Project Overview
The World Health Organization (WHO) Ghana Country Office, under the Health Systems Strengthening for Universal Health Coverage (HSS4UHC) initiative and with funding support from the UK Foreign, Commonwealth & Development Office (UK-FCDO), commissioned tfho-RESEARCH to conduct an impact assessment of a nationwide training programme aimed at strengthening Long-Acting Reversible Contraception (LARC) service provision in Ghana.
The training programme, implemented in collaboration with the Ghana Health Service (GHS), targeted midwives and Community Health Nurses (CHNs) across six regions. Using a blended learning approach that combined online theoretical instruction, face-to-face practical training, supervised clinical practicum, and competency assessments, the programme sought to enhance providers’ capacity to deliver safe, high-quality LARC services.
tfho-RESEARCH conducted this assessment to determine the extent to which the training improved provider knowledge, clinical competence, confidence, and service delivery outcomes, while also identifying factors that influence the sustainability and scalability of training gains.
Objectives
The assessment aimed to:
- Evaluate improvements in providers’ knowledge, competence, and confidence following the training programme.
- Assess the impact of the training on the quality and availability of LARC services.
- Examine trends in LARC uptake and continuity of care after the intervention.
- Identify health system factors that support or hinder the application of acquired skills in routine practice.
- Generate evidence-based recommendations to strengthen family planning workforce development and service delivery in Ghana.
Methodology
TFHO-RESEARCH employed a mixed-methods, pre- and post-test quasi-experimental design to assess the effectiveness of the training programme.
Data sources included:
- Pre- and post-training knowledge assessments.
- Monitoring and supportive supervision reports.
- Routine service delivery data from the District Health Information Management System (DHIMS2).
- Key informant interviews with programme managers, trainers, and trained providers.
- Client exit surveys conducted among LARC service users across selected health facilities.
The assessment examined provider performance in areas such as:
- Clinical competence in LARC insertion and removal.
- Quality of family planning counselling.
- Compliance with infection prevention and control standards.
- Commodity management practices.
- Confidence in delivering LARC services.
In addition, service delivery data were analysed to assess changes in LARC uptake, removals, and continuity of care following the training intervention.
Key Findings and Contribution
The assessment generated valuable evidence on the effectiveness of competency-based training in strengthening family planning service delivery. Findings demonstrated how investments in health workforce capacity can contribute to improved provider performance, enhanced service quality, and expanded access to LARC services.
The study also identified critical factors influencing the sustainability of training outcomes, including supportive supervision, facility readiness, commodity availability, workload pressures, and opportunities for continued skills practice.
Impact
The findings provided WHO Ghana Country Office, the Ghana Health Service, and other stakeholders with evidence-based recommendations for strengthening family planning training programmes and improving the delivery of LARC services nationwide. Lessons from the assessment continue to inform efforts to build a skilled reproductive health workforce and advance equitable access to high-quality family planning services in Ghana.Client: World Health Organization (WHO) Ghana Country Office