The Adolescent mental, sexual and reproductive health and wellbeing policy, program and primary care implementation priorities in West Africa (AdoWA) research project is being conducted in West Africa in Ghana, Niger and Burkina Faso over a 36-month period.
The study design is a multi-country case study in West Africa. Three countries purposively selected for this study to reflect the anglophone francophone language divide in the sub-region as well as stable and more fragile contexts; are Niger, Burkina Faso and Ghana. Specific groups to be studied will be adolescents and their families and communities, national and sub-national level policy makers and frontline health workers. Within each country one region and two rural and two urban districts within the region will be selected for the sub-national level study.
The general objective of this study is to describe the what and analyze the how and why of adolescent wellbeing policy and program priorities in countries in West Africa, mental, sexual and reproductive health services availability at primary health care level (sub-district /health centers and community); the mechanisms by which these services are funded and how efficiently available resources are used to deliver these services at primary care level.
Why Now?
Globally, adolescent pregnancy and childbirth is declining alongside increases in school participation, demand for contraception and age at first marriage. However, in parts of West Africa, rates remain unacceptably high, given the medical and social risks and complications of early pregnancy and childbirth. Eleven percent of the world’s total births is attributed to young women between 15-19 years old and the majority live in low- and middle-income countries.
Sub-Saharan African countries contribute 4.5 million of the 14 million births worldwide among adolescents and young women (WHO, 2015). In addition, more than 4.4 million of these young women have abortions each year. Half of them are estimated to be in dangerous circumstances, and only one third (1/3) use hospitals in complicated cases.
Within Sub-Saharan Africa, the West African sub-region is estimated to have an overall average of 124 per 1000 live births in adolescents. Against this background, we aim 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).
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
Planned Project Impact
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).
Major potential beneficiaries of this research are adolescents, researchers, country and sub-regional level decision makers in the Economic Community of West African States (ECOWAS), frontline health workers, primary care facilities and their managers, families and communities of adolescents, civil society organizations (CSO) and media interested /involved in adolescent mental, sexual and reproductive health promotion and support.
How might they benefit from this research?
1) Adolescents
a) Improved engagement of adolescents in decision making concerning primary care mental, sexual and reproductive health services targeted at improving their health and wellbeing.
b) Improved quality and responsiveness of adolescent primary care mental, sexual and reproductive health services and related improved access and use of these services by adolescents who need them
c) Improved awareness among adolescents leading to their behavior/practice change for better health and wellbeing
2) Researchers
a) Deepened understanding in cross disciplinary research for adolescent health and wellbeing across multiple relevant disciplines such health economics, primary care, health systems and health policy research and analysis.
b) Strengthened capacity to generate evidence to inform advocacy, policy, planning and implementation for adolescent mental, sexual and reproductive health and wellbeing
c) Strengthened South-South research capacity and research networks of individuals embedded in institutions embedded in countries in West Africa
d) Strengthened North-South research networks and collaborative research capacity between individuals embedded in institutions in West Africa, UK and Canada
3) Country and sub-regional Level Decision Makers
a) Improved access to research evidence to inform policy and planning decisions and implementation support for adolescent mental, sexual and reproductive health and wellbeing.
b) Improved use of research evidence to inform adolescent mental, sexual and reproductive health and wellbeing policy and program decision making and implementation and or de-implementation for primary care (including priority setting and resource allocation).
4) Frontline health workers, primary care facilities and their managers
a) Improved prioritization and resource allocation for adolescent primary care mental, sexual and reproductive health services
b) Effective program planning
c) Improved quality, effectiveness and adolescent responsive primary care service design
d) Improved engagement of adolescents in decision making concerning their health and wellbeing.
5) Families and Communities of adolescents
a) Better understanding of adolescent mental, sexual and reproductive health and needs and effects on adolescent health and wellbeing
b) Application of the understanding to provide better support for improved adolescent health and wellbeing at the household and community level
6) Civil Society Organizations (CSO) and Media
a) Improved awareness of adolescent health and wellbeing priorities in the West African sub-region
b) Improved use of evidence to inform adolescent mental, sexual and reproductive health and wellbeing policy and program decision making and implementation and or de-implementation advocacy and information provision.
Timeline
Year 1
Work Package 1: ADOLESCENT HEALTH AND WELLBEING POLICY ANALYSIS
• Obtain ethical clearance for primary data collection in UK, Ghana, Niger and Burkina Faso
• Desk review /Narrative Synthesis of West African anglophone and francophone grey and published literature and synthesis
•Country Level Actor Mapping in Ghana, Burkina Faso & Niger
•National and Sub-regional (West Africa) level KI interviews with decision maker
Work Package 2: EVIDENCE FOR IMPLEMENTATION AND DE-IMPLEMENTATION
• Desk review including narrative synthesis, qualitative and systematic reviews of available evidence on Adolescent Mental health and sexual and reproductive health interventions and their effectiveness or otherwise
Work Package 3: ECONOMIC ANALYSIS OF ADOLESCENT PRIMARY CARE SERVICE DELIVERY
- Resource mapping
- Revenue and expenditure records analysis
Year 2
Work Package 1: ADOLESCENT HEALTH AND WELLBEING POLICY ANALYSIS
• Engagement of adolescents at sub-district and community level in a participatory action research approach to conduct FGD and KI, and analyze data
• District and community level stakeholder validation through small group meetings (FGD)
Work Package 2: EVIDENCE FOR IMPLEMENTATION AND DE-IMPLEMENTATION
• Engagement of adolescents in a participatory action research approach to review the evidence generated from the desk reviews.
• Qualitative interviewing of adolescents, their families, and their care givers for their perspectives.
Work Package 3: ECONOMIC ANALYSIS OF ADOLESCENT PRIMARY CARE SERVICE DELIVERY
- Analyze the level and determinants of efficiency in the use resources towards adolescent health and wellbeing services using Data Envelopment Analysis (DEA) and/or Stochastic frontier analysis (SFA).
Year 3
Work Package 4: POLICY ADVOCACY
• Synthesis of the findings from the different components (policy analysis, econometric, participatory action research using
• FGD and KI with engagement of adolescents) in each country into draft country report
• Conduct of country level stakeholder validation workshops
• Synthesis of the findings from the country report into one West African sub-regional report
• Conduct of West African Stakeholder validation and policy advocacy workshop
