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Generating evidence for efficient and responsive primary health care systems
Grant Reference: MR/T040203/1
Funder: United Kingdom Research Institutes Medical Research Council (UKRI MRC)
Awardee: Ghana College of Physicians and Surgeons
Partners and Collaborators:
Start Date: 1st December 2020
End Date: 30th November 2023
Duration: 36 months
Ethics Approval: Ghana Health Service Ethics Review Committee – GHS-ERC Number: (GHS-ERC 021/05/21) – Approval date 27 May 2021 (Renewal after 12 months)
Project Overview
Despite adolescents (10 – 19 years) forming a large part of the relatively young population of West Africa, adolescent mental, sexual and reproductive health in West Africa has historically received relatively little attention and funding. Adolescence (10 – 19 years) is a special period marked by rapid physical, cognitive, social, emotional and sexual development.
This project seeks to answer the principal research question: “what and why are adolescent wellbeing policy and program priorities in countries in West Africa, what mental, sexual and reproductive health services are available at primary health care level (sub-district /health centers and community) for adolescent health and wellbeing; are they proven effective, what and why are the mechanisms by which these services are funded and how efficiently are available resources used to deliver them”.
The goal of the project is to generate evidence to inform country and sub-regional policy development, advocacy,priority setting, implementation (and de-implementation) for improved adolescent mental, sexual and reproductive health and wellbeing in the Economic Community of West African States (ECOWAS) (West Africa).
The overall study design is a multi-country case study of three countries – Burkina Faso, Ghana and Niger in West Africa.
Our Objectives
Map and analyze country and sub-regional (macro level) actors and their ideas, ideology, interests and power, priorities and institutional environment /contexts and decision making in relation to adolescent health and wellbeing policies and programs in West Africa; which policies and priorities are moved into implementation (or not) and why.
Analyze sub-district and community (micro) level decision making processes of prioritizing which services to deliver and finding and allocating available resources at primary care level to provide adolescents health and wellbeing services
Identify and synthesize the existing evidence on the proven effectiveness (or otherwise) of policy priorities and programs related to mental, sexual and reproductive adolescent health and wellbeing being implemented and generate evidence to support de-implementation where policy and program priorities in implementation are harmful or ineffective
Describe the amounts of resources allocated to the various components of primary health care service provision for adolescents’ health and wellbeing at sub-district and primary health center level
Assess the effectiveness, and technical efficiencies of available primary health centers (public and or private) in providing adolescents’ mental, sexual and reproductive health services
Analyze the factors that explain the technical efficiencies observed in primary health centers in providing Adolescents reproductive health services.
Co-produce interventions and provide recommendations with primary stakeholders (adolescents, their families, communities and service providers) as to how adolescent mental, sexual and reproductive health services should be configured and reconfigured to be more effective and responsive to adolescents’ health and wellbeing needs
| YEAR 1 | Work Package 1: ADOLESCENT HEALTH AND WELLBEING POLICY ANALYSIS | Work Package 2: EVIDENCE FOR IMPLEMENTATION AND DE-IMPLEMENTATION | Work Package 3: ECONOMETRIC ANALYSIS OF ADOLESCENT PRIMARY CARE SERVICE DELIVERY |
| a) Obtain ethical clearance for primary data collection in UK, Ghana, Niger and Burkina Faso | Desk review including narrative synthesis, qualitative and systematic reivews of available evidence on Adolescent Mental health and sexual and reproductive health interventions and their effectiveness or otherwise | a) Resource mapping | |
| b) Desk review /Narrative Synthesis of West African anglophone and francophone grey and published literature and synthesis | b) Revenue and expenditure records analysis | ||
| c) Country Level Actor Mapping in Ghana, Burkina Faso & Niger | |||
| d) National and Sub-regional (West Africa) level KI interviews with decision makers | |||
| YEAR 2 | Work Package 1: ADOLESCENT HEALTH AND WELLBEING POLICY ANALYSIS | Work Package 2: EVIDENCE FOR IMPLEMENTATION AND DE-IMPLEMENTATION | Work Package 3: ECONOMETRIC ANALYSIS OF ADOLESCENT PRIMARY CARE SERVICE DELIVERY |
| a) Engagement of adolescents at sub-district and community level in a participatory action research approach to conduct FGD and KI, and analyze data | a) Engagement of adolescents in a participatory action research approach to review the evidence generated from the desk reviews | Conduct Data Envelopment Analysis (DEA) or Stochastic frontier analysis (SFA). | |
| b) District and community level stakeholders validation through small group meetings (FGD) | b) Qualitative interviewing of adolescents, their families and their care givers for their perspectives. | ||
| YEAR 3 | Work Package 4: POLICY ADVOCACY | ||
| a) Synthesis of the findings from the different components (policy analysis, econometric, participatory action research using | |||
| b) FGD and KI with engagement of adolescents) in each country into draft country report | |||
| c) Conduct of country level stakeholder validation workshops | |||
| d) Synthesis of the findings from the country report into one West African sub-regional report | |||
| e) Conduct of West African Stakeholder validation and policy advocacy workshop |
Research Team and collaborators