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 RCH Annual Report 2007 Page 1 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). RCH Annual Report 2007 Page 2 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 RCH Annual Report 2007 Page 3 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 RCH Annual Report 2007 Page 4 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: RCH Annual Report 2007 Page 5 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. RCH Annual Report 2007 Page 6 - 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. RCH Annual Report 2007 Page 7 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 RCH Annual Report 2007 Page 8 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 RCH Annual Report 2007 Page 9 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. RCH Annual Report 2007 Page 11 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 RCH Annual Report 2007 Page 12 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. RCH Annual Report 2007 Page 13 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. RCH Annual Report 2007 Page 14 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. RCH Annual Report 2007 Page 15 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
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