Field Placement:  Adolescent Health and Development Program (ADHD)
Location: Ghana, Africa
Preceptor:
Student Name: Elinam Dellor
Year: 2008

Reproductive health is recognized as a human right and a global development priority. Although, the reduction of maternal mortality has been a priority for the Ghanaian health sector, the country’s maternal mortality ratio has remained high ranging from 214 per 100,000 live births in some regions to 816 per 100,000 live births in others. In response, on April 2008, the Ghanaian Minister of Health declared maternal mortality a national emergency. In July 2008, a national consultative meeting that brought together stakeholders from different sectors to development a comprehensive approach to reducing the maternal mortality ratio in Ghana.

One of the areas of focus was adolescent sexual and reproductive health. In Ghana, abortions are illegal unless it is a result of rape, incest or threatens the health of the mother or child. Complications from unsafe abortions contribute 22 to 30 percent of all maternal deaths, making it the highest single contributor to maternal mortality. Adolescents make up 60% of these cases. As the agency in charge of implementing public health programs in Ghana, the Ghana Health Service oversees an Adolescent Health and Development Program (ADHD). In 2000, the program launched Adolescent Health Corners (AHCs) specifically designed to improve the quality of existing health services. The AHCs are integrated into existing health facilities throughout the country and are staffed with public health nurses and peer advisors who are trained by ADHD to provide confidential services including family planning counseling and referrals for clinical services such as post abortion care.  They also house Information, Education and Change (IE&C) materials that promote adolescent sexual and reproductive health.  The national consultative meeting highlighted the need to refocus attention on unsafe abortions and its impact on Ghana’s maternal mortality ratio.

During my fieldwork with the ADHD program (July 7 2008-September 12 2008) we developed and pretested IE&C materials.  Since the AHCs stress behavior change through counseling, we also revised the Adolescent Health Manual used to train service providers to include a chapter on counseling adolescents.  The manual will be used for training public health nurses and peer educators in an attempt to standardize the delivery of care for all AHCs.  Finally, as a preparation for nation wide monitoring and evaluation, I visited three AHCs in the Greater Accra area to monitor and observe the types of resources available, the average caseload, and the number of staff present in order to inform the proposal requesting funding and personnel needed to perform monitoring visits in October, 2008

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