Overall use of contraception in Ghana is relatively low-about 17%-and the availability of clinical family planning services has never been advertised to the public through a large-scale media campaign. This might lead you to think that use of clinical family planning services is also low.

But just the opposite is true. Demand for these services, and the capacity to provide them, are great in Ghana. Since 1994, over 21,500 clients have received sterilization or Norplant implants services at over 100 health care facilities throughout the country.

Through our support for Ghana's national family planning program, AVSC has seen its steady growth. Here is a look at how the program's success has been achieved and sustained.

Importance of Training

AVSC's assistance to the program began in 1986 and increased in 1994, when we received a cooperative agreement from the U.S. Agency for International Development. The main focus of our work has been on training, since services can be provided only by teams of trained staff.

To ensure a steady source of trained staff, AVSC worked with Ghana's Ministry of Health (MOH) to develop regional training centers in existing hospitals and clinics. To date, a total of five training centers are in operation in Accra, Cape Coast, Koforidua, Kumasi, and Sunyani.

Doctors, nurses, and nursing assistants have received clinical training in minilaparotomy (a female sterilization procedure), vasectomy, and insertion and removal of Norplant implants. Numerous family planning orientations have also been provided for government health officials.

An Eye toward Quality

A role-play exercise during a counseling.

In addition to clinical services, an effective family planning program must provide counseling and ensure quality of care.

AVSC has been instrumental in introducing family planning counseling into Ghana's health care system. Counseling training is provided to nurses working in all areas of a facility, thereby strengthening the linkages among departments. For example, nurses in prenatal and postnatal wards are trained in family planning counseling, while nurses in prenatal outpatient departments are trained in health education and referral services.

A quality-of-care workshop sponsored by AVSC in 1995 heightened interest in this important aspect of service delivery. Since then, training has been provided in referral services, infection prevention, and medical-monitoring visits, which help to identify and solve problems at facilities.

Satisfied Clients: The Best Advertisement

Several factors have contributed to the program's success and sustainability. The MOH's support for training efforts has lent credibility to the program and its mission. In addition, local doctors have been trained in conducting medical-monitoring visits and facilitating training workshops in infection prevention and overall quality of care.

Perhaps most important, clinical family planning services have been promoted primarily by word of mouth. Clients who like the services speak about and recommend them to their relatives, friends, and neighbors‹ensuring that high-quality, safe, and effective services will keep being used.

Connie O'Connor and Dr. Nicholas Kanlisi manage AVSC's program in Ghana.