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Presentation: Overview Of ADHD Programme Venue: Forest Hotel, Accra Date: 26 th July , 2012

NATIONAL DISSEMINATION OF THE GHANA NATIONAL STRATEGIC PLAN FOR ADOLESCENTS AND YOUNG PEOPLE’S DEVELOPMENT AND STANDARDS AND TOOLS FOR MONITORING ADOLESCENTS AND YOUTH FRIENDLY HEALTH SERVICES IN GHANA. Presentation: Overview Of ADHD Programme Venue: Forest Hotel, Accra

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Presentation: Overview Of ADHD Programme Venue: Forest Hotel, Accra Date: 26 th July , 2012

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  1. NATIONAL DISSEMINATION OF THE GHANA NATIONAL STRATEGIC PLAN FOR ADOLESCENTS AND YOUNG PEOPLE’S DEVELOPMENT AND STANDARDS AND TOOLS FOR MONITORING ADOLESCENTS AND YOUTH FRIENDLY HEALTH SERVICES IN GHANA Presentation: Overview Of ADHD Programme Venue: Forest Hotel, Accra Date: 26th July, 2012 Presenter: Ms. Rejoice Nutakor (ADHD Programme Manager, GHS)

  2. OUTLINE OF PRESENTATION • Concepts of adolescent health • Brief history • Reproductive Health Profile of Adolescents in Ghana • Status of Adolescent Reproductive Health in Ghana • Why Invest In Adolescents • Information Needs of Adolescent Health Programmes • Guiding Principles For Adolescent Health Programming • Major Interventions For Programming For Adolescents • Goals Of Programming For Adolescent Health • ADHD Programme Objectives • Goal • Mission • Vision • Specific objectives • Strategic objectives • standards • Expected Outcomes • Behavioural • Health

  3. OUTLINE OF PRESENTATION 12. Desirable Adolescent Health Status 13. Target Groups 14. Roles and Responsibilities of the Health Sector 15. Management Strategies 16. Key Indicators For Quality Health 17. Monitoring Indicators For AFHS 18 . Achievements 19. Gaps 20. Conclusion 21. Way Forward

  4. 1. ADOLESCENCE Adolescence is a time of intense growth, second only to infancy. It is the only period in an individual’s life when growth velocity increases. During adolescence, individuals can gain 15% of their ultimate adult height and 50% of their adult weight. This rapid growth is accompanied by an increase in nutrient demand, which also is significantly influenced by infection and energy expenditure During this period, body proportion, including indices using height and weight measurements, changes substantially. Adolescent boys generally build more muscle mass, gain weight at a faster rate, have a larger skeleton, and deposit less than girls. Boys also grow for a longer period of time.

  5. 1. ADOLESCENCE • Adolescence means growing up. • Adolescence is a stage when one is no longer a child but also not yet an adult. • Adolescence is a time of great opportunities and also a time of exposure to certain risks. • Adolescence is a time of health promotion. • Adolescence is a window for promoting nutrition. • Adolescence is a time of change from external control to internal control • Adolescence is the age when most people begin to explore their sexuality and have sexual relationships

  6. 1. ADOLESCENCE (CONT’) • Adolescence is a time of major transitions when young people develop many of the habits and skills, patterns of behaviour and relationships they carry into adulthood. This means adolescence is a strong foundation for healthy lifestyles and behaviours over the full life span. It is therefore a bridge between childhood and adulthood. • Adolescence is a phase of development from the appearance of secondary sex characteristics (puberty) to sexual and reproductive maturity; the development of mental processes and adult identity and the transition from total socio-economic and emotional dependence to relative independence. (WHO definition)

  7. 1. ADOLESCENT DEVELOPMENT Adolescent Development is about personal development and is closely linked to adolescent behaviour. It is based on physical, social and spiritual growth over the adolescent period. The development approach is being promoted based on the evidence that health problems are intimately linked to physical and psychological development in adolescence. Adolescent development can be considered from the physical, psychological and social perspectives

  8. 1. ADOLESCENT REPRODUCTIVE HEALTH (ARH) • Adolescent Reproductive Health refers to the health and well-being of adolescent boys and girls in terms of sexuality, pregnancy, birth and their related conditions, diseases and illnesses. • Reproductive health outcomes such as nutritional status, fertility, abortion, illnesses and deaths are the key indicators used to measure ARH.

  9. 1. ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH (ASRH) Adolescent Sexual and Reproductive Health refers to the physical and emotional well-being of adolescents and includes their ability to remain free from unwanted pregnancy, unsafe abortion, sexually transmitted infections including HIV and AIDS and all forms of sexual violence and coercion.

  10. 1. SEXUALITY AND SEXUAL HEALTH Sexuality in adolescence refers to how an adolescent male or female feels, thinks and behaves as a male or female and what he/she wants in terms of close relationships and physical affections. Adolescent sexuality may be healthy or unhealthy. Sexual Health is the ability of males and females to enjoy and express their sexuality free from the risk of STIs, unintended pregnancy, coercion, violence, and discrimination. It is also the ability to have an informed, enjoyable and safer sex life based on mutual respect and a positive approach to sexual expression.

  11. 2. BRIEF HISTORY • Ghanaian tradition recognizes puberty as a special period in one’s life. • Faith-based organizations recognize young people • PPAG, MOE & Other NGOS – 1972 • MOH / GHS set up a desk - 1996 • AYA / Ghana - 2002 • ADHD Resource Team • Task force resource team • Steering committee

  12. 2. BRIEF HISTORY (CONT’) • Adoption of WHO Systematic Approach to addressing the needs of young people (2007) • Situation Analysis • Strategic Plan • Adolescent Friendly Service Delivery Standards • Dissemination of Strategic Plan and Service Delivery Standards • Adaptation/adoption of the W.H.O Orientation Manual For Healthcare Providers • Use Of A Common Orientation Manual For Orientating And Training Service Providers

  13. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA Population Distribution

  14. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) School Enrollment Among 10-14 Year Olds

  15. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) School Enrollment Among 15-19 Year Olds’ (percent)

  16. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Marital Status Among Females

  17. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Adolescents Not In School And Not Living With Either Parents

  18. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) School Enrollment Among 10-14 Year Olds

  19. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Non-Enrollment Among School-Age Children

  20. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Illiteracy Among Females

  21. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Illiteracy And Marriage Before Age 15

  22. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) The 2008 GDHS Report revealed the following: Primary abstinence from sex (Never Married Youth) • 15-19yrs (F: 69%, M: 78.8%) • 20-24yrs (F: 23.7%, M: 31.5%) Age at first sex • Girls: 18.4yrs • Boys: 20yrs Sexual Intercourse Before Age 15 Among Youth (15-24yrs) • Girls: 8.2% • Boys: 3.6%

  23. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) By age 18yrs, 44% of girls and 26% of boys have had sex and 63% of girls and 73% of boys aged 15-19yrs have never had sex. Condom Use At First Sexual Intercourse • 15-19yrs (F: 25.9%, M: 31.4%) • 20-24yrs (F: 24.8%, M: 31.8%) Age at first marriage • Average: 20.1yrs • Highest (Gt. Accra): 22.9yrs • Lowest (UER): 17:8yrs

  24. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) • Median age at first birth: 20.7yrs • Urban: 22.1yrs • Rural: 20.0yrs • Early births for girls < 20yrs: 13% • Contraceptive Use For All Women And Men 15-19yrs F M • All methods: 8.1% 14.7% • Modern methods: 5.1% 11.9% 20-24yrs • All methods 21.3% 57.6% • Modern methods 14.8% 51.3%

  25. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) • Contraceptive Use For Sexually Active Unmarried Women and Men F M • 15-19yrs • All methods 52.6% 72.4% • Modern methods 32.8% 86.7% • 20-24yrs • All methods 43.7% 86.7% • Modern methods 27.2% 78.9%

  26. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) • Significant number of malnourished children are born to older adolescent mothers • Significant number of infant deaths are to children born to adolescents • Comprehensive knowledge about HIV/AIDS Age F M • 15-19yrs 27.7% 30.4% • 20-24yrs 29.0% 39.1% • Knowledge about sources of condom Age F M • 15-19yrs 68.8% 82.4% • 20-24yrs 79.9% 92.5%

  27. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) • Knowledge about HIV status of older adolescents. • Boys : 7% • Girls : 4%

  28. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Induced Abortion Rates – Age specific Abortion Rate (General Abortion Rate) 15-19 yrs - 17 per 1000 women (2nd highest) 20-24 yrs - 25 per 1000 women (highest) NB: Total Abortion Rate : 0.4 abortions per woman Urban/rural variation : 2: 1

  29. 3. REPRODUCTIVE HEALTH PROFILE OF ADOLESCENTS IN GHANA (CONT’) Health problems related to abortion • Severe pain • Bleeding • Injury (e.g. perforation) • Foul-smelling discharge Major reasons given by young people (15-19yrs) for inducing abortion • Want to continue schooling (22.1%) • Not ready to be a mother (14.6%) • Want to continue working (12.4%) • No money to take care of the baby (11.5%)

  30. ADOLESCENT PREGNANCY (INSTITUTIONAL-BASED REPORT)

  31. DISAGGREGATED DATA ON ADOLESCENT PREGNANCY BY AGE GROUP AND REGION

  32. Maternal Mortality in Adolescents (Institutional-based)

  33. Institutional Data On Abortion Source: Midwives Return Form

  34. Institutional Data On Supervised Delivery Recorded for Young People Source: Midwives Return Form

  35. 4. STATUS OF ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH IN GHANA • 1 in 7 pregnancies is to an adolescent (2011 institutional-based data) with regional variation. • 13% of all births are to adolescents (GDHS Report, 2008) • 15% of maternal deaths are to adolescents (2007 Maternal Health survey report) • Unsafe abortion is a major cause of adolescent maternal deaths. Induced abortion rates for young people is 17 per 1000 (2nd highest) women for 15-19 years old and 20-24 years old (highest). • Adolescent contraceptive use in 2008 was 8.5% • Adolescent Birth rate in 2008 was 66/1000 live births • HIV prevalence among pregnant youth (15-24years) in the year 2011 was 1.7%

  36. 5. WHY INVEST IN ADOLESCENTS? • Health Benefits • Current and future health • Intergenerational effects • Economic Benefits • Improved productivity • Return on investments • Avert future health costs • Right • Right to achieve the highest standard or achievable level of health • Survival rights • Development rights • Participation rights • Protection rights

  37. 5. WHY INVEST IN ADOLESCENTS? CONT’ • Achievement of MDGs and other global, regional and country goals Better adolescent health will directly contribute to achieving 5 of the 8 internationally agreed goals: • Reversing the spread of HIV and AIDS • Reducing maternal deaths • Reducing infant and child deaths • Developing and implementing strategies for decent and productive work for youth • Reducing poverty

  38. 6. INFORMATION NEEDS OF ADOLESCENT HEALTH PROGRAMMES • Positive indicators for well-being, health and development • Epidemiological (morbidity, mortality and disability) • Perception of illness and self-risk • Behavioural (sexual practices, substance use, general and oral hygiene, diet, exercise, skills, use of protective devices, first aid, etc)

  39. 7. GUIDING PRINCIPLES FOR ADOLESCENT HEALTH PROGRAMMING • Adolescence is a time of opportunities and risks. • Not all adolescents are equally vulnerable. • Adolescent development underlies prevention of health problems. • Problems have common roots and are interrelated. • The social environment influences adolescent behaviour. • Gender considerations are fundamental.

  40. 8. MAJOR INTERVENTIONS FOR PROGRAMMING FOR ADOLESCENTS • Create safe and supportive environment (live in an adult world) • Provide accurate information and education (still developing) • Build skills • Physically (positive habits) • Psychologically (counselling) • Socially (communication) • Morally (personal responsibility) • Vocationally (entrepreneurial skills) • Improve health services including counselling (need a safety net) • Meaningful involvement of young people in programmes (they are also players)

  41. 9. GOALS OF PROGRAMMING FOR ADOLESCENT HEALTH The main goals of programming for adolescent health are: • To promote healthy development to meet needs and build competencies/skills • To prevent and respond to health problems from early unprotected and unwanted sex, poor nutrition, endemic disease, use of tobacco and misuse of alcohol and other substances, accidents and violence.

  42. 10. ADHD PROGRAME OBJECTIVES Goal To contribute to the improvement of adolescents and young people’s health status through the implementation of realistic interventions that aim to bring appropriate solutions to their major health problems. Vision • To have well-informed adolescents and young people adopting healthy lifestyles physically and psychologically and supported by a responsive health and health related sectors. Mission • To make available appropriate information and counselling services on young people’s health and provide comprehensive health services and other complementary programmes such as self-care, life and livelihood skills to adolescents and young people.

  43. 10. ADHD PROGRAME OBJECTIVES (CONT’) Specific objectives • To increase young people’s access to general health services including sexual and reproductive healthcare in 25% of health facilities and outreach points by the end of the year 2006, 50% by end of 2015 and 100% by end of the year 2020. • To facilitate use of protocols and guidelines on adolescent health and development programming at all levels of the health delivery system to meet needs and build competencies of all stakeholders as an on-going process. • To mobilize resources for adolescent health programming in catchment areas on regular basis.

  44. 10. ADHD PROGRAME OBJECTIVES (CONT’) Specific objectives • To integrate youth-friendly services into existing health services on incremental basis 25% by 2006 and 50% by end of the year 2015. • To establish and use indicators to track quality and coverage of adolescent friendly health services by end of the year 2015. • To integrate ADHD programming into existing monitoring and evaluation systems by end of the year 2015. • To facilitate the establishment of community based groups for adolescent health and development • To conduct operational research into adolescent health issues on regular basis

  45. 10. ADHD PROGRAME OBJECTIVES (CONT’) Strategic objectives (2009 – 2015) • Improve access to appropriate health information by adolescents and young people • Improve access to and utilisation of health services by adolescents and young people • Enhance the social, legal and cultural environment for the improvement of the health of adolescents and young people

  46. 10. ADHD PROGRAME OBJECTIVES (CONT’) Strategic objectives (2009 – 2015) • Improve community participation in the implementation of programmes on adolescentsand young people’s health to increase the demand and utilisation of services • Improve the management of programmes for adolescents and young people’s health programme including resource mobilisation

  47. 10. ADHD PROGRAME OBJECTIVES (CONT’) Standards for service delivery for Ghana • Adolescents and young people are able to obtain health information and counselling relevant to their needs, circumstances and stage of development when seeking healthcare at various levels of health service delivery • Health service providers and support staff have the required knowledge, skills and a positive attitude to provide adolescent and youth friendly health services effectively at all health service delivery points. • Health facilities provide the specified package of health services that are accessible and acceptable to adolescents and young people in an appropriate environment and in a friendly manner. • Promoting partnership among adolescents and young people, health institutions and communities in the provision and utilization of AYFHS. • Health policies and management systems are in place at all levels to support the provision of AYFHS at all service delivery points.

  48. 11. EXPECTED OUTCOMES Behavioral outcomes • Reduction in risky sexual behaviour • Reduction in substance use • Reduction in violence • Improvement in eating habits • Improvement in exercise, rest and recreation

  49. 11. EXPECTED OUTCOMES Health outcomes • Healthy growth and development • Reduced incidence of STIs including HIV • Reduced unwanted/unplanned pregnancies • Reduced abortion cases • Reduced birth injuries • Reduced levels of malnutrition • Reduced levels of mental health problems • Reduced levels of injuries • Reduced levels of communicable diseases • Reduced levels of non-communicable diseases

  50. 12. DESIRABLE ADOLESCENT HEALTH STATUS • Positive parents/guardian/sibling/peer/teacher-adolescent relationship • Good nutrition(eating lots of fruits and vegetables, adequate quantities of plant base proteins and carbohydrates with preference to whole grains) • Healthy lifestyles e.g. exercise, adequate rest, recreation, healthy dressing and positive music and dancing

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