Outline of Presentation

Title of Presentation: Dissemination of Ghana Strategic Plan for Adolescent Health and Development Date: 26th July, 2012 Venue: Forest Hotel, Dodowa Presenter: Dr. Samuel Akor

Outline of Presentation • Background Information • Process of Development • Situation Analysis • Guiding Principles • Vision • Mission • Goal • Strategic Direction • Strategic Objectives • Cross-cutting Approaches • Implementation Plan • Budget Estimate

Background Information • In 2007, Ghana health sector was introduced Systematic Approach Of Addressing The Needs Of Adolescents • a W.H.O approach to enhancing adolescent health and development programmes • Situation Analysis • Strategic Plan • Adolescent Friendly Service Delivery Standards • Dissemination of Strategic Plan and Service Delivery Guidelines • Adaptation/adoption of the W.H.O Orientation Manual For Healthcare Providers • Use Of A Common Orientation Manual For Orientating And Training Service Providers

Process of development of strategic plan for adolescent health and development [1] • A three (3) day orientation meeting of stakeholders from all the regions (6-8/10/07) was held: • situation analysis report presented • gap analysis done • strategic directions identified • strategic objectives drafted • main strategies and key activities drafted • a writing committee was put in place – 2nd and 3rd drafts were done.

Process of development of strategic plan for adolescent health and development [2] • On 17/12/08, a multi sectoral consensus building meeting was held • A 4th draft document was developed with inputs from the meeting • On 15/05/09, a second multi sectoral consensus building meeting was held • On 9th and 26th May 2009, consensus building meetings were held for a cross-section of young people from Curious Minds and Young and Wise respectively. • By the end of 2009, the final draft strategic plan was ready • By December, 2010, the document was printed

Situation Analysis [1] • Demography • 2009 Population is estimated at 23, 416,518 • Total Fertility rate is 4.0 per woman (2008 GDHS) • 50% of the total population is below 15 years • 30.4% are between 10 to 24 years • 21.9% are between 10-19 yrs. • Sexual Activity and Marriage Among Young People • By age 18 years, 44% of women and 26%of men are sexually active. • The median age of marriage is 19.8 years for women.

Situation Analysis [2] • Education • Pre-school gross enrolment ratio is 83%, • Primary level gross enrolment ratio is 93% (2008 Ghana Budget Statement and Economic Policy). • The gender parity index at primary school level is 0.96. • Literacy rate for youth (15 – 24) was found to be 67% for females and 75.4%5 for males (2006 MICS). • Employment • Estimated 350,000 young people join the labour force annually • 40% enter employment • 60% unemployed

Situation Analysis [3] • Health Outcomes HIV/AIDS

Situation Analysis [4] • Adolescent Pregnancy and Childbearing And Outcomes • Adolescent Pregnancy declined from 14.2% in 2004, and 14.0%, in 2005 and 12.2% in 2008 • The median age at first birth is 20.7 years • Births by Adolescent (2008 GDHS)-13% • Urban is 7% • Rural is 21% • Abortion Among Adolescents and Young People • unsafe abortion contributes 22% to 30% of all maternal deaths • older adolescents and young adults make a substantial contribution

Situation Analysis [5] • Communicable Diseases affecting Adolescents and Young People • Malaria • Yaws • Schistosomiasis • Guinea worm • Intestinal parasites • Tuberculosis • A nation-wide mapping survey carried out in May, 2009 showed that 119 out of 139 districts were endemic of schistosomiasis.

Situation Analysis [6] • Non-communicable Diseases • Micronutrient; anaemia • Injury • Mental Illness; 2006 and 2007 OPD, 13.0% and 15.7% respectively (Accra Mental Hospital, 2008) • Oral Health problems; cavities, plaque and eruption of wisdom teeth (School survey) • Caries – urban 35% and Rural 12% • Gum diseases – Urban 60% and Rural 88% • Nutritional status of adolescents in schools in the Kumasi Metropolis (MHD, 2008) • 72.4% had normal weight, • 23.2% were underweight, • 3.6% were overweight • 0.8% were obese.

Situation Analysis [7] • Behavioural Outcomes • Sexual Activities Among Adolescents and Young People 2008 GDHS • Primary abstinence for never married young people • 69% for youth (15-24years) • 78.8% for older adolescents • Young adults (20-24years) is 23.7% for females and 31.5% for males. • Early initiation of sex within ages 15-24 years. (sex before 15 years) is 8.2% for females and 3.6% for males • By age 18 years, 44% of girls and 26% of boys have had sex

Situation Analysis [8] • Contraception • contraceptive use rates among adolescents 15-19 years increased from 5% in 1998, 6.9% in 2003 to 8.5% in 2008 • On the low side • Substance use • The second Global Youth Tobacco Survey (GYTS) carried out in the year 2006 among Junior High School Students. • 14.4% currently use any tobacco product (male-14.6%, female-13.0%), • 4% currently smoke cigarettes (male-4.5%, female-3%), • 12.5% currently use tobacco products other than cigarettes (male-12.4%, female-11.5%) • 14.6% of never smokers are likely to initiate smoking next year.

Guiding Principles • Adolescents are a resource • Promoting equity and equality in youth programmes • Youth participation in decision-making is key • Youth services are an integral part of health services delivery • Research is key in youth programmes • Development of young people needs a multi-faceted approach • Use of life cycle approach in youth programmes is cost- effective • Sustainability in youth programming is key to success

Vision and Mission • Vision • To have well-informed adolescents and young people adopting healthy lifestyles physically and psychologically and supported by a responsive health and health related sectors. • Mission • To make available appropriate information and counselling services on young people’s health and provide comprehensive health services and other complementary programmes such as self-care, life and livelihood skills to adolescents and young people.

Goal • To contribute to the improvement of adolescents and young people’s health status through the implementation of realistic interventions that aim to bring appropriate solutions to their major health problems.

Strategic Direction [1] • Adolescent needs • Physical, mental, emotional and social development • Nutrition (productive and reproductive health) • Healthy lifestyles (healthful behaviour) • Self care, life, livelihood and leadership skills education

Strategic Direction [2] • The response to addressing these needs can be categorised into four strands: • Information and skills • Services and counselling • Safe and supportive environment • Opportunities to participate NB: Health services that are accessible, acceptable, appropriate and equitable

Strategic Objectives • Improve access to appropriate health information by adolescents and young people, • Improve access to and utilisation of quality health services by adolescents and young people, • Enhance social, legal and cultural environment for the health of adolescents and young people, • Improve community participation (adolescents, parents, community leaders, traditional and religious leaders etc..) in adolescents and young people’s health programme implementation to increase the demand and utilisation of services, • Improve the management for adolescents and young people’s health programmes including resource mobilisation.

Strategic Objective 1: Improve access to appropriate health information by adolescents and young people, Strategy 1: To improve overall awareness of young people and civil society on the health and development of adolescents and young people. Main Activities • Conduct KAP study in collaboration with young people, targeting adolescents, young people, parents, teachers, health providers and opinion leaders on their awareness of the health and development of adolescents and young people • Evaluate existing IEC materials targeting/related to the health and development of adolescents and young people with the full participation of young people.

Strategy 1: To improve overall awareness of young people and civil society on the health and development of adolescents and young people. Main Activities (cont.) • Update /develop complementary IEC/BCC materials /relating to adolescents themselves and the community (with more focus on BCC) • Orient main stakeholders on the use of updated IEC materials • Use all channels of communication including ICT for sensitization and orientation on health and development of adolescents and young people

Strategy 2 To improve the knowledge and skills of in-school adolescents and young people. Main Activities • Evaluate the extent to which life skills are integrated in existing modules and curricula of schools • Update/develop complementary modules for life and livelihood skills education in schools targeting specific age groups based on identified gaps following the evaluation of the level of integration in existing modules or curriculum. • Build Capacity of SHEP coordinators and teachers at all levels of school • Introduce/teach the modules in all teacher training colleges and higher learning institutions. • Upgrade the knowledge and skills of existing school counsellors and nurses on adolescent issues

Strategy 2 To improve the knowledge and skills of in-school adolescents and young people. Main Activities (Cont.) • Provide professional counselling on adolescent health and development in schoolsReview/update/develop specific subject related modules on AYPHD including First Aid to train peer educators in schools.Organise peer education on AYPHD including First Aid at the schools under the leadership of school nurses, teachers and professional counsellorsBuild capacity of young people to educate others including leadership trainingAdvocate for the introduction of common geographic-specific prevalent adolescent health and development problems as special subject to be taught at school by specific trained teachers

Strategy 3 To improve the knowledge and skills of out-of-school adolescents and young people Main Activities • Develop specific modules for peer education on AYPHD including First Aid targeting parents, community leaders, religious organisations, adolescents and young people (urban and rural as specific groups) • Train selected peer educators on AYPHD including First Aid (parent peers, adolescent peers, opinion leader peers, heads of local traders associations; e.g. dressmakers, hairdressers) • Organise peer education on AYPHD including First Aid in the communities in places where young people congregate in collaboration with local health facilities

Strategic Objective 2: Improve access to and utilisation of health services by adolescents and young people Strategy 1 To integrate AYFHS in at least 50% health facilities (how many are we talking about) by the end of 2015 Main Activities • Conduct field visits to assess ADHD implementation at selected health facilities • Develop adolescent friendly health services standards and targets • Review /adapt /produce training materials, other tools and guidelines for implementation including materials for out-of-school young people • Train trainers at national, regional and district levels on AYFHS implementation and use of service standards

Strategy 1 To integrate AYFHS in at least 50% of health facilities by the end of 2015 • Use electronic media in the promotion of adolescent and young people’s health and development programmes • Orient regional management teams on scaling up AYFHS delivery • Orient district management teams on scaling up AYFHS delivery • Establish AYFHS in existing public and private sector facilities • Provide adequate commodities and supplies for scaling up AYFHS country wide.

Strategy 2 To introduce young people’s participation and create demand for AYFHS by adolescents and young people Main Activities • Build capacity of adolescents and young people on leadership, decision making and management skills • Advocate for service institutions to include adolescents on management boards and adolescent service delivery teams

Strategy 3 To integrate AYFHS in all other points providing services to adolescents and young people Main Activities • Assess all other existing and potential points of service delivery for adolescents and young people in other sectors • Orient stakeholders/managers of the points of service delivery on AYFHS • Introduce/provide AYFHS at the points of service delivery

Strategy 4 To introduce the teaching of health and development of adolescents and young people in all health training institutions Main Activities • Review existing curricula of all health training institutions • Help develop course contents and instructional plans on health and development of adolescents and young people • Train SHEP coordinators and teachers on the use of the curricula, course content/modules and instructional plans • Provide training materials and tools for teaching in health training institutions • Monitor and evaluate the teaching of health and development of adolescents and youth in health training institutions.

Strategic Objective 3 Enhance social, legal and cultural environment for the health of adolescents and young people Strategy 1 To improve policies on adolescents and young people’s health and development Main Activities • Identify and collate all existing policy documents on adolescents’ and young people’s health and development with the full participation of the young people • Assess Ghana’s status on implementation of international conventions/frameworks related to young people that have been endorsed by government in international settings • Review/Assess the collated policy documents and identify gaps in collaboration with young people

Strategy 1 To improve policies on adolescents and young people’s health and development Main Activities (cont.) • Advocate for review where necessary • Carry out the review of policies • Advocate for the development of new policies based on situational analysis • Collaborate with appropriate agencies and institutions to ensure implementation of policies(for example; the policy on ensuring that pre-adolescents, adolescents and young people stay in school up to at least 20 years)

Strategy 2 To improve and enforce laws and regulations on adolescent and young people ‘s health and development Main Activities • Identify and collate all existing legal documents relating to adolescent and young people with the full participation of the young people • Assess the collated legal documents for any gaps and inconsistencies with policy in collaboration with young people • Advocate, in collaboration with the young

Strategy 2 To improve and enforce laws and regulations on adolescent and young people ‘s health and development Main Activities (Cont.) • Carry out the review of the laws and regulations relating to adolescent health and development • Advocate for the development of new laws based on identified gaps • Collaborate with appropriate agencies and institutions to ensure the enforcement of laws and regulations relating to adolescents and young people’s health

Strategy 3 To reduce harmful socio cultural practices affecting the health and development of adolescents and young people • Assess and document the current situation on harmful cultural practices that affect the health and development of young people • Produce appropriate IEC materials to influence positive behaviour change on these practices • Organize awareness raising campaigns in collaboration with the media

Strategy 3 To reduce harmful socio cultural practices affecting the health and development of adolescents and young people Main Activities (cont.) • Advocate with traditional leaders and other opinion leaders to change harmful practices through development of policies and laws. • Build capacity of targeted stakeholders to sensitize their constituents on harmful practices

Strategic objective 4 Improve community participation and ownership in adolescents and young people’s health programme implementation to increase awareness of self-care and the demand and utilisation of services. Strategy 1 Create awareness among parents/significant others to improve access to information, skills and service utilisation by adolescents and young people Main Activities • Build capacity of parents/significant others on Adolescent health and development issues and intergenerational communication • Strengthen and scale up PAN-TAAN-RAN teams for advocacy on adolescent issues • Facilitate the establishment of support groups of parents/significant others on adolescent issues to improve communication between parents, adolescents and service providers

Strategy 2 Strengthen existing community structures for adolescents Main Activities • Sensitize communities, traditional leaders and local politicians • Encourage the use of community durbars / festivals and other relevant occasions to strengthen and dialogue on adolescent health and development issues. • Build capacity of media personnel on adolescent health and development issues • Advocate for integration ADHD in the celebration of the Youth Day and other events.

Strategy 3 Ensure the sustainability of ADHD activities in communities Main Activities • Facilitate community assessment of existing initiatives for incentive for peer educators and other activities • Help community to integrate ADHD budget in the existing health budget and put in place a system of incentive package for peer educators

Strategic Objective 5 Improve the management for adolescents and young people health programme including resource mobilisation. Strategy 1 To improve the multi-sectoral coordination of adolescent health and development programmes at national level Main Activities • Establish technical coordinating committee of ADHD implementers • Strengthen the adolescent health desk of GHS to serve as the secretariat of the multi-sectoral coordinating body led by NPCS • Establish mechanism of reporting and feedback on stakeholders activities

Strategy 1 To improve the multi-sectoral coordination of adolescent health and development programmes at national level Main Activities (Cont.) • Advocate for revival/restructuring of the NPCS multi - sectoral adolescent reproductive health committee • Develop/update profile of all stakeholders working on adolescents’ and young people’s health and development • Develop/update profile of all youth groups/clubs to track their activities • Expand the national ADHD resource team • Institute a mechanism for adolescents and young people to participate in program design, implementation and M&E

Strategy 2 To improve resource mobilization for adolescents and young people’s health and development programmes at district and community levels Main Activities • Advocatefor increased budgetary allocation from GoG, and from the District Assemblies • Build capacity of stakeholders in the area of proposal development and advocacy for resource mobilization • Utilise established network to facilitate efficient mobilisation/ utilization of resources • Utilise funding opportunities such as GTFAM to mobilise resources for ADHD

Strategy 2 To improve resource mobilization for adolescents and young people’s health and development programmes at district and community levels Main Activities (cont.) • Facilitate joint programming among stakeholders • Strengthen collaboration with CBOs and NGOs working in communities for enhanced efforts on adolescents’ and young people’s health and development programme implementation • Document and disseminate success stories as advocacy material for resource mobilization

Strategy 3 To improve supervision, monitoring & evaluation of the implementation of adolescent health and development programmes, policies, strategies, etc Main Activities • Review existing supervisory, monitoring and evaluation tools on ADHD • Integrate ADHD data into CHIM and other related national data systems • Build capacity to use the revised tools. • Strengthen the Integration of ADHD programming into the supervisory, monitoring and evaluation system of GHS • Put in place a regular system for supervision, M&E and performance review of ADHD policies, strategies and programmes implementation

Strategy 4 To improve research on adolescent health and development Main Activities • Conduct operational research as needed to improve evidence-based ADHD programming and implementation • Put in place a data bank on ADHD at GHS Adolescent health desk

Strategy 5 To improve communication environment Main Activities • Develop communication strategy and framework • Integrate ADHD information on GHS website • Document and share Best Practices On adolescents’ and young people’s participation

Cross-cutting approaches • Leadership and coordination • Resource mobilisation • Advocacy and Behaviour Change Communication • Adolescents and Young People’s participation • Gender mainstreaming • Research • Monitoring and Evaluation

Implementation Plan • Levels of implementation • Community level • Parents, teachers, community leaders, adults and youth, peer educators, community-based health workers including community health officers will be trained to offer lay counselling services and education on basic health issues as relates to growing-up • Sub-district Level The sub-district or facility health teams will be responsible for: • Assessing and re-assessing facilities for youth-friendliness • Developing action plans based on gaps identified • Implementing action plans to make facilities youth-friendly • Monitoring and evaluating youth-friendly activities as an integral part of system management

Implementation Plan District Level • The DHMT will be responsible for: • Conducting research into adolescent health and development issues • Mapping to identify available and potential resources • Managing implementation of the strategic plan as an integral part of district health programmes for technical and non-technical partners • Mobilizing resources to support adolescent health and development activities

Implementation Plan Regional level • Build managerial and technical capacities of district health teams • Mobilize resources from within and outside the region for implementation of the strategic plan • Conduct research • Integrate adolescent health and development into supervision, monitoring and evaluation of regional programmes • Provide expert advice to both public and private health institutions for effective implementation of strategic plan • Manage data and give feed back to districts and public and private sector institutions

Implementation Plan National Level • Inter Agency Coordinating Committee on ADHD (multi-sectoral stakeholders) which will be responsible for reviewing and monitoring the implementation of the plan based on the assigned responsibilities of the various activities. • The National Population Council Secretariat (NPSC) will be responsible for the coordination of the implementation plan. • NPCS will act as the nerve centre for convening the meetings of the Inter Agency Coordinating Committee • GHS ADHD programme of the RCH department will serve as the secretariat • GHS will provide strategic information, policies and programmes, services and commodities and technical support to related sectors • MOH will provide system support

Outline of Presentation