Consultant-Study on Drivers of Successful Task- Sharing Policies in Family Planning in Ghana

1. Purpose of consultancy :

The overall objective of this consultancy is to lead a qualitative study on the success factors of the implementation of task sharing for family planning in Ghana to provide valuable information for other countries wishing to expand access to family planning services.

2. Background

Contraception is an affordable and effective intervention, but health workforce shortages and restrictive policies targeting mid- and lower-level health workers limit access to contraception in low- and middle-income countries (LMICs). Scaling up the implementation of WHO-recommended evidence-based FP practices is WHO's three-tiered priority. Although Member States and national stakeholders have a high level of understanding, awareness, and acceptance of these practices, scaling them up has proven challenging due to various bottlenecks at the community and health system levels.

Over the past decade, Ghana has made notable strides in expanding access to family planning services. According to the Ghana Demographic and Health Survey (GDHS), the modern contraceptive prevalence rate (mCPR) among married women increased from 17% in 2010 to 27.8% in 2022.

Despite this progress, the evaluation of the Ghana Family Planning Costed Implementation Plan (GFPCIP) 2016–2020 revealed persistent challenges that hinder the full realization of family planning goals. These include gaps in supply chain logistics, limited demand generation, weak coordination mechanisms, insufficient monitoring and evaluation systems, inadequate financing, and the need for stronger gender mainstreaming and policy support.

To address these challenges and accelerate progress, the Ghana Health Service (GHS), in collaboration with development partners, has launched a budgeted national action plan for 2024–2030. This plan aligns with Ghana’s FP2030 commitments, which aims to increase modern contraceptive prevalence rate (mCPR) to 44.4% by 2030 through expanded method choice, improved service delivery, and enhanced data systems, reduce unmet need for contraception among sexually active adolescents from 57% to 30% by 2030, integrate family planning services into the National Health Insurance Scheme (NHIS), with full coverage across all districts by 2030, boost domestic financing, with the government committing to procure 20% of the country’s contraceptive commodity needs by 2030 and implement a rights-based social and behavior change communication strategy to promote informed and voluntary contraceptive use.

Identifying and addressing bottlenecks to the scale-up of high-impact, evidence-based family planning interventions will be essential to achieving these targets and support Ghana’s efforts to improve reproductive health outcomes and contribute to broader health and development goals.

Expanding contraceptive service provision can significantly improve access. Task sharing is a strategy to address unmet need for family planning (FP) in low- and middle-income countries. It involves redistributing responsibilities for contraceptive counseling and service delivery to a wider range of health providers, including pharmacists and community health nurses (CHNs). These professionals, who can safely provide services previously reserved for higher-level providers, help reduce inequalities in access to contraception. Although evidence supports the safety

and effectiveness of task sharing, its implementation , particularly for long-acting reversible contraceptives (LARCs) and permanent methods, has been slow. The World Health Organization (WHO) provides guidelines on which health professionals can provide specific contraceptive methods, encouraging the inclusion of community health workers and auxiliary nurses to increase access, particularly in rural and underserved areas. Countries such as Kenya, Malawi, and Ghana have successfully expanded access to family planning through the mobilization of community health workers, leading to increased contraceptive prevalence and decreased unmet need for family planning. These examples demonstrate the potential of task sharing to improve access to family planning and equity in low- and middle-income countries.

General objective of the study

The Exemplars in Global Health initiative has identified three African countries who have made impressive gains in family planning: Ghana, Malawi, and Senegal. All three have seen rapid increases in contraceptive prevalence and declines in unmet need for family planning over the previous two decades. As part of broader health systems strengthening initiatives, all three have expanded access to contraception in rural communities through task sharing.

This study initiated by WHO Human Reproduction Programme with support from the ministries of health of these three countries is aimed at understanding the contexts in which task sharing has been successfully implemented to provide valuable information for other countries wishing to expand access to family planning services.

The specific objectives are:

1)to describe the task sharing policies and programmatic interventions that have been successfully implemented at national and subnational levels.

2)to identify the enabling factors leading to successful scale-up of task sharing, including external influences, the attributes of the policy and its credibility and health systems drivers to successful policy implementation.

3)to investigate how task sharing scale-up contributed to achievement of national family planning goals.

Lessons learned from this study will be shared and disseminated with the global FP community (e.g. through the IBP Network, and peer reviewed publication) to inform future technical and capacity-building support provided to task sharing scale-up initiatives.

Roles and Responsibilities :

The selected consultant will work under the general supervision of the global principal investigator and senior researcher at WHO HRP with technical support from the family planning programme manager of the Family Health Division of the Ghana Health Service and the NPO/RMNCAH of the WHO country office.

·Adaptation of the generic HRP study protocol and research instruments to the Ghana context

·Review of relevant study documents

·Data Collection - participant sampling and participant interviewing - according to the protocol

·Analysis of the study data

·Presentation of key findings to national stakeholders’ workshop (virtual or face-to-face meeting)

·Preparation and submission of the national report

Be the first author of country-specific research outputs, and potentially first author of a global comparative paper, with support from the Senior Researcher and PI

5.Qualifications, experience, skills and languages

Educational Qualifications:

Essential: A postgraduate degree in public health

Desirable: Doctorate (public health related), faculty member of local university

Experience

Essential: At least 10 years of experience in reproductive health services.

Desirable: Experience in program evaluation and/or track record of program evaluation publications as evidenced by at least 5 peer-reviewed articles

Experience in similar work for WHO/ UN agency

Skills/Knowledge:

Essential: Good knowledge of research coordination, data management and analysis

Desirable: Proficiency in Word, PowerPoint and Excel

Languages and level required

Essential:

Expert knowledge of English

6.Location

Accra

7. Travel

Yes, within the country to collect data

8.Remuneration and budget

a.Remuneration: NO- C

b.Expected duration of contract: 3 months

Additional Information (For HR use only):

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