Services availability and readiness assessment of adolescent sexual and reproductive health in primary healthcare facilities: evidence from selected districts in Ghana.
Amenah M, Novignon J, et al. • Reproductive health • 2025
Significant disparities in the availability and readiness of essential adolescent sexual and reproductive health services were found across primary healthcare facilities in Ghana's Greater Accra region, with rural and public facilities demonstrating higher availability compared to urban and private facilities.
Key Findings
Results
Substantial variation in full ASRH service availability existed across the four studied districts, ranging from 16% to 65%.
67 primary healthcare facilities were assessed across four districts in the Greater Accra region using a multi-stage sampling approach.
Shai Osudoku had the highest proportion of facilities offering a full range of selected ASRH services at 65%.
Ningo Prampram had the lowest provision rate at just 16%.
Selected ASRH services assessed included HIV testing, family planning, contraceptive pills, IUCD provisions, and male condoms.
Results
Provision of all selected ASRH services varied by facility type, with health centres performing best and clinics performing worst.
59% of health centres provided all selected ASRH services.
57% of CHPS (Community Health Planning and Services) facilities provided all selected ASRH services.
44% of clinics provided all selected ASRH services.
The WHO SARA tool was used to measure service availability and readiness across facility types.
Results
Rural facilities had slightly higher overall ASRH service provision rates than urban facilities.
Rural areas reported a 54% provision rate of selected ASRH services.
Urban areas reported a 51% provision rate of selected ASRH services.
This finding contrasts with common assumptions that urban areas have better health service availability.
Results
Rural facilities had markedly higher service readiness in terms of both staff training and guideline availability compared to urban facilities.
46% of rural facilities had trained staff, compared to only 23% of urban facilities.
29% of rural facilities had adequate service guidelines, compared to only 21% of urban facilities.
These readiness disparities suggest an uneven distribution of resources between urban and rural PHCs.
Results
A critical lack of service guidelines and trained staff was identified across many facilities overall.
Overall, only a minority of facilities had adequate service guidelines (21% urban, 29% rural).
Staff training rates were low, particularly in urban facilities (23%).
The study identified these gaps as a major barrier to service readiness across the Greater Accra region.
The findings emphasize the need for enhanced training and resource allocation to improve service readiness.
Results
Public facilities demonstrated higher availability of ASRH services compared to private facilities.
The study found rural and public facilities outperformed urban and private facilities in ASRH service availability.
This pattern suggests a potential urban underutilization of public health services.
The study used the WHO SARA framework focusing on key domains including HIV testing, family planning, and contraceptive availability.
What This Means
This research suggests that primary healthcare facilities in Ghana's Greater Accra region are inconsistent in their ability to provide sexual and reproductive health services to adolescents. Researchers visited 67 clinics, health centers, and community health posts across four districts and used a standardized World Health Organization assessment tool to check whether these facilities offered key services like HIV testing, family planning counseling, contraceptive pills, IUDs, and condoms, and whether they had the trained staff and guidelines needed to deliver these services properly. They found large gaps between districts — in the best-performing district, nearly two-thirds of facilities offered the full range of services, while in the worst-performing district, only about one in six did.
Surprisingly, rural facilities slightly outperformed urban ones in both service availability (54% vs. 51%) and readiness indicators. Rural facilities were nearly twice as likely to have trained staff (46% vs. 23%) and more likely to have proper service guidelines (29% vs. 21%). Public facilities also performed better than private ones. This challenges the common assumption that cities have better healthcare access and suggests that adolescents in urban areas may actually face hidden gaps in reproductive health services at the primary care level.
This research suggests that simply having a healthcare facility nearby does not guarantee that adolescents can access quality reproductive and sexual health services. The widespread shortage of trained staff and service guidelines across all facility types points to a systemic need for investment in workforce training and standardized protocols. The findings highlight the importance of targeted policy interventions to ensure that all adolescents — regardless of where they live or what type of facility is nearest to them — can access consistent, quality reproductive health care.
Amenah M, Novignon J, Fenny A, Agyepong I, Ensor T. (2025). Services availability and readiness assessment of adolescent sexual and reproductive health in primary healthcare facilities: evidence from selected districts in Ghana.. Reproductive health. https://doi.org/10.1186/s12978-025-01955-w