Why Pathfinder Works in Ghana
In 1957, Ghana was the first country in sub-Saharan Africa to gain post-colonial independence. Today, thanks to natural resources like gold, timber, and cocoa, Ghana enjoys a per-capita income nearly double that of many of its West African neighbors. Even so, nearly half of Ghana's 22 million people live on less than a dollar per day, and basic health needs of the population often go unmet. This is particularly true in the country's north, which has far fewer health facilities than the south, contributing to higher rates of infant and maternal mortality, and total fertility rate nearly twice that of the nation as a whole.
Pathfinder has worked in Ghana since 2001. For the last five years, the focus of our work has been on addressing unsafe abortions—a major health problem throughout the country. Hospital-based studies at two leading hospitals in Ghana indicate that between 22 percent and 30 percent of maternal deaths are due to unsafe abortion (Wilson, Lassey 1998). Young women under the age of 24 are particularly vulnerable, comprising 60 percent of maternal deaths caused by unsafe abortion. Pathfinder is working to increase access to safe abortion services, while improving the Ghana Health Service's capacity to scale—up safe abortion services to all district hospitals in northern areas of the country.
Pathfinder also works to educate the population about the abortion law, with a particular focus on young people, who are often the most vulnerable to unsafe abortion. The Ghanaian law permits safe abortion in some situations, yet the law is not well known by much of the population-and even some providers within the public health system. This, along with a limited availability of services, and social stigma that causes women to seek clandestine alternatives, has created an environment where unsafe abortions are still widely performed outside of the formal health service structures. As a result, a completely preventable health problem continues to be a leading cause of maternal death and disability. According to the 2008 Ghana Maternal Mortality Survey, unsafe abortion is the second leading cause of maternal deaths in the country.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private and community partners to make informed health-related decisions. In Ghana, examples of the kinds of evidence we collect range from "percentage of young women coming for comprehensive abortion care services in their first trimester" and "number of women who accept dual method use at the time of an elective abortion" to "the number of project-supported facility assessments conducted." Some illustrative data from Pathfinder projects in Ghana suggests that between July 2011 and March 2012:
- More than 1,900 women, including 1,300 women 24 years or younger, received safe abortion and post abortion care services
- 100 percent of CAC service providers in project clinics were trained in the provision of quality comprehensive abortion care services
Building Capacity, Strengthening Systems
Systems strengthening and capacity building are crucial components of Pathfinder's program to improve safe abortion in Ghana. Three overall goals of the program include:
- Building the capacity of the Ghana Health Services to train and support health care workers to provide safe abortion care
- Improving the ability of the Ghana Health Services and local community based partners to mobilize communities to reduce the stigma around abortion and educate women about their rights
- Supporting local and national partners to advocate for improved policies around abortion.
Pathfinder has developed two regional training centers, which provincial hospitals use for trainings on abortion and other health subjects. Additionally, Pathfinder has developed a cadre of trainers in almost each project district who are capable of organizing comprehensive trainings for service providers, as part of supporting the Ministry of Health and the Ghana Health Services to sustain and scale-up quality abortion services, including bringing services beyond the hospital into local clinics, closer to the communities.
This article retrospectively analyzes the scale up of adolescent-friendly contraceptive services in five countries and draws lessons learned to inform implementation and sustainable scale up of HIV and other services for adolescents.
This technical update discusses Pathfinder's global CAC approach and experience in Ghana, as well as the government's recent endorsement to scale up the approach in the north.
This paper presents Pathfinder's comprehensive approach to safe abortion programming including provider training, client friendly counseling, addressing the needs of vulnerable populations including youth, community mobilization, and advocacy.
Increasing Access to Safe, Comprehensive Abortion Care Services in Northern and Upper East Regions of Ghana: The Pathfinder International Community Approach
Pathfinder/Ghana's safe abortion project increases access to services through community advocacy, provider training, and facility upgrades. The project's successes and challenges are described in this paper.
The workshop, which attracted participants from the Upper West and Upper East Regions, treated topics such as, comprehensive abortion care, adult learning skills and youth-friendly abortion services, management of complications as well as overview and guiding principles including legal perspectives.
Dr. Akpablie explained that the NGO had increased its Comprehensive Abortion Care (CAC) services to those who really needed it, reaching out to young women, counseling and guiding them to make their own choices regarding their Reproductive Health.