TFHO trained private‑sector health workers across Ghana using a blended LARC training and mentorship model to strengthen their capacity to deliver high‑quality contraceptive services. A qualitative assessment of 66 interviews showed improved provider knowledge and identified key factors that support or hinder effective implementation of LARC services in the private sector.
Executive summary
The provision and uptake of long-acting and reversible contraceptives (LARCs) represent a viable solution to address unintended pregnancies, and maternal and infant mortality. However, this potential remains largely unrealized due to limited knowledge and skills among private health care providers in delivering LARCs. In the context of Ghana, ensuring access to comprehensive reproductive health (RH) services, including LARCs, is essential for advancing family planning (FP) initiatives and improving maternal and child health outcomes. Although the Ghanaian health care system has made significant progress in making FP and RH services available, challenges persist, especially in the private health sector. LARC services in Ghana are currently predominantly offered at public health facilities (intrauterine devices [IUDs]: 93.6%; implants: 94.2%) (Ghana Statistical Service [GSS] and ICF, 2024).
Given that a substantial proportion of the Ghanaian population seeks health care services from private health care facilities, it is important to train private health workers to provide LARC services. This essential activity will not only address the existing gap but also enhance the accessibility and quality of FP services in Ghana’s private health care sector. In collaboration with the Ghana Health Service (GHS), Non-Catholic Christian Health Association of Ghana, Ghana Registered Midwives Association (GRMA), and Society of Private Medical and Dental Practitioners-Ghana (SPMDP-Gh), the Total Family Health Organisation (TFHO) recruited 100 private facilities in the Savannah, Northern, North East, Greater Accra, Ashanti, Western, Volta, Central, Upper East, and Upper West regions, based on pre-set selection criteria and a checklist. Per a GHS protocol, qualified health care workers at the private health facilities were selected and trained in collaboration with the GHS. The training was led by Jhpiego and used the standardized GHS LARCs training modules.
The cadres of trained private health providers included obstetricians/gynecologists, midwives, and public health nurses. The training consisted of a two-week online session and a one-week in-person session, followed by a three-month mentorship period, which provided hands-on experience in delivering LARC services to clients. Between April and August 2023, TFHO conducted a qualitative assessment to explore the extent to which the training improved health care workers’ knowledge and capacity to deliver LARC services. The assessment sought to:
- Assess the knowledge of private health providers on FP, especially LARC services before and after the blended training approach.
- Explore the experiences and views of relevant stakeholders about the blended training approach to LARC services training.
- Understand the facilitators and barriers to the training and mentorship sessions.
Because this assessment was primarily interested in understanding the blended training approach from the perspectives of trainees, facilitators, and mentors, an exploratory qualitative research design using in-depth interviews (IDIs) was employed. A total of 66 IDIs were conducted, strictly adhering to the Ethical Principles and Guidelines for the Protection of Human Subjects outlined in the Belmont Report (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978). The data obtained were transcribed verbatim, reviewed, and imported into the Dedoose software application for coding and analysis, using the thematic analytical approach.
The analysis revealed key insights on the essential elements needed to implement and improve the Blended Training Approach to LARCs, and to sustain LARC service delivery across both private and public health sectors in Ghana.
Key Findings
- Knowledge of providers on FP services before and after the Blended Training Approach to LARC Services
Before the training, some respondents reported that despite having some level of theoretical understanding of both short-term and LARC methods, there were knowledge gaps specifically on hormonal IUDs. Some participants also admitted to a lack of practical experience offering FP services. Following the training, the respondents reported improvement in their knowledge of FP services, including a pregnancy checklist and safety practices, like instrument sterilization; proper techniques for inserting and removing Implanon and Jadelle; the importance of managing FP-related conditions; the need for treating infections before IUD insertion; the ability to distinguish pelvic inflammatory diseases and sexually transmitted infections (STIs); and making appropriate referrals.
- Experiences and views of stakeholders on the blended training approach
The blended training approach, which combines online self-paced learning and in-person clinical training, was highly valued by participants for its comprehensiveness, engaging nature, and focus on practical skills, despite some challenges related to information technology (IT) literacy and digital device limitations. The role of coaching and mentorship was cited as invaluable for enhancing the understanding and the application of new skills, fostering professionalism, and encouraging continuous excellence.
- Recommendations from respondents to improve the blended training approach
Recommendations included maintaining comprehensive content, increasing the frequency of practical sessions, enhancing onsite coaching and mentorship, improving the online self-paced learning with hybrid approaches to accommodate those with poor Internet access, and modifying certification processes in the coaching and mentorship component for better scheduling coordination and immediate hands-on opportunities post-training.
- Facilitators/motivations for participating in the blended training approach
Trainees were driven to engage in the blended training approach due to a mix of motivations, including a strong desire for knowledge and skill enhancement in FP services. Financial incentives played a significant role, with many seeing the potential monetary rewards as a compelling reason to participate. In addition, some viewed the training as essential for professional development, aiming to enhance their facility’s reputation and credentials, while others were personally motivated by community issues, such as addressing teenage and unwanted pregnancies to effect positive change.
- Barriers to participating in the blended training approach
Participants highlighted several barriers hindering participation, notably insufficient staffing levels and high staff turnover at private health facilities, leading to service provision gaps even post-training. Financial concerns were also significant because private health facilities often perceived FP services as less financially rewarding due to low charges and financial constraints in the communities they serve.
- Recommendations for future training and programing
- The type of LARC service a health provider can offer depends on its cadre. Specialized training, especially for safe access to the uterus, is emphasized. Future training should ensure that it caters to the specific needs of different cadres of health providers.
- Maintain the focus on private health facilities, addressing their unique challenges and needs. This tailored approach has been appreciated by participants.
- Ensure a balanced allocation of time between theoretical and practical aspects of the training. This can enhance learning outcomes and prevent fatigue from lengthy sessions.
- Provide additional support for participants with lower IT literacy, including tutorials, technical assistance, or alternative learning formats. This will ensure that all health care providers can effectively engage with online training materials.
- Provide insights on FP gender-inclusive practices to ensure that health care providers stay informed about evolving perspectives and best practices to address gender-related considerations in service delivery.
- Highlighting the long-term benefits of FP to communities and showcasing success stories can foster a positive perception of the returns on investment.