro – Linksimavi trained
thirty (30) young people to serve as role models and link between traditional leaders and
students. The NGO also provided counseling services.

In the Upper East Region, five (5) adolescent health clubs were formed in the Talensi
Nabdam district.

As at end of the year 2007, Eastern Region had registered 99 youth clubs and held a total of
five hundred and twenty three (523) meetings.
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Youth-Friendly Service Delivery

Integration of youth-friendly health service delivery has been on-going.
Even in facilities where there are no adolescent health corners, services are quite youthfriendly. Counselling towards behaviour change was a key service delivery feature.
Counseling topics discussed included: nutrition and healthy life style, personal hygiene,
environmental hygiene, vaginal discharge, urethral discharge, genital ulcer, scrotal swelling,
cervicitis, substance use / abuse, mental health problems, and injuries. Pregnancy and its
related issues were discussed.
For example, the Greater Accra region counseled three thousand, nine hundred and seventy
eight (3,978) young people on a number of topics including sexuality, STI prevention,
HIV/AIDS and VCT, substance abuse, stress management, emotional disturbances, nutrition
and healthy living. Adolescent pregnancy, HIV and STI infection rate have been used as a
proxy measure for unhealthy sexuality in adolescents.
However, prevalence of HIV among youth (15 – 24years) is used to measure prevalence of
HIV in Ghana.
The National AIDS/STI Control Programme report for the year 2007 indicates 2.6%
prevalence rate among pregnant youth (15-24yrs) and 1.9% among the general population.
Adolescent pregnancies registered in the year 2007 form 12.4% (103,143) out of a total
pregnancies registered thus 91.1% (838,219) of expected pregnancies, were registered.
Adolescent pregnancy remains a major problem the health and related sectors are contending
with. Pockets of studies in Ghana have found multiple contributory factors to the problem.
On the part of adolescents, biological, social and economic factors have been identified as
causal factors.
On the part of stakeholders, not much has been done in terms of provision of accurate
information and education, instituting supportive systems and ensuring youth – friendly
services.
The health system is not fully equipped to provide youth – friendly health services.
Inadequate resources of all forms have contributed to the weakness in the health system.
Inefficient uses of available resources have also contributed to the current situation of the
health system. There is still evidence of weak linkages between programme within the health
sector and other related sectors.
Since adolescent health and development problems are interrelated, use of combined
interventions is the best approach to addressing these problems. In Ghana, sexual and
reproductive health problems are at the centre. From anecdotal evidence, substance abuse is
next. It is important to use primordial, primary secondary and tertiary preventive measures to
address adolescent health problems. Use of minimization of risk factors and enhancement of
protective factors have been found to be an appropriate suppo9rt measure in addressing the
health needs of young people. It is therefore necessary that the problems of young people are
addressed holistically at different levels. In applying the public health framework to
adolescent pregnancy prevention, the following are hints to help providers address the issues:
Primordial Prevention—addressing poverty, gender and other issues that attribute to
delay in initiating sexual health activities.
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Primary Prevention—use pregnancy prevention efforts such as sexuality education, self
care, life and livelihood skills education, and vigorous campaign on contraceptive use by
sexually active youth.
Secondary Prevention—promote positive health-seeking behaviour during pregnancy,
delivery and post-natal care.
Tertiary Prevention—promote rehabilitation of adolescent parents and prevent repeat
adolescent pregnancy.
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Table: 3-4 NATIONAL HEALTH FACILITY DATA
DISAGGREGATED DATA ON ADOLESCENT PREGNANCY BY AGE GROUP AND REGION
Region
Ashanti
Brong-Ahafo
Central
Eastern
Greater Accra
Northern
Upper East
Upper West
Volta
Western
National
Number and Proportion of Pregnancies Registered By Younger
Adolescents
(10-14yrs)
2002
2003
2004
2005
2006
2007
56
163
265
266
246
364
(0.0%)
(0.12%)
(0.2%)
(0.2%)
(0.2%)
(0.3%)
99
207
177
229
267
294
(0.1%)
(0.28%)
(0.2%)
(0.3%)
(0.3%)
(0.3%)
Number and Proportion of Pregnancies Registered By Older
Adolescents (15-19yrs)
2002
16,674
(13.3%)
11,007
(14.5%)
2003
22,300
(13.4%)
14,752
(15.2%)
2004
17,441
(13.4%)
10,887
(15.0%)
2005
17,287
(13.2%)
9,635
(13.0%)
2006
15,973
(12.2%)
11,707
(14.3%)
2007
16,255
(11.7%)
11,766
(13.4%)
18
(0.0%)
75
(0.1%)
96
(0.1%)
22
(0.03%)
102
(0.12%)
120
(0.11%)
99
(0.1%)
193
(0.3%)
106
(0.1%)
149
(0.2%)
168
(0.2%)
227
(0.2%)
168
(0.2%)
159
(0.2%)
145
(1%)
187
(0.2%)
172
(0.2%)
157
(0.1%)
10,255
(15.6%)
13,999
(15.0%)
11,365
(10.1%)
11,085
(15.1%)
19,196
(16.6%)
22,636
(11.1%)
11,584
(15.2%)
11,452
(15.8)
11,085
(10.3%)
11,289
(15.0%)
11,503
(14.8%)
14,322
(12.0%)
11,396
(15.2%)
11,085
(14.1%)
11,422
(9.9%)
11,522
(15.1%)
11,061
(13.1%)
10,455
(8.6%)
59
(0.1%)
11
(0.0%)
25
(0.1%)
109
(0.2%)
105
(0.1%)
652
(0.1%)
44
(0.1%)
3
(0.01%)
12
(0.06%)
167
(0.6%)
239
(0.30%)
1,079
(0.14%)
44
(0.1%)
6
(0.02%)
84
(0.4%)
92
(0.2%)
316
(0.4%)
1,382
(0.2%)
110
(0.113%)
12
(0.032%)
14
(0.1%)
128
(0.2%)
271
(0.3%)
1,574
(0.202%)
51
(0.1%)
21
(0.1%)
24
(0.1%)
143
(0.2%)
171
(0.2%)
1,395
(0.2%)
42
(0.0%)
20
(0%)
18
(0.1%)
145
(0.2%)
217
(0.3%)
1,616
(0.2%)
11,587
(15.5%)
5,715
(15.4%)
2,762
(13.2%)
8,689
(14.3%)
11,834
(16.1%)
103,887
(14.0%)
16,312
(14.0%)
7,756
(15.7%)
4,251
(11.4%)
14,533
(17.1%)
14,899
(16.0%)
147,720
(14.5%)
13,373
(14.9%)
6,092
(15.5%)
2,381
(10.0%)
8,578
(14.3%)
13,381
(15.9%)
106,254
(14.1%)
13,228
(13.6%)
5,601
(15.1%)
2,449
(10.9%)
9,176
(15.0%)
12,667
(15.5%)
107,157
(13.784%)
10,962
(11.6%)
6,896
(16.8%)
2,937
(11.6%)
8,900
(13.7%)
11,837
(14.2%)
103,115
(13.0%)
11,306
(10.6%)
5,995
(13.6%)
6,864
(12.2%)
8,671
(13.3%)
1,1642
(13.4%)
101,527
(12.2%)
SOURCE: NATIONAL REPRODUCTIVE AND CHILD HEALTH ANNUAL REPORTS OF 2002, 2003, 2004, 2005, 2006 & 2007
Facts to







Remember
The recorded adolescent pregnancies are a combination of wanted and unwanted pregnancies but a larger proportion were unwanted
1 in 8 pregnancies is to an adolescent.
Every adolescent pregnancy carries risks of STIs/HIV/AIDS, complications of pregnancy and delivery and possibly maternal and neonatal illnesses and deaths.
Adolescent pregnancies can be prevented to a large extent.
We all are stakeholders.
The problem of adolescent pregnancy is everybody’s concern – it is not far from you.
A reduction in adolescent pregnancy and childbearing will contribute to a reduction of the unacceptably high maternal and infant illnesses and deaths recorded in Ghana.
Key Messages For Adolescents

Abstinence from all forms of sex will not make a girl pregnant.(abstinence is also a delay tactic)

Use of condom correctly every time you have sex is 98% effective (dual protection)

Use of Emergency Contraceptive within five (5) days of unprotected sex is 75-89% effective

Use of delay statements and refusal skills are helpful in pregnancy prevention
RCH Annual Report 2007
Page 17
Table: 3-5 HIV PREVALENCE AMONG YOUNG PEOPLE
Year
2004
2005
2006
2007
Regions
15-24yrs
Ashanti
15-19yrs
Older
Adolescent
0.5
15-24yrs
Youth
1.7
15-19yrs
Older
Adolescents
1.9
15-24yrs
Youth
2.1
15-19yrs
Older
Adolescents
0.8
15-24yrs
Youth
2.1
15-19yrs
Older
Adolescents
0.63
Brong-Ahafo
5.9
3.6
0.0
1.8
0.6
1.3
2.03
3.14
Central
1.0
1.9
0.6
1.9
1.9
2.3
1.91
2.76
Eastern
4.5
4.7
1.0
2.6
2.0
3.6
2.14
4.6
Greater Accra
5.0
3.8
0.5
1.8
1.5
2.3
2.42
2.4
Northern
0.7
1.1
0.7
0.8
0.0
0.9
1.55
1.67
Upper East
2.3
2.6
1.7
2.5
2.5
3.3
1.65
3.1
Upper West
0.8
0.8
0.0
2.2
1.7
2.7
0.58
2.3
Volta
1.4
2.9
0.5
0.7
0.5
2.4
1.86
1.9
Western
0.7
3.4
1.5
3.1
2.1
3.0
1.9
3.2
National
2.0
2.5
0.8
1.9
1.4
2.5
1.6
2.6
Youth
2.8
Culled from NACP reports for the years 2004, 2005, 2006 and 2007
Points To Note
Key Messages For Young People
To reduce the prevalence of HIV, young people can be targeted at three (3) different levels:
- Abstinence from all forms of sex is the best HIV preventive method.
Individual Level
- Abstinence from substance use is a good HIV preventive method.

Provide facts on HIV/AIDS consistently and persistently
- The reproductive tract lining of boys and girls are less defensive to

Provide self-care, life and livelihood skills to young people
sexually transmitted infectious including HIV.
Family Level
- Adolescents girls more vulnerable to being infected because of their

Improve interfamily communication on sexuality
biological make
Community Level

Provide access to youth-friendly services and mass media campaigns directed towards decreasing vulnerability and risks.
RCH Annual Report 2007
Page 18
Requirements for Establishing Adolescent-Friendly Health Facilities
Step 1:
Obtain a health profile on pre-adolescents (5 -9yrs) and young people (10-24yrs)
Step 2:
Develop a database of agencies involved in young people’s health and
development programming
Step 3:
Sensitize all health workers and relevant community groups on adolescent health issues.
Step 4:
Orientate all health workers and relevant community groups on their roles to supporting adolescent health and
development
Step 5:
Obtain the support of ADHD resource persons for your programmes.
Step 6:
Train frontline health workers on adolescent friendly health service delivery.
Step 7:
Conduct an initial facility assessment for youth-friendliness.
Step 8:
Conduct periodic re-assessments of facility for youth-friendliness.
Step 9:
Develop and implement a doable action plan that addresses barriers to youth-
Step 10:
Conduct simple research into adolescent health issues to enhance operations e.g. Operations Research Desk top
review, administration of simple questions.
Step 11:
Establish a functional adolescent health corner within each facility.
Step 12:
Provide technical support to youth-serving organizations and individuals.
Step 13:
Create Youth Information Centres at vantage points within health facilities.
Step 14:
Post and obtain a stock of youth targeted BCC (IEC and advocacy) materials.
Step 15:
Erect signboards indicating availability of adolescent / youth-friendly services in and outside facility.
Step 16:
Keep registers and collate disaggregated health and related data on pre-adolescents and young people in your
catchments area.
Step 17:
Display and use policies that support adolescent-friendly services to serve as a guide in ADHD programme
implementation.
Step 18:
Collaborate with youth serving organisations and individuals in ADHD programming to ensure sustainability.
Step 19:
Use available monitoring and evaluation tools to regularly assess ADHD programme implementation.
Step 20:
Step 21:
friendliness.
Involve young people and relevant community groups in ADHD programme persistently and consistently to
instil a sense of ownership in stakeholders.
Provide promotive, preventive, curative and rehabilitative services to address peculiar needs of young people
NB:
Policy and Planning – Steps 1, 2, 9, 17, 18& 20. Adolescent Health Promotion – Steps 3, 4, 13, 14, 15.
Capacity-building – Steps 3, 4, 5, 6, 7, 8, 9, 11, 12, 20. Youth-friendly Service Delivery – Step 21. Research – Step 10.
Monitoring & Evaluation – Steps 16, 19.
RCH Annual Report 2007
Page 19
Table: 3-6 CRITERIA FOR DESIGNATING A HEALTH FACILITY AS ADOLESCENT/YOUTH FRIENDLY
Indicators
Scores
1
100%
1.
Availability of updated health profile on
pre-adolescents and young people
- 5 – 9years (pre-adolescents)
- 10 – 14years (younger adolescents)
- 15 – 19years (older adolescents)
- 20 – 24 years (young adults)
2.
Availability of disaggregated records on
pre – adolescents and young people.
- Posted service records
- Registers
- Reports
- Others (specify)
3.
Availability of updated community
resource file (database of youth-serving
agencies)
4.
All health workers and relevant
community groups sensitized on
adolescent health issues
5.
All health workers and relevant
community groups orientated to their
roles in addressing barriers to youth –
friendliness at all levels.
6.
Availability of trained resource persons
in ADHD programming within district
of operation.
7.
Availability of trained and competent
frontline health workers and peer
educators in youth – friendly service
delivery
Categories
(Tick as appropriate)
2
3
80%
Below
80%
Comments
4
Not
done
8.


9.
Initial health facility assessment for
youth – friendliness done (where
needed)
Re – assessment of health facility
for youth – friendliness done
Availability of action plan developed
for addressing barriers to youth –
friendliness
RCH Annual Report 2007
Page 20
10. Evidence of a functioning adolescent
health corner
Stages of Progress
- Selected ADH Corner
- Refurbished ADH Corner
- Functioning ADH Corner
 Services provided at ADH
Corner (Counseling, treatment,
games, others)
11. Evidence of research work done on
adolescent health issues.
- Report (published or unpublished)
- In process
12. Technical support provided to other
youth – serving organisations
- Public sector
- Private Sector
13. Availability of information corner for
young people in health facility.
NB: Vantage Points To Consider
- O.P.D.
- Corridors of utility rooms
- Others (Specify)
14. Availability of youth targeted
[IEC/Advocacy materials]
- Posted
- In stock
15. Erected sign boards indicating
availability of adolescent friendly
services in and outside facility.
(Static and Outreach)
16. Availability of BCC Programmes
targetting young people
- Mass media (radio, TV,
billboards, print material, the
internet)
- Interpersonal communication
[client-provider interaction,
group presentations]
- Community mobilization
17. Availability of policy documents that
support youth – friendly health services
Specify
- RH Service Policy and Standards
- ARH Policy
- Population Policy (Revised)
- Ghana version of the Convention
of the Rights of the Child
RCH Annual Report 2007
Page 21
-
Reproductive Rights
STI’s Policy
HIV/AIDS Policy
Others
18. Evidence of collaboration with Youth
Serving organizations.
- Private Sector Institutions
- Public Sector Institutions
- Individuals
- Others
19. Youth Involvement.
Level of youth involved:
- Peer Service Providers
- Peer Educators
20. Availability of clinical and preventive
services for young people
o Counselling towards behaviour
change
o Adolescent Nutrition
o Abstinence promotion
o Family planning
o Education on pre-conceptional
care
o STI management including
screening
o HIV/AIDS management
including VCT
o Antenatal care
o Supervised delivery services
o Post-natal care
o IEC on Cervical cancer
prevention
o Substance abuse management
o Mental health services
o Management of injuries
common among young people
o Games
o Breast and testicular selfexamination
NB: Minimum qualification is 80% done / completion for each of the 21 points. Tick in scores column.
RCH Annual Report 2007
Page 22
Table: 3-7 LIST OF FUNCTIONING ADOLESCENT HEALTH CORNERS THAT ARE IN PLACE AS AT END OF
THE YEAR 2007
Institution/Region
Number of ADH
Locations
Comments
Corners
(Cumulative)
CHAG
10

SDA Hospital, Kwadaso

SDA Hospital, Asamang

SDA Hospital, Onwe,

Urban Aid, Maamobi

Lake Bosomtwi Meth.
Clinic, Amakom

Assin Praso Presby Health
Centre

Assin Nsuta Presby
Health Post

Salvation Army Clinic,
Wiamoase,

Alpha Medical Centre,
Madina, Accra

Church of Christ Mission
Clinic, Bomso Kumasi
PPAG
4

Young and Wise Centre,
Accra

Young and Wise Centre,
Sogakope

Young and Wise Centre,
Kumasi

Young and Wise Centre,
Tamale
Greater Accra
10
Dangbe East District

Ada Foah H/C

Kasseh H/C

Sege HC
Accra Metropolitan Health
Directorate
RCH Annual Report 2007

Mamobi Polyclinic

Ussher Polyclinic
Page 23

Achimota Hospital
Ga West District

Koklobite Community
Clinic
Tema Municipal Health
Directorate
Central
20

Tema Polyclinic

Ashiaman Health Centre

Tema General Hospital
Gomoa District

Obuasi H/C

Nyanyano CHPS Zone

Buduatta

Okyereko

Ngiresi

Gomoa Oguaa H/C
Komenda Edina Eguafo
Abirem District

Elimina Health Centre

Abirem Health Centre
Mfantseman

Essuehyia Health Centre
Awutu-Efutu-Senya District

Bawjiase H/C

Kosoa H/C

Winneba Hospital (MCH
Centre)
Ajumako-Essiam-S District

Ajumako Hospital
AAK

Ayeldo
Cape Coast District

Cape Coast District
Hospital

Ewim H/C
Asikuma-Odoben-Brakwa
District
RCH Annual Report 2007
Page 24

Asikuma RCH Centre

Brakwa H/C
Assin District
Western
9

Assin Nyankomasi H/C

Breku H/C
Jomoro District

Half Assini Hospital
Wassa West District

Tarkwa Hospital
Shama-Ahanta East District

Effia Nkwanta Hospital

Takoradi Hospital
Bia District

Mempeasem Health
Center
Juabeso District

Bonsu-Nkanta Health
Centre
Eastern
36

Juaboso Hospital

Amoaya Health Centre

Bobi Health Centre
Akwapim North District

Akwapim Mampong RCH
Centre

Akwapim Mampong
Hospital

Okrakojo Health Centre
Afram Plains

DHMT Office

Kwasi Fante Clinic

Ekye Health Centre

Trase Health Centre
Akwapim South
RCH Annual Report 2007
Page 25

DHMT

Nsawam Government
Hospital
Asuogyaman

Senchi Ferry Health
Centre

Anum Boso Health Centre
Birim North

DHMT Office

Nkwanteng CHPS Zone

Amuana Praso RCH

Adjobue CHPS Zone
Kwaebibirim District

Kade Health Centre
Kwahu West

Holy Family Hospital,
Nkawkaw

Danteng RCH Centre
Fanteakwa District

DHMT Office
East Akim District

DHMT Office
Birim South

DHMT Office

Manya Krobo

Odumase RCH Centre
New Juabeng

Koforidua RCH

Effiduase RCH

Akadum RCH Centre

Koforidua Zongo Clinic
Suhum Kraboa Coaltar
District

DHMT Office

Suhum Government
Hospital
West Akim District
RCH Annual Report 2007
Page 26

Asamankese Government
Hospital
Yilo Krobo District

Somanya RCH Centre

Agogo Health Centre
Atiwa District

Anyinam Health Centre
Kwahu South
Ashanti
17

Abetifi Health Centre

Atibie Hospital
Kumasi Metropolis

Manhyia Hospital

Suntreso Hospital

Maternal and Child Health
Hospital
Afigya Sekyere District

Agona Hospital

Jamasi Health Centre
Bosomtwe-AtwimaKwanwoma

Kuntanase Hospital

Foase Health Centre
Ejisu Juabeng District

Ejisu Health Centre

Juaben Hospital
Atwima District
RCH Annual Report 2007

Nkwawia-Toase Hospital

Nyinahim Hospital

Abuakwa Health Centre
Page 27
Brong Ahafo
5
Sunyani District

Brong Ahafo Regional
Hospital, Sunyani
Wenchi District

Methodist Church Clinic
Techiman District

RCH Centre, Techiman
Berekum District

Jinijini Health Centre
Asutifi District
Northern
5

Kenyasi Health Centre

Yendi Community Centre

Nyohinin Health Centre
(Sanerigu Sub - district )

Fulera Maternity Home,
Chogu Tamale
Upper East
4

Bamboi Health Centre

Tamale Central Clinic
Bolga District

Plaza Clinic (Bolga South
Clinic)
Navrongo District

Navrongo Central Health
Centre
Bongo District

Bongo Hospital
Bawku District

Upper West
5
Bawku District Hospital
Nadowli District

Daffiama H/C

Nadowli Youth Centre
Wa Central District

Wa Sub Clinic
Wa West

Wechau H/C
Jirapa Lambusie District

RCH Annual Report 2007
Jirapa township
Page 28
/community
Volta
2
Adaklu-Anyigbe District
Hohoe District
Total
RCH Annual Report 2007
127
Page 29
Research

Technical support was provided to students in the School Of Public
Health University Of Ghana specifically. Research work was carried
out by a resident on the topic “Assessment of Adolescent
Friendliness of Health Facilities Serving Communities in Akuapim
South District.”
Key findings:
Out of the 283 respondents:

37.40% were sexually active

63.79% of the sexually active boys and girls had ever
impregnated or been pregnanted before

96.6% of the respondents had some knowledge about
family planning but only 38.4% were current users.

Majority of the users obtained contraceptives from
chemicals sellers.

From the OPD data, malaria ranked highest among the
ten top diseases.

About 64.90% of young people were not satisfied with
waiting time.

About 60.50% of the young people sampled were
dissatisfied with the attitude of nurses towards them
Key recommendations made include the following:
A. Adolescent

Education on sexuality should be intensified in schools starting at
primary school level

There should be a vigorous public health educational campaign
targeted at young people
RCH Annual Report 2007
Page 30

Training of peer educators should be strengthened
B. Parents and Community Leaders
Strong parental and community involvement in promoting adolescent –
friendly health services. Fathers are most needed to support parenting
activities on pages 101-104 of this report
C. MOH/GHS and Health Service Providers
All health facilities should be designated youth – friendly having gone through
the due processes. Checked guide provided.
D. District Assemblies and Ghana Education Service
District Assemblies, Ghana Education Ser vice and Traditional Rulers should
ensure out – of - school youth are re – engaged in school since a good school
environment is a protective factor for promoting adolescent health and
development.

The
Adolescent
Health
and
Development
(ADHD)
programme
was
represented at the Launch of Youth Monograph: Protecting the Next
Generation in Ghana on 24th October, 2007 at the Coconut Grove Regency
Hotel, Accra. The research was done by the PPAG, University Of Cape Coast,
University Of Ghana and Alan Guttmacher Institute.
Data was collected from four (4) districts representing the three (3)
ecological zones, using focus group discussions and in-depth interviews.
The survey period covered January through to May, 2004
About
four
thousand
(4000)
young
people
aged
12-19years
were
interviewed. Parents, teachers, nurses and significant others were also
interviewed.
Key issues researched into were sexual and reproductive health habits of
adolescents, their experiences and sources of information.
Some key findings include the following:

50% of Ghanaian adolescents live in rural areas

96% of adolescents have a religious affiliation

90% of adolescents are unmarried 7% of older adolescents are
married 9%
RCH Annual Report 2007
of older adolescents have given birth Of these,
Page 31
42% did not want their last birth at all while 75% wanted the
birth but at a latter time/date

70% of adolescent girls and 80% of adolescent boys are in
school and it is expected that same proportions will complete
secondary or higher education
25% who are not in school cite inability to pay school fees and
more than 30% claim to have had enough of schooling.
10% of adolescents not in school are not interested in school
and about 10% cited pregnancy as the main reason for leaving
school

75% of adolescents claim parents/ guardians always know their
where about (which places they visit in their leisure hours)

Younger adolescents are not naive about sex

Young people will always go through five transitions in life
(Continuing
Higher
Education,
Work,
Family
Formation,
Citizenship And Healthy Living)

Young people’s knowledge about HIV is broad but not deep

Young people trust the formal sector for health information and
quality healthcare
From discussions, young people expressed the need for the Ghana Health Service
and other providers to ensure health services are made youth-friendly at all levels
especially in the rural areas.
Monitoring and Evaluation

At headquarters level, no specific monitoring visits nor evaluation
activities were carried out

In the regions adolescent health programme activities were
monitored as part of the over all monitoring programme.
RCH Annual Report 2007
Page 32

Inadequate dissemination of polices that support adolescent health
and development.

Inadequate research in monitoring and evaluation of adolescent
health and development.
Challenges
System Level

Lack of financial resources has resulted in the ADHD programme at
headquarters level not being able to deliver as planned.

Inadequate linkages between programmes resulting in non-maxi
mation of use of available resources.
Stakeholder Level

Stakeholders in the health system need continuous education on
adolescent health issues and programming to further enhance the
programme

Other stakeholders need technical support from the health sector
to enable them evolve their capacities towards the promotion of
adolescent health and development
Individual Level (Adolescent)

There is a need for accurate information and appropriate health
service reaching both in and out – of – school youth in all health
facilities

Health services must include counseling for completeness
Way Forward for 2008

Complete and print draft programme documents and other
resource materials as resources permit.

Print 2,000 copies of 2nd Edition of training manual for healthcare
providers on counselling adolescents towards behaviour change.
RCH Annual Report 2007
Page 33

Revive the National ADHD Steering Committee and Regional ADHD
Resource Teams to drive the implementation of the adaptation of
the W.H.O systematic approach and other programme activities.

Coordinate the development of adolescent health and development
strategic plan and standards documents and adaptation of the
W.H.O Orientation Programme for Adolescent Healthcare Providers
handout.

Engage in adolescent health advocacy and awareness creation
activities with stakeholders and develop appropriate IEC and
advocacy materials to meet current needs.

Provide technical support in research into adolescent health issues

Provide technical support in the integration of youth-friendly
services into health delivery system in both public and private
health sectors.

Do advocacy with stakeholders at all levels.

Carry out monitoring visits to sites, districts and regions to assess
level of implementation and provide on-site technical support.

Participate in Programme development and evaluation activities.
RCH Annual Report 2007
Page 34