Assessment of the community based distribution programs in Ghana

The study showed that virtually all the 110 districts in the 10 regions have at least one NGO program, though coverage is sparse, as each program covers only a few communities. Some districts have a disproportionately higher concentration of programs and agents than others with higher populations. The programs differ in the range of services provided, and the status and remuneration of agents and supervisors. All programs provide FP information and education, distribute condoms and pills, and refer clients for clinical FP methods. A number of programs also provide information and education on sexually transmitted infections (STIs) and HIV/AIDS, the Ghana Registered Midwives Association (GRMA) provides other maternal child health services, and the Christian Council of Ghana (CCG) provides home-based care for people living with HIV/AIDS. All the programs use trained supervisors, but only GRMA has full-time CBD agents. Most programs provide a non-monetary incentive such as bicycles, boots, raincoats, T-shirts, or an initial supply of first aid drug kits. Even though agents are trained how to maintain activity records, recordkeeping and reporting is universally poor and lacking information on program performance, making a comparison and evaluation of the different programs impossible. Some 60% of PPAG agents were satisfied with the frequency of supervision. All PPAG agents have received basic training in FP and 92% have been trained in providing services and information to young people. Generally, the agents" and supervisors" knowledge of FP was adequate, though knowledge of the pill"s side effects was poor and knowledge of STIs, including HIV/AIDS, limited. Not many agents were observed to use the pill checklist to assess new client suitability for the method, but they did provide information on method use. A particular strength of the PPAG program was that most clients were observed to receive information on STIs, and most were given a dual protection message about condoms. However, the agents did not always provide other RH-related information to clients; for instance, only 22% of mothers with young children were given information on immunization and growth monitoring. Also, PPAG agents and supervisors, even those working in PPAG"s youth program, were biased against giving information and services to young people, especially those with no children, though female agents had a more favorable attitude than did male agents.