Ghana

Overview

Ghana has made progress in its HIV response, adopting UNAIDS’ guidance on when to initiate antiretroviral therapy and providing universal treatment for children under age five. Yet the country still faces challenges to achieving epidemic control. HIV prevalence remains high among key population groups—a condition made worse by stigma and discrimination—while Ghana’s progressive treatment policies require increased resources to meet the higher demand for drugs.

What We Do

From 2017 to 2019, HP+ Ghana worked in collaboration with key stakeholders to strengthen the country’s national HIV response. We provided evidence-based recommendations to reduce discrimination at the health facility level and generated cost estimates to help policymakers assess the implications of scaling up HIV treatment through adoption of new HIV treatment protocols.

HP+ used a three-phase “total facility” approach to reduce HIV-related stigma and discrimination in health facilities, including stigma toward key populations. Built on global best practices and adapted to the Ghanaian context, this evidence-based approach yielded significant reductions in drivers and manifestations of stigma among health facility staff, including stigmatizing attitudes toward clients living with HIV and increased willingness to care for key populations. Success was measured through a quantitative survey of health facility staff and clients, focusing on pre- and post-intervention trends among staff and using client data to triangulate and support staff data. Integrating stigma and discrimination-reduction interventions into the health system has the potential to significantly increase access to services and improve quality of care.

HP+ also conducted a strategic costing and policy analysis of Ghana’s antiretroviral therapy program to estimate the costs associated with scaling up treatment. Findings from the study provided critical evidence to support advocacy for increased financing across the clinical cascade. Resource allocation decisions based on this evidence, along with the adoption of differentiated care and treatment protocols, will provide Ghana with an opportunity to effectively achieve ambitious scale-up targets for HIV testing, treatment, and retention.

Project Impacts

HP+ Efforts to Reduce Stigma in Health Facilities Featured in AIDS Special Issue

September 2020 —

A journal article authored by HP+ project staff in collaboration with local partners was published this month in a special issue of AIDS. The article, which describes the development and implementation of a three-stage approach to reducing HIV stigma in health facilities, features the approach that HP+ implemented in Ghana and Tanzania. It is an evidence-based, adaptable, scalable approach that has proven successful in generalized and concentrated epidemic settings and can be used to address stigma toward any population. Results of endline evaluations in both countries demonstrate the intervention’s effectiveness, showing significant reduction in drivers and manifestations of stigma and discrimination among facility staff.

Webinar Introduces CIP Performance Dashboard as Performance Monitoring Tool

May 2020 —

An HP+ webinar delivered by Christine Lasway and Laura Hurley on May 14 – What’s Measured Matters: Monitoring Family Planning Costed Implementation Plans – presented an overview of the CIP Performance Dashboard, a data management tool to track CIP performance targets. The discussion included case studies from Madagascar and Ghana, countries using it to monitor execution of their CIPs. The CIP Performance Dashboard, available in Excel and now as an online tool, was developed based on DHIS2. This webinar is ideal for stakeholders looking for a strategic planning performance monitoring tool.

Journal of the International AIDS Society Publishes HP+ Article on Reducing Stigma and Discrimination in Ghanaian Health Facilities

April 2020 —

This month, a project-authored article on reducing stigma and discrimination in health facilities in Ghana was published in the Journal of the International AIDS Society. The article, which evaluates the impact of a “total facility” stigma‐reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff, found that respondents at stigma intervention facilities were 19 percent more likely to report that staff behavior towards people living with HIV had improved over the last year, compared to those at non-intervention facilities. These results provide a solid foundation for scaling up health facility stigma‐reduction within national HIV responses.

Ghana on Track to Meet Family Planning Costed Implementation Plan Performance Milestones

February 2020 —

Recent data indicates that Ghana is on track to meet the milestones in its costed implementation plan for family planning, including achieving the goal of increasing modern contraceptive prevalence among currently married women from 22.2% (2014) to 29.7% (2020). HP+ has supported the development of performance indicators to monitor execution of key results and established and rolled out a web-based performance monitoring dashboard to government stakeholders and implementing partners. Ghana is estimated to have added 590,000 contraceptive users since 2012, bringing coverage to a total of 1,676,000 users and averting 213,000 unsafe abortions and 1,100 maternal deaths.

Stigma and Discrimination Total Facility Approach Featured by PEPFAR

January 2020 —

The HP+ “total facility approach” to reducing stigma and discrimination in health facility settings is being featured on the PEPFAR solutions website. This showcases the work carried out by HP+ in Tanzania and Ghana as an important solution for the HIV response. PEPFAR Solutions are impactful, data-proven approaches intended to guide others in program design and implementation. U.S. government staff and partners around the world use the solutions website as a resource for HIV program design. Having the stigma-reduction approach featured also makes it accessible to mission staff around the world as they embark on their COP20 planning processes.

Reducing HIV-related Stigma and Discrimination in Health Facilities

March 2017 —

USAID and PEPFAR, through the Health Policy Project’s (HPP) follow-on, Health Policy Plus (HP+), shared best practices, resources, and the project’s current work to reduce HIV-related stigma in health facilities during a recent webinar. The HPP/HP+ stigma-reduction package is comprised of a series of tools (assess, train, and sustain); includes a total-facility approach to reducing stigma and discrimination; and is based on a globally validated measurement tool,  participatory training materials, and experiences from Africa, the Caribbean, and South and Southeast Asia. The stigma-reduction package has been implemented globally, with work ongoing in Ghana, Tanzania, and Jamaica. During the webinar, Suzie Jacinthe of USAID/Ghana commented, “We’ve never been able to quantify [stigma-reduction activities] in a way to show that what we’re doing is measurable change. With this activity, the beauty about it is that we…do questionnaires for the health facility as well as questionnaires from the PLHIV perspective of their experiences with those facilities to: gauge both [perspectives], come up with interventions out of the findings of the assessment, pilot them…and measure that change.” Jacinthe went on to say that HP+’s current effort to also cost these interventions, a first, will help governments demonstrate the real costs, alongside the measurable benefits, of implementing and replicating stigma-reduction interventions.

Welcome to the USAID-funded Health Policy Plus (HP+) project website.