DISCLAIMER
The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development 
or the United States Government.
END-OF-PROJECT PERFORMANCE 
EVALUATION OF USAID/GHANA’S
COMMUNICATE FOR HEALTH (C4H) 
PROJECT
JUNE 2019



CONTENTS
EXECUTIVE SUMMARY 1
PRIMARY PURPOSE 2
INTRODUCTION 2
METHODOLOGY 3
FINDINGS 4
GOODLIFE CAMPAIGN AND OTHER MASS MEDIA OUTPUTS 5
GENDER INTEGRATION 12
SUPPORT TO USAID IMPLEMENTING PARTNERS 14
CAPACITY STRENGTHENING 15
RECOMMENDATIONS FOR FOLLOW-ON ACTIVITY 22
ANNEX A. COMMUNICATE FOR HEALTH EXTERNAL EVALUATION SCHEDULE
23
ANNEX B. LIST OF KEY INFORMANT INTERVIEWS, FOCUS GROUP DISCUSSIONS 
AND MEETINGS 27
ANNEX C. COMMUNICATE FOR HEALTH DATA TABLE 32
ANNEX D. RESULTS OF C4H CAPACITY STRENGTHENING ACTIVITIES GLEANED 
AND VERIFIED THROUGH OUTCOME HARVEST 37
ANNEX E. DOCUMENTS REVIEWED BY EVALUATION TEAM 56
ANNEX F. FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING 
SUPPORT OF USAID COMMUNICATE FOR HEALTH TO HEALTH PROMOTION 
DIVISION, 2015–2019 (MAIN DOCUMENT, VOLUME ONE) 62
ANNEX G. FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING FOR 
HEALTH PROMOTION DEPARTMENT, 2015-2019 (UNEXPECTED OUTCOMES, 
VOLUME TWO) 63
ANNEX H. USAID COMMUNICATE FOR HEALTH: ASSESSING COMMUNICATION 
MESSAGES, BEHAVIOR DETERMINANTS AND BEHAVIORS AMONG TARGET 
AUDIENCES IN GHANA. FINAL SURVEY REPORT. NOVEMBER 2019. 64
ANNEX I. ADDENDUM TO FINAL EVALUATION REPORT 65
1 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
EXECUTIVE SUMMARY
This report describes the findings of an end-of-project performance evaluation of Communicate for 
Health, USAID/Ghana’s social and behavior change communication (SBCC) flagship project, conducted 
in June 2019.
The findings of the evaluation suggest that Communicate for Health has been largely successful in 
achieving the objectives described in the project award and subsequent planning documents. The 
evaluation explored two primary questions, corresponding to Communicate for Health’s expected 
result areas (ERs): 
1. Did Communicate for Health contribute to the uptake of healthy behaviors? 
2. Which Communicate for Health capacity building interventions appear to have been most 
impactful with different partners and beneficiary groups, and how can they be replicated or 
expanded moving forward? 
The limited data available to the evaluation team did not clearly demonstrate changes in priority 
behaviors associated with exposure to SBCC interventions developed by Communicate for Health and 
its counterpart organization within the Ghana Health Service (GHS). There were, however, encouraging
changes in a number of important precursors of health behavior, including interpersonal communication 
about health topics; information-seeking; and intent to adopt recommended behaviors. USAID does not 
intend to support an impact evaluation of Communicate for Health, so it is likely that any behavioral 
outcomes of the project will remain undocumented. The findings of this evaluation suggest that the 
SBCC interventions implemented by Communicate for Health were of high quality, however, and that 
any limitations to impact were likely a function of the project’s mandate to focus exclusively on mass 
media, which limited reach; potential for reinforcement of key messages; and attention to normative
drivers of priority behaviors.
Communicate for Health’s performance in the area of capacity strengthening was exceptional, and 
lessons learned through the project have potential application not only in Ghana, but in other countries 
in which development partners and governments are working to enhance public sector leadership in 
SBCC. The project was particularly successful in achieving “systems-level” improvements to Ghana’s 
SBCC landscape through changes to policy; health management information systems; human resource 
management; and coordination functions within the GHS, implying potential for sustained results. While 
these gains are the culmination of longstanding investment by USAID and other donors in SBCC in 
Ghana, the focused and intensive efforts of Communicate for Health were instrumental in ensuring their 
achievement.
In order to sustain the gains achieved by Communicate for Health, it will be critical for the GHS to 
invest in SBCC structures and programming at the national and sub-national levels. Such investment will 
require strategic advocacy and resource mobilization within the Government of Ghana and the 
country’s private sector, in addition to private foundations and (to a decreasing extent) bilateral donors. 
USAID/Ghana and the GHS may wish to consider investment in community-level SBCC structures and 
programming, with attention to both normative drivers of health behavior and improved utilization of 
SBCC principles and approaches in the context of health service delivery.
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 2 
PRIMARY PURPOSE
The primary purpose of the performance evaluation of Communicate for Health is to inform strategies 
for future USAID investments in SBCC activities. The primary audience for the evaluation findings is 
USAID/Ghana, USAID implementing partners, the Government of Ghana (GoG), and other SBCC and 
health promotion stakeholders in Ghana.
INTRODUCTION
Ghana has made notable progress in health outcomes over the last two decades; however, challenges 
remain for the country to meet its goal of universal health coverage. Data from the 2014 Ghana 
Demographic and Health Survey (DHS) and the 2017 Maternal Health Survey (MHS) show significant but 
uneven progress in improving health status.
USAID recognizes the importance of social and behavior change (SBC) in improving health-seeking 
behaviors and the social norms that enable them. SBC is grounded in a number of different disciplines, 
including social and behavior change communication (SBCC), marketing, advocacy, behavioral 
economics, or human-centered design. USAID/Ghana designed Communicate for Health to address key 
individual and normative determinants of priority healthy behaviors, including both household behaviors 
and service utilization. 
Communicate for Health is a five-year (November 2014 to November 2019), USAID-funded 
cooperative agreement (AID-641-A-15-00003; TEC $18,000,000) awarded in 2014 and led by FHI360 in 
partnership with sub recipients Viamo, Creative Storm Network, Mullen Lowe and the Ghana 
Community Radio Network. 
Communicate for Health is one of six activities designed to work together under the USAID/Ghana’s 
Health System’s Strengthening (HSS) portfolio to achieve equitable improvement in the health status of 
Ghanaians. It is mandated to design and implement mass or “above-the-line” media, including radio, 
television, and print, with focused attention to strengthening the capacity of the public sector and civil 
society SBCC partners through “learning-by-doing” and other evidence-based approaches. 
Communicate for health is a national program with targeted efforts in the Northern, Volta, Western, 
Central and Greater Accra regions. The project has three expected results:
• Expected Result 1: Improved behavior change.
• Expected Result 2: Ghana Health Service (GHS)/Health Promotion Division (HPD) capacity 
strengthened.
• Expected Result 3: Capacity of one SBCC local organization developed and strengthened to 
receive direct USAID funding.
3 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Figure A. Communicate for Health Results Framework
Communicate for Health’s areas of focus include family planning (FP); maternal, newborn, and child 
health (MNCH); nutrition; WASH; malaria prevention, control and case management; and the 
prevention and management of HIV/AIDS.
METHODOLOGY
USAID/Washington conducted an internal performance evaluation of Communicate for Health’s 
progress from June 15-28, 2019. The evaluation questions were:
1. Did the project contribute to the uptake of healthy behaviors? Which behaviors were 
adopted as a result of the project and why or why not?
2. What gender dynamics and considerations, either positive or negative, were addressed in 
the implementation of the project and how did the project address them? 
3. What support was the project able to provide other USAID implementing partners in their 
SBCC activities, and what were the results of this support? What were the challenges?
4. What management approaches, at USAID or the prime partner, enabled or impeded the 
achievement of the project’s objectives?
5. Which capacity building interventions appear to have been most impactful with different 
partners and beneficiary groups, and how can they be replicated or expanded moving 
forward? What specific competencies were developed within HPD, implementing partners, 
and local SBCC organizations?
The evaluation was conducted by a team of four staff from USAID/Washington’s Bureau for Global 
Health: Senior SBC Technical Advisors Hope Hempstone and Kama Garrison; Gender Advisor Afeefa 
Abdur-Rahman; and Program Assistant Sylvie Perkins. 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 4 
This evaluation was comprised of a comprehensive desk review and extensive key informant interviews 
and focus group discussions. Available behavioral data collected by Communicate for Health through 
Interactive Voice Response (IVR) technology was also reviewed and synthesized. 
The evaluation team employed a modified version of Outcome Harvesting, a qualitative evaluation 
methodology that seeks to capture both intended and unintended outcomes in its assessment of 
capacity strengthening outcomes. Outcome Harvesting identifies key outcomes of a project after a 
thorough review of existing documentation - in this case, project outputs and relevant Government of 
Ghana documents (see Annex E for a list of documents reviewed). The Outcome Harvesting process 
then requires the evaluators to work backward to assess the contribution of the project toward each 
outcome and define the importance of the outcome. After completing the harvest, the evaluation team 
verifies the outcomes with knowledgeable external sources in order to obtain the final list of vetted 
outcomes. In order to assess the contribution of the project and verify the outcomes, the team 
conducted 21 key informant interviews and 19 focus group discussions over the course of two weeks, 
speaking to a total of nearly 100 project stakeholders (See Annex B for a list of stakeholders 
interviewed). Informants included USAID/Ghana, Communicate for Health, Government of Ghana, and 
implementing partner staff. The majority of time was spent with national partners and stakeholders, but 
two-day site visits were conducted in Tamale (Northern Region) and Ho (Volta Region) to ensure the 
engagement of regional stakeholders (see Annex A for a detailed evaluation schedule).
The Agreement Officer Representative of Communicate for Health, Salamatu Futa, provided technical 
guidance pertaining to questions the evaluation team had during the evaluation. While Ms. Futa 
accompanied the evaluation team to selected site visits, she was not present during interviews and focus 
group discussions. Implementing partner staff also supported the evaluation team by providing 
documentation and information about project implementation. 
The review team encountered one major challenge in its work, which may be considered a limitation. 
The evaluation was not structured to measure population behavior change due to time, funding and 
sampling constraints. In addition, one key informant, Dr. George Amofah (Former Deputy Director 
General/GHS), has a longstanding contractual relationship with Communicate for Health.
It should be noted that there are important internal evaluation activities planned for the final two 
quarters of the project; the results of the final IVR survey and capacity strengthening evaluation should 
be attached to this report for purposes of the public record and revisited for the next design. [Now 
attached in Annexes F, G, and H].
FINDINGS 
The collective investments of the GHS, USAID, and other development partners in SBCC over more 
than two decades have produced an unusually favorable environment for future programming in Ghana. 
Growing GHS commitment; technically and operationally capable local suppliers of SBCC services; and 
sources of SBCC professional education suggest that with strategic investment of continued support, 
this foundation may be expanded into a fully functional SBCC system (see Figure B for a visual depiction 
of the components of such a system).
In general, Communicate for Health has successfully achieved the objectives described in the project 
award and subsequent planning documents. The prime partner and its subrecipients have intentionally 
5 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
and successfully built upon past USAID 
investments in SBCC, introducing a level of effort 
and focus that has enabled achievement of a 
number of significant results within a relatively 
short period. Communicate for Health’s 
achievements in the area of capacity strengthening 
are particularly noteworthy: despite a relatively 
modest level of funding, the project has affected a 
large number of changes to structures supporting 
SBCC within the health system, which implies 
potential for sustained improvements in the scale 
and quality of programming. Due in large part to 
Communicate for Health’s efforts, the GHS/HPD 
is equipped to assume an expanded role in 
coordination, design, implementation, and 
measurement of activities moving forward - if the 
Division is able to assume a role of proactive and 
strategic leadership. Stakeholders within the GHS 
and the development community commented on 
this continued need for proactivity and vision; as 
one respondent said, “They are always reacting...now they need to anticipate and lead.”
Both GHS/HPD and Ghanaian providers of SBCC services with whom Communicate for Health 
partnered have expressed frustration that project activities were not transitioned to their control 
earlier in the life of the project, and that they were not given the opportunity to lead more project 
activities. While these concerns are valid, they must be considered with certain caveats in the context of 
Communicate for Health’s performance, most notably that refurbishment of Korle Bu was not part of 
the original scope. The refurbishment required substantial time, effort and flexibility, delaying the 
timelines for implementation and capacity building. It also, however, reflected the continuous adaptability 
and responsiveness of Communicate for Health. 
Despite the many gains achieved by Communicate for Health and HPD, the GHS does not appear 
prepared to fund SBCC or health promotion activities at any significant level in the near term. It appears 
that both basic operating expenses of HPD and continued implementation of the GoodLife campaign will 
be in immediate jeopardy with the cessation of USAID support through Communicate for Health. 
GOODLIFE CAMPAIGN AND OTHER MASS MEDIA OUTPUTS
This evaluation considered Communicate for Health’s achievements against project Expected Results 
(ERs). It is important to recognize, however, that these results are inherently linked and mutually 
reinforcing, and cannot truly be understood in isolation. Communicate for Health’s emphasis on 
learning-by-doing as a capacity strengthening strategy render it difficult to draw a meaningful distinction 
between “direct implementation” and capacity strengthening. For this reason, activities associated with 
ER 1 (including the design and implementation of the GoodLife campaign) should be considered not only 
in terms of improvement in key behavioral outcomes, but improvement in institutional and individual 
capacity to design, implement, and monitor effective SBCC programming.
Figure B. Public Sector SBCC Competencies, HC3 in 
Action Briefer.
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 6 
The quality of SBCC produced by Communicate for Health and its partners is excellent. The shared 
efforts of Communicate for Health, HPD, and creative partners such as Mullen Lowe have produced a 
compelling, durable brand for GHS’ health promotion activities going forward. Desktop review of 
selected GoodLife campaign materials suggests that they reflect GoodLife’s key brand promise; address 
important determinants of health behavior; and are targeted to primary audiences. The design and 
production quality of outputs is consistently high. Interactive Voice Response (IVR) survey data collected 
by Communicate for Health suggests that exposure to GoodLife media outputs among primary 
audiences increased over the life of the project, with more than 70% of those surveyed reporting some 
exposure to the campaign in midline surveys. 
THE GOODLIFE BRAND IS DISTINCT, COMPELLING, AND WIDELY ACCEPTED AS AN INITIATIVE OF THE 
HPD.
In 2016, the project launched the refreshed GoodLife, Live it Well campaign. The campaign employs a 
life stage approach, addressing the perspectives and concerns of four distinct audience segments. The 
refreshed brand emphasizes collective responsibility for health and empowers different audiences to 
make health “an everyday thing” - a habit that can bring happiness and peace of mind. The refreshed 
brand builds upon the foundation established by the USAID-funded Behavior Change Support project 
(2009-2013), which initially supported GHS in developing the GoodLife brand in 2010. Stakeholders 
acknowledged the pre-existing association between GHS and the GoodLife brand, and appreciated that 
the Communicate for Health-led refresh built from this. The GoodLife brand and associated campaigns 
are widely recognized as an improvement upon past SBC efforts by the GHS; stakeholders consistently 
noted improved clarity in messaging and increased creativity and brand appeal. The GoodLife brand 
manual is recognized by HPD as key to maintenance of the brand and development of new outputs.
There is a deeply held sense of ownership of the GoodLife brand within HPD, and wide recognition of 
the brand within GHS more broadly. Endorsements of various GoodLife products and activities by GoG 
decision-makers, including the recent endorsement of the GoodLife Slice of Life campaign by First Lady 
Rebecca Akufo-Addo, are widely cited as evidence of GoG/GHS ownership of the campaign. A limited 
number of stakeholders reported that GoodLife continues to be associated primarily with USAID within 
the development community. This perception may be reinforced, in part, by the fact that sub-national 
campaign activities are concentrated in USAID priority regions. 
WHILE THE GOODLIFE BRAND AND ASSOCIATED CAMPAIGNS ARE INFORMED BY BEHAVIORAL 
THEORY AND INSIGHTS DERIVED FROM FORMATIVE RESEARCH, THIS THEORY OF CHANGE HAS NOT 
BEEN DOCUMENTED IN AN EASILY ACCESSIBLE FORMAT - LIMITING POTENTIAL FOR TRANSFER OF 
DESIGN CAPACITY TO THE HPD; ALIGNMENT ACROSS PARTNERS; OR ADAPTATION OF PRODUCTS 
TO LOCAL CONTEXTS.
Evidence has demonstrated that effective behavior change programming is premised upon clearly defined 
behavioral objectives, with attention to the major drivers of a given behavior among each primary 
7 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
audience.1 An analysis of select GoodLife outputs confirms a clear focus on specific behaviors among life 
stage audiences, with particular emphasis on increasing knowledge and perceptions of social support for 
priority behaviors. Intermediary behaviors such as interpersonal communication around health and 
health information-seeking are emphasized throughout. 
Despite evidence of an implicit theory of change throughout GoodLife outputs, this framework is not 
explicitly documented. The evaluation team was unable to identify a single, concise description of 
Goodlife’s theory of change, with articulation of the presumed linkages between specific behaviors, life 
stage audiences, and behavioral drivers (or determinants). Program documentation cites a variety of 
behavioral determinants, which vary from one source to another. Furthermore, many program 
documents seem to focus in large part on proximal determinants (intermediary behaviors) such as 
interpersonal communication and information-seeking, and do not clearly describe the distal 
determinants (e.g. knowledge, self-efficacy, outcome expectations, subjective norms, social support) that 
are believed to influence each behavior of interest. While the original Request for Application did not 
require a formal and explicit Theory of Change, the lack of a clear and consistent theory of change may 
limit the ability of HPD and other GHS staff to design or adapt impactful GoodLife products moving 
forward. It may also serve to reinforce a tendency commonly seen in public sector health promotion 
structures to focus on provision of information (health education) rather than more targeted efforts to 
shift key determinants of specific behaviors.
The lack of a consistent theory of change also serves to undermine Communicate for Health’s 
monitoring and evaluation efforts: determinants cited in program documents are not consistently 
measured in internal or external evaluations, making it difficult to infer a causal relationship between 
exposure, change in determinant, and change in behavior. Lastly an explicit theory of change may have 
allowed the project to better illustrate the disconnect between the design of the project and expected 
outcomes. 
GOODLIFE RELIES PRIMARILY (ALTHOUGH NOT EXCLUSIVELY) ON AN ADVERTISING MODEL 
EMPHASIZING SHORT-FORMAT MASS MEDIA AND PRINT MATERIALS. THIS ORIENTATION MAY LIMIT 
THE CAMPAIGN’S REACH AND ABILITY TO ADDRESS SOCIAL AND NORMATIVE DRIVERS OF HEALTH 
BEHAVIOR.
The terms of Communicate for Health’s award and subsequent management guidance from 
USAID/Ghana required an exclusive focus on mass (or “above-the-line”) media, with an estimated 50% 
of total project funding allocated towards direct program costs for communication activities (design and 
production of mass media, radio spots, print materials). This requirement effectively limited the potential 
reach of GoodLife, given the crowded media market in Ghana’s urban centers and inconsistent 
penetration of television and radio in some rural areas. Subsequent design decisions favored short￾format outputs such as 60-second spots. Experience in Ghana and elsewhere has demonstrated that this 
 
1 Noar, S. (2006) A 10-Year Retrospective of Research in Health Mass Media Campaigns: Where Do We Go From 
Here? Journal of Health Communication 11 (1). pp. 21-42.
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 8 
campaign model, while effective for increasing knowledge and addressing other individual beliefs, may 
not be sufficient to shift underlying social and normative influences of some health behaviors.2
Communicate for Health’s long-format media programs (including a regionally-specific GoodLife radio 
serial and the YOLO youth platform) and multi-channel pilot projects (including partner Ghana 
Community Radio Network’s youth-focused FP/RH program and the Community Engagement for 
Malaria Prevention program), offer potential for deeper attention to these factors, but will not be widely 
implemented or evaluated during the life of the project.
Many stakeholders at the regional and district levels associated the GoodLife brand primarily with 
posters and radio spots, and noted that these formats were unlikely to assist them in their work. The 
introduction of a comprehensive set of GoodLife cue cards and video “roll shows” for facility waiting 
rooms during the final months of the project will likely address this need to a certain extent in targeted 
geographies.
Across all stakeholders, there exists a strongly felt need for renewed focus on community-level SBCC. 
One senior leader within HPD noted, “Our [mass media] work is always hanging...we cannot reinforce 
our messages." This sentiment was echoed unanimously by district health promotion officers, one of 
whom noted, "You cannot use mass media without anyone to talk about it!” GHS leadership, HPD staff, 
and other stakeholders noted that existing health promotion structures focus heavily upon community 
entry and engagement with community leadership rather than targeted, evidence-based behavior change 
activities, and expressed the hope that future donor investment would support improved scale and 
quality of community-level activities.
GOODLIFE’S LIFE STAGE-BASED AUDIENCE SEGMENTATION APPROACH, WHICH REFLECTS
ESTABLISHED BEST PRACTICE IN INTEGRATED SBC PROGRAMMING, IS WIDELY APPRECIATED AS BOTH 
NOVEL AND INTUITIVE.
GoodLife is premised upon a life stage-based segmentation approach that promotes priority behaviors 
relevant to 1) pregnant couples; 2) parents and caregivers of children under 5; 3) adolescents; and 4) 
young adults in relationships. This model, which is common in integrated (multi-health element) SBCC 
programs worldwide, allows for establishment of seamless and intuitive linkages between different health 
areas in a single behavior change intervention. Stakeholders familiar with the design of GoodLife, 
including HPD staff, GHS leadership, creative partners, and USAID implementing partners active in 
SBCC, praised this segmentation approach as a departure from past practice in GHS-supported behavior 
change efforts. Health promotion staff at the regional and district levels and partners less steeped in 
behavior change did not demonstrate the same level of awareness of GoodLife’s life stage segments; this 
likely represents an opportunity for improved alignment of partner activities and enhancement of 
community-level behavior change moving forward.
 
2 Abroms, L. and Maibach, E. (2008). The Effectiveness of Mass Communication to Change Public Behavior. Annual 
Review of Public Health 29 (1). pp 219-234.
9 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
THERE ARE INHERENT CONFLICTS BETWEEN USAID’S PRIORITIES AND THOSE OF THE GHS, WHICH AT 
TIMES IMPEDED COMMUNICATE FOR HEALTH’S ABILITY TO EFFECTIVELY AND EFFICIENTLY FULFILL ITS 
MANDATE.
Many stakeholders perceived a tension between USAID/Ghana’s priorities for Communicate for Health 
and those of the GHS/HPD. Examples of this are to be found in GHS’ desire to address life stage 
audiences (the elderly) and health areas (non-communicable diseases such as diabetes) that are not 
prioritized by USAID in its health investments; and GHS’ emphasis on national health days, which have 
not been shown to contribute meaningfully to health behavior change outcomes such as those included 
in Communicate for Health’s results framework. Communicate for Health accommodated GHS 
priorities to the extent possible, but was unable to fully satisfy GHS requests in some cases. Similarly, 
Communicate for Health’s mandate to focus in USAID priority regions was not appreciated by GHS 
leadership, although the project’s national-level mass media programming offsets this critique to a 
certain extent.
USAID/Ghana’s insistence on final review of Communicate for Health outputs was widely seen as 
undermining the authority of the Health Sector SBCC Technical Review Committee (itself established by 
Communicate for Health) and the HPD. Integration of USAID feedback within the Review Committee 
process will likely reinforce both the role of the HPD and GHS ownership of GoodLife outputs moving 
forward.
WHILE THERE IS LITTLE CLEAR EVIDENCE FOR THE BEHAVIORAL OUTCOMES OF THE GOODLIFE 
CAMPAIGN AT THIS POINT, THERE ARE ENCOURAGING IMPROVEMENTS IN KEY PRECURSORS TO 
HEALTH BEHAVIOR CHANGE, SUCH AS INTERPERSONAL COMMUNICATION AND INTENTION. 
C4H monitored the adoption of key behavior using Interactive Voice Responses (IVR) technology 
whereby pre-recorded content in multiple local languages prompts users to listen to questions and press 
buttons on their phone to respond. IVR data, while an innovative solution to the limitations C4H faced 
within the monitoring and evaluation budget, is only able to reflect trends from baseline to follow up. A 
few trends to note:
As was highlighted before, the data suggests an increase in the awareness of the GoodLife, Live it Well 
brand from 61% at baseline to 71% at follow up, surpassing the project target of 70% (Annex C).
Additionally, it appears that more respondents were exposed to family planning messages at follow-up 
(72%) than at baseline (58%). And, for facility delivery messages, the data shows an increased exposure 
from baseline (60%) to follow up (73%). For WASH messages, there was an increase for exposure to 
any handwashing message from 65% to 79% (Annex C). 
Interpersonal Communication, (IPC) an indication of potential behavior change, shows marked increases 
from the baseline to the follow up survey. Interpersonal communication on delaying pregnancy for 
sexually active participants suggests an increase from 50% at baseline to 58% at follow up. IPC on 
delaying pregnancy for sexually inactive participants shows a suggestive increase from participants from 
36% at baseline to 44% at follow up. And, IPC for ITN use shows an increase from 46% at baseline to 
59% at follow up. There were also increases in IPC for WASH (62%-67% and facility delivery (47%-67%) 
(Annex C). 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 10
While this data is reflective of trends and not actual behavior change, the results are promising. 
Overall, it is likely that GoodLife’s behavioral impact will be limited not by the quality of its outputs, but 
by the difficulty of a) achieving sufficient levels of exposure among primary audiences given Ghana’s 
media landscape; and b) inherent limitations of a SBCC program that does not reinforce mass media 
messages through community-level activities. These factors are functions of USAID’s design of the 
mechanism, rather than Communicate for Health’s performance.
Some stakeholders also noted that achieving behavioral outcomes would likely require increased 
attention to specific health areas through nested vertical campaigns (such as the successful Second Year 
of Life Services, or 2YL, campaign) under the broader GoodLife platform. This need was most frequently 
cited in relation to family planning and reproductive health.
A monitoring survey planned by Communicate for Health in the final months of the project will likely 
yield additional information regarding the reach of the GoodLife campaign and potential outcomes on 
both behavioral precursors (determinants) and behaviors of interest.
THERE IS A NEED FOR CONTINUED TRUST-BUILDING BETWEEN THE HPD AND PROVIDERS OF SBC 
SERVICES (E.G. CREATIVE AGENCIES, BEHAVIOR CHANGE-FOCUSED NGOS) TO ENABLE REGULAR AND 
EFFECTIVE COLLABORATION.
The highly participatory processes involved in the refresh of the GoodLife brand; development and 
production of mass media outputs; and launch and maintenance of key GoodLife platforms have 
provided many formal and informal opportunities for collaboration between the HPD and providers of 
SBCC services within Ghana’s private sector and civil society. Stakeholders appreciate both the learning 
and the relationship-building that has occurred as a result of these exchanges - but acknowledge that the 
cultures, motivations and ways of working in the public and private sectors are sometimes at odds. 
Continued cultivation of Ghana’s SBCC ecosystem will likely require ongoing trust- and relationship￾building, and acknowledgement of the comparative advantages and distinct roles of different stakeholder 
groups. 
YOLO’S FORMAT AND POPULARITY SUGGEST POTENTIAL FOR BEHAVIORAL IMPACT AMONG YOUNG 
PEOPLE, BUT ADDITIONAL EVALUATION IS REQUIRED.
The YOLO youth platform, which includes a television serial drama and (periodically) moderated social 
media and roadshow events, has been supported by Communicate for Health since 2017 (two prior 
seasons of the television show were supported by DFID via the National Population Council and 
Palladium, respectively). The television show represents a continuation of The Things We Do for Love, 
a popular serial drama developed by Farmhouse Media in the 1990’s. In its five seasons on air, YOLO 
has proved immensely popular, achieving an average of four million viewers weekly on television (TV3) 
by the end of season four and over 6 million views of season four on YouTube. The platform is 
characterized by a seamless; bi-directional interface between television and social media, which 
simultaneously drives viewership; increases audience engagement; and provides content developers with 
a continued source of audience insights. YOLO employs the entertainment education methodology 
popularized by Miguel Sabido, modeling desired behaviors through the evolution and interaction of a 
range of relatable teenage and adult characters. As such, it attempts to address a wide range of 
behavioral determinants, including both individual and social and normative drivers of health behaviors. 
11 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Communicate for Health and Farmhouse Media have successfully linked YOLO and the GoodLife 
campaign by embedding GoodLife messages and spots within YOLO and creating a shared tagline 
(“YOLO, You Only Live Once – GoodLife, Live it Well”), thereby expanding GoodLife’s reach and 
influence among young people. YOLO’s format and popularity suggest that it has potential to achieve 
behavioral impact if implemented at sufficient scale with linkages between mass media and other 
channels and availability of health products and services.
The range of stakeholders involved in the development and production of YOLO, together with the 
program’s evolving sources of funding, afford an important opportunity to model public-private 
partnership in SBCC. The National Population Council's long standing support for the platform, in 
particular, offers a degree of visibility and high-level GoG support that must be maintained.
COMMUNICATE FOR HEALTH AND ITS PARTNERS SUCCESSFULLY LEVERAGED THEIR RELATIONSHIPS 
WITH MEDIA OUTLETS TO SECURE A SIGNIFICANT LEVEL OF DONATED AIRTIME, WHILE 
STRENGTHENING THE CAPACITY OF THE HPD TO EFFECTIVELY NEGOTIATE MEDIA BUYS IN FUTURE.
Communicate for Health has been very successful in negotiating donations and price reductions in 
airtime for GoodLife and YOLO, exceeding its required level of cost share ($2.7M) by Quarter 2 of 
Year 5. Significant additional cost share is expected during the remaining months of the project, given 
that YOLO/Season 5 is currently being aired on TV3 at no cost to Communicate for Health, and airtime 
for malaria/IPTp spots developed by the project will be purchased by the Global Fund for HIV/AIDS, 
Tuberculosis, and Malaria. Private sector media houses with which Communicate for Health has worked 
report that the quality of the programming offered by the project was instrumental in securing free 
airtime. While HPD staff report increased success in negotiating airtime purchases based on the 
approach modeled by Communicate for Health, it will be critical that high standards of quality are 
maintained if the GHS is to secure airtime in the future.
HPD LACKS AN EFFICIENT, FORMAL SYSTEM FOR DISTRIBUTION OF SBCC MATERIALS, AND THE 
AVAILABILITY OF MATERIALS AT THE DISTRICT AND COMMUNITY LEVELS IS INCONSISTENT.
It appears that the distribution of Communicate for Health outputs is largely opportunistic; and while 
there is space to store materials, it is not clear how HPD will distribute print materials or other 
resources for regional and district-level activities moving forward. The HPD building at Korle Bu and 
nascent regional health promotion resource centers offer space for secure storage of resources, 
assuming a system for their distribution can be established and enforced.
NEITHER INTERNAL NOR EXTERNAL EVALUATION ACTIVITIES ALLOWED FOR ACCURATE 
MEASUREMENT OF RELEVANT BEHAVIORAL OUTCOMES, LIMITING UNDERSTANDING OF 
COMMUNICATE FOR HEALTH’S IMPACT.
Communicate for Health was neither mandated nor funded to conduct an outcome evaluation of the 
GoodLife campaign and other mass media programs; instead, USAID/Ghana recommended that these 
outcomes be measured either through a broader evaluation of health sector investments conducted by 
the Evaluate for Health mechanism, or via comparative analysis of DHS data. In reality, neither of these 
approaches enables appropriate measurement of the impact(s) of SBCC interventions such as those 
supported by Communicate for Health. The surveys conducted by Evaluate for Health focus primarily 
on measurement of facility-level outcomes, which fails to capture the true impact of a program such as 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 12
GoodLife. The DHS is not generally recommended for measuring impact of SBC programs as a) it does 
not allow for attribution due to lack of exposure measures; and b) it does not consistently measure 
relevant behaviors or determinants.
While Communicate for Health attempted to approximate an internal outcome evaluation through 
interactive voice response (IVR) and omnibus surveys, design limitations rendered it difficult to draw 
conclusions regarding behavior change. It should be noted, however, that Communicate for Health’s use 
of IVR surveys has produced valuable lessons learned for use of such surveys as a rapid, cost-effective 
SBCC monitoring tool, and strengthened the capacity of HPD and project partners to collect and 
analyze such surveys. This approach has broad potential applicability in USAID-supported SBCC 
programs elsewhere in the region.
THERE IS LITTLE EVIDENCE OF PLANNED INVESTMENT IN GOODLIFE, YOLO, OR OTHER 
COMMUNICATE FOR HEALTH MASS MEDIA OUTPUTS FOLLOWING THE CONCLUSION OF PROJECT 
ACTIVITIES IN SEPTEMBER 2019.
With the exception of two activities (Ghana Community Radio Network’s youth program, which may 
be implemented through November 2019 by prior agreement with USAID/Ghana, and a forthcoming 
IPTp campaign, for which airtime will be funded by the Global Fund for HIV/AIDS, TB, and Malaria), 
Communicate for Health’s mass media programming will cease to air in September 2019. While HPD is 
assured a minimum level of funding as a department within GHS, it is not clear what level of 
programming, if any, this would support. 
GENDER INTEGRATION
In its application for Communicate for Health, FHI360 proposed employing a tested gender integration 
framework as an internal guide for incorporating a gender-equitable approach into all activities, with the 
aim of “[promoting] gender transformative approaches to examine, question, and change rigid gender 
norms and the imbalance of power that affect both men and women’s health behavior.” While C4H 
addressed gender dynamics in its programming and M&E, these efforts were likely not comprehensive or 
systematic enough to yield sustained change in either health behavior or institutional capacity.
LACK OF ATTENTION TO KEY GENDER-RELATED DETERMINANTS OF HEALTH BEHAVIOR MAY HAVE 
LIMITED THE GOODLIFE CAMPAIGN’S IMPACT.
Communicate for Health successfully designed messages and materials that challenged inequitable 
gender norms around caregiving and household roles. It did not, however, address other gender-related 
norms that impact health behavior, such as shared decision-making and couple communication. 
Addressing these determinants, which have been shown to impact a wide range of health-seeking 
behaviors, is key to affecting and maintaining health behaviors at the population level. 
THE GOODLIFE CAMPAIGN ENGAGED MEN TO IMPROVE HEALTH SEEKING BEHAVIOR WITHIN 
FAMILIES, BUT CAMPAIGN MESSAGING MAY HAVE INADVERTENTLY VALIDATED OR REINFORCED 
INEQUITABLE POWER RELATIONS WITHIN COUPLES. 
To facilitate health seeking behavior by women and within families, the GoodLife encouraged male 
support for women’s health; equitable caregiving responsibilities; and shared responsibility for healthy 
13 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
behavior among men and women and boys and girls. Monitoring data shows that among priority 
audiences, campaign efforts may have increased equitable attitudes around these roles. On the one hand, 
this type of messaging encourages men to be supportive of their partners (e.g. by going with them for 
family planning services and/or antenatal care visits). On the other hand, it does not address the 
underlying power dynamics that increase women’s agency in health (e.g. joint decision making, more 
equitable couple communication). As a result, some campaign messages are gender accommodating (i.e. 
acknowledging men’s control in household decision-making, but not working to address it).3 Given 
potentially gender exploitative practices at the health facility level (i.e. prioritizing women with male 
partners for health services), Goodlife messaging that does not address decision-making and couple 
communication may risk reinforcing men’s control over the decision-making process and undermining 
women’s ability to act as gatekeepers of their own health.4 Further evidence would be required to 
determine any unintended consequences of the male engagement approach of The Good Life campaign. 
SBCC DESIGN AND IMPLEMENTATION AND CAPACITY STRENGTHENING ACTIVITIES ARE NOT 
PREMISED UPON A DEFINED APPROACH TO GENDER INTEGRATION - RESULTING IN AD HOC 
ATTENTION TO GENDER.
While Communicate for Health conducted project-level gender analysis and one training, and has 
explored gender norms and dynamics in its SBCC design activities, it is unclear whether the project uses 
gender integration frameworks or other resources to ensure gender is systematically addressed in its 
activities by staff at multiple levels. For example, the project does not have documented principles for 
operationalizing gender across its three Intermediate Results (IR)s; the GoodLife’s campaign branding 
book does not include gender integration guidelines; and gender review of SBCC materials is intuitive 
and dependent on the opinions and knowledge of individual reviewers. This dynamic also impacts on 
capacity strengthening activities with project staff, GHS/HPD staff, and with Pro-Link/Infinity970. For 
example, although highlighted in project documentation as an element of the Change Agent 
Development Program (CADP) curriculum, many CADP graduates could not adequately describe how 
gender plays a part in SBCC beyond ensuring gender balance in materials, workshops, meetings and 
activities. A more systematic approach to gender integration in SBCC would sharpen attention to 
gender-related determinants of behavior in concept, message and materials development, as well as 
capacity strengthening activities.
GENDER INTEGRATION IN SBCC IS NOT VIEWED AS A PRIORITY BY ALL PROJECT STAFF OR PARTNERS.
Although Communicate for Health addressed gender norms and dynamics in its activities, these efforts 
did not impress upon staff or partners that gender was a priority of the project. Conversations with staff 
and partners also suggest that many viewed gender as a discrete technical area requiring dedicated 
funding and activities, rather than a critical area of analysis in SBCC design and implementation needed 
to address barriers to healthy behaviors and/or surface unintended consequences of programming 
 
3 https://www.igwg.org/wp-content/uploads/2017/05/Gender-Continuum-PowerPoint_final.pdf
4 https://www.igwg.org/wp-content/uploads/2017/05/Gender-Continuum-PowerPoint_final.pdf
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 14
among target audiences. For example, project staff indicated that “gender was not a focus” or “a 
priority” and that “the mission needs to prioritize funds for gender.” 
SUPPORT TO USAID IMPLEMENTING PARTNERS
Although USAID/Ghana’s six health bilateral mechanisms (Systems for Health; Evaluate for Health; 
Water Sanitation and Hygiene (WASH) for Health; People for Health; and Resiliency in Northern Ghana 
(RING)) were designed to function in coordination, it is not clear to what extent and in what manner 
the Mission has prioritized alignment across mechanisms. Despite this, Communicate for Health has 
collaborated effectively with other USAID implementing partners in formal and informal ways, allowing 
for a well-integrated health portfolio that is largely absent of redundancies or inconsistencies in quality 
of programming. Collaboration appears to be largely operational, however, and does not extend to a 
shared, behaviorally-oriented vision for achievement of health objectives.
USAID/GHANA HEALTH IMPLEMENTING PARTNERS VALUE COMMUNICATE FOR HEALTH AS A SOURCE 
OF EXPERT TECHNICAL ASSISTANCE AND AN INTERMEDIARY IN ENGAGEMENT WITH HPD AND 
MEDIA HOUSES.
In general, collaboration between Communicate for Health and other USAID/Ghana health 
implementing partners appears to be positive and productive. Implementing partners value 
Communicate for Health as a source of technical assistance, guidance, and staff capacity strengthening in 
the area of SBCC. Partners cited a wide variety of discrete and ongoing ways in which Communicate for 
Health facilitated achievement of project objectives, including collaborative design of health element￾specific media outputs (e.g. WASH radio spots, Chlorhexidine promotional materials) and facilitation of 
review and clearance through the GHS’ SBCC Technical Review Committee. One partner commented: 
“We were able to design and produce [SBCC] materials faster than anyone ever expected, because 
Communicate for Health helped us put together and prepare for our request to the Technical Review 
Committee. What was expected to take a year took only three months.”
OPPORTUNITIES TO DEVELOP AND SOCIALIZE A SHARED STRATEGIC VISION FOR SOCIAL AND 
BEHAVIOR CHANGE ACROSS USAID/GHANA HEALTH IMPLEMENTING PARTNERS HAVE NOT BEEN 
FULLY REALIZED.
While USAID/Ghana implementing partners are familiar with the GoodLife brand and associated 
campaigns, there does not appear to be a shared strategic vision or framework for social and behavior 
change across all partners. An agreed-upon series of priority behaviors, and segmented audiences among 
whom those behaviors should be achieved, would likely help align and focus implementing partner 
efforts. While it is not clear that USAID/Ghana intended that Communicate for Health would facilitate 
the development of such a vision among partners, it likely would have supported stronger alignment of 
efforts, and improved understanding of the role of SBCC throughout the health system.
THE DESIGN OF USAID/GHANA’S CURRENT HEALTH PORTFOLIO DOES NOT SUPPORT FULL AND 
SEAMLESS PROVISION OF BEHAVIOR CHANGE ACROSS DEMAND- AND SUPPLY-SIDE INVESTMENTS.
The design and management of USAID/Ghana’s current health portfolio appears to have resulted in 
several important points of disconnect across implementing partners, which together contribute to 
insufficient or inaccurate budgeting and lack of program coverage. The broadest example of this is to be 
15 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
found in the lack of attention to community-level behavior change programming for RMNCH or malaria; 
while RING and WASH for Health have been mandated to provide community-level SBCC for nutrition 
and WASH, no partner appears to be providing direct implementation or technical support for such 
work in other health areas. Similarly, the responsibility for production and distribution of print materials, 
a critical and resource heavy component of SBCC programming, is unclear across USAID implementing 
partners. More than one partner provided examples of SBCC outputs that had been designed (often 
through collaboration between implementing partners), without either a shared understanding of which 
partner was responsible for production costs, or sufficient budget for those costs.
CAPACITY STRENGTHENING
Communicate for Health has achieved exceptional results in the area of capacity strengthening (project 
ERs 2 and 3). Despite the fact that less than 19% of total project funding was allocated to activities 
associated with ERs 2 and 3, Communicate for Health contributed to important gains in systems-, 
organizational-, and individual-level capacity for SBCC in Ghana, with attention to both technical and 
operational aspects of performance. Many of the project’s capacity strengthening results are associated 
with a small number of pivotal activities: establishment and maintenance of coordination and technical 
review committees for SBCC; the refresh of the GoodLife brand; outreach and partnerships with the 
press and media outlets; the development and implementation of three in-service training programs for 
GHS health promotion staff; the introduction of health promotion indicators into Ghana’s HMIS system 
(DHIMS II); and a review of the training curriculum for health promotion cadres at the College of 
Health and Well-being at Kintampo. Not 
surprisingly, a large proportion of these 
results were realized in Years 4 and 5 of the 
project, reflecting the long period of trust￾building and preparatory work required to 
affect systems-level change.
While USAID and other development 
partners (most notably UNICEF) have long 
invested in both direct implementation and 
capacity strengthening for SBCC in Ghana, 
the efforts of Communicate for Health were 
more focused and comprehensive than 
other investments. As a result, the project 
was able to build upon existing efforts and 
achieve or expedite a number of systems￾level improvements that had long eluded the 
GHS in its health promotion programming. 
As one former member of GHS leadership 
commented, “Eighty percent of the changes 
in GHS commitment and capacity we have seen in recent years can be attributed to Communicate for 
Health.” A detailed list of results attributed to Communicate for Health’s capacity strengthening 
activities by external stakeholders is to be found in Annex D: Outcome Harvest Results.
Figure C. SBCC Capacity Ecosystem, HC3 (2016).
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 16
Equally important as the gains in technical and operational capacity enabled by Communicate for Health 
are marked improvements in morale and motivation among health promotion staff at the national and 
sub-national levels. Stakeholders consulted for this evaluation consistently remarked upon the improved 
work ethic, empowerment, focus, and assertiveness of HPD staff and regional and district health 
promotion officers due to Communicate for Health. Key informants noted that GHS staff that had 
benefited from Communicate for Health activities “know what [they are] about,” and “can deliver.”
The sustainability of the gains achieved by Communicate for Health is threatened by the lack of planned 
funding for continued capacity strengthening among HPD staff or other health promotion cadres within 
the GHS. Changes to HPD leadership, including a new Director and Deputy Directors for Health 
Communication; Research and Policy; and Advocacy and Social Mobilization offer potential for 
continued organizational strengthening, but may also disrupt some of the gains that have been made in 
recent years.
THE ELEVATION OF HPD FROM A DEPARTMENT UNDER THE FAMILY HEALTH DIVISION (FHD) TO A 
DIVISION UNDER THE GHANA HEALTH SERVICES HAS RAISED THE PROFILE OF HPD AND IMPLIES 
POTENTIAL FOR SUSTAINED INVESTMENT IN SBCC BY THE GHS. 
The elevation of HPD to a Division under GHS represents a significant change in the standing of health 
promotion within Ghana’s public sector. Divisional status assures a minimum level of program funding, 
as well as (reportedly) access to GHS vehicles. HPD leadership will be afforded greater voice and 
decision-making power within the GHS than was previously available to them as they will now have 
access to the Director General and other Senior GHS Management through the Directors’ Forum. Many 
stakeholders view the change in HPD’s status as a clear reflection of GHS’s growing commitment to 
health promotion. Divisional status has also raised the profile of health promotion as a discipline and 
helped to professionalize the image of health promotion staff in HPD and beyond. One interviewee 
commented “They wouldn’t have gotten a division if they hadn’t worked hard.” Optimism about HPD’s 
newfound status is tempered, however, by widely felt anxiety that the Division will not secure the 
funding it requires to operate.
GHS is currently recruiting a new Director for HPD, as well as Deputy Directors for the department’s 
three teams (Health Communication; Research and Policy; and Advocacy and Social Mobilization). There 
is a widespread recognition among stakeholders that the ability of HPD to maintain gains achieved under 
Communicate for Health will depend in large part on the ability of this cohort of leaders to chart a new 
course for the division, its staff, and the GHS’s SBCC efforts moving forward.
CO-LOCATION AT THE HPD OFFICES IN KORLE BU WAS INSTRUMENTAL IN BUILDING TRUST AND 
ENABLING CAPACITY STRENGTHENING THROUGH APPLIED PRACTICE OR “LEARNING-BY-DOING”. 
The staff of Communicate for Health have been co-located with HPD at the latter’s building in Korle Bu 
since May 2017. Effective function of this blended team required an extensive refurbishment of the Korle 
Bu building, which was funded by Communicate for Health. While this refurbishment was costly and 
time-consuming, it is widely credited with enabling HPD staff to carry out daily work functions, and with 
lending HPD a heightened level of credibility within GHS. Many HPD staff also noted that the 
comfortable work environment and equipment afforded them by the renovation served as a source of 
pride and a powerful motivator. The auditorium within the Korle Bu building offers a potential source of 
program income for HPD if appropriately marketed as an event venue to development partners. Already 
17 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
key divisions within the GHS including Public Health and other high-profile GHS events are presently 
hosted at the refurbished auditorium.
The co-location of Communicate for Health with HPD served as an important enabler of capacity 
strengthening and transfer of skills. Co-location enabled the establishment of trust relationships between 
project staff and their HPD counterparts and allowed for continuous, informal collaboration and 
mentoring. As one key informant said, “Suspicion was running high when Communicate for Health staff 
were at Marvel House, but improved once they were working together.” Another informant noted that 
“Co-location broke the cycle of formalized TA and allowed for a more organic, hands-on approach.” 
With paired teams for M&E, media and capacity building, HPD and Communicate for Health were able 
to work as co-creators and team members rather than implementing partner and recipient. This allowed 
for a transfer of skills and an overall improvement in work ethic. Within the M&E team specifically, the 
paired teams between HPD and Communicate for Health worked together on the IVR survey’s ethics 
approval and questionnaire. 
COMMUNICATE FOR HEALTH’S EFFORTS HAVE YIELDED SIGNIFICANT IMPROVEMENTS IN THE 
QUALITY OF MONITORING AND EVALUATION FOR SBCC WITHIN HPD AND THE GHS.
Many stakeholders identified monitoring and evaluation as an area of particular success for 
Communicate for Health and HPD, citing capacity improvements at the systems-, organizational-, and 
individual levels. Monitoring and evaluation was one of three areas in which Communicate for Health 
established paired teams between project and HPD staff, and capacity strengthening in this area was 
grounded in both formal training and continuous learning-by-doing. Communicate for Health and HPD 
staff collaborated closely on many activities, including formative research for the refresh of the GoodLife 
brand and campaign; program outcome monitoring; and improvements to Ghana’s HMIS system. HPD 
monitoring and evaluation staff are confident in their ability to conduct formative research using Action 
Media and other qualitative approaches, and have successfully facilitated Action Media workshops to 
inform the design of the GoodLife campaign. They also report increased confidence in designing, 
conducting, and analyzing IVR surveys, having been closely engaged in all stages of Communicate for 
Health’s outcome evaluation activities. HPD staff have demonstrated their ability to provide supportive 
supervision at the sub-national level, having worked with health promotion officers to validate DHIMS II 
data; synthesize media monitoring data; and ensure completion of monthly and quarterly reports. HPD 
staff are well equipped to provide such supervision moving forward, if they are able to secure funding 
for travel. Engagement in the Monitoring and Evaluation Community of Practice led by USAID partner 
Evaluate for Health, which began in 2015, was cited by many HPD staff as a particularly valuable 
opportunity for continuous learning and technical exchange.
Together with UNICEF, Communicate for Health and HPD were able to negotiate the addition of 22 
health promotion indicators within Ghana’s DHIMS II system, and to support health promotion officers 
in collecting and analyzing high quality monitoring data through staff training, printing of monitoring 
registers, and data quality assurance. The inclusion of such a comprehensive set of health promotion 
indicators within a national HMIS system such as DHIMS II is rare, and represents a significant
improvement in Ghana’s systems-level capacity to implement high-quality, data-driven programming at 
scale. Health promotion officers at the district and regional levels reported that the availability of 
monitoring data enabled them to better plan activities; coordinate with service delivery colleagues; and 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 18
advocate for funds within GHS structures. The Word Bank will reportedly cover some costs associated 
with collection of monitoring data (including printing of additional monitoring registers) moving forward.
COMMUNICATE FOR HEALTH’S IN-SERVICE CAPACITY STRENGTHENING PROGRAMS FOR HEALTH 
PROMOTION OFFICERS HAVE THE POTENTIAL TO IMPROVE THE QUALITY OF COMMUNITY-LEVEL 
SBCC PROGRAMMING IF IMPLEMENTED AT SUFFICIENT SCALE.
Communicate for Health implemented three in-service capacity strengthening programs for health 
promotion professionals at the regional and district levels, which together benefitted nearly 100 GHS 
staff. The Change Agent Development Program (CADP) is an intensive, one-week SBCC course for 
seasoned health promotion officers. Set for Change (SfC) is a six-day, four-session action-learning 
program targeting new graduates of health promotion degree programs as they begin their service as 
district health promotion officers. Lastly, the Change Challenge Fund (CCF) is a competitive 
performance-based grant that provides a small amount of funding to CADP/SfC graduates to design, 
implement, and evaluate an SBCC project, allowing for practical application of skills gained through 
CADP and SfC. All three programs were designed specifically for GHS staff based on capacity 
assessments conducted during Year 1 of Communicate for Health - a fact that was noted and 
appreciated by stakeholders within the GHS. Specific areas of weakness identified during baseline 
assessments (and emphasized in the programs themselves) included advocacy; community mobilization; 
facilitation and presentation skills; proposal writing and resource mobilization; research, monitoring and 
evaluation, and managing and applying data; and coordination skills. Entry to all three programs was 
competitive, with up to three times more applicants than spots available; graduates noted that this 
competitive admissions process served as a powerful motivator, and helped to establish their credibility 
as specialized professionals within their own (regional or district) health teams. 
All three programs were universally lauded by graduates; HPD facilitators and mentors; and GHS 
leadership for their success in empowering health promotion staff and enhancing the quality of activities 
at the regional, district, and community levels. GHS staff involved in mentoring and supervision of 
participants in all three programs noted graduates’ increased confidence and improved performance in 
planning, coordination, and advocacy with GHS and community leadership. Stakeholders involved in the 
programs unanimously recommended their expansion and institutionalization, with particular emphasis 
on the SfC and CCF programs. HPD staff and regional health promotion officers who acted as selection 
committee members, facilitators, mentors, and supervisors for the programs reported that participation 
helped improve their own understanding of SBCC principles and practices; their facilitation skills; and 
their confidence in serving as SBCC leaders within the GHS.
While Communicate for Health conducted one post-assessment of the first cohort the CADP program, 
the SfC and CCF programs have not been evaluated in any systematic manner. Transition of 
sustainability for the programs to HPD and future expansion will likely require both continued attention 
to quality of training and mentoring and evaluation of the programs’ long-term impacts upon the work of 
health promotion officers. 
INTERNSHIPS WITH CREATIVE STORM, MULLEN LOWE AND VIAMO IMPROVED THE TECHNICAL SKILLS, 
PROFESSIONALISM, AND WORK ETHIC OF PARTICIPATING HPD STAFF.
In Years 2017 and 2018, HPD staff completed internships with Communicate for Health partners 
Creative Storm, Mullen Lowe, and Viamo. These full-time practica, which ranged from two weeks to 
19 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
three months in length, were intended to provide HPD staff with applied learning in key skill areas, 
including brand development; creative design of mass media outputs; use of IVR and short message 
services (SMS) for information-sharing and monitoring; and use of social media to increase audience 
engagement in SBCC programs. Both HPD leadership and the organizations that hosted interns 
appreciated the value of the internships for transfer of technical skills and relationship building between 
public and private sector entities. Many stakeholders also noted the improved work ethic and 
professionalism of HPD staff that participated in the program. Former interns appreciated the structure 
and organization of the internships, which were based upon detailed work plans with clear deliverables, 
but also stressed the need to position the opportunity as a ‘fellowship’ given the skills and professional 
level of the HPD staff. Some stakeholders, in noting the value of the internships, expressed concern that 
they would be difficult to institutionalize given lack of a defined (and funded) relationship between HPD 
and private sector providers of SBC services.
HPD STAFF HAVE EFFECTIVELY TAKEN OVER MANAGEMENT OF GOODLIFE’S SOCIAL MEDIA 
PLATFORMS, BUT THE QUALITY OF THE PLATFORMS HAS DECREASED AND THEIR FUTURE IS UNCLEAR.
In April 2018, four HPD staff members completed three weeks of transition training with Creative 
Storm, after which HPD assumed management of the GoodLife Twitter, Facebook, WhatsApp, and 
Instagram platforms. HPD staff feel strongly that they are capable of managing the GoodLife social media 
platform independently. Some stakeholders raised concerns, however, that they lack the time or 
specialized skills to use the platforms to their full potential as an integrated, bi-directional campaign 
channel and not simply a communications platform. A review of the GoodLife Facebook page suggests 
these concerns are warranted: since oversight of the page was taken on by HPD in May 2018, the page 
has ceased to function as a compelling, strategy-driven channel for engagement of priority GoodLife 
audiences (including, for example, a Fan of the Week feature and health promotion content), and 
become a communications vehicle for GHS/HPD events and meetings. The quality of photography used 
on the page has decreased markedly during the same period. It is not clear who the intended audience 
of the page is, or what HPD hopes to achieve through it. 
A number of stakeholders reported that the Office of GHS’ Director General had expressed interest in 
taking over the GoodLife social media platforms from HPD, which simultaneously increases potential for 
sustainability and inclusion of new content, and raises the specter of dilution of the GoodLife brand.
WHILE SPECIFIC TECHNICAL COMPETENCIES AMONG HPD STAFF HAVE IMPROVED MARKEDLY OVER 
THE PAST FIVE YEARS, THE TEAM HAS NOT YET SUCCESSFULLY LED THE DESIGN, IMPLEMENTATION, 
AND EVALUATION OF A LARGE-SCALE SBC INITIATIVE. IT IS THEREFORE UNLIKELY THAT HPD IS 
PREPARED TO FUNCTION WITHOUT CONTINUED TECHNICAL SUPPORT IN THE NEAR TERM. 
HPD staff have been closely involved in all steps of the GoodLife brand refresh and campaign 
development, and have co-led some activities such as Action Media workshops. They have also 
successfully led the design and implementation of focused vertical (i.e. single health area) campaigns, such 
as the immunization-focused Second Year of Life Services, or 2YL, funded by U.S. Centers for Disease 
Control and launched in August 2017 and a refresh of three posters developed by Plan International 
using the Goodlife brand. HPD has not, however, led the design and implementation of a large-scale SBC 
initiative such as the refresh of the GoodLife brand or development of a sector-wide campaign. This may 
be attributed to a number of factors, including delays in Communicate for Health activities due to the 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 20
time required for the refurbishment of the HPD building in Korle Bu and concerns about HPD staff 
capacity and bandwidth.
Stakeholders reported that HPD was reasonably strong in designing print materials, but less so in 
designing or producing television or radio content. Conversations with stakeholders suggests that, given 
sufficient levels of funding and appropriate use of creative contractors, HPD is well-equipped to maintain 
the existing GoodLife brand and design small extension campaigns such as 2YL. Development of larger 
or more complex campaign elements, or long-format mass media such as the existing GoodLife radio 
serial drama, would likely require focused technical assistance.
There is continued disagreement as to the appropriate role of the HPD: HPD staff and some GHS 
leadership argue that the Division has both the mandate and the capacity to conduct all GHS SBCC 
activities, including creative design and production of print materials and short- and long-format media, 
in-house. Other stakeholders contend that HPD should focus primarily on a leadership and coordination 
role, providing knowledge management and capacity strengthening for staff at the regional and district 
levels. In this scenario, HPD would provide oversight of campaigns and long-format mass media, but 
contract specialized creative firms for design and production services. Experience in other countries 
suggests, almost without exception, that targeted and intentional contracting out of key elements of 
SBCC programming by the public sector yields the greatest impact and cost-efficiency. 
THE ROLE AND PERCEPTION OF HEALTH PROMOTION OFFICERS AT THE NATIONAL, REGIONAL AND 
DISTRICT LEVELS HAS BEEN DEFINED AND IMPROVED WITHIN THE GHS, LAYING THE GROUNDWORK 
FOR INCREASED COORDINATION WITH OTHER CIVIL SERVICE CADRES.
Position descriptions form the foundation for a strong human resource system and impact many 
processes such as job postings; recruitment and selection; compensation; requirements for promotion 
and training; and performance management. Communicate for Health assisted HPD to strengthen 
existing position descriptions and identify the skills required for five levels of health promotion officers 
within the GHS. In turn, HPD was able to use these position descriptions to define salaries, promotion 
requirements and articulate a career path for health promotion personnel. Additionally, the job 
description clarified the role of Health Promotion staff and other frontline officers within GHS such as 
Community Health Nurses who also play a role in health promotion. At the sub-national level health 
promotion staff reported that they are now recognized as a professional cadre with specialized skills and 
the leaders of the vertical or line programs seek them out to work together. 
SBCC COORDINATION AND QUALITY ASSURANCE STRUCTURES ESTABLISHED OR REVITALIZED 
THROUGH COMMUNICATE FOR HEALTH HAVE EMPOWERED THE HPD; ENABLED ALIGNMENT ACROSS 
DEVELOPMENT PARTNERS; AND IMPROVED THE QUALITY AND EFFICIENCY OF DEMAND-SIDE 
PROGRAMMING IN GHANA.
In late 2016, Communicate for Health worked with HPD to create an SBCC Technical Review 
Committee (TRC), which was tasked with reviewing all health promotion materials and outputs 
produced in Ghana to ensure technical accuracy; lack of redundancy; and appropriate GHS (GoodLife) 
branding. Stakeholders unanimously cited the establishment of this group as a transformative moment 
for both the HPD and SBCC in Ghana. The existence of the TRC, which is chaired by the Family Health 
Division Director, ensures transparent, efficient, and evidence-based review and approval of materials, 
and supports harmonization of efforts across development partners. It has reinforced the position of 
21 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
GoodLife as the GHS brand, as all materials cleared by the committee are branded with the GoodLife 
logo, and further solidified the role of the HPD as the GoG’s arbiter in matters pertaining to health 
promotion and SBCC. Many stakeholders noted a marked improvement in the quality of health 
promotion and SBCC materials since the establishment of the TRC. One respondent noted partners 
"were working in silos prior to this... [partners now] come together in meetings to develop resources 
without duplication." It appears likely that the group will be maintained moving forward, as meetings are 
held at the GHS offices, with any costs covered by organizations requesting materials review. Some 
stakeholders suggested that TRC meetings could be held more frequently or on a more regular 
schedule, but this perspective did not appear to be widely held. 
Communicate for Health further strengthened the coordination of SBCC activities in Ghana through the 
revitalization of the national Interagency Coordination Committee for Health Promotion (ICC) which 
was established by UNICEF in 2012 but had become largely defunct by 2015. In addition to revitalizing 
the national committee, Communicate for Health supported HPD in establishing three regional ICCs in 
Northern, Western, and Volta regions. Stakeholders repeatedly cited the value of the ICCs as a space 
for communication, trust-building, and coordination across partners. As one respondent commented, 
"The ICC is an important inter-agency structure that has been maintained and led by GHS...it brought a 
lot of people together...should be maintained as their [GHS/HPD] program.” There was, however, 
concern that the ICC would not be sustained after the end of Communicate for Health given lack of 
funding for meetings.
THE SBCC RESOURCE CENTER CAN BE A VALUABLE RESOURCE FOR HPD AND CIVIL SOCIETY HEALTH 
COMMUNICATION PROFESSIONALS; HOWEVER, A WELL PROMOTED ONLINE PLATFORM MANAGED 
BY EMPOWERED HPD STAFF AND FULLY FUNCTIONAL RESOURCE HUBS ARE NECESSARY TO ENSURE 
WIDE-SPREAD ACCESS.
The national resource center and its online platform provides individuals and organizations working in 
health promotion with access to the latest Ghanaian-focused SBCC materials; provides a central 
location for implementers to share their SBCC materials and resources; and enhances HPD’s position as 
the premier source of SBCC resources in Ghana. Although technically sound, the national resource 
center needs to be strategically promoted to increase awareness of the center among intended users in 
the health community and HPD staff need to feel empowered to manage it before transition is 
complete. HPD staff consider themselves skilled in basic operations of the resource center (i.e. loading 
materials on to the online platform, generating data on the usage of the center, basic IT troubleshooting 
and database management). However, given the looming project close-out date, HPD staff are 
concerned they do not have administrative oversight over the administrative and IT functions necessary 
to operate and manage the centers once the project ends. This has implications for the functionality of 
the center and capacity of HPD to manage and troubleshoot the system as needed.
At the regional level, the hubs not only provide district and regional HPD staff with access to the online 
database but also physical space and equipment for resource constrained health promotion officers to 
access the internet and the platform for SBCC content and materials in order to collectively research 
and plan for their community engagement activities. However, the functionality of the resource centers 
varies greatly across different regions with some regional hubs up and running and others with limited to 
no functionality. Additionally, while HPOs working at the regional level appreciate the existence of this 
resource, those working in remote areas continue to be logistically challenged in accessing functional 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 22
hubs. Ensuring that the national center and regional hubs are fully functional and HPD staff are 
empowered to manage the resource is critical to maximize USAID and HPD’s investment in the center, 
provide the health community with a central location to share and access up-to-date, quality and 
Ghanaian specific SBCC materials, and support regional and district HPOs to fulfill their mandates 
effectively.
RECOMMENDATIONS FOR FOLLOW-ON ACTIVITY
There is an immediate and critical need to ensure that the important gains achieved under 
Communicate for Health are sustained following the end of project activities in September 2019. If 
possible, USAID/Ghana may wish to consider supporting Communicate for Health in using existing funds 
to pre-pay discrete operational costs such as internet connectivity at the Korle Bu building, online 
platform costs associated with the national resource center and regional hubs, and airtime for GoodLife 
spots and radio drama through early 2020. Parallel to this, it will be essential that the GHS budget 
appropriately for other operational costs for HPD, as well as routine meeting expenses for the national 
and regional ICCs.
In the longer term, the evaluation team recommends that USAID/Ghana continue to invest in SBC, 
through a combination of direct government-to-government support to the GHS/HPD; and focused 
technical assistance from organizations specialized in SBC, including both international partners and local 
providers of SBCC services.
The GHS/HPD should be empowered and funded to assume primary leadership of key SBCC and health 
promotion functions, including strengthening national and regional staff to support normative change 
through tailored community engagement and providing strategic direction and oversight of public and 
private entities engaged in SBC under the Goodlife brand, ensuring that these efforts are technically 
sound, evidence based, audience driven, multi-channeled and operate in sync at national and community 
levels. 
Future investments should prioritize improved quality and increased scale of community level SBC 
programming reinforced by long format media with attention to intersections between SBC and service 
delivery across key health areas.
23 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
ANNEX A. COMMUNICATE FOR HEALTH EXTERNAL 
EVALUATION SCHEDULE
Date Activity Time Location
MONDAY JUNE 
17TH
Briefing with HPNO 9:00 am - 10:00 am USAID
Interviews with AOR’s and COR’s for 
Systems for Health, Evaluate for Health, 
WASH for Health and MCSP
10:30 am - 11:30 am USAID
Meetings with the C4H team, 
presentation, review of schedule, 
discussion
1:00 pm - 5:00 pm Korle Bu
TUESDAY JUNE 
18TH
Meeting with C4H staff (Q&A session) 9:00 am - 10:00 am Korle Bu
Evaluation Team A: Meeting with 
Viamo and the C4H M&E team to 
discuss IVR/Omnibus
10:00 am - 10:45 am Korle Bu
Evaluation Team B: Interview with 
Joan
10:00 am - 10:45 am Korle Bu
Focus Group Discussion (FGD) with 
C4H Partners, Creative Storm 
Networks, Viamo and Ghana 
Community Radio Network (GCRN)
10:45 am - 11:45 am Korle Bu
Evaluation Team A: Consultations 
and discussions with C4H on M&E, 
Capacity building and Media.
1:30 pm - 2:30 pm Korle Bu
Evaluation Team B: Consultations 
and discussions with HPD on M&E, 
Capacity building and Media.
1:30 pm - 2:30 pm Korle Bu
Meeting with Ms. Eleanor Sey, Act. 
Director, Health Promotion Division
3:15 pm - 4:00 pm Korle Bu
Meeting with Dr. Gloria Quansah￾Asare, Former Deputy Director 
General, GHS 
4:30 pm - 5:15 pm Marvel House
WEDNESDAY 
JUNE 19TH
Discussions with C4H on M&E 9:30 am - 11:00 am Korle Bu
Meeting with Mrs. Grace Kafui Annan, 
Former Head, Health Promotion 
11:00 am - 12:00 pm Korle Bu
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 24
Department 
Interview with Edward 12:20 pm – 1:10 pm Korle Bu
Meeting with Dr. Patrick Aboagye, 
Director, Family Health Division
2:40 pm - 3:00 pm Family Health 
Division Directors 
Office 
Meeting with Dr. Anthony Nsiah-Asare, 
Director General, GHS 
3:45 pm - 4:10 pm Director General’s 
Office 
THURSDAY 
JUNE 20TH
EVALUATION 
TEAM A
Evaluation Team A: Depart Accra 
for Tamale via Africa World Airlines
Departure: 6:00 am 
Evaluation Team A: Meeting with 
Northern Regional Director of Health 
Services, Deputy Director of Public 
Health and Deputy Regional Health 
Promotion Officer
9:30 am - 10:00 am Office of the 
Regional Director
Evaluation Team A: Discussion with 
Deputy Regional Health Promotion 
Officer
10:00 am - 10:30 am
Evaluation Team A: Meeting with 
NORSAAC
11:00 am - 12:00 pm Regional Health 
Directorate
Evaluation Team A: Meeting with 
Radio Listening Group participants in 
Tibung with SIMLE Radio (A GCRN 
Community Radio station) 
1:30 pm - 3:00 pm SIMLI Radio
Evaluation Team A: Meeting with 
RING Project.
4:00 pm - 5:00 pm RING Project Office 
or Systems for 
Health Project office 
THURSDAY 
JUNE 20TH 
EVALUATION 
TEAM B
Evaluation Team B Depart from 
Accra to Ho, Volta Region 
Departure: 6:00 am
Evaluation Team B Meeting with 
Regional Director of Health Services, 
Deputy Director of Public Health and 
8:30 am - 9:30 am Office of Regional 
Director, Ho
25 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Regional Health Promotion Officer
Evaluation Team B FGD with CADP 
and SfC beneficiaries based in Volta
10:00 am - 11:00 am GHS Volta Regional 
Health Directorate 
Conference Room
Evaluation Team B Meeting with 
Systems for Health, Ho
11:30 am - 12:30 pm Systems for Health 
office 
Evaluation Team B Meeting with 
select upcoming Community 
Engagement for Malaria Prevention 
(CE4MP) beneficiaries including District 
Directors, DPHN and DTOHP 
12:30 pm - 1:30 pm GHS, Volta Regional
Health Directorate 
Conference Room
Evaluation Team B Visit a Health 
Centre in a nearby district to interact 
with service providers
3:00 pm - 4:00 pm 
FRIDAY JUNE 
21ST
Evaluation Team A: FGD with 
Change Agent Development Program 
(CADP), Set for Change (SfC) Action 
Learning Set & Change Challenge Fund 
(CCF) beneficiaries based in Tamale 
9:00 am - 10:30 am GHS Conference 
Room, Regional 
Office Tamale
Evaluation Team A: Interview with 
Joseph Ashong (Nutrition Specialist - 
USAID/Tamale).
11:00 am - 12:00 pm 
Evaluation Team A: Interview with 
UNFPA Tamale.
12:00 pm - 12:30 
pm 
Evaluation Team A: Return to Accra 
by flight
Departure: 5:30 pm
Evaluation Team B: Return to 
Accra by Road
Departure: 8:00 am
Evaluation Team B: Discussion with 
Joan Schubert, COP 
2:30 pm - 4:30 pm Marvel House
MONDAY JUNE 
24TH
Meeting with Dr. George Amofah, 
Former Deputy Director General and 
coach for HPD 
10:30 am - 12:00 pm Korle Bu
Meeting with Alhaji Abubakari Sufyan, 
Deputy Chief Health Promoter
12:00 pm - 1:00 pm Korle Bu
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 26
FGD with C4H intern beneficiaries 1:00 pm - 12:30 pm Korle Bu
Meeting with Dr. Keziah Malm, 
National Program Coordinator, 
National Malaria Control Program 
(NMCP) 
NMCP
FDGs with Health Promotion 
Department Teams (M&E, Capacity 
Strengthening, Resource Center)
4:00 pm - 5:00 pm
TUESDAY JUNE 
25TH
Meeting with SHOPS 9:00 am - 9:45 am SHOPS Office
Evaluation Team A: Meeting with 
Systems for Health
10:00 am - 10:45 am Systems for Health 
Office 
Evaluation Team B: Meeting with 
UNICEF
11:00 am - 11:45 am UNICEF Office
Meeting with WASH for Health 12:00 pm - 1:00 pm W4H Office
WEDNESDAY 
JUNE 26TH
Meeting with Multi Media Group 11:00 am -12:00 pm Multi Media Office
Meeting with Ghana Broadcasting 
Corporation
12:00 pm -1:00 pm GBC Conference 
Room
Evaluation Team A: Mullen Lowe 3:00 pm - 4:00 pm 
Evaluation Team B: Farm House 3:00 pm - 4:00 pm 
THURSDAY 
JUNE 27TH
Meeting with Dr. Leticia Appiah, 
Executive Director National Population 
Council 
9:00 am - 10:00 am NPC
Debrief with Sharon Cromer, USAID 
Mission Director
4:15 pm - 5:00 pm USAID
FRIDAY JUNE 
28TH
Debrief with USAID HPNO 10:30 am - 12:00 pm USAID
Participate in FHD second MCHN 
conference. A special panel discussion 
on SBCC by five Change Challenge 
Fund award recipients
12:00 pm - 1:00 pm La Palm Beach Hotel
Debrief preliminary findings with C4H 2:30 pm - 4:00 pm Marvel House
27 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
ANNEX B. LIST OF KEY INFORMANT INTERVIEWS, FOCUS 
GROUP DISCUSSIONS AND MEETINGS
Individual/Organization Title Date 
interviewed
USAID
Sharon Cromer Mission Director 6/27/19
HPNO Leadership Jackie Boni, Acting Office Director, Nutrition Head
Nabil Alsoufi, Acting Family Health Team Lead
6/17/19
Salamatu Futa Communicate for Health AOR Throughout 
evaluation
USAID HPNO Staff Emmanuel Odotei , WASH for Health AOR, Alt 
Communicate for Health AOR
Juliana Pwamang, Program Specialist
Felix Osei-Sarpong, Systems for Health AOR
Aimee Ogunro, Monitoring, Evaluation and 
Communication Officer
6/17/19
Daniel Baako Monitoring and Evaluation Specialist, USAID/Ghana 6/17/19
Joseph Ashong Program Management Specialist, Nutrition, 
USAID/Ghana, Tamale Office
6/21/19
FHI360
FHI360 Headquarters Thaddeus Pennas, Technical Adviser, Social and Behavior 
Change, FHI 360 Headquarters, Chapel Hill, NC
Kara Tureski, Director of Social and Behavior Change 
Division
6/4/19
COMMUNICATE FOR HEALTH AND PROJECT PARTNERS
Joan Schubert Communicate for Health Chief of Party 6/17/19; 
6/21/19 
Edward Adimazoya Communicate for Health Deputy Chief of Party 6/19/19
Eunice Sefa Senior Monitoring and Evaluation Advisor 6/19/19
Group Meeting with C4H
 
 
 
Joan Schubert, COP
Edward Adimazoya, DCOP
Eunice Sefa, Senior Monitoring and Evaluation Advisor
Saul Williams, Program Assistant
Emmanuel Yartey, M&E Technical Assistant
Elvis Nieuman Nanegbe, Malaria Program Officer
6/17/19
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 28
Emefa Ashilley, Program Officer II
Ernest Addison, Program Officer
James Dotse Makumator, YOLO Program Officer
Edith Lamptey, Executive Associate
FGD with C4H staff Eunice Sefa, Senior Monitoring and Evaluation Advisor
James Dotse Makumator, YOLO Program Officer
Saul Williams, Program Assistant
Emmanuel Yartey, M&E Technical Assistant
Elvis Nieuman Nanegbe, Malaria Program Officer
Emefa Ashilley, Program Officer II
Ernest Addison, Program Officer
Samuel Assante-Addo, Resource Center Lead
6/18/19
Viamo Sandra Abrokwa, Country Director
Maame Yaa, Project officer 
6/18/19
Focus group discussion 
with C4H partners
Wilna Quarmyne, GCRN
Sandra Abrokwa, Country Director, Viamo
Maame Ya, Viamo, Project officer 
Victor Kwabla Sabutey, Research & Productions 
Coordinator, Creative Storm
Dr. Kwiesi Okiusu, Executive Director, Creative Storm
6/18/19
Pro-Link/Infinity970, Accra Edem Assisi, Executive Director, Prolink
Emmanuel Adiku, Monitoring and Evaluation Officer, 
Infinity 
Richmond Lampthy, Finance Officer, Prolink
6/24/19
Amos Katsekpor GCRN Community engagement staff, Northern Region 6/20/19
NORSAAC
 
Alhassan Mohammed Awal, Executive Director
Abubakari Kawusada, Gender and Governance Program 
Manager
Musah Yakubu, Finance and Administrative Manager
Hafsah Sey Sumani, Head of Programs and Policy
6/20/19
Mullen Lowe Nokor A. Duah, Chief Executive Officer
Yofi Brew, Creative Director
6/26/19
Farm House Productions Ivan Quashigah, Chief Executive Officer 6/26/19
GHANA HEALTH SERVICE (GHS)
Dr. Gloria Quansah-Asare Former Deputy Director General, Ghana Health Service 
(GHS)
6/18/19
Dr. Patrick Aboagye Director, Family Health Division 6/19/19
Dr. Anthony Nsiah-Asare Director General, GHS 6/19/19
29 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Dr. Keziah Malm National Program Coordinator, National Malaria Control 
Program (NMCP)
6/24/19
Dr. George Amofah Former Deputy Director General, GHS and coach for 
HPD
6/24/19
GHS/HEALTH PROMOTION DIVISION (HPD)
Eleanor Sey (Nellie) Health Promotion Specialist
Acting Director Health Promotion Director
6/18/19
Grace Kafui-Annan Former Head, Health Promotion Department 6/18/19
Alhaji Abubakari Sufyan Deputy Chief Health Promoter 6/24/19
HPD Staff
 
Focus Group Discussion
Irene Hamba 
Uzoma Tetteh
Li
Jerry Fiave 
6/18/19
C4H Interns from HPD Focus Group Discussion
Albert Nyanney, Program Officer
George Nartey, Health Educator
6/24/19
George Nartey Health Educator (Materials Development and Resource 
Center contact)
6/24/19
HPD M&E Focus Group Discussion
Kojo Assante
Yvonne Ampeh, Senior Program Officer, M&E National
6/24/19
Dr. John B. Eleeza Northern Regional Director of Health Service 6/20/19
Dr. John Abenyrare Deputy Director of Public Health, Northern Region 6/20/19
Patience Buahin Deputy Regional Public Health Promotion Officer, 
Northern Region
6/20/19
CADP, SfC and CCF 
Participants, Tamale, 
Northern Region
 
Focus Group Discussion
Fatima Mohammed, District HPO Tamale Teaching 
Hospital, CCF graduate
Kenneth Ayitey, DHPO
Sadia Alhassan, DHPO
Sulemana Alhassan, DHPO, CCF graduate
6/21/19
CADP, SfC, and CCP 
Participants, Ho, Volta 
Region
Focus Group Discussion
Happy Alonu, DHPO
Lynda Buatsi, DHPO
Sampson Damba, DHPO
6/21/19
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 30
CE4MP
 
Focus Group Discussion
Dr. George Nyarko
Francisca Aguzey
Dorcoo Matlida
Ashigbi Xoese
Cynthia Ackuayi
Wisdom Dzandu
Olivia Vifa
Edem Gablibo
MacAndrews Tamakloe
Agnes Lagah
Vivian Adafia
Matilda Atsrim
Yayra Tettey
6/21/19
USAID IMPLEMENTING PARTNERS
SHOPS Dr. Joseph Addo-Yobo, Chief of Party 6/25/19
Systems for Health HQ, 
Accra
Focus Group Discussion
Joyce Ablordeppey, CHPS Advisor
Akua Titius Glover, Behavior Change Communication 
and Gender Advisor
6/25/19
Systems for Health staff, 
Ho Region
Focus Group Discussion
Mary Akoye, Communication Mobilization Advisor
Eric Boabu, Regional Coordinator
Kwame Tcho, Monitoring and Evaluation Officer
Nicole Anyoako, Admin Officer
One additional staff member
6/20/19
WASH for Health HQ, 
Accra
Focus Group Discussion
Albert Wilde, Country Director, WASH and Global 
Communities
Linda_____, BCC staff
Edward_____, BCC Manager, Manoff Group
Marta_____, BCC staff
6/25/19
Mohamed Ali Ibrahim RING SBCC Officer, Northern Region 6/20/19
OTHER STAKEHOLDERS AND PARTNERS
UNFPA/Northern Region 
Tamale
Focus Group Discussion
Tenii Mammah, Program Specialist and Head of Office
Jude Domosie, UNFPA Program Analyst
6/21/19
UNICEF Sherry Nikoi, Communication for Development Officer 6/25/19
Ghana Broadcasting 
Corporation
Focus Group Discussion
Charles Mawuen Ahoblie, Account Manager
6/26/19
31 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Ebenezer Ambabeng, Deputy Director of Television
Claire Binaong, Director of Marketing
Multi Media Group Focus Group Discussion
Daniel Hestachi, Finance Manager
David Max-Fugar, General Manager - Sales
6/26/19
National Population 
Council 
Dr. Leticia Adelaide Appiah, Executive Director
Elton Owusu, Head of Administration
6/27/19
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 32
ANNEX C. COMMUNICATE FOR HEALTH DATA TABLE
Baseline 
(DHS 
2014)
Baseline 
cross￾sectional 
survey 
(IVR 
2017)
Baseline 
Panel 
Survey 
(IVR 
2017)
Follow￾Up 
Panel 
Survey 
(IVR 
2018)
Endline
MNCH
Outcome: Percentage of women 
age 18-49 years with a live birth in 
the 5 years preceding the survey 
who delivered in a health facility
73%
Outcome: Facility delivery 88% 88% 88%
Intention: Intended behavior to 
give birth at a health facility
88% 89% 93%
Interpersonal: Self-reported 
interpersonal communication 
about facility delivery for pregnant 
couples 
47% 67%
Recall: Exposure to messages on 
facility delivery
60% 60% 73%
Recall: Exposure to GLLiW 
messages on facility delivery
66%
FP & RH
Outcome: Percentage of 
individuals who used a condom in 
the last three months
19% of 
men and 
11% of 
women
33 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Outcome: Percentage of women 
age 18-49 years who are using a 
modern contraceptive method
22%
Outcome: Use of modern 
contraceptive method
51% 52% 53%
Outcome: Condom use for 
sexually active youth
19% 17% 17%
Intention: Intended behavior to 
use a method to delay pregnancy
65% 71% 74%
Interpersonal: Self-reported 
interpersonal communication 
about using a method to delay 
pregnancy
34% 36% 44%
Interpersonal: Self-reported 
interpersonal communication 
about condom use for sexually 
active youth
41% 43% 41%
Recall: Exposure to messages on 
condoms
 67% 69% 74% 
Recall: Exposure to messages on 
family planning in previous month
 55% 58% 72% 
Recall: Exposure to GLLiW 
messages on preventing or 
delaying pregnancy
 58% 
MALARIA
Outcome: Percentage of children 
under 5 sleeping under insecticide￾treated nets (ITNs)/long lasting 
47% 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 34
insecticide treated nets (LLIN)
Outcome: Percentage of 
pregnant women sleeping under 
insecticide-treated nets 
(ITNs)/long lasting insecticide 
treated nets (LLIN)
43%
Outcome: Self-reported Malaria 
ITN use for adults
33% 39%
Outcome: ITN bed net use in the 
previous night for children under 5 
years living in the household
51% 61% 64%
Intention: Intention for all 
children under five to sleep under 
ITN 
 64% 67% 63% 
Interpersonal: Self-reported 
interpersonal communication 
about malaria prevention
48% 46% 59%
Recall: Exposure to messages on 
malaria in previous month
75% 77% 78%
Recall: Exposure to GLLiW
messages on malaria
68%
NUTRITION
Outcome: Percentage of children 
0-5 months exclusively breastfed.
52%
Outcome: Percentage of children 
6-8 months who received timely 
complementary feeding.
73% 
35 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Recall: Exposure to messages on 
complementary feeding
69% 81% 76%
Recall: Exposure to messages on 
exclusive breastfeeding
 74% 78% 79% 
Recall: Exposure to GLLiW 
messages on complementary 
feeding
65%
Recall: Exposure to GLLiW 
messages on exclusive 
breastfeeding
67%
WASH
Outcome: Percentage of 
households with availability of a 
place for handwashing with soap 
and water
50%
Outcome: Availability of 
handwashing station
44% 51%
Outcome: Always wash hands 
with soap and water
 29% 32% 31% 
Outcome: Soap and water at 
handwashing station
32% 31%
Intention: Intention to wash 
hands with soap and water in the 
next three months
61% 61% 73%
Interpersonal: Self-reported 
interpersonal communication 
about handwashing 
62% 68%
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 36
Recall: Exposure to messages on 
WASH in previous month
64% 65% 79%
Recall: Exposure to GLLiW 
messages on WASH
 72% 
GENDER
Disagree that it is only the 
woman's responsibility to avoid 
getting pregnant
 66% 73% 73% 
Disagree that child care is solely a 
woman's responsibility
62% 66% 68%
37 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
ANNEX D. RESULTS OF C4H CAPACITY STRENGTHENING ACTIVITIES GLEANED AND
VERIFIED THROUGH OUTCOME HARVEST
Legend: 
• Italicized text under each result describes significance of result as reported by beneficiaries and other external stakeholders.
• Code (SYS, ORG, IND) after each result describes the level of the capacity ecosystem to which the result contributes.5
Number Result Notes/Documentation Internal Verification External Verification
HEALTH PROMOTION DEPARTMENT/GHANA HEALTH SERVICE
HP STRUCTURES AND POLICIES
1.1 On April 2, 2019, HPD was elevated to a full 
department within GHS. (SYS)
[Change indicates level of commitment to HP by 
GHS leadership, recognition of HPD’s technical 
capacity, and minimum level of GoG annual 
funding]
● Departmental status 
confers a minimum level of 
assured program funding 
and use of a vehicle.
● Document: Annual 
report
● FGD: HPD staff
● IDI: Former Director of 
HPD
● FGD: Regional Director 
of Health Services, 
Tamale
● FGD: Health Promotion 
Officers
 
5 https://healthcommcapacity.org/sbcc-capacity-ecosystem/
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 38
1.2 In May 2016, the National Health Promotion 
Strategy and Action Plan was published, with 
C4H providing technical inputs and technical 
and financial support for launch. (SYS)
[Strategy and Action Plan helped justify elevation 
of HPD from a division to a department]
● Document: Annual 
report
● Document: Health 
Promotion Strategy and 
Action Plan 
● FGD: HPD staff
● IDI: Former Deputy
Director General of 
GHS
1.3 Between 2013 and 2015, detailed cost 
estimates were developed for the National 
Health Promotion Strategy and Action Plan. 
(SYS) 
[Cost estimates enhanced GHS understanding of 
costs associated with continued and expanded 
operations of health promotion structures].
● Document: Annual 
report
● Document: National 
Health Promotion 
Strategic Plan 
● FDG: HPD staff
● IDI: Director, FH 
Division
● IDI: Former Deputy 
Director General of 
GHS
1.4 In 2015, the national Inter-Agency 
Coordinating Committee (ICC) for SBCC was 
revitalized. (SYS)
[Functional ICC allows HPD to effectively 
coordinate across development partners and 
media outlets, leveraging the unique strengths of 
different partners.]
● UNICEF established 
national ICC.
● In Year 4, membership 
expanded to include 
multilaterals and non￾USAID IPs.
● Document: Annual 
report
● FGD: HPD staff
● FGD: Tamale Regional 
and District Health 
Promotion Officers 
● FGD: UNFPA/Tamale
● FGD: USAID/Tamale
● IDI: Former Head HPD
● Document: TORs
● Former Deputy 
Director General, GHS 
and coach for HPD
1.5 In 2016, regional ICCs were established in 
Northern, Volta, and Western regions. (SYS)
● Northern regional had a 
pre-existing coordination 
group that was expanded 
● Document: Annual 
report
● IDI: Former Director 
General of GHS
● FGD: Tamale Regional 
39 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
[Regional ICCs enable improved coordination of 
SBC activities in USAID priority regions].
and rendered more 
functional.
Health Promotion 
Officers
● FGD: UNFPA/Tamale
● IDI: USAID/Tamale staff
1.6 In Year 5, the resource mobilization subgroup 
of ICC was established. (SYS)
[Sub-committee affords the GHS and other 
development partners a coordinated forum to 
understand and improve upon the allocation of 
funds to SBCC].
● Committee has not yet 
been convened, possibly 
due to lack of funding to 
sustain it.
● IDI: C4H Chief of 
Party
● FGD: USAID staff
● FGD: HPD staff
● Document: List of 
members 
● Document: TORs
1.7 In late 2016, the SBCC Technical Review 
Committee (SBCC-TRC) was established. 
(SYS) 
[Change improved speed and efficiency of the 
review process, reduced duplication of efforts, and 
ensured alignment between SBC outputs and GoG 
policies]
● High potential for 
sustainability: meetings are 
held at GHS and 
organizations requesting 
review support meeting 
costs.
● Document: Annual 
report
● FGD: HPD staff
● FGD: USAID staff
● FGD: WASH4Health 
staff
● IDI: Former Director 
General of GHS
● Document: TORs
1.8 Since late 2017, SBCC-TRC overseen and 
managed by GHS. (SYS)
[Required clearance of all materials through 
SBCC-TRC affords HPD gravitas and authority].
● Led by DG, who 
designates chairs; HPD 
acts as secretariat.
● Duplicative review process 
by USAID is perceived to 
undermine credibility of 
TRC.
● IDI: C4H Chief of 
Party
● FGD: HPD staff
● FGD: USAID staff
1.9 In all project years, annual National Health 
Day/Week events were organized at the 
● C4H has negotiated with 
HPD to limit its support 
● Document: Annual 
report
● FGD: USAID staff
● IDI: Deputy Chief 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 40
national and regional levels for FP, 
breastfeeding, malaria, and child health. (SYS)
[C4H support enabled broad media coverage and 
clear branding for National Health Days, which 
are a priority of the GHS].
for national health 
days/weeks to 4/year.
Health Promoter, HPD
1.10 In 2016, CH4 supported renovation of the 
HPD building in Korle Bu. (ORG)
[Renovation supported credibility and functionality 
of HPD and enabled co-location of HPD and C4H 
staff, which supported ongoing capacity 
strengthening efforts]
● Document: Annual 
report
● IDI: Acting Director of 
HPD
● IDI: Former Director of 
HPD
● IDI: Regional Health 
Promotion Officer, 
Tamale
● IDI: Former Deputy 
Director General of 
GHS
1.11 In early 2017, the HPD Korle Bu auditorium 
refurbished and made available as conference 
space. (ORG)
[Change offers potential for income generation by 
HPD if they are able to rent to other development 
partners for events]
● Auditorium used by other 
GHS units.
● Document: Annual 
report
● FGD: HPD staff
● IDI: Acting Director of 
HPD
GOODLIFE BRAND AND CAMPAIGN
2.1 In Year 1, C4H conducted a comprehensive 
materials review workshop in Koforidua. 
(IND)
● IDI: C4H Chief of 
Party
● Document: Annual 
report
● IDI: Former Deputy 
Director General of 
GHS
41 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
[Workshop allowed for rapid dissemination of 
high-quality existing SBC materials during the 
refresh of the GoodLife brand, while helping HPD 
staff gain understanding of indicators of quality in 
materials].
● Document: 
Workshop report
2.2 The GoodLife brand has been endorsed by 
GHS. (SYS)
[GHS, and particularly HPD, feels ownership of 
refreshed GoodLife brand].
● Respondents indicated that 
GHS already felt 
ownership of “first 
generation” GoodLife 
brand developed under 
BCS.
● Some respondents 
expressed concerns that 
GoodLife may eclipse the 
GHS institutional “brand.”
● Many respondents 
expressed profound 
concern that the refreshed 
GoodLife brand would 
“die” without additional 
financial support in the 
short term.
● Document: Annual 
report
● FGD: HPD staff
● IDI: Former Deputy DG 
of GHS
● IDI: Acting Director of 
HPD
● IDI: Regional Health 
Promotion Officer, 
Tamale
● FGD: District Health 
Promotion Officers
● Endorsement of 
GoodLife brand book 
by Minister of Health 
and Director General of 
GHS.
● Endorsement of “Slice 
of Life” Good Life 
extension campaign by 
First Lady in March 
2019.
2.3 In Year 2, the GoodLife brand was refreshed 
through a consultative process with GHS and 
HPD staff and creative partners. (SYS, ORG)
[Refreshed brand introduced a new level of 
creativity and clarity in messaging]
● Activities included 
formative research, 
stakeholder consultations, 
pretesting, and launch.
● Document: Annual 
report
● FGD: C4H 
partners
● FGD: HPD staff
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 42
2.4 In 2017 and 2018, a comprehensive GoodLife 
brand manual was developed and distributed. 
(ORG, IND)
[Detailed manual enables maintenance of 
GoodLife brand by a range of GHS employees].
● HPD respondents report 
conflicts between 
requirements outlined in 
GoodLife brand manual 
and expectations of non￾USG donors.
● Document: Annual 
report
● FGD: HPD staff
● Document: Brand 
manual
2.5 By May 2018, GoodLife social media platforms 
owned, managed, and maintained by HPD. 
(ORG)
[Director General’s office has expressed a desire 
to take over social media platforms, implying 
potential for sustainability].
● HPD has designated staff 
to support maintenance of 
social media platforms, but 
this function is not 
reflected in their position 
descriptions.
● Document: Annual 
report
● FGD: C4H 
partners
● FGD: HPD staff
● SOPs for social media 
platform
● Transition plan for 
social media platforms
2.6 In Year 1, C4H and HPD staff conducted four 
Action Media workshops to inform design of 
GoodLife content. (IND)
[Action Media methodology exposed HPD staff to 
new formative research tool well-suited to design 
of SBCC interventions. Through their participation 
in early workshops, HPD staff was able to 
independently facilitate an Action Media workshop 
in Kumasi].
● FGD: C4H staff
● Document: Annual 
report
● Document: Four 
summary reports, 
four life stage 
briefing books, and 
a consolidated 
briefing book
● FGD: HPD staff
● FGD: Pro-link staff
2.7 In 2015, C4H introduced lifestage-based 
audience segments as the foundation for the 
refreshed GoodLife brand. (SYS)
[GoodLife’s lifestage-based segmentation 
approach resonated widely with stakeholders 
within GHS and provided a comprehensible basis 
● Document: Annual 
report
● FGD: C4H staff
● FGD: C4H 
partners
● FGD: USAID staff
43 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
for an integrated SBC campaign].
2.8 Across all project years, C4H effectively 
negotiated media buys at national and regional 
levels, with significant donation ($2.7M, with 
additional donations expected in Year 5 Q1-2) 
of airtime by television and radio stations. 
(IND)
[Reach of GoodLife and YOLO were extended at 
no cost to USAID or GHS. Project exceeded 
required cost share].
● Radio and TV spots aired 
free of charge by media 
houses in Oct/Nov 2015 
(Y2).
● NPC Director negotiated 
to have YOLO aired on 
prime time (Y3).
● Airtime negotiated for 
NMCP advocacy 
documentary (Y3).
● Reruns of YOLO S1-4 
broadcast on TV3 free of 
charge.
● Email with C4H 
staff
● FGD: USAID staff
● IDI: Acting HPD 
Director
2.9 In Year 3, 60 GHS, HPD, and USAID staff 
participated in a GoodLife radio production 
workshop in Northern region. In Year 5, 50 
GHS, HPD, and USAID IP staff participated in 
a similar workshop in Volta region. (IND)
[Workshops facilitated development of locally 
appropriate content; helped increase appreciation 
of use of data in SBC design among GHS and 
HPS staff; and (in Tamale) laid the foundation for 
the SBCC-ICC].
● Prolink facilitated 
workshops in Volta
● Radio drama will be aired 
live with call-in sessions 
and listeners’ groups
● Document: Annual 
report
● IDI: C4H Chief of 
party
● FGD: Ho CADP grads
● IDI: RHP office staff 
member 
2.10 In Year 2, C4H, the National Population 
Council, and Farmhouse Media linked the 
popular T.V. series YOLO with the GoodLife 
brand. (SYS)
● Document: Annual 
report
● IDI: C4H Chief of 
Party
● IDI: Director, 
Farmhouse Media
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 44
[Establishing a linkage between the two brands 
enabled C4H and HPD to reach young audiences 
with GoodLife content].
2.11 Across the life of project, C4H used four (4) 
mobile phone-based IVR surveys for project 
monitoring in conjunction with HPD and 
Viamo. (IND)
[Lessons learned in use of IVR surveys are unique 
and will contribute to global body of knowledge for 
SBC monitoring and evaluation. Viamo staff 
gained new skills in analysis of SBC-related data].
● Document: Annual 
report
● Document: 
Evaluation reports
● Evaluation team prior 
knowledge
● FGD: C4H partners.
KNOWLEDGE MANAGEMENT
3.1 On April 2, 2019, National SBC Resource 
Center launched at HPD headquarters. (SYS) 
[Resource Center allows for organization, curation, 
and dissemination of SBCC materials that was 
previously impossible].
● Document: Annual 
report
● FGD: HPD staff
● IDI: Former Director 
General of GHS
● IDI: HPD Resource 
Center contact
3.2 In Year 5, Regional SBC Resource Centers 
established in 5 regions. (SYS)
[Regional resource centers are a central location 
that enables district HPOs and other regional 
stakeholders to access and disseminate a wider 
array of curated SBC materials which was 
previously impossible]
● It is not clear to what 
extent Regional Resource 
Centers are functional - 
some appear to lack 
internet access and at least 
one other is not open for 
use
● FGD: C4H Staff
● Quarterly report
● IDI: Regional Health 
Promotion Officer, 
Tamale
● IDI: Regional Health 
Promotion Officer, 
Volta
● IDI: Health Promotion 
Division Materials 
Development and 
45 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
Resource Center 
Officer
3.3 In Year 5, an online database of SBC materials 
produced in Ghana created, maintained, and 
promoted to HP professionals (SYS)
[Database positions HPD as central resource for 
locally produced SBC materials]
● It’s not clear if a 
promotional plan has been 
enacted to date so 
knowledge of the 
existence of the database 
is by word of mouth
● Document: Annual 
reports
● FGD: C4H Staff
● IDI: Health Promotion 
Division Materials 
Development and 
Resource Center 
Officer
HPD REPUTATION AND CAPACITY
4.1 By Year 5, HPD repositioned as a trusted 
technical partner, capable of delivering results 
to other GHS operating units. (ORG)
[As a largely unfunded department, HPD depends 
on the “business” provided by funded GHS 
programs].
● Counterparts in other 
departments noted that 
HPD staff are more 
collaborative and 
responsive since their 
engagement with C4H.
● Document: Annual 
report
● IDI: DG
● IDI: Acting Head of 
HPD
● IDI: Former Head of 
HPD
● IDI: Deputy Program 
Officer, NMCP
4.2 Across the life of project, HPD has been 
funded by a growing number of donors. 
(ORG)
[Funding reflects increased confidence in HPD and 
supports long-term sustainability of HPD 
activities].
● Evaluation received varying 
responses to this question, 
but it appears that CDC, 
PACT, WHO, DFID, JICA, 
GTZ, and UNICEF may 
have provided funding for 
discrete activities in recent 
years.
● GFATM has provided 
funding for airtime 
associated with 
forthcoming IPTp 
● IDI: C4H 
backstops
● IDI: C4H Chief of 
Party
● FGD: HPD staff
● IDI: Former Director, 
HPD
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 46
campaign.
4.3 Sound and timely reporting for fixed amount 
award (per requirements of FAR) 
demonstrated by HPD finance staff. (ORG)
[Demonstrated success of HPD in managing FAAs 
implies readiness for broader government-to￾government funding].
4.4 Across the life of project, HPD engagement 
with media and news outlets was expanded 
and rendered more effective. (ORG)
[Improved engagement of the media enabled 
broad coverage of Good Life events, national 
health days, and other HP activities].
● Document: Annual 
report
● IDI: Acting Director of 
HPD
4.5 Across life of project, confidence and ability of 
HPD staff to negotiate airtime purchases 
improved. (IND)
[HPD staff are confident of their ability to 
effectively negotiate media buys with a variety of 
outlets].
● IDI: C4H Project 
Director
● IDI: Acting Director of 
HPD
● FGD: HPD staff
● FGD: HPD capacity 
strengthening team
4.6 In project Years 2, 3, and 4, seven HPD staff 
and 1 ProLink staff participated in 2 week to 3 
month internships with C4H partners. (IND)
[Interns are more confident in fulfilling specialized 
technical aspects of their roles, including the 
campaign design process and use of social media 
● Y2 - 3 staff at Mullen Lowe
● Y3 - two HPD staff at 
Voto
● Y4 - two HPD + 1 ProLink 
at Voto
● Y4 - four HPD staff at 
Creative Storm to facilitate 
● Document: Annual 
report
● FGD: HPD staff
● FGD: Former interns
47 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
platforms. Interns formed trust relationships with 
host organization staff that facilitate continued 
information exchange and mentoring].
transfer of GoodLife social 
media platforms
4.7 In Years 2016 to 2018, HPD staff participated 
in selection of CADP, SfC, and CCF 
applications. (IND)
[Participation in review and selection processes 
helped HPD staff better understand capacity of 
district-level staff].
● 70 CADP/SfC graduates 
applied for CCF - 15 
applications were awarded
● Document: Annual 
report
● FGD: HPD staff
4.8 In Years 2017 to 2019, HPD staff participated 
in review of IVR survey design and 
interpretation of results. (IND)
[HPD staff feels IVR surveys are a valuable tool 
moving forward - particularly for monitoring and 
reaching illiterate populations.]
● Document: Annual 
report
● FGD: HPD staff
HP STAFFING AND PRE-SERVICE TRAINING
5.1 In 2017, the health promotion diploma 
program at Kintampo College was refined and 
promoted. (SYS)
[Revised curriculum provides more comprehensive 
exposure to health promotion theories and 
concepts than was available to district-level health 
promotion officers previously].
● Revision of curriculum 
rendered it more practical.
● Document: Annual 
report
● IDI: Director, Family 
Health Division
● IDI: Former Director, 
HPD
● IDI: Former Deputy 
Director General
5.2 In Year 1, selection criteria for entry-level 
Health Promotion Officers were refined and 
● Document: Annual 
report
● IDI: Former Director, 
HPD
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 48
standardized. (SYS)
[Health Promotion recognized as a specialized 
area of practice within GSA, lending credibility to 
Health Promotion Officers and preventing 
duplication of efforts among staff at regional and 
district levels].
● Document: Position 
description
IN-SERVICE TRAINING AND PROFESSIONAL DEVELOPMENT
6.1 From 2016 to 2018, HPD staff were actively 
involved in planning, facilitating, coordinating, 
and evaluating Change Agents Development 
Program (CADP) and Set for Change (SfC) 
workshops (IND)
[Engagement in CADP and SfC exposed HPD 
staff to new approaches to capacity strengthening 
and enabled them to better understand the 
practical realities faced by Health Promotion 
Officers at the regional and district levels].
● Document: Annual 
report
● FGD: HPD Capacity 
Strengthening team
● IDI: Former Deputy 
Director General
6.2 In Years 2016 to 2018, the capacity of 70 
national, regional, and district health 
promotion staff was improved via 
participation in the Change Agents 
Development Program (CADP). (IND)
[Improved competencies enabled graduates to 
more effectively fulfill their job functions. 
Competitive application process enhanced the 
visibility and legitimacy of Health Promotion staff 
● Prior to the introduction 
of CADP, HPD conducted 
other, less structured 
health promotion trainings.
● Trained HPD staff member 
served as coordinator for 
CADP.
● Ninety-six percent (96%) 
of graduates reported 
improved skills in 
● Annual report
● Training Impact 
Assessment of 
CADP
● FGD: HPD staff
● FGD: CADP graduates, 
Volta
● FGD: CADP graduates, 
Tamale
● IDI: Deputy Chief 
Health Promoter
49 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
within their teams]. advocacy, partnerships, 
and collaboration following 
CADP. Other areas of 
reported relevance and 
improvement are social 
and community 
mobilization, planning and 
coordinating SBCC; and 
integrating SBCC activities 
into the DHMT. 
● Areas in which graduates 
reported continued 
weakness are: sourcing 
funding and conducting and 
using formative research.
6.3 In Fall 2018[date], a system of text message 
technical reminders for CADP graduates was 
developed and implemented by HPD interns 
at Voto. (IND)
[This activity enabled HPD interns to gain 
practical experience in the use of mobile 
platforms to send health messages and 
reminders].
● Document: Annual 
report
● FGD: Interns
6.4 In Years 2017 and 2018, the capacity of 27 
district health promotion staff was improved 
via participation in the Set for Change (SfC) 
program. (IND)
[Participation improved the confidence, 
motivation, and performance of graduates, as 
● SfC participants maintain 
contact via a WhatsApp 
group moderated by HPD 
staff and continue to 
engage in experience￾sharing and problem￾solving.
● Document: Annual 
report
● FGD: District Health 
Promotion Officers, 
Tamale
● FGD: HPD capacity 
strengthening team
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 50
verified by their colleagues and supervisors].
6.5 In Year 5, 15 graduates of the CADP and SfC
programs implemented competitively awarded 
SBC projects with support from the Change 
Challenge Fund micro grants program. (IND)
[Participation in CCP enabled applied practice of 
skills gained in CADP and SfC and increased 
coverage of high quality community-level health 
promotion activities. The experience of serving as 
mentors improved the ability of HPD staff to 
provide tailored capacity strengthening and 
technical guidance to peers].
● Nearly half of all CADP 
and SfC graduates (42/97) 
applied for the CCF; 15 
grants were awarded.
● CCF grantees were 
mentored by HPD staff, 
Regional Health Promotion 
Officers, and other SBC 
professionals.
● A panel of CCF winners 
presented results of their 
projects at the second 
GHS Maternal and Child 
Health conference in June, 
2019.
● Document: Annual 
report
● FGD: District Health 
Promotion Officers, 
Tamale
● FGD: HPD capacity 
strengthening team
6.6 In Year 5 Q1, select RHPOs began supervising 
CCF projects. (IND)
[Benefit not stated].
● Regional Health Promotion 
Officer, Tamale was not 
aware of any CCF 
beneficiaries in her region
● Document: Annual 
report
● FGD: HPD Capacity 
Strengthening staff
MONITORING AND EVALUATION
7.1 Between Year 1 and Year 5, HPD 
CAT/TOCAT scores for M&E competencies 
improved. (ORG, IND)
[CAT scores provide empirical evidence of 
improved capacity using a recognized tool that 
may be repeated periodically over time].
● Endline has been 
completed, but is not 
publicly available. Evaluator 
verbally confirmed 
improvement.
● FGD: HPD staff
● IDI: Former Deputy 
Director General of 
GHS 
51 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
7.2 Monitoring and evaluation framework for HP 
developed. (SYS)
[The framework enables systematic, systems-level 
measurement of GHS’s investments in SBCC]
● Document: Annual 
report
● FGD: HPD staff
7.3 Data collection tool for measuring health 
behaviors developed, to be used on an as￾needed basis. (SYS)
[Benefit not stated]]
● Rapid assessment tool 
developed by HPD (with 
C4H) to determine 
outcomes (intention, 
attitude, interpersonal, 
taken action)
● Document: Annual 
report
● FGD: HPD Staff
7.4 HP data collection tools refined and validated. 
(SYS) 
[The tools provided a standardized approach to 
monitoring HPD work and the results of that 
work] 
● Registers (primary source 
of data - # of activities 
completed etc.), quarterly 
reporting form (NOT a 
compilation of registers - 
report of behavior 
change), data quality tool 
(done quarterly if funding 
is available)
● Document: Annual 
report
● FGD: HPD staff
7.5 Funding for printing and distribution of HP 
registers secured by HPD. (SYS)
[Without registers, monitoring cannot be 
conducted] 
● C4H printed the first run.
● UNICEF helped fund last 
print run.
● World Bank has agreed to 
fund next print run.
● Document: Annual 
report
● FGD: HPD staff
● UNICEF
7.6 22 SBC/HP indicators introduced into DHIMS 
II. (SYS)
[Introduction of measures into GHS’ official health 
● Document: Annual 
report
● FGD: HPD staff
● FGD: CADP graduates, 
Volta region
● UNICEF
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 52
information system reflects increased prioritization 
of health promotion and enables improved use of 
data for decision-making].
7.7 In Sept 2017 Regional HPOS and HIOs in all 
10 regions trained in DHIMS II. (IND)
[The training helped ensure consistent data 
collection practices among health promotion 
staff.] 
● Document: Annual 
report
● Technical brief on 
inclusion of DHIMS 
indicators
● FGD: HPD staff
7.8 In Year 4, HPD consolidated various 
components of HP M&E system (framework, 
data collection tools, DHIMS indicators) in a 
plan describing the department’s approach to 
M&E. (SYS)
[The plan introduced new coherence and detail 
into HPD’s work in M&E]
● Document: Annual 
report
● FGD: HPD staff
7.9 In Year 4, C4H provided TA to HPD in 
developing a roll out plan for the ongoing 
collection of HP indicators. (SYS)
[This document helped HPD staff to plan regular 
data reviews].
● Data are collected on a 
monthly and quarterly 
basis. Monthly collection is 
for HMIS at the district 
level. Quarterly collection 
is data verification for 
quality. 
● Document: Annual 
report
● FGD: HPD staff
7.10 Beginning in fall 2018[date], HP was data 
validated and improved by GHS staff on an 
ongoing basis. (SYS)
[Regular validation of data by HPD motivates 
● HPD staff and CADP 
participants oriented to 
FHI360 PDVIT tool
● Data validated on a 
quarterly basis
● Document: Annual 
report
● FGD: HPD staff
53 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
regional officers collect it].
7.11 Beginning in Year 4 Q1, C4H engaged RHPOs 
and selected TOHPs based in USAID priority 
regions to conduct Manual Media Monitoring 
(MMM). (IND, SYS)
[Structured media monitoring helps GHS staff 
hold media outlets accountable for 
agreements/airtime purchases]. 
● Document: Annual 
report
● IDI: RHPO, Volta region
7.12 In Year 5, HPD lead supportive supervision 
and coaching visits to districts/facilities to 
ensure high quality HP data in DHIMS II. (??)
[This exercise enabled HPD to demonstrate their 
skills in data quality assurance and reinforced the 
importance of collecting health promotion data].
● Document: Annual 
report
● IDI: UNICEF C4D 
Officer.
● FGD: HPD staff
7.13 In Year 5, HPD staff began participating in the 
M&E Community of Practice (MECOP) hosted 
by Evaluate for Health. (IND, ORG)
[Staff have enhanced their skills in a number of 
research, monitoring, and evaluation areas, 
including qualitative analysis, quantitative analysis, 
and survey development].
● Held quarterly since June 
2015. HPD M&E team has 
attended 17 meetings. It is 
run by Evaluate for Health.
● Document: Annual 
report
● FGD: HPD staff
LOCAL NGO
8.1 In 2017, Pro-link/Infinity970 HR policies 
updated per results of Pre-Award assessment. 
(ORG)
● Document: Annual 
report
● FGD: Pro-link staff
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 54
[Benefit not stated].
8.2 Pro-link/Infinity970 staff facilitated Action 
Media workshop to gather insights on key 
populations (MSM and CSW). (IND)
[This workshop showcased Pro-link/Infinity970’s 
deep experience with key populations and 
introduced Pro-link/Infinity970 and GHS staff to a 
new formative research methodology].
● FGD: Pro-link staff
8.3 From August December 2018, Pro￾link/Infinity970 Monitoring and Evaluation 
Officer was seconded to C4H. (IND)
[Secondment allowed Pro-link/Infinity970 
employee to gain extensive applied skills in media 
monitoring; design, collection; and analysis of IVR 
surveys].
● FGD: C4H staff ● FGD: Pro-link staff
8.4 In September 2018Year 5, Pro-link/Infinity970 
staff facilitated a GoodLife radio production 
workshop in Volta region. (IND)
[Experience afforded Pro-link/Infinity970 staff 
exposure to radio production processes].
● Document: Annual 
report
● FGD: Pro-link staff
USAID/GHANA IPS 
9.1 In Years 3 and 4, C4H collaborated with 
WASH4Health to develop eight radio spots. 
(SYS)
● Document: Annual 
report
● FGD: WASH 4 Health 
staff
55 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
[Spots were of higher quality and received faster 
TRC approval than they otherwise would have].
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 56
ANNEX E. DOCUMENTS REVIEWED BY EVALUATION TEAM
COMMUNICATE FOR HEALTH OFFICIAL DOCUMENTS
● USAID Request for Applications: Communicate for Health (Contains original scope of work) 
● Amendment#2.pdf
● Technical Application USAID Communicate for Health
● MOU_USAID & GHS for the implementation of USAID Communicate for Health Project in 
Ghana 
QUARTERLY AND ANNUAL REPORTS
● YR 1 Reports: Q1/Q2, Q3, Q4/Annual
● YR 2 Reports: Q1, Q2, Q3, Q4/Annual
● YR 3 Reports: Q1, Q2, Q3, Q4/Annual
● YR 4 Reports: Q1, Q2, Q3, Q4/Annual
● YR 5 Reports: Q1, Q2
ANNUAL WORKPLANS
● YR 1: Narrative and Costed workplans
● YR 2: Narrative and Costed workplans
● YR 3: Narrative and Costed workplans
● YR 4: Narrative and Costed workplans
● YR 5: Narrative and Costed workplans
LIT REVIEWS AND FORMATIVE RESEARCH
● Communicate for Health Gender Assessment 2015
● Selected Literature Review on Behaviors, Attitudes, Knowledge Levels, Promoters of and
● Barriers to Action in Family Planning/Reproductive Health, WASH, Nutrition, Malaria, Maternal 
and Child Health, and HIV/AIDS, 2015
● A Summary of Key Behaviors and Gaps from a review of literature conducted by the 
Communicate for Health Project in Table Format 2018 
● GCRN Community Consultations for Adolescent Sexual and Reproductive Health and Rights 
2018 
● GCRN Lit Review for Adolescent Sexual and Reproductive Health and Rights 2018
● GCRN USAID HPN Partners Meeting Presentation 2018
● Qualitative Assessment of Key GoodLife Messages and Behaviors 2019 
57 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
INTERACTIVE VOICE RESPONSE (IVR) AND OTHER SURVEYS 
● Communicate for Health Final Activity Monitoring and Evaluation Plan (AMEP)
● Cross Sectional Survey – Wave 1: March 2016
● Baseline Survey: Assessing Communication Messages, Behavior Determinants and Behaviors 
Among Target Audiences in Ghana, June 2017
● Follow up Survey: Assessing Communication Messages, Behavior Determinants and Behaviors 
Among Target Audiences in Ghana, September 2018
● Omnibus Survey: Assessment of GoodLife Live it Well Campaign, 2018
● Survey research with a random digit dial national mobile phone sample in Ghana:
● Methods and sample quality. (Abstract 2018) 
● Assessing mass media exposure and behaviors in an integrated
● health communication campaign in Ghana: Innovations in the use
● of mobile phone technology and random digit dialing (Life Stage IVR Poster)
ACTION MEDIA REPORTS
● Adolescent Action Media Report, Wenchi, Brong Ahafo Region 2015
● Young Adults in Relationships Action Media Report, North Tongu District, Volta Region 2015 
● Pregnant Couples Action Media Report, Winneba, Central Region 2015
● Parents and Caregivers of Children Under Five Action Media in Tamale, Northern Region 2015
● Life Stage Briefing Book for Health Communicators Adolescents aged 15-19 
● Life Stage Briefing Book for Health Communicators Parents of children under five
● Life Stage Briefing Book for Health Communicators Pregnant Couples 18-49 
● Life Stage Briefing Book for Health Communicators Young Adults in Relationships
● C4H Action Media Composite Briefing book, key concepts from Action Media Research in 
Ghana 
● Action Media Data Interpretation and Program Development 2015 
● Enhancing Support for HIV Care for Men Who Have Sex with Men and Female Sex Workers in 
Ghana 
● Mobilising Social Support for Key Populations in Ghana action Media to Address the HIV 
Continuum for Men Who Have Sex with Men: Ahanta, Ghana
● Mobilising Social Support for Key Populations in Ghana Action Media to Address the HIV 
Continuum for Sex Workers: Ada, Ghana
● Action Media to Inform the HIV Continuum Mobilising Support for Key
● Populations in Ghana, 2017
● Action Media for Health Communication in Ghana: Training of Trainers 2015
MAJOR MEDIA REVIEW AND PRODUCTION WORKSHOP REPORTS
● GoodLife, Live it Well Campaign Materials Review Report, Koforidua 2015
● Materials Design and Production Workshop for Northern Ghana Report, Tamale 2017
● GoodLife Radio Drama Series Production Workshop, Ho 2019 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 58
● CAPACITY BUILDING CURRICULA, ASSESSMENTS AND TOOLS
● Social and Behavior Change Communication Capacity Assessment Tool SBCC-CAT
● Capacity Building Support Plan for The Health Promotion Department 
● Ghana Health Service 2016.
● Ghana Health Service Health Promotion Department Report on Social and Behavior Change 
Communication Capacity Assessment August 2015
● Curriculum for the Change Agent Development Program 2017
● Facilitators Handbook Change Agent Development Program
● Set for Change Action Learning Sets for Technical Officers in Health
● Promotion Participants Handbook
● Change Challenge Fund Management Policy and Procedures, February 2016
● Change Challenge Fund Technical and Financial Proposal
● Participants Handbook Change Agent Development Program
● Action Learning Sets for Technical Officers in Health Promotion: Participants Handbook Set for 
Change. June 2016 
● Job Description Technical Officer Health Promotion.docx
● Change Agent Development Programme Training Impact Assessment Report 2017 
● Strengthening the Collective Capacity of an SBCC System (poster presentation)
HEALTH PROMOTION DIVISION
● Revised National Health Promotion Policy
● National Health Promotion Strategic Plan 2015- 2019 
● HPD Job Descriptions (developed with support from C4H)
● Health Promotion Journey Video 2019 (commemorating HPD being elevated to divisional 
status)
INTERNSHIPS 
● Communicate for Health Internship Report: Viamo - March 2018 
● Social Media Transition: Interns Training Communicate for Health: Creative Storm Networks 
April 2018 
● PRO-LINK/INFINITY970 
● Pro-Link Selection Justification to USAID 2016
● Pro-Link Selection Justification to USAID 2017
● SBCC Capacity Assessment of Pro-Link/Infinity970 2017
MASS MEDIA CAMPAIGNS 
● GoodLife Brand Manual (includes GoodLife Manifesto and GoodLife Brand Wheel)
● GoodLife Refreshed Strategy (Mullen Lowe PPT)
● The GoodLife Strategy and Campaign Approach (Mullen Lowe PPT) 
59 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
● Goodlife Phase II “Slice of Life” Communication Materials Pretest Report (Mullen Lowe PPT)
● Roll out Plan YOLO Season Five 
● YOLO Season Five Premiere Report 
● YOLO Season Five Premiere Plan (Appears twice on the drive )
● YOLO Season Five Production Plan 
● YOLO Season Five Premiere with USAID Ambassador Video (Farmhouse Productions)
● GoodLife Live it Well National Launch Video (Mullen Lowe)
SPECIAL CAMPAIGNS 
● Change Challenge Fund: HPD (see also capacity building)
● CE4MP Program Description: HPD
GOODLIFE RADIO SPOTS (Includes English and other language versions)
● GoodLife Teaser Campaign (Mullen Lowe 2016)
● GoodLife Reveal Campaign (Mullen Lowe 2016) 
● GoodLife Tacticals (Mullen Lowe 2016/17)
● GoodLife Story Series (Creative Storm Networks 2018)
● GoodLife “Slice of Life” (Mullen Lowe 2018/19)
● GoodLife First Lady of Ghana spots (Mullen Lowe 2019)
● Water, Sanitation and Hygiene Spots (with WASH for Health)
GOODLIFE Television SPOTS (Includes English and other language versions)
● GoodLife Teaser Campaign (Mullen Lowe)
● GoodLife Reveal Campaign (Mullen Lowe)
● GoodLife Story Series (Creative Storm Networks)
● “Slice of Life” Campaign (Mullen Lowe)
● First Lady Personal Testimonies (Mullen Lowe)
● YOLO Advert: Choices (Farmhouse Productions)
● YOLO Advert: To Buy/Not Buy (Farmhouse Productions)
TELEVISION SCRIPTS AND EPISODES
● YOLO Season 3: 13 scripts and episodes (Farmhouse Productions)
● YOLO Season 4: 13 scripts and episodes (Farmhouse Productions)
● YOLO Season 5: 13 scripts and episodes (Farmhouse Productions)
● Maternal Health Channel: Episodes 1 – 9 (Creative Storm Networks)
● Maternal Health Channel: Three malaria episodes in Twi 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 60
SPECIAL DOCUMENTARIES
● Malaria Advocacy Documentary: “End Malaria for Good”: 26-minute version (Creative Storm 
Networks)
● Malaria Advocacy Documentary: Five-minute version (Creative Storm Networks)
● YOLO Season Three Documentary (Farmhouse Productions)
● YOLO Season Five Documentary (Farmhouse Productions) 
● YOLO Season Five Premiere starring the US Ambassador (Farmhouse Productions)
● Reaching higher: The Journey of Health Promotion in Ghana - Documentary (Mullen Lowe) 
● Ghana “Engage” Advocacy Documentary: Production by National Population Council translated 
into Twi for high level advocacy initiatives 
PRINT MATERIALS
● GoodLife Brochure
● GoodLife Posters (11 Total)
● GoodLife Billboards
● YOLO Season Five Posters (12 Total)
● Malaria Advocacy Brochure
● Pull up banners (GoodLife, Health Promotion Division, Resource Center)
● GoodLife malaria posters with VectorWorks (2 total)
GOODLIFE SOCIAL MEDIA LINKS
● Facebook
● Twitter
● Instagram
SPECIAL POWERPOINTS, PRESENTATIONS AND PAPERS
● Activity Brief USAID Communicate for Health Ghana 2016
● Activity Brief USAID Communicate for Health Ghana 2018 
● Second SBCC Summit in Nusa Dua, Bali 2018 
● “Engaging young adults and popularizing health for a new generation” (oral)
● “Refreshed and integrated mass media campaign for health in Ghana “(oral)
● “Assessing mass media exposure and behaviours in an integrated health communication 
campaign in Ghana, Innovations in the use of mobile phone technology and random digit dialling” 
(oral and poster)
● “Strengthening the Collective Capacity of an SBCC System (poste)
● FHI 360’s Annual Global Digital Health Forum: “Who completes a longitudinal RDD-IVR-mobile 
phone survey in Ghana? Response rates and sample quality for youth and young adults, pregnant 
couples, and caretakers of young children” 2018
61 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
● Using Mass Media as A Tool for Malaria Prevention and Control: Lessons from Ghana. Roll Back 
Malaria Summit in Tanzania 2017
PUBLICATIONS
● L’Engle K, E Sefa, E Adimazoya, E Yartey, R Lenzi, C Tarpo, N Heward-Mills, K Lew, Y Ampeh. 
2018. Survey research with a random digit dial national mobile phone sample in Ghana: Methods 
and sample quality. PLoS ONE 13(1): e0190902 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 62
ANNEX F. FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY 
BUILDING SUPPORT OF USAID COMMUNICATE FOR HEALTH 
TO HEALTH PROMOTION DIVISION, 2015–2019 (MAIN
DOCUMENT, VOLUME ONE) 
63 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
ANNEX G. FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY 
BUILDING FOR HEALTH PROMOTION DEPARTMENT, 2015-2019 
(UNEXPECTED OUTCOMES, VOLUME TWO)
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 64
ANNEX H. USAID COMMUNICATE FOR HEALTH: ASSESSING 
COMMUNICATION MESSAGES, BEHAVIOR DETERMINANTS AND 
BEHAVIORS AMONG TARGET AUDIENCES IN GHANA. FINAL 
SURVEY REPORT. NOVEMBER 2019.
65 | END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT
ANNEX I. ADDENDUM TO FINAL EVALUATION REPORT
USAID Ghana Communicate for Health 
Page 7
“The lack of a consistent theory of change also serves to undermine Communicate for Health’s 
monitoring and evaluation efforts: determinants cited in program documents are not consistently 
measured in internal or external evaluations, making it difficult to infer a causal relationship between 
exposure, change in determinant, and change in behavior. Lastly an explicit theory of change may 
have allowed the project to better illustrate the disconnect between the design of the project and 
expected outcomes.”
Note: Communicate for Health’s monitoring and evaluation system was limited from the beginning due 
to other competing priorities for mass media-based programing. Future project designs can and should 
include a requirement for a comprehensive theory of change, an expanded list of indicators to measure 
behavior change and a robust M&E system to record and account for changes in determinants. 
Page 12
● The GoodLife campaign engaged men to improve health seeking behavior within families, but 
campaign messaging may have inadvertently validated or reinforced inequitable power relations 
within couples.
Note: Addressing inequitable power relations and gender norms has been an important consideration 
during the development of mass media programming to the extent possible given the short radio and TV 
format used (60-120 seconds) and the requirement to pack as much information and messaging in 
campaign spots while making the programming relevant and entertaining to the Ghanaian context. 
Programming was vetted by technical and Gender and Social Inclusion (GESI) specialists and rigorously 
pre-tested with audiences prior to broadcast for message fidelity. Communicate for Health’s longer 
format programming (You Only Live Once—YOLO) and the Maternal Health Channel provided 
opportunities to unpack and address more complex gender and social inclusion norms. 
Follow-on programming and projects should be on constant guard to address potential promotion of 
inequitable power relations in its mass media programming. It is recommended that future USAID 
project designs for SBC and GESI interventions in Ghana look to directly engage media production 
houses, the entertainment community and news outlets to proactively address and combat the 
presentation of gender-based violence and gender stereotypes. 
Communicate for Health has also recommended to GHS/HPD to include an addendum to the GoodLife
Brand Manual to address this concern. The addendum will outline clear gender integration guidelines 
and principles to produce SBCC materials. 
Page 19
● HPD staff have effectively taken over management of GoodLife’s social media platforms, but the 
quality of the platforms has decreased and their future is unclear.
Note: After the Evaluation, the project worked with the Director General of the GHS and the Acting 
Director of the HPD Division to migrate the GoodLife social media platform and the National SBCC 
Resource Centre which includes an E-Library onto the Government of Ghana’s platform via the 
END-OF-PROJECT PERFORMANCE EVALUATION OF USAID/GHANA’S COMMUNICATE FOR HEALTH (C4H) PROJECT | 66
National Information Technology Agency (NITA). NITA is the Government of Ghana Agency 
responsible for coordinating all Information, Communication Technology (ICT) needs of Ministries, 
Departments and Agencies. 
With the migration process completed and a commitment by the Director General to pick up the costs 
for hosting both initiatives once Communicate for Health comes to a close, there is increasing potential 
for long term sustainability and quality of the GoodLife social media platform. 
Page 21
“However, given the looming project close-out date, HPD staff are concerned they do not have 
administrative oversight over the administrative and IT functions necessary to operate and manage the 
centers once the project ends. This has implications for the functionality of the center and capacity of 
HPD to manage and troubleshoot the system as needed.”
Note: The issue about administrative rights has since been resolved. Additional training for key 
managers was organized in November for eight HPD staff to further strengthen and consolidate their 
capacity to manage the resource center.
FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING 
SUPPORT OF USAID COMMUNICATE FOR HEALTH TO HEALTH 
PROMOTION DIVISION, 2015–2019
MAIN DOCUMENT
(VOLUME ONE)
AUGUST 2019
(final edit November 2019)
Dr George Kwadwo Amofah
Public Health Consultant
1 
FINAL DRAFT ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING SUPPORT OF USAID 
COMMUNICATE FOR HEALTH TO HPD, 2015-2019
VOLUME ONE
Dr George Kwadwo Amofah, Consultant
AUGUST 2019
Edited October 2019
2 
Table of Contents 
List of Figures............................................................................................................................................... 4
List of Tables................................................................................................................................................ 5
List of Acronyms.......................................................................................................................................... 6
ACKNOWLEDGEMENTS............................................................................................................................... 7
EXECUTIVE SUMMARY ................................................................................................................................ 8
METHODOLOGY....................................................................................................................................... 8
ASSESSMENT FINDINGS .......................................................................................................................... 8
LESSONS LEARNED ................................................................................................................................11
CHALLENGES AND GAPS .......................................................................................................................11
RECOMMENDATIONS............................................................................................................................12
INTRODUCTION.........................................................................................................................................14
BACKGROUND .......................................................................................................................................14
CONTEXT................................................................................................................................................15
USAID Communicate For Health Project and Capacity Building Support Plan (CBSP) for HPD.........16
Endline Technical and Organizational Capacity Assessment ..............................................................19
Endline Technical Training Outcome Assessment...............................................................................20
Definitions and Framework for Assessment........................................................................................20
STRUCTURE OF REPORT........................................................................................................................22
CHAPTER ONE: BASELINE SITUATION ANALYSIS OF HPD CAPACITY.......................................................24
1.1 BOTTLENECK ANALYSIS...................................................................................................................24
1.2 TECHNICAL AND ORGANIZATIONAL CAPACITY ASSESSMENT IN 2015.........................................24
CHAPTER TWO: TECHNICAL PERFORMANCE OUTCOME ASSESSMENT.................................................26
2.1 ENDLINE TECHNICAL AND ORGANIZATIONAL CAPACITY ASSESSMENT OF HPD.........................26
2.2 EVIDENCE IN SUPPORT OF ORGANIZATIONAL CAPACITY IMPROVEMENT ..................................27
2.3 CADP Training (Baseline Training Process Indicators, 2016) ........................................................29
2.4 ENDLINE INDIVIDUAL TRAINING OUTCOME ASSESSMENT, 2019 ................................................34
2.5 EXAMPLES OF SUCCESS STORIES AND PERFORMANCE ENABLERS, 2019....................................41
2.6 VALIDATION BY SUPERVISORS OF CADP AND SfC PARTICIPANTS, ENDLINE 2019 ......................42
CHAPTER THREE: INPUTS, PROCESSES AND OUTPUTS ...........................................................................44
3.1 CHANGE CHALLENGE FUND ...........................................................................................................44
3.2 CO-LOCATION..................................................................................................................................48
3.3 CAPACITY BUILDING IN FINANCIAL MANAGEMENT......................................................................49
3 
3.4 CAPACITY BUILDING IN PROPOSAL WRITING ................................................................................50
3.5 INTERNSHIP .....................................................................................................................................50
3.6 GENDER ASSESSMENT AND TRAINING ..........................................................................................52
CHAPTER 4: CONCLUSIONS OF STRENGTHS/KEY ACHIEVEMENTS AND WEAKNESSES.........................54
4.1 Summary of Conclusions of Strengths, Weaknesses/Challenges per ToR...................................54
CHAPTER FIVE: RECOMMENDATIONS......................................................................................................61
REFERENCES ..............................................................................................................................................63
APPENDICES...............................................................................................................................................65
Appendix 1: List of Interviewees for End Line Assessment of HPD ....................................................65
Appendix 2: The primary design documents of the CBSP...................................................................71
Appendix 3: Endline Individual Training Outcome Assessment Tool (Beneficiary and Supervisors) 89
Appendix 4: Detailed Comparison of Organizational Capacity Assessment of HPD, 2015 and 2019
................................................................................................................................................................97
 
4 
List of Figures 
Figure 1 Monitoring and Evaluation Framework; Source: GHS/PPME...................................................23
Figure 2 Comparison of pre and post assessment of organizational capacity, 2015 and 2019. Endline 
2019...........................................................................................................................................................27
Figure 3 Comparison of pre- and immediate post-training individual assessment score for CADP 
cohort 1, 2016...........................................................................................................................................31
Figure 4 Comparison of Pre- and immediate Post Training Assessment Scores for CADP cohort 2 
participants, 2017. Source: USAID C4H Y3 annual report.......................................................................32
Figure 5 Comparison of Pre- and immediate Post Training Assessment Scores for CADP cohort 3 
participants, 2017. Source: USAID C4H Y4 annual report.......................................................................33
Figure 6 Comparison of CADP outcome assessment by Cohort, End line 2019....................................35
Figure 7 Comparison of self-assessed performance by SfC cohorts 1 and 2/3, End Line 2019............38
5 
List of Tables 
Table 1. Capacity and Performance Variables Defined...........................................................................21
Table 2 Comparing before and after scores for CADP participants by cohort, Endline 2019...............36
Table 3. Comparison of application of knowledge and skills by CADP cohort before and after training, 
Endline, 2019.............................................................................................................................................37
Table 4 Comparison of what has been done before and after training, CADP by cohort, Endline 2019
....................................................................................................................................................................37
Table 5 Comparing SfC participants before and after by cohort, Endline 2019....................................39
Table 6 Comparison of application of knowledge and skills by SfC cohort, Endline 2019....................39
Table 7. What has been done differently by SfC cohorts, Endline 2019................................................40
Table 8 Relevance of training by CADP cohort........................................................................................40
Table 9 Relevance of SfC training by cohort, 2019 .................................................................................41
Table 10 CCF beneficiaries and topics of their proposals.......................................................................44
6 
List of Acronyms 
2YL Second Year of Life
CAD Change Agent Development
CADP Change Agent Development Plan
CAT Capacity Assessment Tool
CBSP Capacity Building Support Plan
CCF Change challenge Fund
CDC Centers for Disease Control
CHPS Community Health Planning & Services
CPD Continuous Professional Development
DHIS District Health Information System
ER#2 Expected Results Area 2
FAA Fixed Amount Award
FHD Family Health Division
GHS Ghana Health Service
GoG Government of Ghana
HIO Health Information Officer
HMIS Health Management Information System
HP Health Promotion
HPD Health Promotion Department
HPO Health Promotion Officer
IKG In Kind Grant
JICA Japanese International Cooperation Agency
M&E Monitoring & Evaluation
MCH Maternal and Child Health
MOH Ministry of Health
MOU Memorandum of Understanding
NGOs Non-Governmental Organizations
PD Program Development 
PPME Policy Planning Monitoring and Evaluation
SBCC Social and Behavior Change Communication
TRC Technical Review Committee
SfC Set for Change
SOPs Standard Operations Procedures 
TOA Technical Outcome Assessment
TOHP Technical Officer Health Promotion
ToR Terms of Reference
USAID United State Agency for International Development 
WASH Water Sanitation and Hygiene
7 
ACKNOWLEDGEMENTS 
I take this opportunity to express my sincerest thanks to USAID Communicate for Health for the 
opportunity afforded me to facilitate in aspects of the design and implementation of its capacity 
building support to the Health Promotion Department. I am extremely grateful for the confidence 
reposed in me to conduct the endline assessment of the capacity building support to Health 
Promotion Department. It has been a privilege and a period during which I have learned much in the 
various roles I played.
I thank the officers of Health Promotion Department for the reception they accorded me throughout 
the period of my engagement with them. It is my hope that, collectively, we shall all continue to 
endeavor to make the new Health Promotion Division achieve the objectives for which it was 
created.
I thank all the respondents and persons interviewed from the national, regional and district levels for 
spending precious time to provide very useful responses and comments that formed the content of 
the report.
Special thanks go to Mr. Saul William Evans of USAID Communicate for Health for providing all the 
documentation that enabled me to complete the assessment.
8 
EXECUTIVE SUMMARY 
The main objective of the endline capacity assessment of USAID Communicate for Health’s capacity 
building support to the Health Promotion Department (HPD) is to determine the level of 
improvement in its technical capacity to develop, design and implement theory-informed, evidence￾based social and behavior change communication (SBCC) programs. 
In 2015, USAID Communicate for Health initiated a capacity building project, which envisaged 
providing capacity building support to national, regional and district level health promotion staff to 
enable them to deliver on their mandate. In order to achieve this objective, a Capacity Building 
Support Plan (CBSP) was developed. The CBSP was designed to be an integrated, mutually re￾enforcing technical capacity building plan with core elements initially envisaged to include the 
following:
1. Change Agent Development Program (CADP)
2. The Set for Change (SfC) Action Learning Sets
3. Internship programs for national and/or regional staff to work with USAID Communicate for 
Health core partners to learn elements of SBCC skills on the job
4. Change Challenge Fund
5. Co-location: This was conceived within the context of Action Learning where the “Learning by 
Doing Model” was operationalized
METHODOLOGY 
A mixed method, combining qualitative and quantitative approaches, was adopted for the 
assessment. The process included desk and literature reviews, key informant interviews, and field 
visits to four of five USAID focus regions, as well as baseline and endline (2019) self-assessments by 
HPD officers of their organizational and individual technical capacity improvements, using the same 
outcome assessment tools as in May–Jun 2019. 
ASSESSMENT FINDINGS 
A. Organizational technical capacity assessment of HPD to lead design, development, 
coordinate, and implement evidence-based SBCC campaigns showed that the endline 
organizational technical capacity assessment of performance increased from 58% in 2015 to 
83.9% in 2019, an actual increase of 44.6%. See figure below. 
9 
Fig. 2 Comparison of pre- and post-assessment of organizational capacity, 2015 and 2019. Endline 
Assessment 2019
B. There were three CADP training sessions over the period of support. Cohort CADP 1 
participants assessed themselves highest as very high performing at endline (30%), followed 
by cohort 3 CADP participants (17.4%) and then cohort 2 CADP participants (11.1%). The 
observed differences were statistically significant (Fishers’ exact test of independence, 
p<0.001) [Table i]. 
Table 2 Comparing before and after scores for CADP participants by cohort, Endline 2019
Performance Level
Non performance Low performance Average performance High performance Very high performance P-value
Cohort 1 <0.001
Before (n=20) 0 15 65 20 0
After (n=20) 0 0 0 70 30
Cohort 2 <0.001
Before (n=18) 0 16.7 61.1 11.1 11.1
After (n=18) 0 0 16.7 72.2 11.1
Cohort 3 <0.001
Before (n=23) 0 21.7 60.9 17.4 0
After (n=23) 0 0 21.7 60.9 17.4
NB: All values within that table represent row percentages, n = frequency of participants. P-value was obtained from 
Fishers’ exact test of independence
10
C. There were two training sessions for TOHPs: SfC cohort 1 and SfC combined cohorts 2 and 3. 
In cohort 1, 33.3% assessed themselves in 2019 as very high performing in application of 
knowledge and skills acquired from the trainings, compared with 0% in 2016 before training. 
In SfC cohorts 2 and 3, 26.3% of participants combined assessed themselves in 2019 as very 
high performing in application of knowledge and skills acquired from the trainings compared 
with 6.7% in 2017 before training [Table ii]. 
Table 5 Comparing SfC participants before and after by cohort, Endline 2019
Performance Level
 Non 
performance
Low 
performance
Average 
performance
High 
performance
Very high 
performance P-value
Cohort 1 0.005
Before (n=9) 11.1 11.1 77.8 0 0
After (n=9) 0 0 22.2 44.4 33.3
Cohort 2/3 0.001
Before (n=15) 6.7 0 73.3 13.3 6.7
After (n=15) 0 0 13.3 60 26.7
NB: All values within the table represent row percentages, n = frequency of participants. P-value was 
obtained from Fishers’ exact test of independence.
Fifteen CADP and SfC participants have so far received initial funding for various SBCC 
projects at the local level. The evidence so far shows that they are able to negotiate with 
stakeholders, and their working relations with colleagues have improved enabling them to 
mobilize community and others to support their planned SBCC projects. 
Co-location: USAID Communicate for Health project team co-located with the HPD at 
national level to facilitate the application of an effective and efficient form of institutional 
and individual capacity building to ensure local ownership and sustainability. USAID 
Communicate for Health staff supported, coached, and problem-solved with their HPD
counterparts, enabling them to take the lead in planning, implementing, and monitoring 
SBCC project activities.
D. Internship: To complement the CADP and SfC training programs, the CBSP included 
promotion of an internship program where officers were embedded into private sector 
institutions (Mullen Lowe, VIAMO, and Creative Storm Networks) for hands-on practical 
training in various aspects of SBCC programs. 
The internship at Mullen Lowe has enhanced the technical capacity of the materials development 
unit of HPD and has contributed greatly to the attraction of SBCC contracts from various partners 
and their successful execution. 
The internship with VIAMO provided opportunities for two HPD staff to develop knowledge and skills 
in how to plan, design, and deploy SBCC campaigns using cutting edge SMS mobile technology, 
including those used for the project’s mobile phone cohort survey. 
11
Three staff from the HPD and another from the Family Health Division (FHD) had a 3-week internship 
training in 2018 with Creative Storm Networks on social media. Currently, a Social Media Unit has 
been established and operated by HPD officers and partly equipped at the Department to livestream 
activities of the GHS on the various social media platform as part of the structure of the new 
Division. So far, the Facebook page established by the social media unit of HPD has 38,900 likes and 
39,000 followers as of June 26, 2019; Twitter and Instagram have 1302 and 1314 followers
respectively. 
LESSONS LEARNED 
A. Focusing only on “hard” issues of project implementation is not helpful and will result in 
conflicts and delayed implementation of activities due to “cultural” shocks between different 
parties. The “softer” aspects such as attitudinal changes, commitment, and motivation are 
equally important for capacity building. 
B. It is necessary to build conflict resolution mechanisms into projects, such as support from 
senior highly-respected officers with enough clout to intervene when things are not moving 
well.
C. It is important to ensure there is synergy and complementarity of “above the line” and 
“below the line” SBCC efforts to avoid creating a gap in implementation.
D. Co-location and internship approaches enhance performance and improve efficiency, as they
provide opportunity for transfer of knowledge and skills from one partner to another on the 
job rather than in a classroom setting.
CHALLENGES AND GAPS 
CADP and SfC: Despite the carefully planned and executed CADP and SfC training plans, the 
participants scored themselves low in certain areas such as knowledge and skills acquired in 
mobile technology, effective SBCC through TV documentary, understanding social marketing 
and understanding formative assessment in SBCC. 
A. There is a need to revisit the training syllabus and change either the content, facilitators, or 
mode of delivering these topics to include more practical sessions. Currently, the training 
program is dependent on donor support from USAID Communicate for Health and is not 
sustainable if not internalized. 
B. Specific to CCF, owing to delays in release of funds due to circumstances beyond the 
project’s control, only one round of CCF awards had been made as of time of assessment in 
June 2019, although the plan was to make three awards during the entire project lifespan. All 
three tranches of funds were released to the CCF by the end of the project.
12
Co-location: There appears to have been an initial “cultural shock” due to different work 
ethic (public vs. private mentality). This affected the transfer of knowledge and skills from 
USAID Communicate for Health officers to their counterparts at the beginning of the project. 
Internship: One weakness of the internship program for HPD was the limited number of 
officers who benefitted from it: two at VIAMO, three at Mullen Lowe and three at Creative 
Storm Networks. The problem is that the capacity built depends on a few officers who may 
be overburdened as work load increases.
RECOMMENDATIONS 
Based on the interviews, findings, observations, and analysis of all that has happened to HPD from 
2015 to 2019, the following recommendations are made to enhance future capacity building 
initiatives of the new Health Promotion (HP) Division moving forward.
A. Prior to training, conduct a training needs assessment among the officers of HP Division 
based on the defined responsibilities and expected roles of key officers of the new HP 
Division, as well as on the job descriptions of Health Promotion practitioners. 
B. Continue and institutionalize the capacity building effort through CADP and SfC and other 
technical courses to further build capacity of HP officers, while considering weaknesses and 
suggestions provided by participants. Specifically, there must be greater focus on improving 
quality of delivery of topics and practical skill acquisition during the training (including use of 
simulation exercises), and less on theoretical concepts that have not proven that useful for 
the participants. 
C. Explore other ways of providing technical capacity support to HPOs and TOHP to 
complement current CADP and SfC approaches, such as online courses, access to e-books, 
and use of digital applications such as Skype and Zoom for workshops to minimize training 
cost and enhance efficiency. 
D. Advocate for the formalization of modified CADP and SfC by the professional Allied Council as 
a Continuous Professional Development (CPD) course for HP officers. This will serve as an 
incentive for HP officers to participate in such courses.
E. Support the incorporation of CADP and SfC into the curriculum of the Kintampo College of 
Health and Wellbeing and other HP training institutions to improve capacity of trainees at 
pre-service level.
F. Institutionalize the internship capacity building system (two-weeks or so) with creative firms 
or local or international organizations doing media, social marketing, social media or SBCC 
work, for key technical staff. 
G. In addition to SBCC, other areas where capacity building is required and proposed include 
training in leadership and management, advocacy and networking, strategic planning, 
13
resource mobilization, policy development, health promotion practice, knowledge transfer, 
and research.
H. Establish annual best HPO and TOHP awards as envisaged in current National HP Strategy to 
boost morale and encourage competition.
I. Initiate an annual HP conference during which beneficiaries of CADP, SfC, CCF and other 
capacity building initiatives can be invited to showcase what they are doing currently in their 
respective areas after training. Partners can be invited and encouraged to sponsor aspects of 
the program and to make presentations. 
14
INTRODUCTION 
BACKGROUND 
The Health sector in Ghana consists of both public and private health systems distributed across 10 
regions: Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern, Upper East, Upper West, 
Volta and Western Regions. In 2019, the regions were further subdivided into 16 regions. The public 
sector is run by Ghana Health Service (GHS) and teaching hospitals. The private sector is made up of 
faith-based and private-for-profit health institutions. The GHS is a three-tier health delivery system 
of primary, secondary, and tertiary levels. The GHS consists of about 10 divisions, including Family 
Health Division (FHD). 
The primary level is the district level where a district hospital with a medical doctor serves Health 
Centers in Sub-districts with Physician Assistants in charge. In some sub-districts are Community 
Health Planning and Services (CHPS) zones where Community Health Officers (CHOs) work with 
community volunteers to increase access to health care. A typical district with a population of 
100,000 has one hospital, five health centers and 10–15 CHPS zones. The leadership of the district is 
the District Director of Health Services who works with a District Health Management Team and 
reports administratively to the District Chief Executive (Political Head) and technically to the 
Regional Director of Health Service. Komfo Anokye, Korle-Bu, Tamale, and Cape Coast are the 
current teaching hospitals providing tertiary care and training of doctors, though there are a few 
private teaching hospitals emerging that provide the same services. The chief executives of the 
public teaching hospitals report to the Minister of Health through a board. 
At the regional level is the regional hospital, which is the referral level for secondary care and is run 
by general practitioners and specialists. The Regional Director of Health Services oversees all matters 
of health in the region, works with a team (Regional Health Management Team), and reports 
administratively to the regional Minister (Political Head) and technically to the Director General of 
the Ghana Health Service who reports to the Minister of Health through a Council [ MOH/GHS 2013]. 
The HPD has evolved over the years from a unit at the Ministry of Health to a Department of the 
GHS under Family Health Division until April 2019 when it was elevated to the status of a Division of 
GHS. At the national and regional levels are Health Promotion officers (now Health Educator, Health 
Promotion), who hold a minimum of a first degree in Health Promotion (HP) from a recognized 
university, while at the district level are Technical Officers Health Promotion, who have a diploma in 
Health Promotion, trained at the Kintampo College of Health and Wellbeing. As of June 2013, there 
were 70 health educators on MOH payroll and 33 on GHS payroll countrywide. Only 42 out of the 
then 216 districts had Health Promotion Officers as of 2014. Currently, there are about 310 HPOs 
and TOHP in GHS distributed in all the regions and districts of Ghana. Institutions providing training 
to Health Promotion staff are KNUST (Masters in health education and promotion; University of 
Ghana (Bachelors/Master in Public Health Promotion); UCC (Masters in Health Education); College of 
Health Science Kintampo, now called Kintampo College of Health and Wellbeing (Diploma in Health 
Promotion); Catholic University at Fiapre (Public Health Education)); University of Health and Allied 
15
Sciences (Bachelor’s in Public Health (Health promotion)); and UHASS/ Leeds Met. (MSc Public 
Health (Health Promotion) [GHS 2017a]. 
 
CONTEXT 
The practice of Health Promotion (HP) has had a checkered history in Ghana, struggling to be 
recognized as a technical service over the years, even within the Ministry of Health and Ghana
Health Service, mainly due to the promotion of a bio-medical model of health in Ghana. The practice 
of HP has therefore often been an afterthought in the country, with over concentration on curative 
health care and service delivery to the neglect of a preventive, protective, and promotive health 
delivery model that places emphasis on the social determinants of health. Consequently, despite 
several attempts to uplift the image of HP, the discipline has been plagued with low morale due to 
lack of financial and other support, inadequate technical capacity to deliver, as well as weak policy 
and strategic direction, among other issues. 
The first major attempt to provide guidance and policy direction for health promotion in Ghana was 
in 2005 when the first Health Promotion Policy was drafted; this was revised in 2013 due to 
emergence of a number of new issues. To further improve the environment for HP, in 2015, the 
process for the development of a National Strategic Plan was started to attract development 
partners and to facilitate the translation of the HP policy into a plan for easy implementation. Three 
strategic objectives including 1) improved quality of health promotion services, 2) improved healthier 
communities and 3) increased collaboration and partnerships for health promotion were identified
[GHS/HPD 2015]. A number of partners were secured, notably UNICEF, USAID, and WHO had been 
supporting Health Promotion Department over the years, but many gaps remained to be filled (see 
Chapter 1 for details).
It is within this context that USAID, through the Communicate for Health project, entered the scene 
in 2015 to support the Department. after five years of capacity strengthening efforts and with USAID 
Communicate for Health support coming to an end, it has become necessary to assess the Health 
Promotion Department. The purpose of this assessment is to determine the level of improvement in 
its technical and organizational capacity to develop, design and implement theory-informed, 
evidence-based social and behavior change communication programs, which was one of the key 
focus areas for the USAID Communicate for Health project. It is expected that the findings of the 
assessment will also feed into the development of a new Strategic Plan for HP from 2020, as the 
current one ends in December 2019. 
A summary of Terms of Reference (ToR) for the assessment is listed below:
1. Has Health Promotion Department (HPD) increased its capacity from 2015–2019 to lead 
design, development, coordinate, and implement evidence-based social and behavior change 
campaigns?
2. To what extent have Health Promotion Officers (HPOs)) applied the knowledge and skills 
acquired through participation in the CADP to develop proposals, plan, and implement 
evidence based social and behavior change and health promotion campaigns? 
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3. To what extent have Technical Officers for Health Promotion (TOHP) applied the knowledge 
and skills acquired through participation in the Set for Change (SfC) Action Learning Sets 
program to develop proposals, plan and implement evidence-based social and behavior
change and health promotion campaigns?
4. To what extent and in what ways has the Health Promotion Department increased its 
capacity for evidence-based social and behavior change communication through the 
different capacity building approaches rolled out by the Communicate for Health project? 
5. Are there any unintended outcomes resulting from the implementation of the capacity 
building programs, and how have these complemented the intended outcomes? In addition, 
are there any unintended outcomes in HPDs capacity achieved over the life of the project 
that can be attributed to the capacity strengthening efforts of the Communicate for Health 
project?
6. What important successes and lessons can be learned through rollout of the HPD capacity 
building program for future programming?
7. What challenges were encountered during rollout of the capacity building programs that 
could inform the design of future capacity building programs? 
USAID Communicate for Health Project and Capacity Building Support Plan (CBSP) for 
HPD 
USAID Communicate for Health is a five-year USAID funded project (2015–2019) that has been 
working in collaboration with the Health Promotion Department and had three key results areas. 
Expected Result #1: Improved behavior changes in family planning, water, sanitation and hygiene 
(WASH), nutrition, maternal and child health (MCH), and malaria prevention and treatment through 
the development and implementation of social and behavior change communication (SBCC) 
strategies. Expected Results #2 (ER#2): Health Promotion Department (HPD) capacity strengthened to 
effectively coordinate and deliver SBCC and health promotion campaigns. Expected Result #3:
Capacity of one local Social and Behavior Change Communication (SBCC) organization developed and 
strengthened to be a potential direct recipient of USAID funding. This review covers only ER#2, 
which envisaged providing capacity building support among others to national, regional and district 
level health promotion staff, in partnership with other stakeholders, to enable them deliver on their 
mandate. 
In order to operationalize ER#2, a Capacity Building Support Plan (CBSP) was developed in 
collaboration with the then Ghana Health Service Health Promotion Department, local Ghanaian 
partners and international development partners [USAID Communicate for Health, February 2016]. 
The Plan sets forth the following: 
• specific activities available and the associated learning objectives
• for whom these activities are designed 
• how they can be assessed
• how they will be delivered and when 
The CBSP and the curriculum for training were informed by a number of assessments including:
17
• A summary of bottleneck analysis undertaken by HPD in 2014
• A rapid organizational/institutional assessment of the GHS Health Promotion Department 
SBCC knowledge and skills conducted in April/May 2015 among HQ-based Health Promotion 
staff, as well as some staff from Northern, Volta and Western regions 
• Individual assessments of all national staff and staff from the five focus regions 
• A review of the draft job descriptions for HP officers 
• A one-day workshop and group discussion with eight TOHPs from a selection of regions to 
discuss and explore capacity needs and job challenges. 
 
Core Elements of CBSP 
The CBSP was designed to be an integrated, mutually re-enforcing technical capacity building plan 
with core elements envisaged initially to include the following, which is taken and edited from the 
well-articulated CBSP document. A summary of the plan is provided below (see Appendix 2 for 
details) [USAID Communicate for Health, February 2016]: 
Change Agent Development Program: The Change Agent Development Program (CADP) is a 
one-week program designed to strengthen the individual technical capacity of select 
national, regional and district-level staff through technical presentations followed by 
questions and discussion, use of case studies, and practical group exercises. Participants are 
selected after a rigorous clearly defined selection criteria jointly designed by HPD and USAID 
Communicate for Health personnel.
Set for Change: The Set for Change (SfC) Action Learning Sets, as elaborated in the CBSP, is a 
learning set for Technical Officers Health Promotion (TOHP) participants that convenes for 
1.5 days four times over a six-month period; it covers personal development and 
effectiveness, technical skills in problem solving, and development of HP practice in their 
new role. The Set for Change is a hybrid approach that combines an action learning set 
model with taught technical inputs and practical hands-on group work to promote critical 
thinking and problem solving, increase technical knowledge and skills, as well as build 
confidence, create a greater sense of self, and improve personal effectiveness. In addition to 
the action learning component of the SfC, there are taught sessions delivered by experts on a 
range of topics such as Monitoring and Evaluation (M&E), community mobilization, program 
management, and use of mobile technology for SBCC [USAID Communicate for Health, 
February 2016]. 
Gender integration trainings: Gender integration training is designed to improve technical 
competencies in creating gender sensitive programming and activities for national and some 
regional staff. The training is expected to help participants understand how cultural 
practices, traditional beliefs, social, and gender norms can affect our behavior and our 
motivation to change. 
Stretch assignments: The CBSP also was designed to include stretch assignments for regional 
and district level staff to work at the national or regional level on a specific task or activity 
such as developing a campaign or the M&E framework. 
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1. Internship programs. These programs were designed for HP officers to work with USAID 
Communicate for Health’s core partners (Ghana Community Radio Network, VIAMO 
[formerly VOTO Mobile], Creative Storm Networks) and contractors, Mullen Lowe, to learn 
elements of SBCC skills on the job. 
2. Peer Mentoring: Selected past participants of CADP and SfC are expected to offer support 
and mentoring to their colleagues who have yet to have attended a development program. 
Change Challenge Fund: This is a competitive, performance-based grant to allow recently 
trained change agents to conceive, develop, and implement small-scale SBCC 
activities/campaigns at the district or regional level that are aligned with the overarching 
GoodLife strategy. The Change Challenge Fund (CCF) has been set up to ensure CADP and SfC 
participants have the opportunity to use and apply their new knowledge and skills in their 
daily work and are not constrained by lack of resources. The fund is managed through a Fixed 
Amount Award (FAA) by a management board.
6. Post-training motivational support through mobile phone messages, prompts to act and 
reminders on behaviors and practices, refresher tips, quizzes, and games to consolidate 
learning and reinforce the adoption of particular skills or actions on the job was provided to 
all CADP and SfC graduates.
7. Co-location: This was conceived within the context of Action Learning where the “Learning by 
Doing Model” was operationalized [USAID Communicate for Health Project Proposal 2014]. 
The Plan was for the USAID Communicate for Health team to co-locate with the HPD at 
national level to facilitate the application of an effective and efficient form of institutional 
and individual capacity building to ensure local ownership and sustainability. USAID 
Communicate for Health and its partners were expected to work side-by-side with HPD staff 
as a blended team to conceive and implement a comprehensive SBCC and health promotion 
campaign under the Expected Result #2 of the project. 
Methodology 
A mixed method methodology, combining qualitative and quantitative approaches, was adopted for 
the assessment based on the ToR, with triangulation of findings for validation and to generate 
evidence to answer key assessment questions. There was an initial meeting with USAID 
Communicate for Health project staff to clarify ToR and the Scope of Work. 
An inception meeting with the consultant and staff of HPD and USAID Communicate for Health was 
held on April 17, 2019 to:
• Understand the ToR
• Agree on the methodology for carrying out the assessment
• Agree on timelines
• Understand draft interview guides
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• Book appointments 
• Finalize administrative arrangements for interviews and field visits
This was followed by desk review of a number of documents to understand and obtain information 
on the inputs, processes, outputs, and outcomes of HP interventions in support of the HPD by 
various partners, as available, and to obtain baseline and trend of HP indicators. Some of the key 
documents that were reviewed include:
• USAID Communicate for Health, CBSP technical proposal and its Annual Monitoring and
Evaluation Plan (AMEP), [USAID Communicate for Health, 2014] 
• The primary design documents of the Change Agent Development Program, “Set for Change” 
Action Learning Sets, Change Challenge Fund [see Appendix 2]
• USAID Communicate for Health, 2015. Baseline capacity assessment reports of HPD at 
national and in the three regions (Western, Northern and Volta), August 2015. [USAID 
Communicate for Health August 2015]
• USAID Communicate for Health, 2016. Outcome assessment reports of CADP cohorts 1 
[USAID Communicate for Health 2016]
• Pre- and post-training evaluation reports during CADP and SfC training [USAID Communicate 
for Health Annual Report 2016] 
• USAID Communicate for Health annual progress reports, [USAID Communicate for Health, 
2015-9] 
• USAID and GHS Memorandum of Understanding (MOU) for the implementation of USAID 
Communicate for Health in 2015 [USAID Communicate for Health, 2018 
• Situation Analysis and bottleneck analysis of HPD in 2014 [GHS 2014] 
• HP Strategic Plan 2015-2019 [GHS 2015]
• Job descriptions for HP Program Managers and Technical Officers [GHS 2019] 
• HPD Annual Reports, 2015-2018
A literature review was also undertaken to understand current thinking about capacity building to 
inform the framework to be adopted. A number of interview guides were developed for individual 
and institutional assessment, and an orientation session was organized for interviewers to familiarize 
themselves with the tools. 
Endline Technical and Organizational Capacity Assessment 
The SBCC CAT tool [C-Change March 2011] that was used for baseline capacity assessment in 2015 
was used again on May 2, 2019, for HPD officers to self-assess organizational capacity 
improvements, if any, at the national level, using mostly HPD staff who participated in the initial 
baseline assessment, depending on their availability. The SBCC CAT tool has five component SBCC 
areas [Understanding the Context through Situation Analysis; Focusing and Designing the 
Communication Strategy; Creating Interventions and Materials for Change; Implementing and
Monitoring Change Process; and Evaluation and Re-planning for Outcome and Sustainability]. Each 
component area has sub-component questions which explore further different aspects of the 
component area. 
20
The participants were brought together in a room and the tool projected on a screen so that all
could see the questions and respond accordingly. The consultant went through each question to 
ensure clear understanding of each question and the scale for assessment. The participants were
allowed to discuss each of the questions and come to a consensus followed by self-scoring of their 
own performance on a scale of 1–4 with defined scorecard scores (1= poor; 4 = best). The reason for 
each scoring was elicited and recorded, in addition to the consensus value itself. 
Key informant and in-depth interviews were also undertaken to obtain additional information and 
opinions of interviewees on what they think about HPD in terms of their competence and ability to 
deliver on key technical SBCC elements. Qualitative approaches including key informant interviews
and in-depth interviews were used for Health Promotion Officers and Technical Officers of Health 
Promotion. Regional Directors and District Directors from four of the five USAID focus regions (Volta, 
Central, Western and Greater Accra regions; Northern was not included because of distance) were 
visited for in-depth interviews to gain additional understand of HP situation in these regions [see 
Appendix 1 for list of people interviewed]. Similar interviews were conducted with partners who have 
supported HPD since the initial assessment in 2015 such as UNICEF, WHO, and PATH. Key USAID 
Communicate for Health officers and partners such as Mullen Lowe, Creative Storm Networks, and 
VIAMO, where HPD interns were deployed, were also interviewed using relevant interview guides 
tailored to the organization. 
Endline Technical Training Outcome Assessment 
An endline Technical Training Outcome Assessment was also done in 2019 (2–4 years after the CADP 
and SfC trainings) based on methodology described below using an outcome assessment tool (see 
appendix 3) for participants of CADP, SfC and CCF from the regions and districts. This was to 
determine any individual capacity building improvements and how participants have applied their 
new knowledge and skills since attending the various capacity building trainings. Participants were 
asked to assess the relevance of the training to their job description, application of knowledge and 
skills acquired after their training, as well as what has been done differently as a result of their 
participation in the training.
Sampling methodology: (Inclusion and exclusion criteria)
All participants (from regions and districts) who had participated in CADP, SfC or CCF (and their 
supervisors from all the regions) were contacted for the technical training assessment using a 
Google version of the technical outcome assessment tool. This approach was selected as it gave the 
opportunity to reach most of the participants through a simple tool, in order to obtain enough 
information for comparative analysis of different cohorts. 
 
Definitions and Framework for Assessment 
The framework for the assessment is based on that provided by Lammert et al. 2015, which defines 
capacity building as “interventions that strengthen an organization’s or individual’s ability to fulfil its 
mission by promoting sound management, strong governance and persistent rededication to 
21
achieving results.” [Lammert et al. 2015]. It goes on to state that capacity building depends on having 
adequate numbers of staff with requisite knowledge and skills, adequate technical and managerial 
systems, suitable physical infrastructure, and ample financial and other resources. In the context of 
HPD, the mission is to provide a sustained health promotion service that will contribute to improving 
health and wellbeing, in line with the health sector goal of ensuring a healthy and productive 
population. This will be achieved through promotion of early preventative strategies, promotion of 
healthy behaviours and wellbeing, and creation of environments where individuals, families and 
communities are informed and empowered, and able to live healthier, happier lives [GHS 2015]. 
Capacity building is a process, rather than a final output, and it requires deliberate and planned 
change to produce goods and services to an acceptable standard. Capacity represents the potential 
for using resources effectively and maintaining gains with gradually reduced levels of external 
support [La Font et al 2003]. To be effective, capacity building requires long term multi-level 
approaches at four levels: systems, organization, health personnel, and community. Focus of this 
assessment principally covered the organizational and health personnel levels and, as appropriate, 
at the systems level. The technical capacity at the health personnel level was assessed as ability to 
apply knowledge, skills, and experience in management, training, service delivery, and other related 
activities [La Font et al 2003]. However, it is recognized that performance to deliver does not depend 
only on technical capacity but also on a favorable enabling environment in terms of supportive 
policies, adequate infrastructure, financial access, and requisite numbers of properly motivated 
staff. 
According to Morgan, motivation, commitment, and behavior are important in evaluation as well as 
changes in resources availability, skills, and management structure [Morgan 1997]. It also includes 
ability to form productive relationships with groups outside itself and sell itself through rebranding. 
Hence these enabling factors were also assessed in addition to the technical capacity. It is also 
recognized that demonstrating causality and attribution is very difficult as it is non-lineal, hence 
analysis of contextual factors was done, as indicated, for plausible association rather than causality 
[James 2001]. 
Table 1 provides definition of various capacity and performance variables used as part of the 
assessment.
Table 1. Capacity and Performance Variables Defined
Input
Set of resources, including health personnel, financial resources, space, policy orientation, 
and program service recipients, that are the raw materials that contribute to capacity at each 
level (system, organization, health personnel, and individual/community)
Process Set of activities, practices, or functions by which the resources are used in pursuit of the 
expected results
Output Set of products anticipated through the execution of practices, activities, or functions
Outcome Set of results that represent capacity (an ability to carry out stated objectives), often 
expected to change as a direct result of capacity-building intervention
Performance
Set of results that represent productivity and competence related to an established objective, 
goal or standard. The four capacity levels together contribute to overall system-level 
performance.
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Impact
Long-term results achieved through improved performance of the health system: sustainable 
health system and improved health status. Impact measures are not addressed in capacity￾building M&E.
Source: La Fond, Anne and Brown, Lisanne 2003.
STRUCTURE OF REPORT 
Based on the capacity building framework described in above, triangulation of data from desk 
review, key informant interviews, and assessment reports was done to derive information to answer 
the ToRs. The report is structured in two volumes: the main report in Volume one focuses on 
assessing the technical improvements in HPD due to USAID Communicate for Health capacity 
building support as per the CBSP, while Volume two assesses the unintended outcomes of the 
capacity building support to HPD (ToR 5) during the period.
A summary of baseline situation of HPD is described in Chapter 1 to provide information on 
contextual situation of the Department at the beginning of 2015, to put in perspective any changes 
that would be observed at the end of the USAID Communicate for Health project. Chapter 2 answers
the question of whether there have been any technical improvements at organizational and 
individual levels in HPD as of 2019. This was assessed by comparing the self-assessment at baseline
with that of 2019 (endline), using the same organizational and individual technical assessment tools 
described above. The evidence for their self-assessment is then provided. Since a large aspect of the
CBSP consisted of CADP and SfC trainings, special analysis was done for each of them to find out 
whether there have been any technical improvements at the individual level immediately after 
training, and two to four years after the training. Pre- and post-technical training outcome 
assessments’ results for CADP participants were compared for performance changes, with Fisher’s 
exact test of independence (significance at P< 0.05) used to determine significance of any changes 
observed before and after training. The story behind the figures were explored to provide insight 
into the reasons for any performance changes, or lack thereof. 
23
Chapter 3 looks at some of the other capacity building initiatives of the project as envisaged in the 
CSBP. Only positive achievements are highlighted in this chapter; challenges/weaknesses and gaps 
are discussed in Chapter 4. 
Chapter 4 and summarizes discusses conclusions of the achievements and weaknesses, challenges, 
and gaps per ToRs, in capacity building effort. Finally, Chapter 5 makes recommendations for 
sustaining the gains in technical capacity built for HPD going forward. 
A first draft of the assessment report was compiled and circulated followed by a stakeholders’ 
meeting to discuss the report on June 20, 2019 for their inputs. A second draft report was then 
developed and circulated on July 9, 2019 for final inputs by stakeholders before two volumes of the
Endline Assessment Report were prepared and submitted. 
 
Figure 1 Monitoring and Evaluation Framework; Source: GHS/PPME
24
CHAPTER ONE: BASELINE SITUATION ANALYSIS OF HPD CAPACITY. 
This chapter provides information on the baseline capacity situation of Health Promotion
Department, especially in relation to SBCC initiatives, as of January 2015. 
1.1 BOTTLENECK ANALYSIS 
A bottleneck analysis was conducted in 2014 to provide information to feed into the development of 
the HP Strategy. A summary of findings is presented below [GHS 2014]. 
1. There were no staffing norms and job descriptions for health promotion staff in GHS. 
Almost all professional health officers of GHS had staffing norms and job descriptions developed 
by Human Resource Division of GHS and Ministry of Health (MOH) to guide staff career 
development, job placement, promotion, and salary structure. Unfortunately, as of January 
2015, there were no such documents for HP officers. This gap was a very demotivating factor for 
HP officers and a deterrent for other health professionals considering the discipline as a 
profession. Not surprising, as of June 2013, there were only about 33 Health Educators on GHS 
payroll. 
2. There was no in-service training plan for health promotion officers. 
Even though a number of training sessions were organized by various partners in which HP 
officers participated, these training sessions were ad hoc and not tailored to the needs of HP in 
contemporary times. There was therefore no systematic in-service training plan specifically to 
build technical capacity of HP officers after their graduation as of January 2015. 
3. The capacity of health promotion staff was inadequate to deliver on their mandate.
Not surprising, with the exception of a few HP professionals, the existing HP officers lacked the 
technical capacity to deliver quality SBCC campaigns then.
4. There was uncoordinated production of health promotion materials and messages. As of 2015, 
SBCC materials were being produced by various partners, usually without recourse to HPD and 
there was no systematic process and structure in place to review the SBCC materials before 
production. 
5. Monitoring and supervision of health promotion activities at all levels was irregular and ad hoc. 
The problem was compounded by the lack of national HP indicators in the then District Health 
Information Management System 2 (DHIMS2). 
1.2 TECHNICAL AND ORGANIZATIONAL CAPACITY ASSESSMENT IN 2015 
Another activity that provided useful information at beginning of the USAID Communicate for Health
project for design of the capacity building support plan was an Organizational Technical Capacity
assessment in 2015 using the SBCC-TOCAT tool [C-Change 2011; see session 2.1]. Capacity 
25
assessment of national HPD was completed with 18 staff, and 22 others from Western Volta and 
Northern regions in 2015. The HPD team identified several areas of weakness in SBCC for capacity 
strengthening. These weaknesses and deficiencies informed the design of the Capacity building plan 
for HPD between 2015 and 2019 by USAID Communicate for Health.
A summary of areas of SBCC that were found inadequate is provided below: 
• Knowledge and application of relevant theories and models for situation analysis and SBCC 
program design
• Documentation and implementation of a comprehensive communication strategy
• Design of programs for target audience segments
• Development of SMART communication objectives for all SBCC programs
• Use of key elements of SBCC material development, including creative briefs, and effective 
material and message design
• Development and implementation of comprehensive documentary systems to record the use 
of the key elements of effective material and message design
• Development and implementation of a plan for strengthening staff SBCC competencies
• Structured training of management and technical staff in SBCC
• Linking program indicators to communication objectives
• Development and implementation of a data collection and analysis plan for all SBCC 
programs
• Training of staff in data collection, analysis and quality assurance
• Documentation of best practices
• Analysis of M&E data
• Development and implementation of mechanisms to record the use of M&E data to assess 
and improve programs
• Development and implementation of a comprehensive system of data archival and 
management [USAID Communicate for Health, 2016]. 
 
26
CHAPTER TWO: TECHNICAL PERFORMANCE OUTCOME ASSESSMENT 
Two main tools were used to determine effectiveness of the SBCC capacity building initiatives of the 
USAID Communicate for Health project support to HPD. Organizational outcome performance 
improvement was measured mainly by comparing 2015 and 2019 organizational self-assessment by 
HPD officers using the SBCC-TOCAT tool (see 2.1 below). The outcome assessment of individual 
technical capacity was similarly done by comparing performance as assessed by individuals 
themselves before training and 2-4 years after training using another tool (see 2.2 below). The basic 
question addressed in this chapter is: has there been any improvement in technical capacity of HPD 
to design and deliver SBCC campaigns? And if so, to what extent and in which areas?
2.1 ENDLINE TECHNICAL AND ORGANIZATIONAL CAPACITY ASSESSMENT OF HPD 
A repeat technical and organizational self-assessment was undertaken in 2019 using the same SBCC￾TOCAT tool that was used for the baseline assessment in 2015. The SBCC-TOCAT tool has five
component SBCC areas [Understanding the Context through Situation Analysis, Focusing and 
Designing the Communication Strategy, Creating Interventions and Materials for Change, 
Implementing and Monitoring Change Process, and Evaluation and Re-planning for Outcome and 
Sustainability]. Each component area has sub-component questions that explore further different
aspects of the component area.
As described in the Methodology section, the participants from national HPD were brought together 
in a room and the tool projected on a screen so that they could all see the questions and respond 
accordingly. The consultant went through each question with them for clear understanding of the 
meaning of the question and the scale for assessment. The participants were then allowed to discuss 
each of the questions and come to a consensus followed by self-scoring of their own performance 
on a scale of 1-4 with defined scorecard scores (1= poor; 4 = best). The reason for each scoring was 
elicited and recorded in addition to the consensus itself. The baseline and endline assessments were 
compared for any technical organizational improvements. 
FINDINGS 
Technical Capacity Organizational SBCC Performance 
Out of a possible total score of 112, the post organizational assessment score in 2019 was 94 (83.9% 
of total), showing an actual increase of 44.6% compared with pre-assessment score in 2015 of 65
(58% of total) [see figure 3; and full details in Appendix 4]. 
27
The greatest actual increases were in the area of Implementing and Monitoring Change Process
(78.3%); Focusing and Designing the Communication Strategy (41.2%); and Understanding the 
Context through Situation Analysis (36.4%). In contrast, there was a deterioration of over 33% in the 
area of Evaluation and Re-planning for Outcome and Sustainability. This was corroborated during the 
other interviews due mainly to lack of analysis of HP data collected and inadequate use of the 
information to re-plan and evaluate SBCC activities, especially at national level. 
Figure 2 Comparison of pre- and post-assessment of organizational capacity, 2015 and 2019. Endline 2019
2.2 EVIDENCE IN SUPPORT OF ORGANIZATIONAL CAPACITY IMPROVEMENT 
The essence and purpose of any technical capacity building effort such as provided by USAID 
Communicate for Health to HPD is to enable it to perform and deliver on its mandate as far as SBCC 
is concerned. The improved organizational technical capacity of HPD, especially in the area of SBCC 
development and implementation as indicated above, is evidenced by the increasing number of key 
partners who have over the period sub-contracted HPD to develop and execute SBCC projects on 
their behalf. Some of the partners include JICA, GIZ, JHPIEGO, and PATH. 
A short description of the projects are outlined below:
28
i) HPD developed audio visual materials for JICA for its CHPS plus project [see link for audio-visual 
materials developed].
1
ii) HPD supported USAID Communicate for Health to develop cue cards on Malaria, Family Planning, 
and Nutrition. 
iii) HPD, in collaboration with PLAN Ghana and other stakeholders, reviewed existing posters and a 
leaflet on antenatal care, breastfeeding, post-natal care, family planning, and promotion of 
adolescent friendly services to reflect current issues that are gender sensitive and change behavior. 
Consumer dipstick, stakeholder meetings, and pretesting were carried out to finalize and print these 
materials. 
iv) The Centers for Disease Control and Prevention (CDC)/USAID initiated a Second Year of Life (2YL) 
immunization program in collaboration with the Ghana Health Service, Ghana Red Cross Society, 
UNICEF, WHO, Ghana Coalition of NGOs in Health, Mullen Lowe, Accra, and other local partners in 
2017. The goal of the Project was to improve child survival by ensuring that services provided after 
first year of life are strengthened. The Project was piloted in three regions: Volta, Northern, and 
Greater Accra regions. The districts selected in the selected regions included Accra Metro, Ga East, 
Ho Municipality, Adaklu, Tamale Metro, and Savelugu Nanton. 
The HPD was specifically tasked to:
• Supervise and ensure appropriate design and implementation of SBCC campaign based on 
promoting primarily vaccination in second year of life in three selected regions by an 
advertising agency. 
• Monitor and evaluate the campaign to achieve desired behavioral change as part of the 
larger program to reduce vaccine preventable diseases in project regions. 
In all, 640 health workers were trained in the three regions. (Northern – 120, Volta – 130, and 
Greater Accra – 390). A total of 12,122 children were referred for vaccinations, while a total of 9,176
children received follow up visits after referral; 5,130 children were referred for Vitamin A. The 
project was well-executed to the satisfaction of CDC, and all project objectives were achieved [GHS 
2017b]. 
v) HPD collaborated with the Ridge Hospital and other stakeholders to develop materials on cervical 
cancer for public education. 
 
1 Link to the audio-visual materials produced by HPD and JICA on CHPS.
https://fhi360web￾my.sharepoint.com/:f:/g/personal/swevans_fhi360_org/EjOvirwPNg9EubOpYUBZPXUBqA7MCLYq-bfUvih￾ekWnMA?e=0rnxnB
29
vi) HPD was involved in two Action Media Workshops held in Ada (Greater Accra) and Agona 
Nkwanta (Ahanta West District – Western Region) in February and March 2016. The purpose of the 
exercise was to promote community participation in the material development process. The focus 
was on Sexual Workers and Men Who Sleep with Men. HPD assisted in the development of six 
jingles and 33 draft posters on how to fight against stigma and discrimination on sex workers and 
Men Who Sleep with Men. 
vii) Malaria Vaccine Initiative
HPD chaired the Advocacy Communication and Social Mobilization (ACSM), which is responsible for 
coordinating and ensuring the successful implementation and management of all communication 
activities related to the new malaria vaccine in four regions in Ghana: Brong Ahafo in all the 27 
districts, Central – 20 districts, Volta – 25 districts, and Upper East – 4 districts.
In spite of massive fake news and misinformation (with all sorts of conspiracy theories) from social 
media to prevent the public from patronizing the vaccine, almost everything has gone well. This was 
largely due to a counter SBCC campaign mounted by key stakeholders under the direction of HPD. 
Over 7,500 children received the vaccination, with only 23 refusals three weeks after onset of the 
effort. 
viii) HPD provided technical support to JHPIEGO in the development of Early Childhood Development
specific materials. These include a flipchart, wallchart, leaflet, ToR and a manual.
ix) HPD developed a poster on Neglected Tropical Diseases (NTDs) for the NTD Unit of Ghana Health 
Service to be used for its training of trainers’ sessions.
Interviews with a number of the partners and review of project reports indicate very high 
satisfaction by the partners of the output of the work done by HPD. As one partner remarked, “HPD 
is on top of their game. Their performance from concept development to end product has been 
excellent.”
2.3 CADP Training (Baseline Training Process Indicators, 2016) 
As noted in the introduction and per Appendix 2, the Change Agent Development Program (CADP) is 
a one-week program designed to strengthen the individual technical capacity of competitively 
selected national, regional, and district-level staff through technical presentations. Topics covered 
include the following:
• Developing and implementing long term SBCC strategies and emergency health 
communication strategies
• Evidence-based social and behavior changes
• Working with the TV, radio, and press media to promote social and behavior change
• Social and cultural dimensions of behavior change and the role of gender
30
• The role of different channels and mediums to promoting both individual and social behavior
change.
• Co-ordination and management of community health communication activities
• Monitoring and Evaluation (M&E) for health promotion
• Advocacy and influencing skills
• Personal effectiveness and leadership skills
• Mentorship guide to enable participants to adopt a peer mentee and impart the new 
knowledge and skills to the mentee. 
There were three cohorts for the CADP training during the period. The CADP cohort 1 involved 26 
participants from national, regional and a few from district level. Cohort 1 training was intended as a 
pilot and lessons learned used to amend and improve cohorts 2 and 3 trainings. An additional day 
was added for the second and third cohort trainings due to suggestions by the cohort 1 participants 
after the training. Process and timeline for the applications, including call for application and review 
and selection of applicants with eligibility criteria, were developed together by HPD and USAID 
Communicate for Health. 
Cohort 1 CADP
The first CADP training was held from June 27–July 1, 2016, at Dodowa in the Greater Accra Region; 
participation was competitive and 23 out of 26 selected HP practitioners completed the training. 
Pre- and immediate post-CADP training assessment forms were administered to determine how 
successful the training has been in increasing the SBCC knowledge and competence of individual 
participants. The pre-training assessment questionnaire was given to all participants at the time of 
registration for completion prior to the start of the program, while the post training assessment was 
administered at the close of the training program. The post-training assessment covered the 
relevance, delivery, and understandability of the course contents.
Pre- and immediate post-training results for same participants showed significant improvements in 
participants’ total scores (with a maximum possible of 30 points), ranging from 10 to 40 percent. 
See below.
31
 
Cohort 2 CADP
The second CADP session was held from July 10–15, 2017, at the Hephzibah Christian Health Centre, 
Peduase. The pre- and post-CADP assessment forms were similarly administered to determine how 
successful the training has been in increasing the SBCC knowledge and competence of individual 
participants. The pre-training assessment questionnaire was given to all participants at the time of 
registration for completion prior to the start of the program while the post-training assessment was 
administered at the close of the six-day program. Analysis of the completed pre- and post-training 
assessment results showed significant improvement in the scores for all participants with an average 
score of 13%, which gives an indication that learning had taken place as a result of the CADP as 
indicated in Fig. 4 [CADP Training Report 2016]. 
Participants also noted that the session on M&E in SBCC (session 7) needed to be redesigned and 
simplified for comprehension, as the contents were deemed to be somewhat abstract, complex, and 
contextually above participants’ level of understanding. This expression by participants somehow 
proves that M&E was a difficult area among HPD staff, because the same concern of lack of 
understanding was expressed by the first CADP cohort. 
 
0 
5 
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
PARTICIPANT 
PRE POST
 CADP first cohort pre- and post- training assessment scores 
Figure 3 Comparison of pre- and immediate post-training individual assessment score for CADP cohort 1, 2016
32
Figure 4 Comparison of Pre- and immediate Post Training Assessment Scores for CADP cohort 2 participants, 2017. Source: USAID C4H 
Y3 annual report
Cohort 3 CADP
The third CADP training occurred from May 28–June 2, 2018, at the HPD conference room, Korle Bu. 
The assessment for cohort 3 CADP participants followed a pattern similar to their cohort 1 and 2 
counterparts. Analysis of the completed pre and post training assessment results showed 
improvement in the scores for all participants with an average score of 12%, which gives an 
indication that learning had taken place as a result of the CADP as indicated in Fig. 5. 
19 
13 
18 
24 23 
18 
26 
17 
21 
19 
17 18 
15 16 
23 22 23 22 21 22 
25 26 26 
21 22 23 22 
24 25 
22 22 
25 
0
5
10
15
20
25
30
2nd CADP Cohort-Pre & Post Assessment Results
Pre-Assessment Score Post Assessment Score
33
Figure 5 Comparison of Pre- and immediate Post Training Assessment Scores for CADP cohort 3 participants, 2017. Source: USAID C4H Y4 annual 
report.
34
In addition to the pre-and post-assessment test, almost all the CADP cohorts were made to evaluate 
each session to gauge content relevance, delivery, understandability and new things learned 
immediately after the training. The participants rated the following sessions as very high in terms of 
content and delivery soon after the training: 
Session 1 – Culture and its Influence on SBCC
Session 2 – Understanding SBCC Theory
Session 4 – Creating and Implementing Effective SBCC
Session 6 – Advocacy, Building Strategic Partnerships, Alliances, and Collaborations
Session 7 – Understanding Social Marketing
Session 8 – Working Effectively with the Media 
Session 9 – Effecting Social Behavior Change through TV Documentaries
Session 10 – Mobile Technology and Health Promotion
Session 11 – Effecting Change with Community Radio
Session 13 – Planning and Coordinating SBCC
Participants also noted that the following sessions needed to be redesigned and simplified for easy 
comprehension, as the contents were deemed to be somewhat, complex and too theoretical and 
above their level of knowledge. This challenge was reinforced by the fact that the time allocated to 
these sessions was said to be insufficient to allow for further discussions.
Session 3 – Understanding Formative Assessment in SBCC
Session 5 – Understanding Social and Community Mobilization
Session 12 – Monitoring and Evaluation in SBCC
Session 14 – Leadership and Personal Development [USAID Communicate for Health report 2017]
2.4 ENDLINE INDIVIDUAL TRAINING OUTCOME ASSESSMENT, 2019 
As mentioned under Methodology section, a special interview tool [USAID Communicate for Health 
2019] was developed and sent through a Google link to all participants of CADP and SfC from the 
regions and districts as part of Endline assessment in 2019. As explained earlier, the key objectives of 
the Endline training Outcome Assessment (TOA) were to understand: 
• outcome of the training on job performance, 
• relevance of the training to the execution of job responsibilities, 
• extent to which newly acquired knowledge, skills, and abilities were being applied on the job, 
and
• enablers and barriers to the application of newly acquired knowledge, skills, and abilities. 
The tool used was to determine any individual capacity building improvements, the participants 
assessment of the relevance of the training topics to their work as HPOs and TOHP after 2–4 years in 
the field, and how participants have used the knowledge and skills since the training. It also assessed 
some of the enabling factors and barriers to performance after acquisition of new technical 
knowledge and skills during the training. The tool consists of a number of close ended coded 
35
questions with “yes” and “no” answers for each question as applicable (see Appendix 4). The 
information was used to answer the second and 3rd questions as per ToR in relation to CADP and 
SfC respectively. 
CADP
There were 67 CADP participants from the all the regions, as well as 27 SfC participants. Other CADP 
participants were from the national level or from implementing partners and were excluded from 
the analysis. A similar tool [USAID Communicate for Health 2019] was sent to supervisors of the 
participants for their views concerning the programs and the performance of participants under 
their care. Analysis was done for all CADP and SfC participants together (response rate only), then 
CADP cohorts 1, 2 and 3 separately, and then SfC cohort 1 as against SfC cohorts 2 and 3 to 
determine any deviations in performance by cohort. Fishers’ exact test of independence was applied 
as appropriate to test the statistical significance of any observed changes in scoring.
Out of 94 CADP and SfC participants from the regional and district levels, 84 responded, giving a 
favorable response rate of 89.4%. Figure 6 represents a summary of the results of the endline 
outcome assessment after the training is presented. 
Participants self-assessed their performance by answering the question, “On a scale of 1–5, how 
would you rate your performance after the CADP training?” according to the following scale: 
0 0 0 0 0 0 
15 
0 
16.7 
0 
21.7 
0 
65 
0 
61.1 
16.7 
60.9 
21.7 20 
70 
11.1 
72.2 
17.4 
60.9 
0 
30 
11.1 11.1 
0 
17.4 
0
10
20
30
40
50
60
70
80
Before After Before After Before After
CADP 1 CADP 1 CADP 2 CADP 2 CADP 3 CADP 3
Comparison of CADP cohorts 1, 2, 3
Non performance Low performance Average performance High performance Very high performance
Figure 6 Comparison of CADP outcome assessment by Cohort, End line 2019
36
1 – Non-performance
2 – Low performance
3 – Average performance
4 – High performance
5 – Very high performance. 
In summary, 30% of CADP cohort 1 participants scored themselves as very highly performing in 2019, 
compared to 0% in 2016 before training [also 70% in 2019 vs. 20% in 2015 as high performing]. 
Among CADP cohort 2 participants, 11.1% assessed themselves as very highly performing in 2019, 
compared with same figure in 2017 before training [ also 72.2% in 2019 vs. 11.1% in 2016 as high 
performing]. Among CADP cohort 3 participants, 17.4% assessed themselves as very high performing
in 2019, compared with 0% in 2018 before training [also 60.9% in 2019 vs. 17.4% in 2018 for high 
performing [ Fig 6).
It can be seen from Table 2 that the differences are statistically significant (Fishers’ exact test of 
independence, P< 0.001), indicating that the differences observed before and after among the 
cohorts are not due to chance. It can also be seen that in terms of assessment as very high 
performing, cohort 1 participants assessed themselves highest (30%), followed by cohort 3 (17.4%) 
and then cohort 2 (11.1%). The conclusion is that the changes made after CADP cohort 1 training 
(such as adding another day to training period) did not significantly affect the on-the-job 
performance of cohorts 2 and 3 participants after training. 
Table 2 Comparing before and after scores for CADP participants by cohort, Endline 2019
Performance Level
 Non performance Low performance Average performance High performance Very high 
performance P-value
Cohort 1 <0.001
Before (n=20) 0 15 65 20 0
After (n=20) 0 0 0 70 30
Cohort 2 <0.001
Before (n=18) 0 16.7 61.1 11.1 11.1
After (n=18) 0 0 16.7 72.2 11.1
Cohort 3 <0.001
Before (n=23) 0 21.7 60.9 17.4 0
After (n=23) 0 0 21.7 60.9 17.4
NB: All values within that table represent row percentages, n = frequency of participants P-value was obtained from 
Fishers’ exact test of independence
Application of Knowledge and Skills
Understanding how the knowledge, skills, and experience acquired during training are applied on 
the job is a key measure of performance (and a key objective of the CBSP). 
To determine which areas of the training curricula helped or did not help participants in their job 
performance post- training, they were asked to score to what extent the training curricula 
contributed to their improved performance, as of 2019. Most of CADP participants in all cohorts 
assessed themselves low in application of knowledge and skills acquired in mobile technology (30%), 
effective SBCC through TV documentary (20%), understanding social marketing (20%), and 
understanding formative assessment in SBCC (50%) compared with other components (Table 4). 
37
Culture and its influence on SBCC (100%), understanding social and community mobilization (95%), 
creating and implementing effective SBCC (80%), working effectively with the media (80%), and 
planning and coordinating SBCC (80%) were scored highest. A similar assessment immediately after 
the trainings produced slightly different results, which are discussed below. 
Table 3. Comparison of application of knowledge and skills by CADP cohort before and after training, Endline, 2019
Application of Knowledge and Skills. CADP % CADP 1 CADP2 CADP3
N=20 N=18 N=23
Culture and its influence on SBCC 100 100 100
Understanding SBCC theory 60 44.4 52.2
Understanding formative assessment in SBCC 55 22.2 43.5
Creating and implementing effective SBCC 80 77.8 78.3
Understanding social and community mobilization 95 88.9 100
Advocacy, building strategic partnerships, alliances and collaborations 65 66.7 87
Understanding social marketing 60 33.3 43.5
Effecting social behavior change through tv documentaries 20 11.1 26.1
Working effectively with the media 80 44.4 65.2
Mobile technology and health promotion 30 27.8 30.4
Effecting change with community radio 40 27.8 56.5
Planning and coordinating SBCC 80 61.1 82.6
Monitoring and Evaluation in SBCC 70 55.6 73.9
Writing a wining proposal 65 38.9 60.9
NB: All values within table represent percentages, N = frequency of participants 
In terms of what they had done differently as a result of their participation in the CADP, sourcing 
funds for SBCC (45%), using mobile technology to communicate to target audience (40%) and 
developing indicators to monitor SBCC activities (40%) were scored low by all cohorts. 
Negotiated/utilized airtime for SBCC/HP programs (90%), partnered and collaborated with external 
organizations (85%) and integrated SBCC/HP activities into those of the DHMT (85%) came out 
higher in terms of what they did differently after their training. Interestingly, once again, cohort 1 
participants scored themselves highest in almost all categories followed by cohort 3 and cohort 2 
[Table 4]. 
Table 4 Comparison of what has been done before and after training, CADP by cohort, Endline 2019
What have you done differently as a result of your participation in the CADP CADP 1 [N=20] CADP2 
[N=18]
CADP3 
[N=23]
Developed/contributed/implemented a community mobilization plan 70 61.1 65.2
Developed/contributed to/implemented an SBCC plan 75 72.2 69.6
Sourced funding for SBCC activities 45 22.2 56.5
Integrated SBCC/HP activities into those of the DHMT 85 72.2 78.3
Partnered and collaborated with external organizations, e.g., NGOs and MMDAs 85 50 78.3
Used mobile technology to communicate to target audience. 40 22.2 34.8
Negotiated/utilized airtime for SBCC/HP programs. 90 50 69.6
Developed indicators to monitor SBCC/HP activities 45 27.8 47.8
Wrote a proposal to solicit funds for SBCC activities 55 22.2 52.2
NB: All values within table represent percentages, N = frequency of participants 
Set for Change
38
As summarized in introductory section and elaborated in CBSP, the Set for Change (SfC) is a learning 
set for Technical Officers Health Promotion (TOHP) participants that meet for 1.5 days four times 
over a six-month period covering personal development and effectiveness, technical skills in 
problem solving, and development of HP practice in their new roles. In addition to the action 
learning component of the SfC, there are taught sessions on a range of topics such as Monitoring 
and Evaluation (M&E), community mobilization, program management, and use of mobile 
technology for SBCC. Learning from taught sessions is expected to be consolidated through practical 
group exercises. [USAID Communicate for Health, February 2016].
SfC Cohort 1 met a total of four times: July 4–5, 2016 at Dodowa; November 17–18, 2016 in Accra; 
January 11–12, 2017 in Ho, and February28 –March 1, 2017 at Dodowa. Unfortunately, due to 
logistic and administrative challenges SfC Cohort 2 met only once, from July 17–19, 2018 at Peduase. 
Figure 7 Comparison of self-assessed performance by SfC cohorts 1 and 2/3, End Line 2019
A similar assessment of performance was done for SfC participants in 2019 as for CADP participants. 
There were only two cohorts for the training: cohort 1, and cohorts 2 and 3 combined. The Action 
Learning Set Cohort 1 participants scored themselves as very high performing (33.3%) in 2019, 
compared with 0% in 2016 before training [also 44.4% in 2019 vs. 0% in 2016 for high performing].
Among cohorts 2 and 3 participants, 26.7% combined assessed themselves as very high performing
in 2019, compared with 6.7% in 2017 [also 60% in 2019 vs. 13.3% in 2017 as high performing] before 
training [see Fig. 7]. 
0
10
20
30
40
50
60
70
80
90
Before After Before After
BT1 [9] AT1 [9] BT2/3 [15] AT2/3 [15]
SFC%
Non performance Low performance Average performance High performance Very high performance
39
It can be seen that SfC cohort 1 trainees assessed themselves higher (very high performing, 33.3%) 
compared with 26.7% for cohort 2/3 combined. The observed differences between SfC Cohort 1 and 
SfC Cohort 2/3 are statistically significant (Fishers’ exact test of independence, p<0.001), meaning 
that the differences are not due to chance [Table 5]. Once again, it can be concluded that any 
changes made after SfC cohort 1 training did not improve the outcome of future trainings as far as 
confidence in assessing their performance after training was concerned. The four training sessions 
that cohort 1 benefitted from positively affected their performance, compared with SfC cohorts 2/3 
who only had one training session. 
 
Table 5 Comparing SfC participants before and after by cohort, Endline 2019
Performance Level
 Non performance Low performance Average 
performance
High 
performance
Very high 
performance P-value
Cohort 1 0.005
Before (n=9) 11.1 11.1 77.8 0 0
After (n=9) 0 0 22.2 44.4 33.3
Cohort 2/3 0.001
Before (n=15) 6.7 0 73.3 13.3 6.7
After (n=15) 0 0 13.3 60 26.7
NB: All values within the table represent row percentages, n = frequency of participants P-value was obtained from 
Fishers’ exact test of independence. 
To determine specific areas of the training that helped or did not help SfC participants in their post￾training performance at work, participants were asked to indicate which areas contributed to their 
improved performance, if any, just as was done for CADP participants. SfC participants assessed 
themselves low in applying their understanding of SBCC theory (44.4%), creating and implementing 
effective SBCC (33.3%), understanding social marketing (33.3%), using mobile technology (0%), and 
writing winnable proposals (44.4%). SfC cohort 1 scored themselves very high in understanding 
social and community mobilization (100%) and working effectively with the media (88.9%). Once 
again, cohort 1 appeared to have been applying knowledge and skills better than cohorts 2 and 3 
combined in almost all areas. [Table 6]. It looks as if there was some “dilution” of the CADP and SfC
training programs, instead of the expected enhancement, for subsequent cohort trainings. 
Table 6 Comparison of application of knowledge and skills by SfC cohort, Endline 2019
Application of Knowledge and Skills. SFC SCORE SFC1
[N=9]
SFC 2/3
[N=15]
Culture and its influence on SBCC 55.6 66.7
Understanding SBCC theory 44.4 33.3
Understanding formative assessment in SBCC 55.6 33.3
Creating and implementing effective SBCC 33.3 33.3
Understanding social and community mobilization 100 80
Advocacy, building strategic partnerships, alliances and collaborations 66.7 53.3
Understanding social marketing 33.3 33.3
Effecting social behavior change through tv documentaries 11.1 13.3
Working effectively with the media 88.9 53.3
Mobile technology and health promotion 0 20
Effecting change with community radio 55.6 33.3
40
Planning and coordinating SBCC 66.7 60
Monitoring and evaluation in SBCC 55.6 40
Writing a wining proposal 44.4 0
NB: All values within that table represent percentages, N = frequency of participants 
What has been done differently?
In terms of what they have done differently since training, SfC participants indicated that they did 
very little in sourcing funding for SBCC activities, using mobile technology to communicate to target 
audience, and writing a proposal to solicit funds for SBCC activities [Table 7].
Table 7. What has been done differently by SfC cohorts, Endline 2019
What have you done differently as a result of your participation in the SFC?
SFC1 
[N=9]
SFC 2/3
[N=15]
Developed/contributed/implemented a community mobilization plan 77.8 60.0
Developed/contributed to/implemented an SBCC plan 55.6 40.0
Sourced funding for SBCC activities 22.2 26.7
Integrated SBCC/HP activities into those of the DHMT 77.8 73.3
Partnered and collaborated with external organizations. E.g. NGOs and MMDAs 66.7 46.7
Used mobile technology to communicate to target audience. 0.0 20.0
Negotiated/utilized airtime for SBCC/HP programs. 66.7 66.7
Developed indicators to monitor SBCC/HP activities 44.4 20.0
Wrote a proposal to solicit funds for SBCC activities 22.2 46.7
Enablers or Success Factors from Trainings
Another question sought to ascertain what training facets enabled participants to improve their 
performance. The participants from both CADP and SfC cohorts identified boosted confidence, 
improved knowledge and skills, improved team work, and enhanced working relations with 
stakeholders as keys to their enhanced performance. It must be noted that the objectives of the 
CBSP included building confidence in oneself to deliver on the job due to enhanced knowledge and 
skills in key topic areas after training. The objectives of the CBSP also include ability to form 
productive relationships with groups outside itself and sell itself through rebranding [USAID 
Communicate for Health February 2016]. Specific examples of how these factors enhanced their 
performance are listed under section 2.5 below.
All CADP 1 participants found the CADP training relevant to their job responsibilities. A total of 75% 
(N=20) claimed the training boosted their confidence, and 85% said it improved their 
skills/knowledge, while 80% said it enhanced working relations with stakeholders [Table 8]. 
 
Table 8 Relevance of training by CADP cohort
Relevance CADP [%] N=20 N=18 N=23
How useful? CADP1 CADP2 CADP3
Boasted my confidence 75% 44.4 69.6
Improved my skills/knowledge generally 85% 88.9 95.7
41
Improved my teamwork skills 80% 94.4 60.9
Enhanced working relations with stakeholders 80% 56.6 65.2
About 55.6% of SfC cohort 1 said training had boosted their confidence as of 2019 compared to 60% 
of SfC cohort 2/3 participants, while 77.8% of cohort 1 claimed the training has improved their 
knowledge and skills compared to 73% for SfC cohorts 2/3 [Table 9]. In general, SfC cohort 1 
participants scored themselves higher than SfC cohort 2 and 3 in terms of improved skills, teamwork 
and enhanced relations with stakeholders, key objectives of CBSP. 
 
Table 9 Relevance of SfC training by cohort, 2019
Relevance % N=9 N=15
How useful? SfC 1 SfC 2/3
Boasted my confidence 55.6 60
Improved my skills/knowledge generally 77.8 73.3
Improved my teamwork skills 88.9 80
Enhanced working relations with stakeholders 66.7 53.3
It must be noted that the scoring after the training in 2016 may differ from the scoring of same topic 
in 2019 since following the training, the participants were scoring their understanding of the topic 
and its delivery, while in 2019 they were scoring how useful the application of knowledge and skills 
acquired (in topic area) had been in helping them perform their work. For instance, after the training
in 2016, session 5 (Understanding Social and Community Mobilization) was scored low because they 
claimed not to understand the topic or its delivery. However, two to four years later, both the CADP 
and SfC participants scored the same topic 95% and 100% respectively as having been helpful in 
application of knowledge acquired later on the job. It goes to show that some of these topic areas 
are very relevant and important to their job but presentations during future training must be 
enhanced and made more practical. 
2.5 EXAMPLES OF SUCCESS STORIES AND PERFORMANCE ENABLERS, 2019 
To reinforce how beneficiaries of CADP and SfC assessed their performance, a few examples of what 
some of them have been doing in practical terms are cited below. 
SFC SUCCESS STORY: Ms. Janet Wepiah Batako, of the Kintampo South District Health Directorate, 
said that prior to participating in the SfC program, she had no desk and was rarely included in DHMT 
meetings. With the skills and confidence gained through the SfC, she succeeded in convincing the 
DDHS to provide her with basic furniture and tools, and she was invited to participate in DDHS 
meetings. 
CADP SUCCESS STORIES: The CADP training has positioned some of the beneficiaries to source 
funding from other sources in the face of dwindling government financial support to the GHS. For 
example, Ms. Vida Ntiwaa Gyasi of the Ga South sub-metro successfully submitted and sourced 
funding from KAITEC to procure furniture for the Health Promotion unit amounting to 4,000 Ghana 
42
Cedis (GHS4,000.00, about $800). Ms. Gyasi also submitted a proposal to source two thousand, five 
hundred Ghana Cedis (GHS2,500.00, about $500) from Pambros Limited to support the Global Hand 
Washing Day celebration. 
The role of the TOHP is to coordinate implementation of evidence-based SBCC and HP campaigns at 
the district level and galvanizing support to address the social determinants of health at the DHMT, 
Sub District and Community levels, including resource mobilization. Prior to the CADP and SfC 
trainings, TOHP complained they were not involved in DHMT meetings and quite often were left out 
in decision making around SBCC and health campaigns (including resource mobilization), practically
relegating them to the periphery of coordination and execution of SBCC campaigns. This finding 
suggests that TOHP are now being included in decision making at the DHMT level with implications 
for wider health system improvements for SBCC indicators. A similar observation was made by the 
District Director for Sunyani West who said that through the CADP, SfC and CCF program where Miss 
Mary Ayobi gained a grant to implement a campaign on malnutrition, she has become the fulcrum 
around which SBCC work operates in the district and has substantially improved team work among 
DHMT members in the Sunyani West District. 
“There is now effective networking with community radios to educate people using appropriate SBCC 
messages. Now when I sit at the radio station, I talk confidently because I know how to go about the 
issues. I have been able to secure more air times for radio health discussions after the training.” An 
SfC participant 
“As a result of the training, I have been able to use my lobbying skills to acquire free air time on the 
two main radio stations and some Local FM Stations to promote SBCC activities. This means a lot to 
me because before the training, almost everyone wanted us to pay for air time given.” An SFC 
participant
"Initially, proposal writing was something I do not event attempt at all because I was deficient of the 
knowledge but now proposal writing is part of me after the training.” A participant
“My working relationship with my co-workers has also improved tremendously due to my knowledge 
in personality identification, a skill acquired during the training.” A participant
“My community mobilization skills have been enhanced due to my ability to identify the appropriate 
structures in the communities.” A participant
These comments by CADP and SfC participants after the training give an indication of improved 
confidence, improved working relations with colleagues, and enhanced communication skills, which 
have improved their technical performance, due to application of knowledge and skills gained during 
the training they had received to enhance their performance.
2.6 VALIDATION BY SUPERVISORS OF CADP AND SfC PARTICIPANTS, ENDLINE 2019 
43
In order to validate the self-assessed performance by CADP and SfC participants after their training, 
their supervisors were interviewed in 2019 on how they assess the performance of their officers 
after returning from the CADP or SfC training. Out of 10 supervisors, eight responded.
All supervisors interviewed found the content of the CADP and SfC training program relevant to the 
job responsibilities of the HP officers at regional or district levels. 87.5% of supervisors indicated that 
the trainees had applied their knowledge and skills in their day-to-day work after the training. 
Citing changes that they had seen about the participants or things that were being done differently, 
the following examples were given:
“It has built his confidence and his capacity to write many proposals and mentor other health staff on 
health promotion activities.” 
“Capable of analyzing data from DHIMS2. He is able to draw maps, graphs and charts to improve 
behavior change in individuals and communities.” 
“Capable of planning and implementing health promotion activities in their various districts with little 
or no assistance. They are more enthusiastic to do more to improve the health of the people.” 
“During campaigns activities, his engagement with the media has improved. He was able to build 
about ten community health staff capacity on radio discussion.” 
“Advocated for the introduction of tippy taps in homes to prevent diarrhea diseases and healthy 
communities’ program; solicited for support from an NGO to buy some equipment for the office. 
Developed some SBCC material with the support from a JICA Volunteer. Able to lobby for free airtime 
from radio stations in the district. Collaborated more with partners (such as environmental, NGOs, 
GES etc.) and the media.” 
“He is more organized now and shows systematic and evidence-based approach to health promotion 
activities.” 
In summary, the responses from the supervisors affirm their positive assessment overall of 
enhanced performance of CADP and SfC participants after the training. Not surprisingly, 86.7% of 
the supervisors indicated that they would recommend the CADP and SfC training to other HP officers 
who had not yet benefited from them, in view of what they had witnessed in those who had 
completed the training.
44
CHAPTER THREE: INPUTS, PROCESSES AND OUTPUTS 
This chapter discusses some inputs, processes, and outputs (apart from CADP and SfC), as relevant 
to USAID Communicate for Health’ ER#2, that have contributed to any changes in technical 
performance identified in Chapter 2 and elsewhere. The focus is on positive achievements that 
enhanced technical performance. Discussions on conclusions of weaknesses and challenges are 
presented in Chapter 4, while Chapter 5 provides the final recommendations for the new HP Division 
to maintain and enhance performance. 
3.1 CHANGE CHALLENGE FUND 
The CCF is a competitive performance-based grant that allows recently trained change agents to 
conceptualize, develop, and implement small-scale SBCC activities/campaigns at the district or 
regional level that are aligned with the overarching Good Life strategy. The Change Challenge Fund 
(CCF), up to GHC 6,000, has been set up to ensure CAD and SfC participants have the opportunity to 
use and apply their new knowledge and skills in their daily work and are not constrained by lack of 
resources. This fund is not to be used to cover salaries or routine activities that are the mandatory 
responsibility of a district but rather to fund specific activities that meet clearly designed eligibility 
criteria. 
In October 2016, HPD and Communicate for Health completed the design and policy framework for 
managing and initiating the CCF. The mechanism for implementing the CCF was through an FAA with 
FHD/HPD. It was supposed to have been launched in 2017 and at least 75% of Set for Change (SfC) 
participants from the USAID five-supported regions were to be targeted. A management board was 
constituted in 2017. However, USAID gave approval of the FAA in April-June of 2018 for roll out, and 
the Competition for the CCF grants was opened in June 2018 to all 94 graduates from regions and 
districts from the CADP (67) and SfC (27) sessions. The CCF management board approved it on 
September 25, 2018 and 15 of the applicants’ proposals (see Table 10) were approved based on 
defined criteria. The successful applicants were expected to receive their first disbursements by 
October 2018. 
Table 10 CCF beneficiaries and topics of their proposals
No. NAME DISTRICT REGION TOPIC
1 Janet Wepiah 
Batako
Kintampo 
South
Brong 
Ahafo
Handwashing: To enhance proper handwashing 
(hand washing with soap under running water) 
using the correct technique among 2000 
households within the Kintampo South District by 
the end of December 2019. 
2 Mary Ayobi Sunyani West Brong 
Ahafo
Malnutrition: To reduce malnutrition among 
children under five in the Sunyani West District from 
10.3% to 4%. 
3 Gerald Kwakye Gomoa Afransi Central Teenage pregnancy: To improve adolescent health 
by reducing teenage pregnancy rates in 2017 from 
9.5% to 7.5% and STIs from 1.44% in 2017 to 1.0% 
45
No. NAME DISTRICT REGION TOPIC
by the end of first quarter of 2019. 
4 Augustine Fobi Twifo Hemang Central Teenage pregnancy: To reduce teenage pregnancy 
and anemia while improving the nutritional status of 
adolescent girls in the district. 
5 Gladys Gbadagbali Ashaiman Greater 
Accra
Campaign against filth: To promote health and good 
sanitation for GoodLife among the people of 
Ashiaman through SBCC in the municipality. 
6 Vida Ntiwaa Gyasi Ga South Greater 
Accra
Still births: To reduce still births from 0.5% to 0% in 
the Ga South municipality. 
7 Rosemond Appau Ga East Greater 
Accra
Reduction in hypertension: To reduce hypertension 
among females in reproductive age group from 
17.0% to 13.0% by end of 2019. 
8 Mohammed 
Fatima
Tamale Northern Adolescent health corner: To establish an 
adolescent health corner that will provide 
counselling services and reproductive health 
services to adolescents in an enabling environment 
devoid of fear and intimidation. 
9 Hon. Yakubu 
Rahinatu
Tamale Northern Maternal deaths: To reduce maternal deaths 
through the use of SBCC and advocacy 
(interpersonal communication) in building the 
capacity of 100 midwives in the Sagnarigu 
Municipality. 
10 Alhassan 
Sulemana
Nanumba 
North
Northern Maternal deaths: To reduce maternal mortality 
from six to two per 1,000 live births through SBCC 
sensitization of the inhabitants of some selected 
communities in Nanumba North municipality on the 
possible causes and preventive measures of 
maternal mortality.
11 Maakpe John 
Vianney
Wa Upper 
West
Maternal deaths: To empower men and other 
stakeholders with knowledge and skills about health 
services—especially antenatal care, skilled delivery, 
and post-natal care services. 
12 Prosper Songyele Lawra Upper 
West
Anemia in pregnancy: To reduce anemia in 
pregnancy in the Lawra municipality from 55% to 
20% by the end of 2019. 
13 Bawakyillenuo 
Julius Ngmentiere
Wa East Upper 
West
Maternal deaths: To determine and address socio￾cultural, clinical, and socio-demographic factors that 
contribute to maternal mortality. 
14 Abdul - Wahid A. 
Dawono
Dafiama Bussie 
Issa 
Upper 
West
Handwashing – diarrhea in Cu5: To mitigate the 
determinants that contribute to the occurrence and 
spread of diarrhea among children below five years 
of age as a result of poor handwashing practices in 
the Daffiama Bussie Issa District.
15 Evans Whaja Tarkwa 
Nsuaem
Western Maternal deaths: To reduce maternal death cases 
among women in the Tarkwa Nsuaem municipality 
through advocacy for improved antenatal 
attendance. 
46
 
Assessment of CCF Performance So Far 
It is too early to talk about outcome performance thus far as the funding has delayed and only 
process and output indicators can be described. However, a number of impressive achievements 
have been chalked up by beneficiaries and they have rolled out many activities (see photo gallery2
). 
a) The first tranche of the fund that had been released at time of the endline assessment was 
received mostly in February 2019 due to administrative and other issues. All the 15 beneficiaries 
received an initial amount of GHC 2,400, (about $480) for planned activities. 
b) Participants had carried out all 48 activities planned for the first tranche period at time of the 
assessment. These activities were verified from reports and what was planned in the original 
proposals. A multisector approach was adopted by all applicants for implementation of their 
activities, ranging from GHS, district assemblies, community leaders, NGOs and other public sectors. 
c.) A sample of comments and success stories mentioned by some beneficiaries [CCF monitoring visit 
reports, endline 2019] during the interviews is provided below. Some of these were shared during 
the second MNCH conference in July 2019 and were well received by participants.
SUCCESS STORIES 
Beneficiary No. 4, Augustine Fobi
Augustine Fobi from Twifo Hemang Upper Denkyira in CR developed an SBCC project to reduce 
teenage pregnancy and anemia while improving the nutritional status of adolescent girls in the 
district with funding from CCF. Approaches adopted included:
• Bring young adolescent girls together and empower them to make healthy nutrition and 
reproductive health decisions for themselves
• Identify women who have achieved higher education and success in the district to educate 
and mentor them
• Give adolescent girls a voice to be able to freely express themselves and also contribute to 
solving their own problems
• Undertake activities such as nutrition and reproductive health education folic acid 
supplementation and quarterly meetings
Observations by beneficiaries: 
“Gifty Akpatso is my name, I am sixteen years of age and schooling at Hemang Assemblies of God 
International School. I have a baby; luckily I had people who encouraged me to go back to school 
after birth. The Adolescent Health and Nutrition Girls Squad is an exciting group that has helped me 
to get back my confidence.” 
 
2 Link to Photo gallery.https://fhi360web￾my.sharepoint.com/:w:/g/personal/swevans_fhi360_org/ESNXJKdIeB9Fsv_bBiZ8UA8BrkZapUpZB4-
Ix53UeJ7IlQ?e=7eIbCS
47
“I was educated on teenage pregnancy during meetings. I always come to the meetings to learn 
more about the menstrual hygiene and its management from the facilitators. I thank the team for 
their love and also our supporters for bringing such a wonderful program to my district. This program
has really changed my life entirely.”
Beneficiary 15. Evans Whajah Municipal Health Promotion Officer, Tarkwa Nsuaem (Western region. 
Project: To reduce maternal death cases among women in the Tarkwa Nsuaem municipality through 
advocacy for improved antenatal attendance through Community sensitization and awareness 
creation on maternal deaths. 
Approaches: identification and training of local information and radio operators. (community 
champions/advocates); Production and airing of jingles on maternal health; organization of durbars 
(Community Engagement) and radio discussion.
Observation by beneficiary
“I am Abdulai Sayibu 45 yrs of age who live at Badukrom in the Tarkwa Municipality. I did not know 
that maternal deaths were so high in the municipality and also thought that women who are able to 
deliver at home without going to the hospital are strong and respected but learnt after today’s 
training that delivery at home could cause maternal deaths. I have therefore decided that none of my 
family members will deliver at home anymore. I will advise all other pregnant women in my 
community to regularly attend ANC and also deliver in the health facility.”
Beneficiary 11 John Vianney, Wa. 
Project was to promote behavior change among men to support their partners during pregnancy 
and child care. 
Approaches included men wearing a 10 kg pregnancy jacket while they performed some tasks such 
as sweeping, carrying water, bathing a baby, etc. Men who wore the pregnancy jacket were made to 
share their experiences with the audience.
A man said “I never knew what women do feel when it comes to pregnancy until I wore the 
pregnancy jacket. Now I have made an informed decision to support my wife during pregnancy and 
child care.”
Other comments and lessons learned and shared by other beneficiaries include:
“One very powerful success story is that one girl who is 14 years who delivered [a baby] and she had 
stopped school for almost a year or two was able to return to school as part of a CCF funded 
advocacy project. Another success story is that one girl who is 13 years of age who got miscarriage 
and stopped school is now in school through the same advocacy project funded through CCF in 
district.” 
48
“Success Stories: Wisdom Academy School is one of the basic schools located in the Main Ashaiman 
market, a suburb of Blakpatsona Sub municipality. The school had no hand washing facilities, dust
bins, or a health club. Rubbish was put in sacks and placed in front of the school which disfigures the 
school. After discussions and deliberations with teachers and the pupils, they saw the need to have 
dust bins, hand washing facilities, and a health club in the school. Currently, all the interventions have 
been implemented by the school authority. Here, there has been a change in the behavior of the 
school where most of the activities now are being coordinated by the head teacher and the school’s 
club has established a health club (having an executive and a president and a vice; secretary and 
deputy and organizer and sanitation officer). Again, a hand washing facility was handed over to the 
school after the various interventions put in place together with the Health Promotion Officer and her 
team.” 
“Good community entry is success to programs in the communities.”
“I have learned that although there was delayed of funds, it was a good practice to start with those 
activities I could do (of which I think is a good practice) because if I had waited before 
commencement of the activities I would not have gotten something to write about at the end of the 
first quarter.” 
All the above comments came from beneficiaries of CCF who were describing various activities, 
lessons learned, and a few results after initiating activities funded through CCF. As already noted, it 
is too early to be definitive about outcome of these activities, but early results look impressive and 
there is palpable enthusiasm among CCF beneficiaries that at least they have a little support to 
embark on simple self-designed projects at district and community levels.
3.2 CO-LOCATION 
A key strategy of the USAID Communicate for Health CBSP was to provide technical onsite training, 
as well as improve management and leadership practices by ensuring staff of the project co-locate 
with HPD staff at Korle Bu in the Health Promotion building. Co-location did not occur in 2015 as 
planned due to the extensive nature of some unanticipated renovations and repairs to the HPD 
building at Korle-Bu. However, after the initial delay, the Project successfully established a system 
that allowed pairs of USAID Communicate for Health and HPD staff to work together on specific 
tasks from the renovated HPD office from March 2017. Staff were paired and worked together 
collaboratively to provide deliverables in technical areas including monitoring and evaluation, 
capacity building, mass media, SBCC collaboration and partnerships, and a senior project 
management team. Co-location was a USAID requirement for the project. 
Technical Capacity Building through Co-location
The co-location strategy enabled officers of HPD and USAID Communicate for Health to work closely 
together and plan and transfer skills to HPD. It led to improved interaction, thereby enhancing 
workflow, as well as improved bonding and enhanced chemistry among officers that facilitated 
transfer of knowledge and skills from USAID Communicate for Health to HPD officers after working 
together for some time. Proximity and easy access to team members to discuss technical and 
49
program issues in real time and resolve challenges also enhanced the technical capacity building of 
HPD officers. 
As part of co-location, monthly joint planning meetings were held between HPD and staff of USAID 
Communicate for Health at the onset when a lot of activities were being rolled out; these were later 
held quarterly when implementation gradually eased. Chairmanship of these meetings rotated from 
HPD to USAID Communicate for Health, and mutual learning occurred. Especially from HPD 
perspective, it offered opportunity to learn some private sector work ethic in terms of meeting 
deadlines, writing meeting minutes and developing deliverables. Prompt feedback mechanisms were 
established for joint program operations, which allowed for understanding of the different systems 
of financial and operational systems between FHI 360 and USAID on one hand, and Government and 
GHS on the other. These meetings became a driving force for collaboration, decision making, and 
team building. Over time, they became increasingly productive, highly professional, and results￾driven—with HPD often taking on a lead role for coordination. HPD staff have also become more 
involved in implementing key decisions arising from the joint meetings, along with their “paired” 
technical counterparts from Communicate for Health, according to USAID Communicate for Health 
officials. Specifically, HPD used such meetings to follow up with progress with implementation of its 
own Strategic Plan, as well as use opportunities afforded to undertake regional and district 
monitoring of its own activities, something which rarely happened due to funding challenges before 
the USAID Communicate for Health project. 
Communicate for Health organized annual work plans with HPD and key implementing partners 
before end of each year to develop Program of Actions for ensuing years. The exercise provided 
additional opportunity for building capacity of HPD staff especially in terms of rigorous requirements 
of USAID and other private partners in developing annual plans of work. There was a conscious
effort to harmonize the activities planned for in the HPD Strategic Plan 2015–2019 and the USAID 
Communicate for Health project activities for each year. 
3.3 CAPACITY BUILDING IN FINANCIAL MANAGEMENT 
The two main funding channels used by USAID Communicate for Health are the Fixed Amount Award 
(FAA) and the In-Kind Grant (IKG) mechanism. IKG is used by USAID Communicate for Health for 
procurement of goods and services on behalf of HPD. FAA arrangement involved HPD writing 
effective Program Description (PD) based on its own identified priorities and executing the approved 
activities based on a fixed budget with agreed deliverables.
Capacity has been partly built for HPD on financial management to implement the FAA with support 
from USAID Communicate for Health staff. HPD is now able to prepare Plan of Action, deliverables 
and budget as per FHI360/USAID requirements with minimal support. HPD staff were taken through 
a training session with focus on sub-award process or the procurement of external services. It also 
included tips for writing effective Program Descriptions for grants or Scope of Work (SOW) for 
subcontracts. The broader training objectives were as follows:
1. Identify basics and best practices to be used in writing a Program Description (PD)
50
2. Explain the legal significance of the PD
3. Learn the “5 Cs” of good PD writing
4. Understand the difference between results, deliverables, and requirements
5. Understand the components of a strong PD [USAID Communicate for Health Feb 2016]
3.4 CAPACITY BUILDING IN PROPOSAL WRITING 
The 23 Health Promotion Practitioners who were trained in the first cohort of the CADP in July 2016 
were brought together again and trained on proposal writing on February 27, 2017. This was found 
necessary because proposal writing was not initially included in the curriculum of CADP, but cohort 1
participants requested for its inclusion in future training sessions which was done for CADP cohorts 2 
and 3, and for all SfC cohort trainings. A day was dedicated in the trainings for proposal writing. The 
training sought to strengthen proposal writing skills of trainees to enable them write winning 
proposals to access the Change Challenge Fund (CCF) under the USAID Communicate for Health 
project as well as source funds for other activities [GHS 2017c]. Analysis of endline assessment once 
again showed that 65% of cohort 1 CADP participants indicated that they had written winnable 
proposals by 2019 compared with 38.9% for cohort 2 and 60.9% for cohort 3 [see Table 4]. This once 
again goes to possibly confirm, as previously, the higher quality of training for cohort 1 participants 
than the subsequent trainings.
3.5 INTERNSHIP 
 
The CBSP included placing HPD officers to selected implementing partners (VIAMO, MULLEN LOVE 
and CREATIVE STORM Networks) for capacity building in an internship arrangement to learn 
firsthand some practical aspects of SBCC programming and implementation. It created opportunities 
to expand skills and knowledge outside the work place. A draft internship policy was developed in 
2016 with support from USAID Communicate for Health to guide the capacity building placement of 
key HPD staff to the selected implementing partners. The internship program afforded selected HPD 
staff to be part of an SBCC process, working alongside others who are experts in their field, to really 
understand the process and the components of its design, pretesting and production of campaigns, 
as well as the roles and responsibilities people play and the skills they draw from. 
Based on the initial organizational assessment, it came out that the creative process is an area HPD 
staff understand but lack expertise or in-depth knowledge of the processes and skills used to 
develop creative concepts and messaging for target groups. The same can be said of how to develop 
a campaign starting with a creative brief, how to develop an effective radio program or radio spot, 
how to use story telling in their community approaches, or how to work with communities to 
develop a social documentary. It is possible to have such things explained in a classroom setting but 
the effect will be much less impactful than being involved in the actual “doing” and “creating” 
[USAID Communicate for Health CBSP, 2016]. The internship program design was based on these 
concepts, as part of the capacity building plan for HPD. 
MULLEN LOWE
51
In 2016, three HPD staff completed a three-month internship program with Mullen Lowe, the 
creative agency that worked with Communicate for Health and the GHS/HPD to refresh the 
GoodLife, Live It Well brand. The internship appointments allowed HPD staff to experience working 
with a professional creative firm, taking them through the process of needs assessment, creation of 
concept, brand development, and materials design. The participants from the material development 
unit of HPD had the opportunity to be involved in the refreshing and relaunch of GoodLife, Live it 
Well campaign. Their capacity has been built as far as SBCC is concerned, and this has contributed 
greatly to the attraction of contracts for development of various SBCC materials as described in 
Session 2.2. The text box shows comments by interns and the Chief Executive Officer of Mullen Lowe 
concerning the internship program. 
Assessment by Interns: “The program was very useful—particularly the hands-on experience with 
the GoodLife campaign development, including photo shooting, pretesting, and graphic design.” 
Assessment by LOWE: “Contribution of trainees increased as well as institutional knowledge of SBCC
and enhancing the working environment through absorbing private sector culture.” 
VIAMO
In 2018, VIAMO provided opportunities for HPD to develop skills and gain practical experience using 
mobile phones as tools for SBCC messaging (SMS and voice) and data collection. Two HPD Program 
Officers, worked with VIAMO staff at their offices in Accra for six months from September 11, 2017 
(48 contact hours total). Sessions were facilitated by VIAMO’s SBCC Advisor/Project Manager, with 
support from other VIAMO staff. They were taken through modules on digital and mobile health, 
productivity management tools and work ethics and efficiency. 
The internship with VIAMO provided opportunities for HPD staff to develop knowledge and skills in 
how to plan, design, and deploy SBCC campaigns using cutting edge mobile technology, including 
those used for the project’s mobile phone cohort survey, as well as applications such as Slack3 and 
Wrike4
. The internship also focused on improving the interns’ skills in other Microsoft Office suites 
including Google Office and MS Excel. They are now able to send high-volume SMS messages 
without support from VIAMO. Messages have thus far been sent to Communicate for Health and 
GHS staff at the national, regional, and district levels. Unfortunately, not much has been executed 
from the trainees since the internship even though their technical capacity in SBCC messaging has 
been built, due to delays in receiving approval of messages before transmitting, as well as
diminished enthusiasm in that area of communication.
CREATIVE STORM NETWORKS: SOCIAL MEDIA INTERNSHIP AND CAPACITY BUILDING 
There was a relaunch of the GoodLife Social Media Platform in January 2018 with Creative Storm 
Networks, one of Communicate for Health’s partners that had designed and promoted the original 
 
3 Slack facilitates instant and secure communication among colleagues to, for example, assign tasks, share documents, 
and collaborate.
4 Wrike is an online project management software. 
52
platform in 2017. A road map for transitioning the social media platform to the GHS was drafted and 
adopted in February 2018. 
Four HPD staff underwent a three-week internship program during which they understudied with 
the social media team at Creative Storm Networks between April 9–27. Training focused on hosting 
and managing social media platforms; recruiting new members on WhatsApp, Twitter, and 
Instagram; responding to and managing clients on the different platforms; and developing new 
social media groups. The training also covered skills in livestreaming indoor and outdoor health 
events to the general public, measuring social media impact and socio-media monitoring, and linking 
with other platforms for synergy. As part of the training program, participants covered the launch of 
the World Immunization Day, the 2018 MOH Annual Health Summit, and the 2018 World Malaria 
Day Commemoration. 
Later the GHS/ HPD allocated an office space within the HPD offices at Korle Bu for the social media 
set-up. Communicate for Health installed four desktop computers, a printer, and two tablets, which 
facilitated smooth migration of the platform from Creative Storm Networks to HPD. Currently, the 
social media unit is manned by HPD officers and equipped at the Department to handle information 
and also stream live activities of the GHS on the various social media platform as part of the 
structure of the new division. 
The social media team livestreamed the elevation of HP department to Divisional Status and, more 
recently, the 2nd Maternal and Child Health Conference on June 26-28, 2019, was streamed live by 
the unit, as well as the 8th Annual Newborn Stakeholders’ meeting from July 30–August 1, 2019. The 
training manual on social media that was developed for the training is available to trainees. So far 
the Facebook page established by the HPD social media unit has 38,900 likes and 39,000 followers as 
of June 26, 2019; Twitter and Instagram have 1,302 and 1,314 followers respectively, even though 
their facilitators believe they could have done more after the training.
3.6 GENDER ASSESSMENT AND TRAINING 
USAID requires that all new projects funded after July 2013 conduct a gender analysis/assessment. 
Consequently, gender mainstreaming capacity building was included in the CBSP of USAID 
Communicate for Health initiative. A gender assessment was planned for and budgeted in the initial
proposal to USAID for the USAID Communicate for Health [USAID Communicate for Health 2015]. Dr. 
Andrea Bertone, director of the FHI 360 Gender Department traveled to Ghana from June 25– July 
22, 2015, to conduct the gender assessment with the USAID Communicate for Health and HPD 
teams. During the last week of the trip (July 13–14, 2015), Dr. Bertone facilitated a two-day gender 
workshop for 41 participants including 16 HPD and regional officers, representatives from GHS/FHD, 
USAID Communicate for Health, Ghana Community Radio Network, Creative Storm, VIAMO, and 
USAID implementing partners. The purpose for conducting the gender assessment and trainings 
during the project start-up year was to ensure that USAID Communicate for Health does not 
exacerbate unequal gender norms among individuals and groups, and that societal gender norms do 
not prevent the project from achieving identified objectives. Topics covered during the training 
included: 1) overview of gender and international development; 2) gender synchronized 
53
approaches—evidence for gender transformation; 3) gender integration continuum—achieving 
gender transformation overview; 4) conducting a gender assessment; 5) gender mainstreaming and 
gender integration; and 6) measuring changes in gender norms [USAID Communicate for Health Feb 
2016]. 
The impact of the gender training is difficult to measure now as there has not been many direct 
activities in this area over the project period. 
54
CHAPTER 4: CONCLUSIONS OF STRENGTHS/KEY ACHIEVEMENTS AND 
WEAKNESSES 
This chapter provides a summary of strengths/achievements and weaknesses/gaps, based on the 
literature and desk reviews, interviews with key stakeholders at national, regional and district levels, 
baseline and endline assessment of technical capacity, and interactions with HPD officers over the 
years. It is designed and arranged to answer the questions raised in the ToRs. Detailed descriptions 
of various elements have already been presented in earlier chapters. Recommendations are 
provided in Chapter 5.
4.1 Summary of Conclusions of Strengths, Weaknesses/Challenges per ToR 
The following sections summarize the conclusions to answer the questions as per the ToR.
ToR 1: Has Health Promotion Department (HPD) increased its capacity from 2015 to lead, design, 
development, coordinate, and implement evidence-based social and behavior change campaigns? 
The answer is yes. Organizational technical capacity assessment of HPD to lead, design, 
development, coordinate, and implement evidence-based social and behavior change campaigns 
showed that the endline organizational technical capacity assessment of performance increased 
from 58% in 2015 to 83.9% in 2019, an increase of 44.6%. The greatest actual increases were in the 
area of implementing and monitoring change process, focusing and designing the communication 
strategy, and understanding the context through situation analysis. In contrast, there was a 
deterioration of over 33% in the area of evaluation and re-planning for outcome and sustainability, 
due mainly to lack of analysis and use of reported HP indicators, especially at the national level.
The improved organizational technical capacity of HPD, especially in the area of SBCC development 
and implementation, is evidenced by the increasing number of key partners who have over the 
period sub-contracted HPD to develop and execute SBCC projects on their behalf and to their 
satisfaction. Some of the partners include JICA, GIZ, JHPIEGO, PATH, CDC and National Malaria 
Control Program. Almost all partners were impressed with the technical competence of HPD, 
especially at national level and in some regions. The consensus of partners is that HPD has capable 
and competent staff who can work professionally if provided the required resources and a favorable
enabling environment. 
ToR 2: To what extent have Health Promotion Officers (HPOs)) applied the knowledge and skills 
acquired through participation in the CADP to develop proposals and plan and implement evidence￾based social and behavior change and health promotion campaigns? 
The improved performance chalked by HPD came about over the period mainly through the 
development of a well-structured capacity building support plan (CBSP) to train HPOs and TOHP 
through CADP and SfC from national, regional, and district levels, through the instrumentality of its 
key partner, USAID Communicate for Health.
55
There were three CADP training sessions over the period of support. Cohort CADP 1 participants 
assessed themselves highest as very high performing at endline (30%), followed by cohort 3 CADP 
participants (17.4%) and cohort 2 CADP participants (11.1%). The observed differences were 
statistically significant (Fishers’ exact test of independence, p<0.001). 
In terms of component areas in the CADP training curriculum that facilitated application of 
knowledge and skills acquired during the training, most of CADP participants in all cohorts assessed 
themselves high in areas such as understanding social and community mobilization (95%), planning 
and coordinating SBCC ( 80%), and creating and implementing effective SBCC ( 80%). Interestingly, 
cohort 1 participants scored themselves highest in almost all categories followed by cohort 3 and 
cohort 2. 
The conclusion is that the changes made after CADP cohort 1 training (such as adding another day to 
training period) did not significantly affect the self-assessment of cohorts 2 and 3 participants as far 
as their performance after training is concerned.
In terms of areas that facilitated application of knowledge and skills acquired during the training, 
most of CADP participants in all cohorts assessed themselves low in application of knowledge and 
skills acquired in mobile technology (30%), effective SBCC through TV documentary (20%), 
understanding social marketing (20%) and understanding formative assessment in SBCC (50%) 
compared with other components. However, they scored themselves high in all the other areas such 
as understanding social and community mobilization (95%), planning and coordinating SBCC (80%), 
and creating and implementing effective SBCC (80%). Interestingly, cohort 1 participants again
scored themselves highest in almost all categories followed by cohort 3 and cohort 2. There is the 
need to review the training syllabus and either change the content (especially in areas where 
persistently the participants scored themselves low, as there appears to be minimal impact on their 
performance) or change the facilitators or mode of delivering these topics.
In terms of what they had done differently by 2019 as a result of their participation in the CADP, all 
cohorts scored themselves low in the following areas: sourcing funds for SBCC (45%), using mobile 
technology to communicate to target audience (40%) and developing indicators to monitor SBCC 
activities (40%). 
Tor 3: To what extent have Technical Officers for Health Promotion (TOHP) applied the knowledge and 
skills acquired through participation in the Set for Change (SfC) Action Learning sets program to 
develop proposals and plans and implement evidence-based social and behavior change and health 
promotion campaigns? 
There were two training sessions for TOHPs: SfC cohort 1 and SfC combined cohorts 2 and 3. Among 
cohort 1, 33.3% assessed themselves in 2019 as very high performing in application of knowledge 
and skills acquired from the trainings compared with 0% in 2016 before training [44.4% in 2019 vs. 
0% in 2016 for high performing].
56
Compared to the self-assessment of cohort 1, only 26.3% of SfC cohorts 2/3 participants assessed 
themselves in 2019 as very high performing in application of knowledge and skills acquired from the 
trainings compared with 6.7% in 2017 before training. The differences observed are statistically 
significant (p<0.001). 
It can be concluded that any changes made after cohort 1 training did not improve outcome of 
future training of cohort 2/3 participants as far as confidence in application of knowledge and skills 
acquired by participants during SfC training is concerned. Reduction of training sessions from four 
(SfC cohort 1) to just one (SfC cohorts 2/3) appears to have adversely affected their post-training 
performance.
In terms of areas that facilitated application of knowledge and skills acquired during the training, SfC 
participants assessed themselves low in applying their understanding of SBCC theory (44.4%), 
creating and implementing effective SBCC (33.3%), understanding social marketing (33.3%), using 
mobile technology (0%), and writing winnable proposals (44.4%). However, they assessed 
themselves high in understanding social and community mobilization (100%) and working effectively 
with the media (88.9%). 
The responses from the supervisors affirm their overall positive assessment of enhanced 
performance of CADP and SfC participants after the training. Not surprisingly, 86.7% of the 
supervisors indicated that they would recommend the CADP and SfC training to other HP officers 
who had not yet benefited from them, in view of what they had witnessed in those who had 
completed the training.
CCF
So far, 15 CADP and SfC participants have received initial funding for various SBCC projects at the 
local level. Early results from activities funded by CADP and SfC beneficiaries look impressive. 
Beneficiaries are highly motivated, knowing that they now have a little financial support to embark 
on their own self-designed simple projects at district and community levels. The evidence so far 
shows that they are able to negotiate with stakeholders, and their working relations with colleagues 
have improved, enabling them to mobilize community and other support to their planned SBCC 
projects. Four beneficiaries of CCF recently showcased their projects by making presentations during 
the 2nd Maternal and Child Health Conference on June 26–28, 2019, to the admiration of many. 
ToR 4: To what extent and in what ways has the Health Promotion Department increased its capacity 
for evidence-based social and behavior change communication through the different capacity building 
approaches rolled out by the Communicate for Health project? 
A number of other capacity building approaches (apart from CADP, SfC and CCF) were rolled up by 
the USAID Communicate for Health project to build capacity of HPD in SBCC. The approaches 
included:
57
1. Co-location: USAID Communicate for Health project team co-located with the HPD at national 
level to facilitate the application of an effective and efficient form of institutional and individual 
capacity building to ensure local ownership and sustainability. They worked as a blended team to 
conceive and implement a comprehensive social and behavior change communication and health 
promotion campaign. USAID Communicate for Health staff supported, coached, and problem-solved 
with their HPD counterparts, enabling them to take the lead in planning, implementing, and 
monitoring SBCC project activities.
2. Internships: To complement the CADP and SfC training programs, the CBSP included promotion of 
an embedded internship program where officers were embedded into private sector institutions 
(Mullen Lowe, VIAMO, and Creative Storm Networks) for hands-on practical training in various 
aspects of SBCC programs. 
In 2016, three HPD staff from the Material Development Unit of HPD completed a 3-month 
internship program at Mullen Lowe. The internship has enhanced the technical capacity of the 
Material Development Unit, and has contributed greatly to the attraction of SBCC contracts from 
various partners and their successful execution as mentioned above. 
The internship with VIAMO provided opportunities for HPD staff to develop knowledge and skills in 
how to plan, design, and deploy SBCC campaigns using cutting edge mobile technology. They are 
now able to send high-volume SMS messages without support from VIAMO. Unfortunately, not 
much has been executed from the trainees after the internship even though their technical capacity 
in SBCC messaging has been built mostly due to diminished interest in that area after their training. 
Three staff from the Health Promotion Department and another from the FHD had a 3-week 
internship training in 2018 with Creative Storm Networks—a media production firm, as part of the 
social media contract with USAID Communicate for Health. Currently, a social media unit has been 
established and manned by HPD officers and partly equipped at the Department to handle 
Information and also stream live activities of the GHS on the various social media platform as part of 
the structure of the new division. The social media team livestreamed the elevation of HP 
department to Divisional Status and, more recently, the 2nd Maternal and child Health Conference 
on June 26–28, 2019, as well as the 8th Annual Newborn Stakeholders’ meeting from 30th July 30–
August 1, 2019. So far, the Facebook page established by the social media unit of HPD has 38,900 
likes and 39,000 followers as of June 26, 2019; Twitter has 1302 and Instagram has 1314 followers, 
even though their facilitators are of the opinion that they could have done more after the training.
ToR 6: What important successes and lessons can be learned through roll out of the HPD capacity 
building program for future programming? 
 
A number of lessons have been learned during implementation of the USAID Communicate for 
Health partnership project with HPD.
58
a.) Focusing only on “hard” issues of project implementation is not helpful and will result in conflicts 
and delayed implementation of activities. The “softer” aspects such as attitudinal changes, 
commitment, and motivation are equally important; projects should invest in addressing these areas 
also. Tolerance and mutual respect of all partners are important for successful implementation of 
projects. 
b.) It is necessary to build conflict resolution mechanisms into projects, such as support from senior 
highly-respected officers with enough clout to intervene when things are not moving well.
 
c.) One lesson is aptly quoted from a senior officer of USAID Communicate for Health: “An added 
component of community engagement or mobilization to the USAID Communicate for Health 
Project would have added value to the mass media communication, which was the main focus of the 
project. There was a gap in terms of community mobilization and engagement, thus the interface 
between the health system and the community suffered. This element sat with another 
implementing partner, and without effective coordination to bring all the arms of SBCC together 
under one umbrella (that is mass media, advocacy, and community mobilization), realization of SBCC 
outcomes would be difficult. In the future, it will be important to ensure there is synergy and 
complementarity of “above the line” and “below the line” SBCC efforts.”
d.) Co-location enhances performance and improves efficiency, as it provided opportunity for 
transfer of knowledge and skills from one partner to another. 
ToR 7: What challenges were encountered during roll out of the capacity building programs that could 
inform the design of future capacity building programs? 
Despite the impressive achievements over the past 5 years of the project, a number of weaknesses, 
gaps, and challenges have been identified during the assessment which have to be addressed going 
forward. These are based on my analysis of the various interviews from all stakeholders and my 
inside knowledge of the project from its inception. The key focus once again is on the technical 
capacity support plan. 
Technical Capacity Building – CADP and SfC
Despite the carefully planned and executed CADP and SfC training plans, the participants scored 
themselves low in certain areas such as knowledge and skills acquired in mobile technology, 
effective SBCC through TV documentary, understanding social marketing, and understanding 
formative assessment in SBCC. There is the need to revisit the training syllabus and either change 
the content or the facilitators or mode of delivering these topics. The mode of delivery of CADP and 
SfC is still too didactic and lacks practical sessions which were originally envisaged. SfC was designed 
to have participants determine the issues to be addressed prior to the training, but that was not 
made clear and had to be predetermined, hence partly losing the ACTION LEARNING intention. 
The process for selection of candidates is too rigorous, especially the requirement of an overly 
detailed proposal development process for selection to SfC. This has the potential to limit many 
potential officers at district level from benefiting. The original SfC training was designed for around 
59
10 participants from each cohort who were expected to attend a three to four-day program on 
multiple occasions. This required a lot of travel time and logistics so organizers ended up adding 
days per sessions and combined participants per training to make them more cost effective. In 
actual practice, 10 participants took part in SfC cohort 1 over four sessions, but only 17 participants 
made up cohorts 2 and 3, which were combined into one training session due to logistical and 
financial constraints. This appears to have affected self-assessed performance, as SfC cohort 1 
participants typically scored themselves higher than combined SfC cohort 2 and 3.
In order to reinforce and consolidate learning, Communicate for Health was expected to work with 
VIAMO to develop motivational messages for the CADP and SfC beneficiaries after their training, but 
this could not materialize due to funding issues. Currently, the training program is dependent on 
donor support from USAID Communicate for Health and is not sustainable if not internalized. 
Specific to CCF, owing to delays in release of funds due to circumstances beyond the project’s 
control, only one round of CCF awards had been made as of time of assessment in June 2019, 
although the plan was to make three awards during the entire project lifespan. 
Co-location
There appears to have been an initial “cultural shock” due to a different work ethic (public vs. 
private mentality). This tense atmosphere at the start of project support affected the transfer of 
knowledge and skills from USAID Communicate for Health officers to their twin counterparts. This 
initial atmosphere was not conducive to learning and exchange of ideas—a key objective of the co￾location strategy, but eventually the situation improved. 
Internship
One weakness of the internship program for HPD was the low number of officers who benefitted 
from it: two at VIAMO, three at Mullen Lowe, and three at Creative storm Networks. The problem is 
that the capacity building depends on a few officers who may be overburdened as work load 
increases or if they leave the HPD (an emerging threat).
The other challenge is the long process of clearance and approval of SBCC messages for VIAMO, 
which affected timely delivery of SBCC messages e.g., through SMS, a prerequisite for using such 
mode of delivery. The expensive nature of SMS messaging compared with other social media 
platforms such as WhatsApp make it unattractive to many. The CCF group is using WhatsApp to 
communicate and support one another, without any clearance requirements, and it is free. 
Another challenge faced by the interns was that some of them were busy elsewhere and so there 
was the need for constant readjustment of schedules by the private firms, thereby affecting 
learning. The team spirit among interns who were trained at Creative Storm Networks was strained 
initially, and this has partly affected their output after the training. They have found it difficult to 
share information on various social media platforms, and according to the resource person during 
the internship, he has not been impressed with their performance even though they have the 
technical capacity to deliver if they so wish.
60
Another challenge was the provision of required resources to participants after the internship 
training to implement what had been learned. For instance, the newly established social media unit 
lacks a video editor for effective functioning. 
Stretch assignments 
The CBSP also was designed to include stretch assignments for regional and district level staff to 
work at the national or regional level on a specific task or activity such as developing a campaign or 
the M&E framework. It was supposed to provide the opportunity for trainees to be challenged, use 
new skills, learn new work contexts, and experience a different setting, as they worked on an SBCC￾related task with specified deliverables. Unfortunately, this did not materialize.
Peer Mentoring
The CBSP envisages that selected past participants of CADP and SfC will offer support and mentoring 
to their colleagues who have yet to have attended a development program. With the exception of a 
few past participants (such as Ms. Uzomah of HPD becoming a facilitator and coordinator for CADP 
and SfC after training), this initiative did not materialize during the period and is an area of weakness 
that needs to be addressed in future technical capacity plans.
61
CHAPTER FIVE: RECOMMENDATIONS 
Based on the interviews, findings, observations, and analysis of all that has happened within HPD 
from 2015 to 2019, the following recommendations are made to enhance capacity building 
initiatives of the new HP Division moving forward.
1. Undertake a training needs assessment of the HP Division officers based on the defined 
responsibilities and expected roles of key officers of the new HP Division, as well as on the 
job descriptions of Health Promotion practitioners before any training is started. 
2. Continue and institutionalize the capacity building effort through CADP and SfC and other 
technical courses to further build capacity of HP officers, while taking cognizance of 
weaknesses and suggestions provided by participants. Specifically, there must be more focus 
on improving quality of delivery of topics and practical skill acquisition during the training 
(including use of simulation exercises), and less on theoretical concepts, which have not 
proven that useful for the participants. There was no evidence that extending the duration of 
training after the first cohort training improved performance, and this issue should be further 
discussed after review of the course content. 
3. Explore other ways of providing technical capacity support to HPOs and TOHP to 
complement current CADP and SfC approaches, such as online courses, access to e-books, 
and use of digital applications for workshops such as through Skype and Zoom to minimize 
training costs and enhance efficiency. 
4. The modified CADP and SfC should be formalized with the professional Allied Council as a 
Continuous Professional Development (CPD) course for HP officers. This will serve as an 
incentive for HP officers to participate in such courses.
5. CADP and SfC should be incorporated into the curriculum of the Kintampo College of Health 
and Wellbeing and other HP training institutions to improve capacity of trainees at pre￾service level. 
6. Rapidly deploy CCF for CADP and SfC graduates in future projects to run concurrently with 
the mass media campaigns to create the needed synergy for rapid behavior change. Such an 
initiative should be built into the normal budget of HP Division from the Government of 
Ghana, with funding support from interested partners as required.
7. Institutionalize the internship capacity building system (two weeks or so) with creative firms
or local or international organizations doing media, social marketing, social media or SBCC 
work, for key technical staff. A formal MoU should be developed with parties specifying the 
roles and responsibilities of each partner in the internship program. If properly structured
and promoted, many more HP officers can benefit from the program at minimum cost, as 
other partners may buy into the initiative as part of their support. 
62
8. In addition to SBCC, other areas where capacity building is required and proposed include 
training in leadership and management, advocacy and networking, strategic planning, 
resource mobilization, policy development, health promotion practice, knowledge transfer, 
and research.
9. Establish annual best HPO and TOHP awards as envisaged in current National HP Strategy to 
boost morale and encourage competition.
10. Initiate an annual HP conference during which beneficiaries of CADP, SfC, CCF, and other 
capacity building initiatives can be invited to showcase what they are doing currently in their 
respective areas after training. Partners can be invited and encouraged to sponsor aspects of 
the program and make presentations. HP Division can learn from Family Health Division, 
which has successfully organized annual conferences on Maternal, Child, and Newborn 
Health, which were well patronized locally and internationally. 
63
REFERENCES 
1. C-Change 2011. Social and Behavior Change Communication - Capacity Assessment Tool 
(SBCC-CAT), for Use with Organizations March 2011. 
2. GHS 2014. Situation Analysis and bottleneck analysis of HPD in 2014.
3. GHS 2015. National HP strategic Plan 2015-2019. 
4. GHS 2017a. Draft Report of Mapping Exercise of Health Promotion Resources in Ghana. 
5. GHS 2017b Second Year of Life evaluation report, 2017. 
6. GHS 2017c. HPD Annual report 2017.
7. Google Link to CDAP and SfC supervisors’ tool, 2019: https://forms.gle/2oSkb9Jp3cRnWVDG7
8. Google link to Technical Outcome Assessment tool 2019. 
https://docs.google.com/forms/d/1Dww6S1-Ehfp1jdlORvk￾VawdqbTxvcgJNMsceE2hZR4/edit?usp=sharing_eil&ts=5cc72e3d
9. James R. 2001. Practical Guidelines for the Monitoring and Evaluation of Capacity building 
Experience from Africa. London: Intrah. 
10. La Fond, Anne and Brown, Lisanne. A guide to Monitoring and Evaluation of Capacity-Building 
Interventions in the Health Sector in Developing Countries. MEASURE Evaluation Manual. 
Series, No. 7. Carolina Population Center, University of North Carolina at Chapel Hill: 2003 
11. Lammert, J.D, Johnson, L., & Fiore, T. A, (2015). Conceptualising capacity building. Rockville, 
MD: Westat. 
12. MOH/GHS 2013. National Malaria Program Review. Final Report June 2013. 
13. Morgan 1997. The Design and Use of Capacity Development indicators. CIDA 1997.
14. Link to the audio-visual material produced by HPD and JICA on CHPS. https://fhi360web￾my.sharepoint.com/:f:/g/personal/swevans_fhi360_org/EjOvirwPNg9EubOpYUBZPXUBqA7M
CLYq-bfUvih-ekWnMA?e=0rnxnB
15. USAID Communicate for Health 2014. Technical project Proposal 2014
16. USAID Communicate for Health 2015. Report on Social and Behavior Change Communication 
Capacity Assessment. August 2015.
17. USAID Communicate for Health 2016. Impact assessment reports of CADP cohorts 1, 2016.
18. USAID Communicate for Health 2016. Pre- and post-training evaluation reports during CADP 
and SfC training. USAID Communicate for Health Annual Report YR2 (2016). 
19. USAID Communicate for Health 2017. USAID and GHS Memorandum of Understanding 
(MOU) for the implementation of USAID Communicate for Health.
20. USAID Communicate for Health 2018. USAID Communicate for Health, Annual Report YR4 
(2018).
21. USAID Communicate for Health 2019. Endline assessment photo gallery. https://fhi360web￾my.sharepoint.com/:w:/g/personal/swevans_fhi360_org/ESNXJKdIeB9Fsv_bBiZ8UA8BrkZapU
pZB4-Ix53UeJ7IlQ?e=7eIbCS
22. USAID Communicate for Health 2019. Individual Training Outcome Assessment Tool for CADP 
and SfC (participants). 
23. USAID Communicate for Health 2019. Individual Training Outcome Assessment Tool for CADP 
and SfC (supervisors). 
64
24. USAID Communicate for Health 2015. Baseline capacity assessment reports of HPD at 
national and in the three regions (Western, Northern and Volta), August 2015. 
25. USAID Communicate for Health, February 2016. Capacity Building Support Plan.
26. USAID Communicate for Health. 2015-2019. Communicate for Health annual progress 
reports, 2018-2019. 
27. WHO 1986. Milestones in Health Promotion, Statements in Global conferences. WHO Ottawa 
1986. 
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APPENDICES 
Appendix 1: List of Interviewees for End Line Assessment of HPD 
Endline Organizational Capacity Assessment - HPD Headquarters: May 2, 2019
1. Alhaj Abubakar Sufyan - Dep. Chief – HP
2. Isaac Akumah - Administrator
3. Mr. Seth Adjei - Program Officer
4. Mr. Kwadwo Asante-Afari - Program Officer
5. Mrs. Uzomah Tetteh - Program Officer
6. Mr. George Nartey - Program Officer
7. Mr. Albert Nyanney - Program Officer
8. Vincent Oduro - National Service Personnel
9. Jerry Fiave - Intern 
10. Ernest Yeboah - Program Officer
11. Elizabeth Kusi Ababio - Program Officer
12. Douglas Adu-Fokuo - PR Officer
Field Visit to Central, Western, and Greater Accra Regional Health Directorates
1. Dr. Alexis Nang-Beifubah - Regional Director Health Services (Central)
2. Dr. Jacob Mahama - Regional Director Health Services (Western)
3. Dr. Yaw Ofori Yeboah - Deputy Director Public Health (Volta)
4. Dr. Osei Assibey - Ag. District Director – Shama (Western)
5. Angela W. Dadzie - DDNS (PH) – (Western) 
6. Augustine A. Owusu - Regional Accountant – (Western)
7. Joseph E. Mozu - Chief Pharmacist – (Western)
8. Thomas Tamah - DDA – (Western)
9. Daniel Bomfeh - Western Regional Health Promotion Officer
10. Matthew Ahwireng - Central Regional Health Promotion Officer
11. Patricia Baku - Volta Regional Health Promotion Officer
12. Anna Obir-Bonney - Technical Officer – Health Promotion (Central)
13. Benjamin Amihere - Technical Officer – Health Promotion (Western)
14. Emelia Kpodo - Technical Officer – Health Promotion (Western)
15. Mercy Fuachi - Health Promotion Officer (Western)
16. Shine Gavey - Technical Officer – Health Promotion (Volta)
17. Abiba Abdul Rashid - Technical Officer – Health Promotion (Western)
18. Vida Ntiwaa Gyasi - Health Promotion Officer (Greater Accra)
Field Visit to Partners that Work with HPD
NAME ORGANIZATION POSITION
Barbara Davies Infinity970 Executive Director
Emmanuel Adiku Pro-Link M&E Coordinator
Norkor Duah Mullen Lowe Chief Executive Officer 
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NAME ORGANIZATION POSITION
Sandra Abrokwa Viamo Country Director
Patience Dapaah PATH Advocacy Advisor, MNCHN
Victus Sabutey Creative Storm Network Research & Productions Co-ordinator
Frank Adetor Skill-Up Project Former Senior Organizational 
Development Specialist for C4H
Submission of Filled Questionnaire via Email
• Geeta Sharma Communication for Development (C4D) Specialist, Unit Head
• Afewu Christine Esenam Program Officer – GIZ
Interview with Staff (HPD and Communicate for Health)
• Eunice Sefa Senior M&E Advisor
• Yvonne Ampeh Senior Program Officer
CADP and SfC Beneficiaries Who Completed Online Assessment
Name of beneficiary Region District/Municipality Designation (Job position) 
Siepele B. Ernest Upper West Nadowli-kaleo District Technical Officer Health Promotion 
(TOHP)
Edward K Beyereh Upper West Wa West District Health 
Administration
Public Health (Health Promotion)
Jemima Damalie Volta Volta Regional Health 
Directorate, Ho.
Technical Officer Health Promotion 
(TOHP)
Abubakari Abudardai Western Juaboso Technical Officer Health Promotion 
(TOHP)
Seidu Ayatolai Northern Central Gonja District Technical Officer Health Promotion 
(TOHP)
Danah Kubanue Mariam Uoper East Bawku West Technical Officer Health Promotion 
(TOHP)
Augustine Osei Eastern Birim North Technical Officer Health Promotion 
(TOHP)
Atsrim Matilda Mawunyo Volta Afadzato South District Technical Officer Health Promotion 
(TOHP)
Enoch Atta Aggrey Western Prestea Huni-Valley Technical Officer Health Promotion 
(TOHP)
Alhaji Osman Upper east Pusiga Technical Officer Health Promotion 
(TOHP)
Anna Obir-Bonney Central Regional Health 
Directorate
Technical Officer Health Promotion 
(TOHP)
Buatsi Lynda Volta Adaklu District Technical Officer Health Promotion 
(TOHP)
Francis Eduku Boahulu Western Wassa Amenfi Central Technical Officer Health Promotion 
(TOHP)
Bridget Anim Eastern New Juaben Regional Health Promotion Officer 
(RHPO)
Anastious Aaron Essuman Central Cape Coast Technical Officer Health Promotion 
(TOHP)
Eric Kofi Oduro Amankwah Bono East Techiman Municipal Health Educator (Health Promotion 
67
Name of beneficiary Region District/Municipality Designation (Job position) 
Manager)
Emmanuel K Koomson Eastern District Technical Officer Health Promotion 
(TOHP)
Nasiratu Imoro Greater Accra GA West Municipal Technical Officer Health Promotion 
(TOHP)
Evans Whajah Western Municipality Technical Officer Health Promotion 
(TOHP)
Yakubu Rahinatu Bint 
Abukari
Northern Tamale Metro Regional Health Promotion Officer 
(RHPO)
Augustina Nartey Eastern Municipal Regional Health Promotion Officer 
(RHPO)
Matthew Owusu Western Sekondi Takoradi Technical Officer Health Promotion 
(TOHP)
Vida Ntiwaa Gyasi Greater Accra Ga South Health Promotion Officer (HPO)
Maakpe john Vianney Upper West Wa Municipal Regional Health Promotion Officer 
(RHPO)
Emmanuel Tetteh Nartey Western North Sefwi Akontombra Technical Officer Health Promotion 
(TOHP)
Joseph Kaku Western Wassa Amenfi East 
Municipal
Technical Officer Health Promotion 
(TOHP)
Osman Abdul-Ganiyu Northern Kumbungu Technical Officer Health Promotion 
(TOHP)
Augustine Fobi Central District Technical Officer Health Promotion 
(TOHP)
Nyaaba Mary Anapoka Upper East Talensi Technical Officer Health Promotion 
(TOHP)
Emmanuel Opoku Ashanti Offinso Municipal Technical Officer Health Promotion 
(TOHP)
Arthur Mariam Bono East Kintampo municipal Technical Officer Health Promotion 
(TOHP)
Alhassan A Sulemana Northern Nanumba North 
Municipality
Technical Officer Health Promotion 
(TOHP)
Gerald Kwakye Central Gomoa East Technical Officer Health Promotion 
(TOHP)
Dambayi Ansbet Patience Upper East Bongo District Technical Officer Health Promotion 
(TOHP)
James Ebukeley Forson Western District Technical Officer Health Promotion 
(TOHP)
Songyele Prosper Upper West Lawra Technical Officer Health Promotion 
(TOHP)
Rosemond Appau Greater Accra Ga East Municipality Technical Officer Health Promotion 
(TOHP)
Alhassan Sadia Northern District Technical Officer Health Promotion 
(TOHP)
Anokye Akwasi Baafi Brong East Kintampo Health Tutor
Amanda Adjoa Andorful Central Asikuma Odoben Brakwa Technical Officer Health Promotion 
(TOHP)
Eunice Joan Teah Greater Accra Accra Metro Regional Health Promotion Officer 
(RHPO)
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Name of beneficiary Region District/Municipality Designation (Job position) 
Aboziah Ernest Upper East District Technical Officer Health Promotion 
(TOHP)
Mildred Naa Komey Western 
(Transferred) 
Regional Health
Directorate
Health Promotion Officer (HPO)
Daniel Bomfeh Western Sekondi - Takoradi Metro Regional Health Promotion Officer 
(RHPO)
Benjamin Amihere Western Sekondi-Takoradi 
Municipal
Technical Officer Health Promotion 
(TOHP)
Abiba Abdul Rashid Western Shama Technical Officer Health Promotion 
(TOHP)
Gladys Gbadagbali Greater Accra Ashaiman Municipality Technical Officer Health Promotion 
(TOHP)
Abubakar Naimatu Upper East Binduri Technical Officer Health Promotion 
(TOHP)
Abdul-Mumin Mohammed Savanna East Gonja Technical Officer Health Promotion 
(TOHP)
Wuur Margaret Mary Upper west Nandom Technical Officer Health Promotion 
(TOHP)
Patricia Mawufemor Baku Volta Volta Regional Health 
Directorate, Ho.
Regional Health Promotion Officer 
(RHPO)
Dzidefo Yao Akar Eastern Kwahu South Health Promotion Officer (HPO)
Damba Mayebi Sampson Volta Agotime-Ziope Technical Officer Health Promotion 
(TOHP)
Amoah Karikari Bono East Sene West Technical Officer Health Promotion 
(TOHP)
Robin Appiah Bono Sunyani Municipality Health Promotion Officer (HPO)
Felix Frimpong Ashanti Kumasi Metro Health Promotion Officer (HPO)
Raphael Amegago Volta Ketu North Technical Officer Health Promotion 
(TOHP)
Bawakyillenuo Julius 
Ngmentiere
Upper West Wa East District Technical Officer Health Promotion 
(TOHP)
Felix Akudugu Greater Accra Okaikoi Sub Metro Technical Officer Health Promotion 
(TOHP)
Abdulai Karim Upper West Sissala West Technical Officer Health Promotion 
(TOHP)
Pearl Dzordzordzi Greater Accra Ablekuma Sub Metro Technical Officer Health Promotion 
(TOHP)
Alfred Adomako Yeboah Eastern New Juaben South 
Municipal 
Technical Officer Health Promotion 
(TOHP)
Thomas Quayson Ashanti Atwima Kwanwoma Technical Officer Health Promotion 
(TOHP)
Alonu Happy Volta South Dayi District Technical Officer Health Promotion 
(TOHP)
Isaac Tachie Asare Bono Jaman North Technical Officer Health Promotion 
(TOHP)
Vida Wewupadi Agoriwo Greater Accra La-nkwantanang Madina Technical Officer Health Promotion 
(TOHP)
Shine Gavey Volta Ho Municipality Technical Officer Health Promotion 
(TOHP)
69
Name of beneficiary Region District/Municipality Designation (Job position) 
Daniel Kaku Blay Western North District Technical Officer Health Promotion 
(TOHP)
Eva Tawiah Foron Central Cape Coast Technical Officer Health Promotion 
(TOHP)
Abdul-Wahid A. Dawono Upper West Daffiama Bussie Issa Technical Officer Health Promotion 
(TOHP)
Olivia Naa Norley Aboagye Ashanti Asante Akim Central 
Municipal
Technical Officer Health Promotion 
(TOHP)
Mavis Quainoo Ashanti Asokore Mampong 
Municipal
Technical Officer Health Promotion 
(TOHP)
Amma Gyankomah Asirifi Brong Ahafo Sunyani Municipality Regional Health Promotion Officer 
(RHPO)
Naa Afaale Sackley Dagadu Greater Accra Ga West Municipal Technical Officer Health Promotion 
(TOHP)
Agusika Jacob Upper East KNWD Technical Officer Health Promotion 
(TOHP)
Mavis Kofie Western Ahanta West 
Municipality
Technical Officer Health Promotion 
(TOHP)
Dongluome Patience K. Upper West Nandom Technical Officer Health Promotion 
(TOHP)
Kulah Janet Northern Bole Health Promotion Officer (HPO)
Kpintaatobo Edwina Upper West Lawra Technical Officer Health Promotion 
(TOHP)
Lambert Apoore Wonsaga Upper East Kasena-Nankana 
Municipal
Technical Officer Health Promotion 
(TOHP)
Mohammed Fatima Northern Tamale Metropolis Technical Officer Health Promotion 
(TOHP)
Mary Ayobi Brong Ahafo Sunyani West Technical Officer Health Promotion 
(TOHP)
Christiana Ayichuru Upper East Builsa South District Technical Officer Health Promotion 
(TOHP)
Kenneth Ayitey Northern Tolon Technical Officer Health Promotion 
(TOHP)
Bertha Abla Agbaglo Central Abura Asebu 
Kwamankese
Technical Officer Health Promotion 
(TOHP)
CADP and SfC SUPERVISORS WHO FILLED ONLINE ASSESSMENT
Name of Supervisor Region District/Municipality Designation (Job position) 
Caroline Kafui Agbodza Central Twifo Hemang Lower 
Denkyira
DPHN/Ag DDHS
Osei Assibey Western Shama District Director of Health Service
Maakpe John Vianney Upper West 
Region
Wa Municipality Regional Health Manager
Patricia Mawufemor Baku Volta Volta Region Regional Health Promotion Officer
Yaw Ofori Yeboah Volta Ho Deputy Director (Public Health)
Honesty Attah-Mensah GAR Greater Accra Region Regional Health Promotion Officer
Amma Gyankomah Asirifi Brong Ahafo 
Region
Sunyani Regional Health Promotion Officer
70
Daniel Bomfeh Western Sekondi Takoradi Metro Regional Health Promotion Officer
Change Challenge Fund (CCF) Beneficiaries Who Filled Online Assessment
Name of beneficiary Region District/Municipality Designation (Job position) 
Maakpe John Vianney Upper West 
Region
Wa Municipal Regional Health Promotion Officer 
(RHPO)
Gerald Kwakye Central Gomoa East Technical Officer Health Promotion 
(TOHP)
Songyele Prosper Upper West Lawra Technical Officer Health Promotion 
(TOHP)
Bawakyillenuo Julius 
Ngmentiere
Upper West 
Region
Wa East District Technical Officer Health Promotion 
(TOHP)
Augustine Fobi Central District Technical Officer Health Promotion 
(TOHP)
Evans Whajah Western Tarkwa Nsuaem 
Municipality
Technical Officer Health Promotion 
(TOHP)
Alhassan A Sulemana Northern Nanumba North 
Municipality
Technical Officer Health Promotion 
(TOHP)
Janet Wepiah Batako Bono East Kintampo South Technical Officer Health Promotion 
(TOHP)
Mrs. Rosemond Appau Greater Accra 
Region
Ga-East District Health Promotion Officer (HPO)
Abdul-Wahid A. Dawono Upper West Daffiama Bussie Issa (DBI) Technical Officer Health Promotion (at 
Region)
Gladys Gbadagbali Greater Accra Ashaiman Municipality Technical Officer Health Promotion 
(TOHP)
Mary Ayobi Brong Ahafo Sunyani west District Technical Officer Health Promotion 
(TOHP)
Vida Ntiwaa Gyasi Greater Accra 
Region
Ga South Municipal Health Promotion Officer (HPO)
Yakubu Rahinatu Northern region Tamale metro Regional Health Promotion Officer 
(RHPO)
Mohammed Fatima Northern Tamale Metropolis Technical Officer Health Promotion 
(TOHP)
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Appendix 2: The primary design documents of the CBSP 
 
 
Communicate for Health in Ghana
Cooperative Agreement No: AID-641-A-15-00003
CAPACITY BUILDING SUPPORT PLAN
HEALTH PROMOTION DEPARTMENT - GHANA HEALTH SERVICE
FEBRUARY 2016
Contact Person and Address:
Joan W. Schubert
USAID/Communicate for Health Project
FHI360 Ghana
P.O. Box 4033, Accra, Ghana
Tel: 233-501421355, 233-302740780
72
1. Purpose of the Capacity Building Support Plan (CBSP)
The Capacity Building Support Plan (CBSP) sets out the overall approach offered by the USAID 
funded project Communicate for Health to the Ghana Health Services Health Promotion Department 
(GHS HPD). 
Developed in collaboration with the Ghana Health Service Health Promotion Department and 
Human Resources Directorate, local Ghanaian partners and, international development partners, it 
sets out:
• the specific activities available and the associated learning objectives,
• who these activities are designed for 
• how they can be accessed
• how they will be delivered and when. 
2. Background
One of the aims of National Health Promotion Policy (2007) and the draft National Strategy and 
Action Plan for Health Promotion (2014-2018) is to build the capacity of health promotion staff at all 
levels. 
Communicate for Health is a five-year USAID funded project (2014–2019). It is one of a suite of 
USAID funded health projects and as such works in a coordinated way with other USAID 
implementing partners to support the Government of Ghana (GoG). The Health Promotion 
Department (HPD) within the Ghana Health Service (GHS) is Communicate for Health’s key GoG 
partner. The project has three key results areas of which one directly relates to strengthening the 
capacity of the HPD.
Expected Result #1: Improved behavior changes in family planning, water, sanitation and hygiene 
(WASH), nutrition, maternal and child health (MCH), and malaria prevention and treatment through 
the development and implementation of social and behavior change communication (SBCC) 
strategies.
Expected Results #2: Health Promotion Department (HPD) capacity strengthened to effectively 
coordinate and deliver SBCC and health promotion campaigns. 
Expected Result #3: Capacity of one local organization with social marketing capacity developed and 
strengthened to receive direct USAID funding. 
3. Aim and Objectives of the Capacity Building Support Plan (CBSP) 
The aim of the CBS plan is to strategically strengthen the capacity of the HPD to further increase its 
effectiveness in coordinating and delivering social and behavior change communication (SBCC) and 
health promotion (HP) campaigns. 
Objectives of the CBS Plan are as follows:
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• Address specific capacity gaps in both the areas of SBCC technical and personal effectiveness 
skills that were identified through the SBCC capacity assessment conducted at the national, 
regional and district health promotion levels in May 2015. 
• Increase HPD’s ability to conceive of, design, develop, implement and rigorously evaluate 
SBCC and health promotional campaigns and materials. 
• Support HPD to improve its technical service delivery profile as experts in delivering quality 
SBCC programs and materials both internally within the GHS, and externally with 
development partners and interested partners. 
• Provide a practical learning experience that directly connects participants’ daily work, current 
SBCC activities and challenges in Ghana with knowledge of practical and theoretical SBCC 
processes through training and other development opportunities such as stretch 
assignments.
• Ensure that those who have gained knowledge and skills from the CBS share these with other 
members of the HPD at different HP levels through an organized system of mentoring. 
• Create the beginnings of a community of practice through active networks of health 
promotion staff across the country. To connect with each other to exchange information, 
ideas, good practice and provide peer support and encouragement. 
• Attract the most motivated and committed HPD staff through a competitive application 
process who will commit and be able to mentor others upon completion of their training. 
4. Core Elements of the Capacity Building Support Program (CBSP)
In recognition of people’s different learning styles, the CBS plan offers a range of approaches. Core 
elements are outlined below and described in more detail later in this document.
Change Agent Development Program: One week development program covering a range of technical 
areas and skills taught through lectures, use of case studies and practical group exercises. There will 
be two different program curriculum, one designed for national and regional staff and one for the 
new cadre of TOHPs. Both programs are designed to fill the identified skills gaps for each group.
Set for Change: A hybrid action learning set with taught technical inputs designed for Technical 
Officers for Health Promotion (TOHPs). Participants will meet together on four separate 
occasions/sessions over a six-to-eight month period. Each of the four sessions will last 1.5 days and 
will be facilitated by a qualified and experienced learning set facilitator. The sets are designed to 
support the new cadre of TOHPs to succeed in their new role through personal development and 
effectiveness skill building such as critical thinking and problem solving, advocacy and building 
strategic partnerships for change. Technical skills input will support the implementation of national 
campaigns at the local level through communities, local organizations and key advocates. 
Free online courses providing more in-depth theory and practice in technical aspects of designing 
and conducting SBCC. USB modems will be offered to those with limited internet access under a 
carefully managed loan scheme.
74
Support to individuals in creating personal development plans and gaining access to free on line 
resources and identifying continuing professional development opportunities. 
Gender integration trainings to improve technical competencies in creating gender sensitive 
programming and activities for national and some regional staff.
Stretch assignments will provide the opportunity for individuals to be challenged to use new skills 
and apply new knowledge. Stretch assignments are supervised, discrete pieces of work with clear 
objectives to be conducted over a given period of time and lead to the production of specified 
deliverables. 
Internships/practicums will provide the opportunity for national and/or regional staff to work with 
Communicate for Health core partners or contractors such as Lowe Lintas, Ghana Community Radio 
Network, VOTO Mobile, or Creative Storm. Internees will be actively involved in designing or 
delivering elements of the SBCC campaigns whilst learning new skills on the job. Like stretch 
assignments these will be supervised, discrete pieces of work with clear objectives to be conducted 
over a given period of time and lead to the production of specified deliverables
Peer Mentoring: Past participants of CAD and SfC will be asked to offer support and mentoring to 
their colleagues. A structured system will be in place to enable this. This support could be through 
the transference of new knowledge and skills by providing technical guidance or sharing resources 
or help to develop a PDP.
Change Challenge Fund: Is a competitive performance-based funding opportunity. It allows recently 
trained CADP or SfC participants to apply for a small resource to enable them to utilize their new 
knowledge and skills to conceive of, develop and implement small-scale innovative SBCC 
activity/national campaign implementation at the district or regional level.
Post training support to increase consolidation of learning and motivation to apply new knowledge 
and skills in the work setting through mobile phone messages, prompts to act and reminders on 
behaviors and practices, refresher tips, quizzes and games to consolidate learning and reinforce the 
adoption of particular skills or actions on the job will be received by all CAD and SfC graduates.
“Best Health Promoting District Award” and “Best Health Promoter Award” concepts are designed to provide a 
motivator for districts and individual health promotion staff to aim for. Other GHS services that have awarded 
staff for excellence have demonstrated that such recognition and acknowledgement from peers motivate and 
encourage staff. In the case of health promotion this increased effort and improved service will hopefully 
improve health outcomes for the community served. It is anticipated that the awards will be made annually 
and developed in conjunction with support from a number of private sector partnerships. Communicate for 
Health will provide support in the development stage of these awards, which will be owned, managed, and 
maintained by the GHS HPD.
75
5. What has informed the content of the Capacity Building Support Plan?
The curriculum and learning objectives of the different types of support have been informed by 
several fact-finding activities. These include:
1. A rapid organizational/institutional assessment of the GHS HQ HPD staff knowledge and skills 
of social and behavior change communication conducted in April/May 2015. 
2. Individual capacity assessments conducted with five HPD regional staff. Other assessments 
will be added as they are conducted such as those on applicants selected for the Change 
Agent Development Program (CADP) and Set for Change (SfC) Action Learning Sets. 
3. The GHS Human Resource Division and the GHS Health Promotion Department supported by 
Communicate for Health have conducted a review of the job qualifications and 
responsibilities for HP officers. 
4. A series of all-day focus group style workshops were conducted with a group of TOHPs from 
a selection of regions to discuss and explore capacity needs and job challenges. 
6. Change Agent Development 5 Day Program
6.1. The CAD Program
The Change Agent Development Program (CADP) is a one week program designed to strengthen the 
individual technical capacity of select national, regional and district-level staff through technical 
presentations followed by questions and discussion, use of case studies, and practical group 
exercises. Participative approaches to engage people fully will be an important focus as will the 
integration of the current and emerging health priorities and SBCC campaigns. In addition to 
technical skills the CAD will seek to improve the personal effectiveness and leadership style of the 
participants.
The program will be facilitated by an experienced external consultant with the Communicate for 
Health Capacity Building Advisor. Some taught contributions will be made by local experts in the 
different technical areas.
6.2 The CADP Beneficiaries
The CADP is a tailored capacity building program to meet the needs of national and regional staff. 
Approximately 20 participants are expected to participate in the national and regional CADP in 
project year 2. This will be treated as a pilot and lessons learned will inform changes to the CADP 
delivered to TOHPs in years 3 and 4 of the project. 
The CADP in year 2 of the project will be conducted in Kumasi or Accra over 5 days including one or 
two evening guest speaker sessions. To consolidate learning, incentivize and prompt participants to 
adopt behaviors and utilize learning at their respective workplaces long after the training has 
finished a series of motivational mobile phone messages, games and messages and quizzes will be 
sent to participants. 
6.3. Key Areas of the CADP 
The CADP is a 5-day participatory and interactive classroom-based training and development 
program covering key knowledge, skills and personal effectiveness gaps across a range of the 
following areas: 
76
Key Areas Covered Learning Objectives 
Monitoring and Evaluation (M&E) for health 
promotion and the adoption and implementation 
of M&E systems at the local level in line with 
nationally established systems and indicators.
Understand: The new draft M&E system and 
indicators for HP and proposed reporting 
processes.
Know how: to develop SMART targets and 
indicators for SBCC initiatives developed locally 
and to report on key routine HP indicators.
Evidence Based Social and Behavior Change,
Developing and implementing long term SBCC 
strategies and emergency health communication 
strategies 
(The focus and angle of this session will vary 
depending on which participant group. 
National/regional will be more strategic and 
district focus will be more operational.)
Understand: the theory underpinning SBCC, the 
critical components of an evidence-based 
approach, different objectives and approaches 
between social and individual behavior change, 
the theories underpinning the behavior change 
continuum
Know How: The structure of an SBCC strategy 
looks and how to follow the steps to develop and 
implement an SBCC strategy from formative 
research, creative brief, target groups, testing 
concepts, channels, monitoring and evaluation 
etc., prepare for emergency communication for 
the next outbreak
Working with the TV, radio and press media to 
promote social and behavior change.
Understand: how the media is organized, local and 
national, TV, radio and press, what motivates 
them, costs involved.
Know how: to approach the media; use 
approaches that will help you how to get the 
results you want; to write a press release and 
understand its uses; to organize a press 
conference; to organize different kinds of media 
coverage; to nurture champions, how to manage 
expectations.
Social and cultural dimensions of behavior change 
and the role of gender.
(This session will include invited guest 
contributors to share real examples such as 
Afrikids work to eliminate the spirit child 
phenomena in UE region.)
Understand: how the role of cultural practices, 
traditional beliefs, and social and gender norms 
can affect our behavior and our motivation to 
change. 
Know How: to challenge social norms 
appropriately; to approach taboo or controversial 
issues such as family planning in conservative 
communities.
The role of different channels and mediums to 
promoting both individual and social behavior
change. This session will look at mobile 
technology, community radio, social documentary 
TV and story-telling. Expert technical inputs from 
project partners Ghana Community Radio 
Network, Creative Storm and VOTO Mobile with 
some hands on practical group work.
Understand: How community radio works and 
how to get the best from working with them. 
What role mobile technology can play in SBCC. 
How can social documentary and story-telling act 
as a catalyst for social change.
Know How: to develop participatory community 
radio program with local radio stations; to 
support a SBCC intervention with a simple mobile 
app; to use the power of story-telling for social 
change.
Co-ordination and management of community 
health communication activities and an 
introduction to the tenets of the C4H supported 
Understand: The importance of planning and 
coordination in the implementation of SBCC at 
any level. The current roles of the national ICC HP 
77
Key Areas Covered Learning Objectives 
national campaigns, the materials, the messages, 
and life stages tool kits. 
(Other USAID implementing partners such as 
Evaluate for Health, Systems for Health, UNICEF 
or other GoG departments may be drawn on to 
share relevant programs of work.)
and regional ICC HPs. The tenets of the national 
SBCC campaigns and available resources. The 
work of some other USAID or development 
partner projects. 
Know How: to implement national campaigns at 
regional and district level, how to make best use 
of resources, how to plan and work strategically 
to ensure other projects and GoG work streams 
such as community mobilization, systems 
strengthening, are integrated and support your 
work to promote social and behavior change. 
How to develop a budget for a small scale SBCC 
intervention.
Advocacy and influencing skills 
(Contributors will include donors and 
development partners.)
Understand: the basic principles of advocacy; 
different strategies and advocacy approaches, 
ways to influence decisions, create champions, 
profile your agenda 
Know How: to identify and target those you need 
to influence; to understand those you seek to 
influence (their agendas operating environments 
etc.); to build successful strategic partnerships 
and avoid pitfalls at all levels with decision makers 
and key stakeholders.
Personal Effectiveness and Leadership Skills Understand: the critical aspects of personal 
effectiveness and leadership for SBCC; your own 
Myers Briggs Type Indicator (MBTI) and your 
strengths and weaknesses; your default team 
player role; your priority areas for development 
and a deeper appreciation of your role and what 
you can aspire to achieve.
Know How: to apply techniques and strategies to 
improve your personal effectiveness; to use your 
MBTI analysis to develop and increase impact 
from your own personal leadership style; to 
better manage your time and activities for greater 
impact; to complete and use pro-actively your 
own personal professional development plan and 
access resources to meet your on-going 
development needs.
Mentorship guide to enable participants to adopt 
a peer mentee and impart the new knowledge 
and skills to them.
Understand: The basic principles of mentoring; 
the available resources to support continuing 
development in HP; identify your own support to 
meet your needs.
Know How: To work with a peer as a mentor, 
support a mentee to complete and use pro￾actively their own personal professional 
development plan and access resources to meet 
their on-going development needs.
78
6.4. Number of places available on each CADP
In 2015/16, year 2 of the Communicate for Health project, 15 – 20 places will be available for 
national and regional staff. This will be treated as a pilot and lessons learned used to amend and 
improve future programs. In year 3 and 4 of the Communicate for Health project, one of the CADPs 
will be offered with 35 places available for the TOHP cadre only. 
There will be a selection process and it is expected there will be more applicants than places, 
unsuccessful applicants will be encouraged to apply again the following year. The mentorship 
program will also be available for unsuccessful candidates to apply for as a mentee.
6.5. The application process, timescales and selection criteria 
The programs will be held sometime between April and June each year. The first CAD program will 
run in 2016 and the last CAD program in 2018. The application process will commence in January 
each year. 
The call for application notice will be sent to all levels using GHS’s channel of communication. To be 
eligible for selection the prospective applicant MUST: 
• Serve at least 12 months after appointment as TOHP and not be within 3 years to retirement. 
• Be willing and agree to provide mentoring, advice and support to other TOHPs who have not 
yet attended the CADP or SfC learning set after completion.
• Receive approval of Head of BMC (Head HPD, RDHS and DDHS).
Each applicants will be required to complete an application for selection form 
The applications will be collated by Capacity Building Support Coordinator of the HPD with support 
from the Senior Organizational Development Specialist of Communicate for Health Project and 
reviewed by a panel made up of the following:
• The Head of Health Promotion–GHS
• A Senior member of GHS Human Resources Directorate.
• The Senior Advisor to Communicate for Health Project and HPD
• The Deputy Chief of Party of Communicate for Health Project
• The Capacity Building Support Coordinator at HPD
• Senior Organizational Development Specialist of Communicate for Health Project
Selection will be based on the following information provided by prospective applicants:
• Health status and known social and behavioral barriers of the community they work in, 
supported by recent data 
• An outline of the key health challenges 
• The role they perceive SBCC to have in addressing these health challenges 
79
• A description of their role and their most notable success in this role, and finally, 
• An outline of their development needs and reason (s) why they want to participate in the 
SfC. 
The USAID five focus regions’ (GAR; VR; NR; CR;WR) are required by the donor USAID to be reflected 
in the selected participants by at least 50%. All applicants selected will undergo an individual 
capacity assessment prior to joining the program unless they have already had this assessment 
conducted within the last year. TOHPs cannot apply for both the Set for Change Learning Set and the 
Change Agent Development program, they must choose only one.
Process and Timeline for the Applications 
Process
• The call for application notice will be sent to all levels using GHS’s current mechanisms and 
channels of communication. 
• The applications can be submitted electronically or in hard copy but only on the templates 
provided. 
• Applications must be endorsed by the District or Regional Directors of Health Services for the 
District and Regional level staff respectively. Similarly those for national level staff must be 
endorsed by the Head of HPD. 
• Applications from the District and Regional level staff should be collated at the regional level 
by the RHPO and forwarded to the Director of Family Health Division with a cover letter duly 
signed by the respective Regional Director of Health Services. 
• Electronic applications are strongly encouraged although hard copies will be accepted.
Management 
• The CBS Coordinator at HPD will register all applications upon receipt. He/she will be 
responsible for managing the receipt of all applications received either electronically or in 
hard copy from the regions. 
• He/she will deal with enquiries and requests for assistance, filtering out the applications that 
do not meet the eligibility criteria, preparing aggregated applications for review by the 
selection committee, circulating these to the selection committee and co ordinating their 
final scores for each applicant. 
• He/she will also be responsible for communicating with applicants. 
Each call for application will be subjected to the following process and timeline:
• The application deadline will be 4 weeks from publication;
• Review and Selection of applicants – 3 weeks after the application deadline;
• Notification of successful and unsuccessful applicants – within 3 weeks after completion of 
work by the review panel. 
• Unsuccessful applicants who meet the criteria will be encouraged to apply again the 
following year.
7. Set for Change “Action Learning Set” 
80
7.1 The ‘Set for Change’ model 
The Set for Change (SfC) is a hybrid approach that 
combines an action learning set model with taught 
technical inputs and practical hands on group work to 
promote critical thinking and problem solving, increase 
technical knowledge and skills as well as build 
confidence, create a greater sense of self and improve 
personal effectiveness. 
Action Learning is a distinctive form of learning and 
capacity building ideal for the new cadre of TOHPs to 
help them carve out this new role, develop strategies 
and tactics to deal with the complexity of the 
environment they work in, manage relationships with 
the range of stakeholders, navigate the organizational
culture and work collaboratively with colleagues, create opportunities and manage the challenges 
they will face. The hybrid action learning set offers a facilitated approach to help TOHPs understand 
the context in which they work as well as provide new knowledge and skills to enable them to be as 
effective as possible in their new role. Beyond their strength to conduct small-scale activities, they 
also need to harness all possible channels, social networks, people, and opportunities to promote 
positive behavior change and influence the creation of an enabling environment for people to adopt 
new behaviors. The action learning model of planning, action, reflection and learning will provide a 
framework for discussions and create confidence to experiment in the workplace, bring back results 
to the group, reflect and learn together. 
The TOHPs positions are filled mostly by less experienced staff new to the GHS and recent graduates 
from the College of Health and Wellbeing - Kintampo. The position itself is new within the District 
Health Management Team (DHMT) and the role as it develops will need to be more clearly defined. 
By the time the action learning sets start the job descriptions for the Health Promotion Department 
will have been reviewed and the role of the TOPHs more clearly defined not only for the benefit of 
the TOHPs themselves but the rest of the DHMT. 
The learning set offers a process for TOHP to present a problem or situation from their work place 
and through a series of structured questioning be able to see the situation differently and chart a 
course of action. They will agree actions and commitments to fulfil in their work setting then report 
and reflect on in the next learning set meeting. Peer-to-peer learning establishes strong 
relationships and a supportive exchange that extends long after the learning sets have finished. It 
also helps establish a strong sense of identity and sense of belonging to a wider health promotion 
department. Creating the right organizational and professional culture for health promotion to be 
effective, evidence based and collectively reflective is important to the success of a unified and 
active health promotion function nationally.
81
In addition to the action learning component of the SfC there will be the taught sessions delivered by 
experts on a range of topics such as M&E, community mobilization, program management, use of 
mobile technology for SBCC. Learning from taught sessions will be consolidated through practical 
group exercises. Important foci threaded throughout the meetings will be the emerging health 
priorities and current SBCC campaigns, coordination of SBCC at the local level and the HP M&E 
framework (currently under development). Evening speakers will be organized to provide the TOHPs 
with insights into different organizational cultures and professional roles such as the local assembly, 
NGOs and development partners. 
7.2 Set for Change Beneficiaries
SfC is for the TOHPs working at the district and regional level. It is recognized that these are new 
roles and positions and will therefore need to become established within the DHMT. This provides 
an enormous opportunity to promote SBCC but also presents some challenges. Some of the TOHPs 
may not have held a position before and may benefit from support in developing strategies and 
approaches to establish themselves effectively and appropriately within the DHMT and district 
context. 
In addition many of the TOHP are graduates from the College of Health and Wellbeing, Kintampo 
where a good basic training has been provided. The taught inputs will supplement this with 
advanced technical skills training and practical hands on practice.
7.3 The Application Process
The application process requires prospective applicants to provide the following information:
• health status and known social and behavioral barriers of the community they work in, 
supported by recent data 
• an outline of the key health challenges 
• the role they perceive SBCC to have in addressing these health challenges 
• a description of their role and their most notable success in this role, and finally, 
• an outline of their development needs and reason (s) why they want to participate in the SfC. 
7.4 Available Placements on the SfC
There will be six Set for Change (SfC) action-learning sets over the life of the Communicate for Health 
project involving approximately 10 HP staff in each. Two will commence in Year 2 and a further two 
will take place each year in year 3 and 4 of the Communicate for Health project. The available 
placements are summarized below:
• 2015/16 20 places (i.e. two sets per year)
• 2016/17 20 places (i.e. two sets per year)
• 2017/18 20 places (i.e. two sets per year)
7.5 Set for Change Format and Content
82 
Each SfC action learning set will involve 10 people. They will meet four times over a 6-month period, 
each meeting will last 1.5 days and include an after-dinner session with external contributions from 
technical experts or key stakeholders/strategic partners. 
Each SfC meeting will be run in four sections:
• Section one will be an opportunity for a member of the group to bring a real-life current 
issue or a problem from their work life into a safe, structured and facilitated session. 
• Section two will focus on a technical input session drawn from the Change Agent 
Development program. The exact program for each set will be determined by the needs of 
the group identified through pre assessment and group agreement. Once these have been 
established then the technical inputs will be determined. It is expected that the CADP 
program will be drawn upon given the SfC participants have similar needs but will not 
participate in both the SfC and the CADP. 
• Section three will be an after-dinner session where an external contributor will be invited to 
offer specialist input such as:
o how to use mobile technology for SBCC or how to work with development partners, 
or understanding decentralization and the opportunities for SBCC, and or 
o experience and contextual insights of a particular organizational culture or 
professional role such as understanding the role and how to influence the district and 
regional health directors, or the role of the regional Minister.
• Section Four in day two will be in two parts.
o Part one will be dedicated to personal development and effectiveness building and 
gaining insights and personal leadership skills required to be successful in the TOPHs 
role. The MBTI and other tools for self-reflection, personal effectiveness will be used 
o Part two participants will work in sub groups on specific SBCC work related activities 
that are being tested out in the work setting and experiences, progress and 
challenges brought back to the sub group to share and plan for how to further the 
work in their districts. 
• The final hour will be dedicated to planning and personal commitments of each participant 
for completion for the next set SfC . At the very end of each SfC learning set meeting there 
will be a short group discussion and reflection on how well the meeting worked and whether 
aspects need to be changed or done differently next time. 
The exact program for each SfC learning set will be determined by the needs of the group identified 
through pre assessment and group agreement. Selected technical taught sessions will be drawn 
from the CADP and replicated in the SfC.
7.6 The application procedure and selection criteria for the SfC.
Applicants MUST meet initial eligibility requirements before they are eligible to apply. 
• Serve at least 12 months after appointment as TOHP and not be within 3 years to retirement. 
83
• Be willing and agree to provide mentoring, advice and support to other TOHPs who have not 
yet attended the CADP or SfC learning set after completion.
• Receive approval of Head of BMC (Head HPD, RDHS and DDHS).
Each applicants will be required to complete an application for selection form as indicated in Annex 
B. The applications will be managed in the same way as those for the CADP 
8. Change Challenge Fund (CCF)
8.1 The Change Challenge Fund
The Change Challenge Fund (CCF) has been set up to ensure CAD and SfC participants have the 
opportunity to use and apply their new knowledge and skills in their daily work and are not 
constrained by lack of resources. Participants are encouraged to think boldly and innovatively as well 
as systematically and based on sound information and are invited to apply for resources to put into 
practice and utilize the skills and knowledge they have developed. This fund is not to be used to cover 
salaries or routine activities that are the mandatory responsibility of a district but rather to fund 
specific activities that meet the eligibility criteria detailed below. The Change Challenge Fund will run 
for four years from 2016 to 2019. 
8.2 Eligibility and Timeline
The CCF is available only to those regional or district level HP staff who have completed either a 
Change Agent Development Program or a Set for Change Learning Set. 
‘Partnership bids’ i.e., from more than one district working together will be accepted where at least 
one applicant has participated in a CAD program or Set for Change Learning Set. 
Call for applications will be sent out in July 2016 for the first set of CCF beneficiaries. The awards will 
be made in September, 2016.
8.3 Application Procedure and Selection Criteria 
Applicants will be required to complete the application form in Annex C. 
8.3.1 Eligibility Criteria
• The initiative proposed is led by a reliable and accountable multi stakeholder strategic 
partnership that includes the district assembly, DDHS and the head of program area. 
• Aims and objectives directly linked to the national HPD objectives or the Communicate for 
Health SBCC priorities. 
• The application comes with a letter of endorsement from the district or regional director of 
the GHS depending on the level at which the applicant works. 
8.3.2 Selection criteria
The main selection criteria include: 
• Clear description of the problem 
84
• Clearly defined and realistic milestone targets
• Innovation and creativity of the approach
• Feasibility of the activities to be successfully implemented and achieve the desired outcomes
• Clearly defined linkages to a new skill learned from participation in a CAD or SfC
• Clear approach for evaluating the success or impact of this project in direct relation to the 
objectives
8.4 Processing the Application and Duration 
(Please refer to 6.5) 
8.5 The Change Challenge Fund (CCF) Management Board
A Management Board shall be established to manage the processes leading to the award of CCF 
funds to beneficiaries. The Management Board will be responsible for reviewing all eligible 
applications and select suitable applicants using the evaluation procedure set out in Annex 4. The 
final list will be submitted to the Chief of Party, Communicate for Health Project for the awards to be 
made to the successful applicants. The Management Board will ensure that the correct procedures 
and systems are in place for the smooth running of the CCF. 
Members of the CCF Management Board include the following:
• The Head of Health Promotion–GHS
• A Senior member of GHS Human Resources Directorate.
• A senior member of the HPD 
• The Senior Advisor to Communicate for Health and HPD
• The Deputy Chief of Party of Communicate for Health Project
• The Capacity Building Support Coordinator at HPD
• Associate Director- Finance – Communicate for Health
• Senior Organizational Development Specialist of Communicate for Health Project
The CBS Coordinator of HPD will be supported by the Senior Organizational Development Specialist 
of Communicate for Health Project to coordinate the work of the Management Board by ensuring 
that all the processes are properly documented, and relevant reports prepared and submitted to the 
various levels.
Selection will be based on the quality of the application against the four selection criteria of which 
each is worth up to 25 marks of an overall possible score of 100. 75% of successful applicants are 
required by the donor USAID to be drawn from the five focus regions prioritized by USAID: Volta, 
Northern, Western, Greater Accra, and Central.
8.6 Budget and Financial Management
The budget available for the Fund and its management is 25,000 USD per year for the next four 
years between 2016 and 2019. This amount will cover the costs of the management board co￾ordination; co-ordination of the application process; administrative co-ordination of the applications 
received; support and supervision of the awards (mainly per diem and travel costs) and the 
85
disbursement of the award installments. Funding will be subject to attainment of performance￾based targets and disbursed in three installments i.e. 40%:40%:20%.
The management and the disbursement of the awards will be conducted by FHI360 under an in-kind 
arrangement in compliance with USAID rules. 
8.7 Support and Supervision of CCF Recipients
A joint team from Communicate for Health and HPD will monitor and supervise the implementation 
of the activities in order to ensure that the allocated funds are used for the intended purpose. 
Each funded initiative will be assigned a nominated national or regional HP staff member to provide 
ongoing support in the management and execution of the initiative where requested or can be seen 
to be needed. Agreed support and supervision visits will take place twice during the course of the 
initiative. Nominated supervisors should make themselves available for the awardees at all times to 
help them deal with challenges or resolve difficulties. 
Two support and supervision visits should be made by the nominated supervisor. This visit should 
focus on working with the awardee but should also involve a conversation with the district or 
regional director and the Chair of the strategic partnership group leading the initiative. A brief report 
completed after each visit using a standardized CFF support and supervision visit (using the template 
in Annex 5) and submitted to the nominated HPD and Communicate for Health personnel. 
8.8 Evaluation of CCF 
Evaluation against objectives: Each CCF recipient will be required, as part of their application, to have 
articulated how they will demonstrate the extent to which the project has achieved its objectives. 
Each recipient’s evaluation report will be reviewed by the assigned HP and Communicate for Health 
personnel and summarized. This summary will be submitted to the CCF Management Board for its 
consideration and should highlight successes and draw attention to any concerns.
Process evaluation: A summative evaluation form will be sent to awardees, chair of the strategic 
partnership leading the initiative and the respective district director/regional director at the end of 
the award period at the point the last installment is made. This will require completion, to cover 
what has worked well and what less well and why. Recommendations for improvements for the 
following round of awards will be requested. These questionnaires will be aggregated by the HPD 
nominated person and a report submitted to the CCF Management Board to determine changes to 
the process in the next round.
9. Stretch Assignments
9.1 What are stretch assignments?
Stretch assignments are designed to give members of HP staff the opportunity to conduct a work 
assignment that is more demanding than would be normally expected in their current role. It 
provides the opportunity to be challenged, use new skills, learn new work contexts and experience a 
different setting, working on an SBCC related task. Stretch assignments are time limited. They are 
86
supervised, discrete pieces of work with clear objectives that lead to the production of specified 
deliverables. 
9.2 What kind of assignments are available?
A number of assignments will be made available over the course of the Communicate for Health 
project. They will take different forms for example a district TOHP may conduct a stretch assignment 
at the regional level conducting an assignment or task that would normally be expected of a regional 
HPO or an assignment in a different environment such as a district assembly or a community radio. 
Stretch assignments for regional staff may be at the national level or assignments for national staff in 
other national divisions. There will also be some stretch assignments/internships with sub partners 
to gain direct experience of working in different settings that are relevant to the SBCC process such 
as a creative agency managing media buys, filming and interviewing in the community, conducting 
formative research, with a TV station, a community radio station, an NGO, a mobile technology 
organization etc.
9.3 Who is Eligible?
A set number of stretch assignments will be available for health promotion staff from all three levels 
,district, regional and national. These will be made available at the start of years 3, 4 and 5.
9.4 What is the application process?
To be discussed and agreed.
Could be a matching of staff to the assignments.
10. Mentoring 
10.1 What are mentors
Mentorship is a relationship in which a more experienced or more knowledgeable person, the 
mentor, helps to guide a less experienced or less knowledgeable person. The mentor may be older 
or younger but will have a certain area of expertise to share or help steer, guide or counsel the 
mentee.
10.2 Who are the mentors 
Mentors will be drawn from the HP staff whom have participated in a CADP or a SfC. During the 
CADP and the SfC programs a session will be dedicated to discussing the role of a mentor, providing 
training on the skills of mentorship. This will be supplemented with a handbook to support mentors 
fulfil this role. 
The HPD will develop a process of matching mentors and mentees (see section 10.3) The mentor will 
share insights, resources and key learning points from the CADP or SfC and assist the mentee in the 
creation of a personal development plan.
The mentor program aims to support the creation of a community of practice within the HPD by 
creating a structure for the cascade of knowledge. This will also help improve performance and 
motivation and build strong relationships between HP staff. The result sought is an appreciation of 
87
the value of routine sharing ideas, lessons learned, successes and failures, challenges and 
opportunities with colleagues and peers to provide support, inspiration and evidence.
Mentors will be available to prospective mentees during year 3, 4 and 5.
10.3 Process for the Allocation of Mentors?
To be discussed
11. Online courses from Witts University
11.1 Who are these online courses for
11.2 What will the on line courses cover
11.3 What is the application process for these online courses
12. Personal Development Plans (PDPs)
12.1 What are PDPs?
A personal development plan is a structured way of thinking about the range of technical and 
personal skills you may need to develop and improve upon in order to do your current job 
effectively. It is also a way to help an individual think about what they may want to progress their 
career in the future and plan for that too. PDPS are the basis of Continuing Professional 
Development (CDP). CPD embraces everything that you do to improve your job performance and is 
another way to ensure that you achieve the right abilities to do your job and maintain/enhance your 
expertise and your ‘lifelong employability’.
12.2 What support is available to develop a PDP?
The SfC and the CADP both have allocated time where participants will be supported to look at their 
role and their job description and think about the kinds of activities and responsibilities they are 
required to conduct. Participants will then examine their strengths and weaknesses not only in 
technical knowledge and skills but also personal skills such as working within a team, personal 
presentation skills, influencing skills etc. and begin to establish areas where they feel they need to 
improve and develop.
Participants will work with a template that sets out questions they need to answer.
What do I want to learn, what do I have to do, what support and resources will I need, how can I 
access these, how will I measure success, how regularly will I review progress? Participants will be 
encouraged to develop SMART goals for themselves to help ensure they are clear about what they 
want to do, and that this is attainable, realistic and time bound, 
Given financial resources are likely to be limited guidance will be offered on how to access free 
resources such as online courses, consider self-directed learning through journals or electronic 
resources, shadowing more senior colleagues or colleagues in other organizations you need to 
understand better, stretch assignments and to think creatively about how they can achieve their 
learning objectives. 
88
PDPs need to be realistic and achievable but non the less aspirational.
Part of the mentoring role will be to offer support to mentees in developing PDPs.
89
Appendix 3: Endline Individual Training Outcome Assessment Tool (Beneficiary and 
Supervisors) 
 
 
Communicate for Health in Ghana
Cooperative Agreement No: AID-641-A-15-00003
Training Impact Assessment Questionnaire – Beneficiaries
 Change Agent Development Program (CADP)
Training Impact Assessment Questionnaire
(Beneficiary) 
My name is …………………………………………………………………………………………………………………………………………. 
I am conducting this interview on behalf of Ghana Health Service Health Promotion Department and 
the USAID Communicate for Health project. The main objective of this interview is to assess the 
impact of the Change Agent Development Program (CADP). The information provided by you will 
enable the Communicate for Health Project in collaboration with the Health Promotion Department 
of the Ghana Health Service to further improve the quality and relevance of the CADP training 
program. Your participation in this interview is voluntary and will take about 30 minutes of your 
time. 
May I proceed with the interview?
Respondent Agrees to be interviewed…………1 
Respondent Refuses to be interviewed……………2.
Thank you. 
Date of Interview……………………………………………
Region: ………………………………………………………. 
District: ………………………………………………………………………….
Q# Question Responses Directions
BACKGROUND INFORMATION
1. What is your sex? 1. Male
2. Female
2. At what level do you work? 1. National
2. Regional
3. District
90
4. Sub-metro
3. What is your highest qualification 1. Masters
2. Postgraduate 
Certificate/Diploma
3. Bachelor’s Degree
4. Diploma Certificate
5. Other
4. Age
RELEVANCE
5. Were the courses in the CADP useful to your job responsibilities?
1. Useful
2. Somewhat useful
3. Not useful
Go to Q6
Go to Q6
Go to Q7
6. If yes, how useful were the courses to the execution of your job 
responsibilities?
a. Boasted my confidence 1. Yes
2. No
b. Improved my skills/knowledge generally 1. Yes
2. No
c. Improved my teamwork skills 1. Yes
2. No
d. Enhanced working relations with stakeholders 1. Yes
2. No
e. Other specify………………………….
7. If the courses were not useful to your job responsibilities, indicate 
reasons?
a. The CADP did not cover my training needs 1. Yes
2. No
b. The CADP was too theoretical and not job oriented 1. Yes
2. No
c. The CADP was too general 1. Yes
2. No
d. Limited time allocated to sessions 1. Yes
2. No 
Other Specify
APPLICATION OF KNOWLEDGE AND SKILLS.
8. Which of the training courses have you applied to your day-to-day 
assignments (list)
a. Culture and its influence on SBCC: 1. Yes
2. No
b. Understanding SBCC Theory 1. Yes
2. No
91
c. Understanding Formative Assessment in SBCC 1. Yes
2. No
d. Creating and Implementing effective SBCC 1. Yes
2. No
e. Understanding Social and Community Mobilization 1. Yes
2. No
f. Advocacy, Building Strategic Partnerships, Alliances and 
Collaborations
1. Yes
2. No
g. Understanding Social Marketing 1. Yes
2. No
h. Effecting Social Behavior Change through TV 
Documentaries
1. Yes
2. No
i. Working effectively with the Media 1. Yes
2. No
j. Mobile Technology and Health Promotion 1. Yes
2. No
k. Effecting Change with Community Radio 1. Yes
2. No
l. Planning and Coordinating SBCC 1. Yes
2. No
m. Monitoring and Evaluation in SBCC 1. Yes
2. No 
n. Writing a wining proposal 1. Yes
2. No
o. Other (specify ………………)
9. What have you done differently as a result of your participation in 
the CADP?
a. Developed/contributed/implemented a community 
mobilization plan 1. Yes 
2. No 
b. Developed/contributed to/implemented an SBCC plan 1. Yes
2. No
c. Sourced funding for SBCC activities 1. Yes
2. No
d. Integrated SBCC/HP activities into those of the DHMT 1. Yes
2. No
e. Partnered and collaborated with external organizations. 
E.g. NGOs and MMDAs 
1. Yes
2. No
f. Integrated SBCC/HP activities into those of the DHMT 1. Yes 
2. No 
g. Used mobile technology to communicate to target 
audience.
1. Yes
2. No
h. Negotiated/utilized airtime for SBCC/HP programs. 1. Yes
2. No 
i. Developed indicators to monitor SBCC/HP activities 1. Yes
2. No
j. Wrote a proposal to solicit funds for SBCC activities 1. Yes
2. No
92
k. Other (specify…………………)
ENABLERS AND BARRIERS TO APPLICATION OF KNOWLEDGE AND SKILLS.
10. What factors contributed to your ability to apply the skills and 
knowledge acquired during the CADP? 
a. Program was very practical oriented 1. Yes
2. No
b. Received support from DDHS/DHMT 1. Yes
2. No
c. Program reference materials 1. Yes
2. No
Other (specify…………..)
11. What were the barriers that hindered your ability to apply the skills 
and knowledge acquired during the CADP? 
a. Lack of practical sessions 1. Yes
2. No
b. Lack of support from DDHS/DHMT 1. Yes
2. No
c. Inadequate course reference materials 1. Yes
2. No 
Other (specify…………..)
12. On a scale of 1-5, how would you rate your performance before 
the CADP training?
1. Non-performance
2. Low performance
3. Average performance
4. High performance
5. Very high performance
13. On a scale of 1-5, how would you rate your performance after the 
CADP training?
1. Non-performance
2. Low performance
3. Average performance
4. High performance
5. Very high performance
14. What are your suggestions towards the improvement of the CADP?
93
15. Overall Comment(s):
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
Name of CADP Beneficiary: 
……………………………………………………………………………………………………………………
Designation: 
………………………………………………………………………………………………………………………………………….
Signature: 
…………………………………………………………………………………………………………………………………………….. 
Date: ……………………………………………….
*********Thank you for your time and cooperation*********
94
Training Impact Assessment Questionnaire – Supervisors
 Change Agent Development Program (CADP)
Training Impact Assessment Questionnaire
(Supervisor) 
My name is …………………………………………………………………………………………………………………………………………. 
I am conducting this interview on behalf of Ghana Health Service Health Promotion Department and 
the USAID Communicate for Health project. The main objective of this interview is to assess the 
impact of the Change Agent Development Program (CADP). The information provided by you will 
enable the Communicate for Health Project in collaboration with the Health Promotion Department 
of the Ghana Health Service to further improve the quality and relevance of the CADP training 
program. 
Your participation in this interview is voluntary and will take about 30 minutes of your time. 
May I proceed with the interview?
Respondent Agrees to be interviewed…………1 
Respondent Refuses to be interviewed……………2.
Thank you. 
Date of Interview……………………………………………
Region: ………………………………………………………. 
District: ………………………………………………………………………….
4. Did you discuss the post CADP training report with the trainee?
a. Yes
b. No
5. If yes, what were highlights of the issues discussed?
a. ……………………………………………………………………………………………………………………………………………………
b. ……………………………………………………………………………………………………………………………………………………
c. ……………………………………………………………………………………………………………………………………………………
6. If no, kindly share with me the reasons for not being able to discuss the post CADP training 
report?
95
a. ……………………………………………………………………………………………………………………………………………………
b. ……………………………………………………………………………………………………………………………………………………
c. ……………………………………………………………………………………………………………………………………………………
7. In your view, do you find the CADP useful to his/her job responsibilities? 
a. Yes
b. No
8. If yes, how useful were the courses to the execution of his/her job responsibilities?
a. …………………………………………………………………………………………………………………………………………………
… 
b. …………………………………………………………………………………………………………………………………………………
… 
9. Has he/she been able to apply the knowledge, skills and abilities of the CADP to his/her day-to￾day assignments.
a. Yes
b. No
10. If your answer to question 6 above is yes, in what ways has he/she been able to apply the 
knowledge, skills and abilities of the CADP to his/her day-to-day assignments (list).
a. …………………………………………………………………………………………………………………………………………………
… 
b. …………………………………………………………………………………………………………………………………………………
… 
c. …………………………………………………………………………………………………………………………………………………
… 
11. If your answer to question 6 above is no, what were the barriers that hindered his/her ability to 
apply the skills and knowledge acquired during the CADP?
a. ……………………………………………………………………………………………………………………………………………………
b. ……………………………………………………………………………………………………………………………………………………
c. ……………………………………………………………………………………………………………………………………………………
12. What has he/she done differently since his/her participation in the CADP?
96
a. ……………………………………………………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………………………………………
c. …………………………………………………………………………………………………………………………………………
13. Would you recommend the CADP to any of your staff member in the future?
a. Yes
b. No
14. If yes, why?…………………………………………………………………………………………………………………………
15. If no, why?..................................................................................................................................
Name of Supervisor: ………………………………………………………………………………………………………………
Designation: ……………………………………………………………………………………………………………………………
Signature: ………………………………………………………………………………………………………………………………… 
Date: ……………………………………………….
*********Thank you for your time and cooperation*********
97
Appendix 4: Detailed Comparison of Organizational Capacity Assessment of HPD, 2015 
and 2019 
Component 1: Understanding the 
Context through Situation Analysis.
2015 2019 Score change
Q 1.1 Do you conduct a situation 
analysis before designing SBCC 
programs?
3 4 +1
Q1.2 Do you use theories or 
models for situation analysis or 
communication strategy design?
2 3 +1
Q1.3 Do you use research data to 
assist with SBCC program design?
3 4 +1
Q1.4 Do you review the activities 
of stakeholders during a situation 
analysis?
3 4 +1
Sub total 11/16 [68.8%) 15/16 (93.8%) 4
Component 2: Focusing and 
Designing the Communication 
Strategy
Q2.1 Do you have a communication 
strategy for your SBCC programs?
3 4 1
Q2.2 Do you select audiences and 
segment them into specific groups 
to tailor their programs effectively?
3 4 1
Q2.3 Do you set SMART 
communication objectives that 
address barriers to change?
2 4 2
Q2.4 Do you have a communication 
strategy that proposes using more 
than one communication channel 
to reach audiences?
3 4 1
98
Q2.5 Do you have communication 
strategies that seek to influence 
different levels of the problem 
(individual, family, community, 
regional, and national)?
3 4 1
Q2.6 Do you have a 
communication strategy that is 
driven by a strategic approach that 
links all strategies and channels into 
a coordinated effort or campaign or 
intervention?
3 4 1
Sub-Total 17/24 [70.8%] 24/24 100% 7
Q3.1 If you develop your own 
materials, do you use the key 
elements of effective materials and 
message design? or, If you use 
materials from other organizations, 
do you use the key elements of 
effective materials and message 
design to check if it fits your needs?
2 3 1
3.2 If you develop your own 
materials, do you have a review by 
technical staff and stakeholders for 
accuracy of information?
3 4 1
Q 3.3 If you develop your own 
materials, do you develop and test 
them with members of your 
audience and incorporate their 
feedback? 
3 3 0
Sub-Total 8/12 [66.7%] 10/12 83.3% 2
Component 4: Implementing and 
Monitoring Change Process
Q. 4.1 Do you develop workplans 
for SBCC programs?
3 4 1
Q. 4.2 Do you coordinate 3 4 1
99
implementation of the program 
with other programs? (e.g. referral 
for products and services)
4.3 During development of the 
workplan, do you develop detailed 
and accurate budgets before 
initiating SBCC program activities?
3
4
1
Q. 4.4 Do you coordinate 
implementation of activities for 
impact?
2
3
1
Q.4.5 Does your management and 
technical staff have the capacity to 
manage and implement SBCC 
programs?
1
3
2
Q. 4.6 Is there a plan for 
strengthening staff’s SBCC 
competencies (basic SBCC training, 
on
-the
-job training, etc.) that is 
implemented?
1
4
3
Q. 4.7 If you work with field 
workers, do you require supervisors 
make regular visits to staff and 
volunteers to observe strengths 
and/or identify areas in need of 
more support?
1
3
2
Q. 4.8 If you work with field 
workers, do you make sure field 
workers have communication 
materials to support outreach?
2
2
0
Q.4.9 Do you develop M&E plans 
for your SBCC programs?
2
3
1
Q. 4.10 Do you develop indicators 
for SBCC programs that are linked 
to your communication objectives?
2
3
1
100
Q.4.11 Do you have tools to 
monitor implementation of SBCC 
programs?
2 4 2
Q. 4.12 Do you have a system in 
place to make sure high quality 
M&E data is collected and 
analyzed?
1 4 3
Sub-total 23/48 [47.9%] 41/48 [85.4%] 18
Component 5: Evaluation and 
Replanning for Outcome and 
Sustainability
Q. 5.1 Do you document and 
disseminate results, lessons 
learned, and best practices?
2 2 0
Q.5.2 Do you analyze data 
generated by M&E and share it 
with implementers of SBCC 
programs?
2 1 -1
Q.5.3 Do you use M&E data to 
improve current SBCC programs?
2 1 -1
Sub-total 6/12 [50%] 4/12 [33.3%] -2
GRAND TOTAL 65/112 [58%] 94/112 [83.9%] 29 
 
FINAL ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING FOR 
HEALTH PROMOTION DEPARTMENT, 2015-2019
UNEXPECTED OUTCOMES
(VOLUME 2)
DR. GEORGE AMOFAH, PUBLIC HEALTH CONSUTANT 
AUGUST 2019
(final edit November 2019)
1 
 
ENDLINE ASSESSMENT REPORT OF CAPACITY BUILDING OF HPD, 2015-2019
UNEXPECTED OUTCOMES
(VOLUME 2) 
Dr George Amofah, Public Health Consultant
Table of Contents
List of Acronyms.................................................................................................................................... 3
List of Tables.......................................................................................................................................... 4
List of Figures......................................................................................................................................... 4
CHAPTER 1: UNINTENDED CAPACITY BUILDING INITIATIVES FOR HPD ............................................. 5
1.1 Purpose........................................................................................................................................ 5
1.2 Context and Rationale ................................................................................................................ 5
1.3 Health Information System (HIS)................................................................................................ 5
1.4 Monitoring and Evaluation Community of practice (MECOP)................................................10
1.5 National SBCC Resource Center...............................................................................................10
1.6 National SBCC Technical Review Committee (SBCC-TRC).......................................................11
1.7 Inter-agency Coordinating Committee (ICC-HP) .....................................................................12
1.8 Financial Resources and Mobilization......................................................................................13
1.9 Policy and Legal Framework .....................................................................................................14
1.10 Human Resource.....................................................................................................................15
1.11 Equipment and Infrastructure................................................................................................16
1.12 Elevation of HPD to Divisional Status.....................................................................................16
1.13 Curriculum Review..................................................................................................................17
CHAPTER 2: CHALLENGES/GAPS.........................................................................................................19
2.1 SBCC Technical Review Process................................................................................................19
2.2 Health Information System.......................................................................................................19
2.3 SBCC Resource Center..............................................................................................................20
2.4 ICC-HP........................................................................................................................................20
2.5 Leadership and Governance.....................................................................................................20
2.6 Financial Management and Resource Mobilization................................................................21
2 
2.7 Opportunities............................................................................................................................21
2.8 Threats to PHD ..........................................................................................................................22
CHAPTER 3: ADDITIONAL RECOMMENDATIONS...............................................................................23
Leadership and Governance...........................................................................................................23
Partnership ......................................................................................................................................23
Resource Mobilization ....................................................................................................................24
Health Information System.............................................................................................................24
Strengthen SBCC Resource Center................................................................................................. 24
REFERENCES ........................................................................................................................................25
APPENDICES.........................................................................................................................................26
Appendix 1: SBCC Materials Currently Uploaded onto Goodlife Repository...............................26
Appendix 2: Standard Operation Procedures (SOP) for National SBCC Technical Review 
committee .......................................................................................................................................29
Appendix 3: Equipment, Furniture, and Supplies to HPD from USAID Communicate for Health
..........................................................................................................................................................34
Appendix 4. Draft Standard Operation Procedures (SOP) for National Resource e-Library .......35
Appendix 5: Organogram for Health Promotion Division .............................................................37
3 
List of Acronyms
CBSP Capacity Building Support Plan
CCF Change Challenge Fund
CE4MP Community Engagement for Malaria Prevention
CHPS Community Health Planning and Services
CPD Continuous Professional Development
DHIO District Health Information Officer
DHMIS2 District Health Management Information System 2 
FAA Fixed Amount Award
FHD Family Health Division
GHS Ghana Health Service
HIO Health Information Officer
HMIS Health Management Information System
HP Health Promotion
HPD Health Promotion Department
HPO Health Promotion Officer
ICC-HP Inter-agency Coordinating Committee-Health Promotion
IKG In-Kind Grant
IT Information Technology
M&E Monitoring and Evaluation
MECOP Monitoring and Evaluation Community of Practice 
MOU Memorandum of Understanding
NGOs Non-Governmental Organizations
NTDs Neglected Tropical Diseases
PC Personal Computers
PD Program Development 
PPME Policy Planning Monitoring and Evaluation
SBCC Social and Behavior Change Communication
SOPs Standard Operation Procedures 
TOHP Technical Officer Health Promotion
ToR Terms of Reference
TRC Technical Review Committee
USAID United State agency for International Development 
WASH Water Sanitation and Hygiene
4 
List of Tables
Table 1. USAID MECOP ATTENDANCE BY HPD OFFICERS FROM 2015 TO 2019..............................10
Table 2. FUNDING TO HPD FROM 2015-2019...................................................................................13
List of Figures
Figure 1. Quarterly Reporting Rate of HP indicators from Jul–Sep 2017 to Apr–Jun 2019. ............. 8
Figure 2. Completeness of Reporting of HP Indicators Aug–2017 to Mar–2019. ............................. 9
Figure 3. Timeliness of Reporting of HP Indicators Aug–2017 to Mar–2019. ................................... 9
5 
CHAPTER 1: UNINTENDED CAPACITY BUILDING INITIATIVES FOR HPD
1.1 Purpose 
Volume one of the capacity assessment report focused exclusively on the Social Behavioral
Change Communication (SBCC) technical capacity improvements of Health Promotion 
Department (HPD) resulting directly from USAID Communicate for Health capacity initiative as 
contained in the Capacity Building Support Plan (CBSP). This volume goes beyond the CBSP and 
assesses all the unintended outcomes resulting from various capacity building initiatives of the 
USAID Communicate for Health project, as well as contributions by other key partners.
1.2 Context and Rationale 
In addition to the integrated technical capacity building support plan provided by USAID 
Communicate for Health from 2015–2019 discussed in the assessment report volume one, 
several other initiatives occurred during the period supported by USAID Communicate for Health 
and various other partners and Ghana Health Service (GHS) itself. Going back to the contextual 
framework for the assessment, capacity building is described as “interventions that strengthen 
an organization’s or individual’s ability to fulfil its mission by promoting sound management, 
strong governance and persistent rededication to achieving results.” [Lammert et al. 2015]. It is 
recognized that performance to deliver does not depend only on technical capacity but also on 
favorable enabling environment in terms of supportive policies, suitable physical infrastructure, 
financial access and requisite numbers of properly motivated staff. It also includes ability to form 
productive relationships with groups outside itself and sell itself through rebranding. Hence, this
chapter brings together information to answer the Terms of Reference (ToR) question: 
“Are there any unintended outcomes resulting from the implementation of the capacity building 
programs, and how have these complemented the intended outcomes? In addition, are there 
any unintended outcomes in HPDs capacity achieved over the life of the project that can be 
attributed to the capacity strengthening efforts of the Communicate for Health project?” 
Attribution may be difficult to assign but the following sections describe various unintended 
outcomes of the USAID Communicate for Health project and mention contributions of all 
stakeholders as appropriate, with particular focus on contributions by the USAID Communicate 
for Health.
1.3 Health Information System (HIS) 
If there is one area where much progress has been made from 2015–2019, it is in HIS, which 
includes the online data management system of GHS (formerly called District Health Information
Management 2 (DHIMS 2) but now labeled District Health Information System (DHIS)). Over the
years, despite efforts, a systematic approach for collecting and analyzing health promotion￾related data and using it to improve programming and targeting for improved performance in 
6 
the midst of limited resources has been a challenge at all levels. The implications of such a gap 
are obvious as it affects proper monitoring of Health Promotion (HP) activities, use of data for 
decision making, and appropriate targeting of resources and technical support.
Beginning in June 2015, five HPD officers and one Family Health Division (FHD) officer worked 
with USAID Communicate for Health and many other partners such as UNICEF, Policy Planning 
Monitoring and Evaluation Division of GHS (PPME), Evaluate for Health, and Systems for Health
to develop and implement a roadmap for HIS, which included: 
• Collation of all existing HP M&E tools
• Development of a results framework based on HP Strategic Plan
• Development of an indicator table detailing indicator definitions, levels of data 
disaggregation, sources of data collection, and methodology and frequency of data 
collection
• Development of data collection tools and standard operation procedures (SOPs)
• Stakeholder engagement meetings to review and provide inputs into the process
• Pretesting of tools
• M&E workshop or “Boot Camp” to incorporate all reporting/summary forms into the 
then DHMIS2 
• Training of Headquarters, regional, district, and frontline workers on tools and Standard 
Operation Procedures (SOPs). In total, 310 Technical Officers Health Promotion (TOHPs)
and District Health Information Officers (DHIOs) from Ashanti, Brong Ahafo, Volta, 
Western, and Greater Accra Regions were trained. UNICEF supported a national Training 
of Trainers for Regional HPOs and HIOs. For DHIOs, TOHPz and sub-district staff, trainings 
were conducted in Upper East, Upper West, Northern, Eastern, and Central Regions. All 
10 regions have now received the essential DHIS training for DHIOs and TOHPs. 
To operationalize the HIS roadmap, the following M&E tools were developed: 
• Volunteers register for health promotion activities
• Health staff register for health promotion activities
• Master register for regional trainings
• Master register for district trainings
• Monthly reporting form
• Quarterly health promotion reporting form 
• Summary master registry for trainings (regional level)
• Standard Operation Procedures (SOPs) for health promotion
• District monitoring checklist
• Regional monitoring checklist 
• Rapid assessment tool 
• Criteria for assessment of healthy HP districts [USAID Communicate for Health annual 
reports, 2015-2019]
A total of 12,200 copies of Health Worker Registers for HP were printed by USAID Communicate 
for Health and distributed to all facilities in all the ten regions for use as the primary source of 
7 
data collection on health promotion activities before entering them into the DHMIS2. Data 
collection using the Register for HP activities in all facilities began in August 2017. Entry of data 
into HP Data sets into the then DHMIS2 was also activated in September 2017 for the Monthly 
Reporting Form for HP activities. The Monthly Reporting form is a summary of data collected 
from the primary data collection tool which is the Health Worker Register for HP activities. The 
availability of the registers literally forced HPD and GHS to monitor Social Behavioral Change 
Communication (SBCC) and other HP activities. 
The following HP indicators were agreed on to be reported monthly through DHMIS2 by district 
and regional HP officers. [See Table 1 for examples of some HP indicators in DHIS.] 
 
Table 1: Examples of HP indicators in DHIS:
• Number of sessions held
• Number of times SBCC materials were used during HP activities
• Number of channels used
• Number of target audience reached
• Number of media houses engaged
• Number of Health Promotion (HP) documents developed (output)
• Percentage of clients satisfied with health promotion services
• Number of Health Promotion Officers (HPOs) at post (input)
• Proportion of trainings conducted by HPD (process)
• Number of HP personnel/focal persons trained on other topics (output)
• Number of HP personnel/focal persons trained on risk communication (output)
• Number of HP personnel/focal persons trained on interpersonal communication(output) 
• Number of HP personnel/focal persons trained in the utilization of SBCC materials 
(output)
• Proportion of HP Personnel/Focal Persons trained on HP protocols and guidelines 
(output)
• Percentage of community members practicing desired health behaviors (Outcome)
• Proportion of SBCC materials used (output)
• Number of target audience reached with SBCC activities (output)
• Number of HP events/ programs jointly planned with partners (process)
• Number of HP events/ programs jointly held/organized with partners (output)
• Number of advocacy sessions held with key decision-makers and partners (output)
• Number of Health Promotion Champions (HPC) identified (output)
• Number of active Health Promotion Champions (HPC) (output)
• Proportion of activities in the action plan implemented by HPC (output)
Figure 1 shows the reporting rate from the onset in August 2017 to April–June 2019. There has 
been a percentage increase in reporting rate from 74% (July–September) 2017 to a high of 
98.25% (January–March 2018) and a dip to 92.8% (October–December 2018), a percentage 
increase of 18.8%. The low reporting rate of 77.1% for January–March 2019 was due to non￾reporting from Ashanti region which was corrected in the second quarter.
8 
Figure 1. Quarterly Reporting Rate of HP indicators from Jul–Sep 2017 to Apr–Jun 2019. 
Source: GHS PPME. DHIS 2019.
In terms of completeness of reporting, there has been a percentage increase of 23.4% from 
57.8% in Aug 2017 to 81.2% in Jun 2019 (Fig. 2). Timeliness has also improved from 45% in Aug 
2017 to 74.5 % in Mar 2019, an increase of 29.5% (Fig. 3). Despite the gradual improvements in 
completeness and timeliness of reporting, the rates are still below 85%.
7.7
74
92.2
98.5 98.2 98.1 97.4
77.1
92.8
0
20
40
60
80
100
120
Jan to Mar
2017
Apr to Jun
2017
Jul to Sep
2017
Oct to Dec
2017
Jan to Mar
2018
Apr to Jun
2018
Jul to Sep
2018
Oct to Dec
2018
Jan-Mar
2019
Apr-Jun
2019
Ghana
Ghana
9 
Figure 2. Completeness of Reporting of HP Indicators Aug–2017 to Mar–2019. 
Source: GHS PPME. DHIS 2019.
Figure 3. Timeliness of Reporting of HP Indicators Aug–2017 to Mar–2019. 
Source: GHS PPME. DHIS 2019
57.8 60.6 60.7 60.3 60.5 
67.6 67.8 67.5 67.4 67.8 67.9 67.9 67.7 67.2 67.1 67 67.4 73.5 76.6 81.2 
0
10
20
30
40
50
60
70
80
90
COMPLETENESS
Ghana
45 
53.5 
58.7 58.7 59 
62.2 63.6 63.2 
65.4 66.1 66.5 66.3 65.9 64.4 65.2 64.2 66.1 
68.4 69.7 
74.5 
0
10
20
30
40
50
60
70
80
TIMELINESS
Ghana
10
1.4 Monitoring and Evaluation Community of Practice (MECOP) 
MECOP, was an Evaluate for Health initiative that provided opportunities for USAID project staff
including USAID Communicate for Health to build their technical capacity on monitoring and 
evaluation (M&E). These activities are organized usually on a quarterly basis and provide a 
platform for capacity strengthening in a broad range of M&E topics, including peer learning 
among USAID partners. Although invitations for these trainings/activities are sent primarily to 
USAID partners, Communicate for Health has always ensured that as part of activities in capacity 
strengthening for evidence-based SBCC programming, staff from HPD and a project partner, Pro￾Link participate in these meetings. HPD participated in 18 of 22 MECOP activities conducted. 
MECOP thus provided another avenue for the M&E technical capacity building of HPD staff, an 
area that was found to be the weakest among all the SBCC elements assessed at baseline in 
2015. Table 2 outlines the topics covered during the MECOP training sessions over the period. 
Table 1. USAID MECOP ATTENDANCE BY HPD OFFICERS FROM 2015 TO 2019
NO. Date Topic Discussed 
1 June 3–4, 2015 USAID M&E requirements; standard templates; steps and roles in preparing 
for and carrying data quality assessments (DQAs)
2 August 26–Sept 8,2015 Data analysis including challenges and best practices
3 0ctober 13, 2015 2015 Data Quality Assessment (DQA) process
4 December 3, 2015 Geographic Information Systems
5 December 19, 2015 Performance Management: Target setting, data demand and us
6 April 7, 2016 PPR Reporting
7 June 30, 2016 AID TRACKER Plus and HPNO Expectations
8 September, 2017 Mini MECOP M&E Basics
9 September, 2017 Gender integration in M&E
10 October 25, 2017 FY17 PPR guidelines, including analysis of PPR performance indicators, 
deviation narratives and the Performance Data Tables (PDT). 
11 December 5, 2017 Key findings of the 2017 HPNO Midline survey) FY 17 Performance Plan 
Reporting (PPR)
12 April 12, 2018 Key Performance Plan indicators and other technical updates/ plan for E￾Tracker roll out
13 May 29–31, 2018 Capacity Building on the Culture of USAID Monitoring and Evaluation for 
Newly Hired M&E Officers 
14 July24–25, 2018 Database Design and Management
15 September 26–29, 2018 Infographics/ Data Visualization
16 November 13–15, 2018 Survey Design and Mobile Data Collection Training
17 April 30–May 2, 2019 Qualitative Data Analysis
18 June 25–27, 2019 Advanced Excel for Quantitative Data Analysis 
Source: USAID Communicate for Health M&E team, 2019
1.5 National SBCC Resource Center 
National SBCC Resource Center and 5 regional hubs have been established and made functional 
at the national level. The objective of the National SBCC Resource Center is to have a repository 
of all SBCC materials in one place and to place them onsite, and ultimately online, for research 
11
and other purposes. Such a resource center for SBCC is a necessity to support any technical 
capacity building to consolidate learning and facilitate teaching and research. It also has the 
potential to attract many partners to the new Division. This was financed by USAID Communicate 
for Health exclusively, including provision of technical support to train HPD officers and 
installation of required equipment at the national level and in five USAID focus regions -
Northern, Volta, Greater Accra, Central and Western. An information technology (IT) technical 
officer contracted by USAID Communicate for Health worked on the task full time, procuring all 
necessary equipment and software, and finalizing the design, customization, configuration, and 
test demonstrations of the E-Library software, (DSpace). 
A team from the Health Promotion Department and Communicate for Health Project carried out 
these trainings and orientations and at the end, two desktop computers and a printer were 
presented to each of the regions. These machines were installed, and health staff were trained 
on their use [USAID Communicate for Health Annual Report Y4]. 
The national resource center includes a library, store room, exhibition and conference room. 
USAID Communicate for Health procured 5 computers and accessories for the onsite library. So 
far, 30 people have registered to access the materials at the facility, and 120 SBCC materials 
have been uploaded and available for onsite downloading [Appendix 1]. 
During the field visit, however, it was learned that none of the regional hubs in the regions 
visited (Volta, GAR, Central Region and Western) had been used yet, and none were working 
either due to faulty UPS, faulty computer, or lack of internet access, although all were tested and 
working at the time of installation and training in the regions. Efforts are being made by the 
USAID Communicate for Health consultant to address these challenges and make them 
operational, and it is expected that they will be functional by the end of project as capacity has 
already been built at the regional level to operate the SBCC hubs. 
1.6 National Health SBCC Technical Review Committee (SBCC-TRC) 
A National Health SBCC-TRC was established by Director General in December 2016 to ensure 
materials produced for Social and Behavior Change campaigns are technically accurate and 
reflect current GHS policy and National Health Promotion Policy. USAID Communicate for Health 
worked behind the scenes for its establishment and has actively supported (including provision 
of technical support) and funded its operations since its inception, but HPD has now fully taken 
this on board as part of their mandate. Guidelines on material development [GHS 2019] and 
standard operation procedures for the Health Sector SBCC-TRC have been developed and 
finalized to streamline its activities (see appendix 2). The Committee is usually chaired by 
Director of FHD on behalf of DG, or in his absence, one senior officer is nominated to chair with 
HPD serving as the secretariat. The committee is playing a very important role in providing 
coordination, confidence, and consistency in content of SBCC materials. The committee also 
ensures that all SBCC materials that come out are of standard, technically sound and culturally 
accurate. It thus provides leadership and vision for harmonizing all educational materials and 
12
also ensure that they conform to the existing GHS policies. The review process affords officers of 
HPD to have regular hand-on practical experience of applying what they have learned in SBCC 
material development. 
A number of SBCC materials developed by partners (print, audio, and audio-visuals) have been 
reviewed by the committee. The committee has so far approved 300 audios, 50 videos, and 70 
print SBCC materials from various partners on Water Sanitation and Hygiene (WASH), nutrition, 
malaria, newborn care, breastfeeding, safe motherhood, and family planning by the committee
as of August 1, 2019. Among partners that have used the SBCC–TRC to solicit feedback and 
approval for campaigns and materials during the period include JICA, GIZ, People for Health, 
JHPIEGO, PATH, WHO, Neglected Tropical Diseases (NTDs), National Malaria Control Programme 
and Afro Star. 
A comment by a partner is provided below as an example of the trust that is building between 
partners and the committee.
“This is a very helpful service. Through this structure, stakeholders get direct feedback on their 
production work so that at the end of the day, messages are accurate, up-to-date, and support 
the GHS’s needs. SOPs need to be finalized and circulated so that stakeholders understand the 
purpose of the National SBCC-TRC and what they can expect as services. HPD needs to be careful 
that they do not make going through the SBCC-TRC a burden for small NGOs (i.e., insisting on 
lunch, snacks, and travel and transportation). Right now, some people are brought in from the 
regions for these meetings.” 
1.7 Inter-agency Coordinating Committee (ICC-HP) 
ICC-HP is an inter-agency coordinating body aimed at bringing together stakeholders in health 
promotion and agencies involved in health for a common goal of ensuring people are healthy. It 
functions in an advisory capacity to achieve the goal of National Health Promotion Strategy and 
its core objectives are to mobilize, harness, and make effective use of stakeholder resources in 
implementing health promotion activities. In 2015, a process began to prepare for re-launch of 
the ICC-HP during first quarter of 2016. The processes included re-development of the TOR for 
the ICC-HP at national and later regional levels, identification of an experienced media person as 
chairperson, and selection of stakeholders to form the ICC-HP. About 20 different organizations
(private, public, development partners, academia, non-governmental organizations (NGOs), 
community leaders) were brought together to form the refreshed ICC-HP.
The main achievements are conducting quarterly multi-sector meetings to provide oversight 
guidance for HP in Ghana, strengthening of Regional ICC-HP in three USAID Communicate for 
Health focus regions (Volta, Greater Accra and Western), and establishment of a resource 
mobilization sub-committee with ToR.
Establishment of the Northern Region USAID Implementing Partners (IPs) SBCC Coordination 
Committee
13
This committee is an initiative of the USAID Communicate for Health project. It was initiated in 
2015 at the request of USAID for USAID Communicate for Health to coordinate SBCC 
investments in the region. It began with USAID Implementing Partners (IPs) but expanded to 
include other SBCC players in the region with profound results. Although started by USAID 
Communicate for Health, it was coordinated and driven by the Regional Health Promotion 
Officer and Deputy Director Public Health. The committee met quarterly to share best practices 
in health promotion among staff from USAID Communicate for Health and HPD at the national 
level, even though it was more hands-on work between partners based in the Northern region. 
This activity has helped to raise the profile and visibility of Health Promotion in the region. 
1.8 Financial Resources and Mobilization 
One recurring constraint over the years is lack of funding for HP activities. Funding from 
government of Ghana, apart from for salaries, has been very minimal. Consequently, HPD has 
had to depend on donor funding for the most basic needs. The total 5-year USAID Communicate 
for Health project budget to support mass media campaigns, capacity building, and various 
health promotion activities at the national level and five USAID focus regions was almost USD 18 
million. In terms of ER #2, however, a total of about GHC 2,438,749.42 (about USD 468,990) of 
direct funding has been spent as at the time of the assessment in July 2019 [see Table 3]. The 
funding support excludes other indirect support to HPD by USAID Communicate for Health (see 
Appendix 3). 
A number of other partners, notably UNICEF and PATH, have also provided financial support to 
HPD over the period as shown in Table 3.
Table 2. FUNDING TO HPD FROM 2015-2019 
Organization Amount Comments 
USAID Communicate for Health GHS 1,048,620
(USD 283,584)
Renovation of HPD building
USAID Communicate for Health GHS 1,037,419
(USD 201,657.70)
FAA (1,2,3)
USAID Communicate for Health GHS 352,709.24
(USD 67,829.0)
IKG 
USAID Communicate for Health 
TOTAL DIRECT FUNDING 
GHS 2,438,748.24
(USD 468,990)
UNICEF GHS 1,035,479 (2015–
2018) [USD 199,130.6]
PATH USD 384,000 
[GHS 1,996,800]
GoG Not available
Source: Interview with key informants of respective partners, Endline 2019
14
The two main funding channels are the Fixed Amounts Award (FAA) and the In-Kind Grant (IKG) 
mechanism. IKG is used by USAID Communicate for Health for procurement of goods and 
services on behalf of HPD. FAA arrangement involved HPD writing effective PDs based on its own 
identified priorities and executing the approved activities based on a fixed budget with agreed 
deliverables or deliverables. There have been three FAAs. The first (total GHS 292,874 [about 
USD 56,322]) was to provide logistical support to the HPD to jointly co-create, refresh, and 
launch the GoodLife brand and campaign. Additionally, and carry out many of the activities 
indicated in the Health Promotion Policy including holding stakeholder meetings for the 
elevation of HP to a division, quarterly SBCC ICC-HP meetings at the national level and the 
regions, monitoring and supervision of HP activities in the region, national assessments of HP’s 
strengths and weaknesses, and integration of HPD indicators into DHIS etc. 
The second is the Performance Based Change Challenge Fund (CCF) awards (Total GHS107,595
[USD 20,691.34]) to graduates of the Change Agent Development Program and SfC Action 
Learning Sets to access up to GHC 6,000 [about USD 1,154] each to conceive, design, and 
implement a priority SBCC campaign approved by the districts where they live and work. 
Currently, 15 CCF beneficiaries are funded under the CCF fixed award and have implemented
SBCC projects ranging from maternal, child, adolescent health, nutrition, and WASH. 
USAID Communicate for Health has approval to release a third FAA (Total GHc 637,950 [about 
USD 122,683]) for the implementation of the Community Engagement for Malaria Prevention 
(CE4MP) initiative in the Volta region. The CE4MP project will reinforce USAID Communicate for 
Health’s above-the-line SBCC activities by GHS/HPD. The GHS/HPD officers at the district and 
community levels will be engaging communities to design and implement tailored malaria 
Community Action Plans (mCAP) with local leaders and health workers based on the realities of 
the areas where they live and work. The initiative will mobilize communities across 95 functional 
Community-Based Health Planning and Services (CHPS) zones in seven out of the twenty-five 
districts in the Volta region, which will implement a range of advocacy, community mobilization, 
and behavior change communication initiatives. The period of performance for this Fixed 
Amount Award (FAA) was July 8–September 30, 2019 and is managed and coordinated from 
HPD/FHD of GHS in Accra. 
The inception meeting was held in Ho on April 24, 2019 to introduce stakeholders at the regional 
and district levels to the CE4MP initiative. Following the inception meeting, the tools and 
guidelines for the implementation of the CE4MP initiative were finalised. There is ongoing 
engagement with HPD to finalize print materials, develop a work plan with timelines, collect 
baseline data on malaria indicators from the beneficiary districts, and engage a vendor to 
translate the Maternal Health Channel episodes on malaria into Ewe for showing in communities 
as part of the planned activities for the initiative. The Maternal Health Channel is an educational 
and entertaining television series developed by the project with Creative Storm Networks. 
1.9 Policy and Legal Framework 
15
The implementation of the HPD USAID Communicate for Health collaboration was guided by a 
number of policy and strategic guidelines, including:
• HS/USAID MOU on Communicate for Health
This Memorandum of Understanding (MOU) provides the broad framework for 
collaboration between the Parties with regard to the goals, targets, benefits, 
expectations and requirements for cooperation and partnership in mutually beneficial 
areas of interest. This agreement took effect from January 31, 2017 and is expected to 
expire on November 30, 2019. The MOU also provides principles and values guiding the 
partnership, roles and responsibilities of the parties, communications with external 
parties, as well as conflict resolution mechanism [USAID Communicate for Health 2018]. 
• Approved USAID Communicate for Health project document and M&E framework [USAID 
Communicate for Health 2014]
• Complementary Programs: USAID Rules, Regulations and Guidelines, Grants 
Management
• National HP Strategic Plan 2015–2019 [GHS 2015] A National HP Strategic Plan 2015–
2019, together with its implementation plan, was developed during the period to guide 
strategic direction for HPD activities, including technical capacity building. The Plan also 
provided guidance for other partners to buy into and support other aspects of HPD 
programs. Though started independently by HPD, USAID Communicate for Health 
supported HPD financially to finalize and print the National HP Strategic Plan 2015-2019 
and Health Promotion Policy 2013. 
• National HP Policy, 2013 [GHS 2013] 
• GoodLife Brand Manual
• Standard Operation Procedures (SOP) for National Resource e-Library (draft) [Appendix
4] 
• Standard Operation Procedures (SOP) for National SBCC Technical Review committee
[Appendix 2] 
• Material Development Guidelines (draft) [GHS 2019]
1.10 Human Resource 
For the first time, clear job descriptions for all categories of HPD officers have been developed￾an unintended outcome which resulted from the capacity building programs of USAID 
Communicate for Health. The process was begun before the project, but the project facilitated 
the process through financial and technical support to HRDD and HPD of GHS. The GHS Council 
has officially approved the job descriptions for various categories of HP officers. This has 
improved job placement, clarified the promotion process, and enabled GHS to put HPD officers 
in the appropriate salary scales at par with their counterparts in other professional categories. 
Now there is a clear career path and progression for Health Promotion within the service, an 
achievement that has boosted the morale of the HP officers. 
16
As part of the process for developing the job descriptions, GHS Human Resource Division (HRD) 
organized a workshop for 34 Health Promotion staff from national and regional levels at Dodowa 
from June 11–13, 2017. Job descriptions addressed included various categories of HP officers, 
from Health Educator (Health Promotion Manager) through Senior Health Educator (Senior 
Health Promotion Manager), Principal Health Educator (Health Promotion Manager), Deputy 
Chief Health Educator (Deputy Chief Health Promotion Manager), to Chief Health Educator.
A similar exercise was done for the technical officer grade from Technical Officer, Health 
Promotion to Chief Technical Officer HP. The job description consists of different components: 
Job Title, Grade, Responsible To, Job Purpose, Main Duties and Responsibilities, Communication 
and Working Relationships; Personal and People Development; Health and Safety 
Responsibilities; Quality Assurance; and Person Specification.
 
1.11 Equipment and Infrastructure 
In addition to direct funding support to HPD, USAID Communicate for Health supported HPD 
through equipment donations and an IKG during the period (see appendix 3 full list). The 
provision of these equipment and facilities provided the conducive environment that enabled 
HPD to improve upon its capacity and deliver on its mandate. 
1. USAID Communicate for Health delivered two used Ford Explorer vehicles, inherited from 
a previous USAID project, and rehabilitated three old HPD vehicles. Besides routine 
maintenance, the project also procured tires for these vehicles. The project also donated 
a server for setting up the National SBCC Resource Center and restored internet to the 
entire HPD building following its refurbishment in 2016. The project also procured 
furniture for the Head of Health Promotion and his deputy and some other national level 
staff. 
2. The project renovated the old HPD headquarters building and equipped it with furniture, 
internet connectivity, air conditioners, and other social amenities to create a conducive 
working environment for staff. This has made the operationalization of the co-location 
component of the CBSP possible. Two conference rooms have been made available for 
internal and external use for workshops, meetings, and conferences to facilitate capacity 
building. The project was financed solely by USAID Communicate for Health and these
facilities have provided an avenue for internally generated funds for HPD.
3. A number of desk top computers were provided to the Head of HPD and other officers, 
as well as photocopier and printers. 
4. The National SBCC Resource Center was equipped with new personal computers (PCs). 
5. The Social Media office was resourced with 5 PCs, 2 IPads and an IPhone X. 
1.12 Elevation of HPD to Divisional Status 
One fruit of the advocacy initiative of the USAID Communicate for Health was the elevation of 
HPD from a department under Family Health Division to a separate Division under the Director 
17
General. The GHS Council funded a consultancy aimed at giving Health Promotion the desired 
status in healthcare delivery within the Ghana Health Service. The HPD benefited from this
elevation to Divisional status by being repositioned and rebranded, with the objective of 
developing an institutional vision and brand identity for HPD to increase its level of influence. A 
consultant was engaged by USAID Communicate for Health to work with the HPD on achieving 
this goal by working with staff to assess professional values, beliefs, and culture, and increase the 
profile and visibility of HPD, as well as improve its methods of working with other sectors within 
the Ghana Health Service, partners, and stakeholders. The process included finalizing the Health 
Promotion Policy 2013 and the National Strategy and Action Plan for Health Promotion 2015–
2019 for formal adoption and subsequent launching of these documents. 
The consultants engaged by GHS Council held in-depth and interactive discussions with several 
stakeholders including the Director of the Family Health Division, staff of the hitherto Health 
Promotion Department, Director and staff of the Human Resource Development Division of the 
GHS, the Director-General and members of the 5th Ghana Health Service Council, culminating in 
a report to the GHS council and an aid memoire by the Joint Donor Partner Community
endorsing the elevation of HPD to a Division. 
The report to the GHS Council from the consultants covered the following:
• Finalized mission/vision statement and functions to be performed by the new division. 
• Finalized organogram, detailing core responsibilities and specific job description for all 
categories of staff under the proposed structure at all levels (national, regional, district, 
sub-district and CHPS) [appendix 5]. This activity was supported also by USAID 
Communicate for Health.
• Finalized human resource staffing norms for the new division. The development of the 
job description that facilitated the development of staffing norms was funded and 
technically supported by USAID Communicate for Health.
• Plan for recruitment of staff developed in conjunction with GHS Human Resource Division 
to occupy key positions.
• Finalized total budgetary requirement (Human Resource and others) for the 
establishment of the new division.
• Finalized draft implementation plan for the establishment of the new division. 
The new Health Promotion division is to be headed by a Divisional Director with three Deputy 
Directors proposed for three (3) key technical departments and a secretariat for the Office of the 
Director of the Division. The proposed key technical departments include 
• Health Communication 
• Advocacy and Social Mobilization 
• Research and Healthy Policy 
Provision has also been made for Units under the respective technical departments, and their 
functions described. [see appendix 5 for organogram for division]. 
1.13 Curriculum Review 
18
The training curriculum of Kintampo College of Health and Wellbeing for the training of TOHP 
has been revised with funding and technical support from USAID Communicate for Health and 
HPD, in line with the National HP Policy and Strategy. This will offer the opportunity for pre￾service training of HP technical officers in SBCC before they are deployed to the districts. The 
review included enhancing the SBCC component of the old syllabus. 
19
CHAPTER 2: CHALLENGES/GAPS 
Despite the impressive achievements over the past 5 years of the project, several weaknesses, 
gaps and challenges have been identified within the enabling environment for capacity building 
during the assessment which have to be addressed going forward. These are based on my own 
analysis of the various interviews from all stakeholders and my own inside knowledge of what 
has happened between 2015 and 2019 as far as HPD is concerned Recommendations for 
addressing these gaps are provided in Chapter 3.
2.1 SBCC Technical Review Process 
The current SBCC technical review process is too cumbersome, time consuming, and needs to be 
made more efficient, in spite of a SoP recently developed by HPD and USAID Communicate for 
Health officers. The concern is due to the fact that donor-funded projects are time sensitive, and 
any delays may lead to pressure. At times, it has been difficult to assemble members of the SBCC 
TRC to perform its assignment due to various administrative and operational challenges, 
resulting in delayed meeting timelines. Operational challenges include not providing enough 
notice to members on meeting days, and delayed sharing of draft materials which have to be 
reviewed before the meeting. There isn’t usually enough time to thoroughly review materials 
especially multiple materials. The committee membership, especially from HPD, is also too large, 
making it unwieldy and leading to delays in decision making.
Furthermore, some partners often want to circumvent key steps of the SBCC TRC’s SOP, such as
providing concept paper before materials are developed, with the excuse of limited funding and 
time pressure. Another challenge is that a few partners have their own brand; as such, they are 
not comfortable with the policy of using the GHS’ GoodLife brand. 
2.2 Health Information System 
The greatest weakness in Health Information System is lack of regular quarterly and half 
year/annual meeting of HP staff, especially at national level, to analyze HP indicators and provide 
feedback on performance to influence strategy.
Though the reporting rate of HP indicators through DHIS has improved (over 92% as at June 
2019), the quality of data reported is suspect. Timeliness and completeness are still low (never 
reached 85%), as not all districts are reporting on time and completely as required. There are 
also some fluctuations in reporting rates due to poor performance by some regions. This is 
where data can be used as feedback and for monitoring, but this is hardly done at the national 
level.
20
The current set of HP indicators is too focused on activities carried out rather than outputs and 
outcomes. In addition, there are currently no targets set for HP to measure performance or link 
outcome or achievements to interventions.
2.3 National SBCC Resource Center 
Not many people are aware of or utilizing the National SBCC Resource Center for SBCC research. 
Currently, only about 30 people have registered onsite to use the facility. During the assessment, 
the regional hubs were found to be malfunctioning due to minor operational and equipment 
challenges, even though the equipment had been tested and was functional during the regional 
trainings. Fortunately, the IT expert has been addressing these challenges to make them fully 
functional. 
2.4 ICC-HP 
The ICC-HP, like most of other initiatives, is too donor dependent and suffers from funding 
challenges. Initially, it was supported through an IKG and later through FAA with USAID 
Communicate for Health. A few challenges resulted in infrequent meetings due to inadequate 
liquidation of funds by HPD, as well as failure to mobilize additional funding from other partners 
to support the meetings. ICC-HP could not mobilize additional resources to support HP activities, 
even though a resource mobilization sub-committee was set up with a defined ToR. Currently, 
the committee has not been able to meet for over eight months due to funding challenges.
2.5 Leadership and Governance 
In spite of new job descriptions having been developed for all categories of HPD staff, the delay 
in moving from department to divisional status due to delayed appointment of key managers has 
left a big vacuum at the national level in terms of who leads the new division. Most of the 
officers are unsure of their standing as far as proposed division departments and units are 
concerned. The exit of the former head of HPD who has gone on compulsory retirement has 
worsened the vacuum created by the delay in appointing a director and deputy directors for the 
new division by the Public Service Commission. Currently, there is a major threat in maintaining 
the capacity building gains chalked over the period due to lack of leadership to guide the process 
moving forward. 
Too many internal “clashes” and squabbles among some officers of HPD at the beginning of the 
USAID Communicate for Health project led to tense working relationships, which spilled over to 
affect relationship with partners. The situation can be attributed to different business culture
(public vs. private), different expectations, confusion over roles, and different interpretations of 
responsibilities by key stakeholders about the nature and design of the USAID Communicate for 
Health project. Be as it may, its effect cannot be downplayed in a co-location environment, as it 
led to suspicions and mistrust, and precious time was spent on conflict resolution, which 
resulted in delays in implementation at the initial stages. 
21
Some senior staff appear to be more committed to programs and projects outside the HPD than 
department-related projects, hence, their contribution to the overall success of the department 
was sub-optimal. This has created a situation where a few technical staff are currently burdened 
with the ever-increasing work load due to improved technical capacity. Most of the experienced 
officers are aging and exiting, leaving younger, less experienced officers. This is a major challenge 
which has to be addressed soon. Furthermore, even though HPD meets regularly, there is no 
opportunity to critique each other, a key ingredient for excellence, due to fear of offending each 
other. Currently, there appears to be lack of innovators at HPD. Someone stated, “There are 
certain people at HPD who are tired and have lost their passion.” 
2.6 Financial Management and Resource Mobilization 
Despite the additional funds it has attracted over the period, HPD is still under-resourced and 
too donor-dependent, a situation which is not sustainable. HPD finds the procurement system of 
USAID Communicate for Health too cumbersome, leading to delayed implementation of 
activities. However, delayed reporting, liquidation, and documentation by HPD, especially of 
funding through FAA, resulted in delayed release of funds.
2.7 Opportunities 
During the assessment, a number of opportunities were identified for HPD moving forward. 
These may not be directly related to the USAID Communicate for Health project support, but the 
intention of any such support is to enhance technical performance beyond the lifespan of the 
project. A few of these opportunities are briefly outlined below. 
 
1. The Sustainable Development Goals has led to increased interest in health promotion by the 
global society. HPD should be able to build upon the clout of GHS to develop winnable 
proposals from multiple sources. It is important for HPD to make a difference now that it has 
been elevated to division. With its new status as a Division, HPD should be able to garner 
national support within the health system and with other actors outside GHS to realize 
health for all according to the Ottawa Charter.
1
2. Another opportunity is for HPD to become the SBCC hub, by continuing to build on its ability 
to deliver, which will increasingly attract additional funding and partners for collaborative 
actions. The Materials Development Unit should be the engine of HP to generate its own 
resources (internally generated funds) from both internal and external actors in the SBCC 
space to support some of its activities. 
3. Within GHS, there is opportunity to attract communication activities previously being carried 
out by other departments and units for coordination and execution by HPD, as the other 
programs recognize the technical capacity of HPD to deliver. Already a number of programs
 
1 WHO 1986. Geneva. Milestones in Health Promotion, Statements in Global conferences. WHO 
Ottawa 1986
22
of GHS such as NTDs, Malaria and EPI are partnering with HPD to deliver on SBCC 
components of their programs. 
4. A number of private, for profit institutions are engaged in projects which include SBCC as 
part of cooperative social responsibilities. There is an opportunity here for HPD to position 
itself properly to benefit from such initiatives through public-private partnerships.
5. There is currently an increasing number of community radio/ television outlets and print 
media with capacity to accommodate multiple languages and this offers another opportunity 
for HP Division to deliver on its mandate moving forward. 
6. Furthermore, there is a growing IT infrastructure and social media networks that have 
enormous potential to reach wider audiences at minimal cost, and these areas offer major 
opportunities for HP Division moving forward.
2.8 Threats to HPD 
A few internal and external threats to HPD were also identified which have to be addressed 
moving forward.
1. As technical capacity of HPD officers improve, there is increasing threat of key officers 
moving to private or international organizations for better remuneration.
2. The leadership vacuum created, due to delayed appointments of substantive senior 
managers to run the Division, is a major threat to performance. Weak leadership that is 
unable to change mentality of current staff at HPD to play expected roles of a new Division 
will result in ‘work as usual’ attitude. 
3. All departments and units of GHS are practicing health education and they consider this as 
Health Promotion, so if measures and systems are not well defined, it will affect the
performance of the Division.
4. In the midst of dwindling resources, emergency situations such as outbreaks and natural 
disasters may distract partners from supporting regular health development activities, 
including SBCC. 
23
CHAPTER 3: ADDITIONAL RECOMMENDATIONS 
Based on the interviews, findings, observations and analysis of all that has happened to HPD 
from 2015 to 2019, the following additional recommendations are made, focusing on the 
enabling capacity building environment, to enhance performance of the new HP Division moving 
forward.
Leadership and Governance 
1. As soon as possible, GHS Council should appoint a strong Director with advocacy skills 
to provide strategic leadership for the Health Promotion Division. The new Director
should have the capacity to bring all staff together for the common good of the 
Division as per its mandate and mobilize enough resources for the Division. All the 
vacant positions, especially the three Deputy Directors, should be filled to avoid 
creating a gap in the proper functioning of the new Division. The Director should build 
a core team of innovators who are willing to build a creative culture and generate 
ideas and concepts for innovations for the new Division. 
2. Review the staffing needs of the Division and make urgent effort to fill critical gaps. It 
is particularly important to embed digital technology into work of HPD to cover all 
interventions, in the light of new IT infrastructure and expanding roles of the Division.
3. There may be the need to establish a digital communication unit with a dedicated 
hotline as part of SBCC effort. Strengthen the social media program by providing 
needed logistical and financial support, including engaging a video editor.
4. Immediately after their appointment, the new leaders should take steps to review the 
current HP Strategic Plan (which ends in December 2019) and develop a new one for 
2020–2024. The plan should include strategies to address the current work ethic to 
avoid a “business as usual” mentality by incorporating lessons learned from the 
private sector during the various internship projects to enhance performance. 
5. Market HPD to make it attractive to interested stakeholders by outlining
achievements of the Division over the past 5 years and its future capabilities. The new 
Strategic Plan (2020–2024) should include an advocacy and marketing plan to 
enhance its visibility and sell its capabilities to the general public and partners. The 
social media unit should use its various platforms as part of the marketing strategy to 
market the Division and its capabilities.
6. Streamline the review process of the Health Service SBCC Technical Review 
Committee for existing and new SBCC messages to make communication more 
efficient. 
Partnership 
1. Make every effort to sustain ICC-HP committee meetings by making it less donor￾driven and dependent. Its activities should be made part of the new Division budget 
24
so that partners can support funding of its activities rather than the Division being 
entirely dependent on them. 
2. The recently formed mobilization sub-committee of ICC-HP should be reactivated and 
charged by ICC-HP with operationalizing the ToR which has been developed to guide 
its functioning.
Resource Mobilization 
HPD should develop a resource mobilization plan and enhance its technical capacity in 
proposal writing to attract funding. This area is still weak, and HPD may need a fund￾raiser to support its resource mobilization effort with specified deliverables.
Health Information System 
1. Review the current HP indicators from activities to include output and outcome measures 
as appropriate and develop targets to measure performance. Examples of such indicators 
include:
• Percentage of clients satisfied with health promotion services 
• Proportion of Health Promotion Officers receiving Continuous Professional 
Development (CPD)
• Percentage of districts designated as “healthy” as per the national best health 
promoting district award criteria
• Percentage of community members practicing desired health behaviors
• Number of target audience reached with SBCC activities
 
2. Address the current weak data management system by establishing systems for regular 
analysis and use of HP Indicators in DHIS at all levels, especially at national level.
Strengthen the National SBCC Resource Center 
Strengthen SBCC Resource Center. Extend the regional hub to all regions and make it
functional to provide available information required by interested stakeholders and facilitate 
the SBCC review process and HP research. Publicize the SBCC Resource Center to all 
interested stakeholders for wider access. 
25
REFERENCES 
1. GHS 2013. National Health Promotion Policy. 
2. GHS 2015. National HP Strategic Plan 2015–2019. 
3. GHS 2016. Job descriptions for HP Program Managers and Technical Officers. 
4. GHS 2019. SBCC Material Development Guidelines. 
5. Lammert, J. D, Johnson, L., and Fiore, T. A, (2015). Conceptualising capacity building. 
Rockville, MD: Westat. 
6. USAID Communicate for Health 2014. Technical Project Proposal 2014. 
7. USAID Communicate for Health Annual Report YR 4, 2018.
8. USAID Communicate for Health, 2018. USAID and GHS Memorandum of Understanding 
(MOU) for the implementation of USAID Communicate for Health in 2015.
9. USAID Communicate for Health, February 2016. Capacity Building Support Plan. 
10. USAID Communicate for Health. 2015-2019. Communicate for Health annual progress 
reports, 2018–2019. 
11. WHO 1986. Geneva. Milestones in Health Promotion, Statements in Global conferences. 
WHO Ottawa 1986. 
26
APPENDICES 
Appendix 1: SBCC Materials Currently Uploaded onto Goodlife Repository 
S/N ITEM AUTHOR COLLECTION
1 Advocacy Video on Stunting and Chronic Under Nutrition SPRING Nutrition
2 Bites BCS Malaria
3 Bites (Twi) BCS Malaria
4 Breastfeeding Positions: Attachment SPRING Nutrition
5 Breastfeeding Positions: Cradle and Underarm Holds SPRING Nutrition
6 Child Nutrition Flip Chart - Grow, Glow, Go! BCS Nutrition
7 Cholera Animation UNICEF Cholera
8 Community Health Volunteer Manual SPRING Flip Chart and
Manual
9 Contraceptive Methods – Implants Willows Int'l Ghana Family Planning
10 Contraceptive Methods – Injectables Willows Int'l Ghana Family Planning
11 Contraceptive Methods - Intrauterine Device (IUD) Willows Int'l Ghana Family Planning
12 Contraceptive Methods - Male Condom Willows Int'l Ghana Family Planning
13 Contraceptive Methods - The Pill Willows Int'l Ghana Family Planning
14 Counselling Cards for Children CARE Ghana Flip Chart and
Manual
15 Counselling Cards for Women CARE Ghana Flip Chart and
Manual
16 District Assessment Tool for Anemia SPRING Flip Chart and
Manual
17 District Assessment Tool for Anemia - FACILITATOR’S GUIDE SPRING Flip Chart and
Manual
18 District Assessment Tool for Anemia - User’s Guide SPRING Flip Chart and
Manual
19 Documentary Video Facilitator’s Guide SPRING Flip Chart and
Manual
20 EBOLA Brochure WHO Ebola
21 EBOLA Fact Sheet-A3 WHO Ebola
22 Emergency Contraception Willows Int'l Ghana Family Planning
23 Eni Boni-malaria (English) BCS Malaria
24 Eni Boni-malaria (Twi) BCS Malaria
25 Enriched Complementary Feeding SPRING Nutrition
26 Exclusive Breastfeeding TV Story C4H Nutrition
27 Facilitator’s Guide for Father-to-Father Support Groups SPRING Flip Chart and
Manual
28 Facilitators Guide: The Community Infant and Young Child 
Feeding Counselling
UNICEF Flip Chart and
Manual
29 Family Planning Flip Chart BCS
30 Family Planning Methods-English-Life Choices BCS Family Planning
27
S/N ITEM AUTHOR COLLECTION
31 Family Planning TV Story C4H Family Planning
32 First Lady Endorsement: Exclusive Breastfeeding - (English) C4H Nutrition
33 First Lady Endorsement: Exclusive Breastfeeding - (Ga) C4H Nutrition
34 First Lady Endorsement: GoodLife - (English) C4H Video
35 First Lady Endorsement: GoodLife - (Ga) C4H Video
36 First Lady Endorsement: Malaria - (English) C4H Video
37 First Lady Endorsement: Malaria - (Ga) C4H Malaria
38 Game Plan-Malaria (English) BCS Malaria
39 Game Plan-Malaria (Twi) BCS Malaria
40 Ghana ENGAGE Advocacy Documentary (Abridged) - 13min NPC Family Planning
41 GoodLife Brand Manual C4H Flip Chart and
Manual
42 GoodLife Teaser – English C4H Video
43 Handwashing Global Communities WASH
44 Handwashing (Akan) Global Communities WASH
45 Handwashing Poster-1 Global Communities WASH
46 Handwashing Poster-2 Global Communities WASH
47 Handwashing Spot BCS WASH
48 Handwashing Tips Global Communities WASH
49 Health Worker Training Manual for Anemia Control -
Facilitator Guide
SPRING Flip Chart and
Manual
50 Hemo Cue Facilitator's Guide SPRING Flip Chart and
Manual
51 How To Breastfeed Your Baby UNICEF Flip Chart and
Manual
52 How To Feed A Baby After 6 Months UNICEF Flip Chart and
Manual
53 Infant and Young Child Feeding Counseling Cards for Workers UNICEF Flip Chart and
Manual
54 JHU-Nutrition Bumper sticker BCS Nutrition
55 Key Messages Booklet: The Community Infant and Young 
Child Feeding Counselling
UNICEF Flip Chart and
Manual
56 Life Choices-Mechanic BCS Family Planning
57 Malaria Documentary - 30min C4H Malaria
58 Malaria Documentary - 5min C4H Malaria
59 Malaria TV Story C4H Malaria
60 MHC-Breastfeeding Programme-1 C4H Nutrition
61 MHC-Breastfeeding Programme-2 C4H Nutrition
62 MHC - IPTp Programme C4H Malaria
63 MHC-Kangaroo Mother Care-1 C4H Newborn Care
64 MHC-Kangaroo Mother Care-2 C4H Newborn Care
65 MHC-Long Lasting Insecticide-Net (LLINs) – Malaria C4H Malaria
28
S/N ITEM AUTHOR COLLECTION
66 MHC-Newborn Programme-1 C4H Newborn Care
67 MHC-Newborn Programme-2 C4H Newborn Care
68 MHC-Test, Treat and Track C4H Malaria
69 Newborn Care TV Story C4H Newborn Care
70 Northern Region Specific Breastfeeding Poster C4H Nutrition
71 Northern Region Specific Malaria Poster C4H Malaria
72 Ntomtompo Soro (English) BCS Malaria
73 Ntomtompo Soro (Twi) BCS Malaria
74 Nutrition Brief SPRING Briefs and Reports
75 Nutrition During Pregnancy and Breastfeeding UNICEF Flip Chart and
Manual
76 Nutrition Video: Grow, Glow, Go! BCS Nutrition
77 Nutrition Video: Grow, Glow, Go! (Twi) BCS Nutrition
78 Orientation of WASH 1000 Community Drama Presentation SPRING Flip Chart and
Manual
79 ORS+Zinc Brochure BCS Diarrhoea
80 ORS+Zinc Poster BCS Diarrhea
81 ORS+Zinc TV Informational BCS Newborn Care
82 Proper Refuse Disposal Global Communities WASH
83 Proper Refuse Disposal (Akan) Global Communities WASH
84 Proper Refuse Disposal (Ga) Global Communities WASH
85 Quality Improvement Brief SPRING Reports and Policies 
(RP)
86 Ration Guide SPRING Flip Chart and
Manual
87 Reducing Anemia in Ghana SPRING Briefs and Reports
88 Refreshed GoodLife Complementary Feeding Poster C4H Nutrition
89 Refreshed GoodLife Exclusive Breastfeeding Poster C4H Nutrition
90 Refreshed Goodlife Family Planning Poster C4H Family Planning
91 Refreshed Goodlife Malaria Poster C4H Malaria
92 Refreshed Goodlife Newborn Poster C4H Safe Motherhood
93 Refreshed Goodlife Pregnant Couple Poster C4H Healthy Life Style
94 Refreshed Goodlife Service With A Smile Poster C4H Healthy Life Style
95 Refreshed Goodlife Wahala Free Poster C4H Healthy Life Style
96 Refreshed Goodlife Young Adults Poster C4H Adolescent 
Health/Youth
97 Revised Implementation Guideline - TARGETED 
SUPPLEMENTARY FEEDING (TSF)
SPRING Reports and Policies 
(RP)
98 SBBC Materials Used – Catalogue Global Communities Briefs and Reports
99 Sister-Sister Family Planning Methods BCS Family Planning
100 Slice of life - Family Planning C4H Family Planning
101 Slice of life - Hand washing C4H WASH
29
S/N ITEM AUTHOR COLLECTION
102 Slice of life – Malaria C4H WASH
103 Slice of life – Nutrition C4H Nutrition
104 SPRING Nutrition Advocacy Video Documentary SPRING Nutrition
105 Stop Open Defecation Global Communities WASH
106 Stop Open Defecation - (Ga) Global Communities WASH
107 Stop Open Defecation (Akan) Global Communities WASH
108 Supportive Supervision/Mentoring and Monitoring for 
Community IYCF
UNICEF Flip Chart and
Manual
109 The Community Infant and Young Child Feeding Counselling 
Package
UNICEF Flip Chart and
Manual
110 The Integrated 1,000-Day Brief SPRING Briefs and Reports
111 Training for RDNOs on TSF - Presentation SPRING Flip Chart and
Manual
112 Training Tracker C4H Flip Chart and
Manual
113 WASH 1000 Day Community Video Documentary – Dagbanli SPRING WASH
114 WASH Disposal of Refuse Poster-1 Global Communities WASH
115 WASH Disposal of Refuse Poster-2 Global Communities WASH
116 WASH Disposal of Refuse Poster-3 Global Communities WASH
117 WASH Drama Video Facilitator's Guide SPRING Flip Chart and
Manual
118 WASH Open Defecation Poster-1 Global Communities WASH
119 WASH Open Defecation Poster-2 Global Communities WASH
120 WASH Open Defecation Poster-3 Global Communities WASH
Appendix 2: Standard Operation Procedures (SOP) for National SBCC Technical 
Review committee 
Introduction
Development of social and behavior change communication materials is important to the 
MoH/Ghana Health Service and all health partners. To ensure materials produced for Social and 
Behavior Change Communication are technically accurate and reflect current MoH/GHS policies 
and programs, a National SBCC Technical Review Committee (herein referred to as “the 
Committee”) has been established. 
To ensure quality work is undertaken by the committee, there is the need for a standard 
protocol to guide the work of this technical committee. Hence this Standard Operation
30
Procedure (SOP) has been developed for responsive, efficient, effective functioning and 
coordination of the SBCC Technical Review Committee’s work. 
Operational Definition of SBCC Materials: For the purpose of this SOP, SBCC materials include but 
not limited to audio, audio-visual, multimedia infomercials/spots, social media, and print 
(posters, drama, flipcharts, counselling cards, job aids, etc.).
Committee Functions: The committee shall: 
• Streamline, review and approve the content of SBCC materials 
• Ensure approved materials are in line with current MoH/GHS policies and programs 
• Serve as a clearing house for all SBCC materials 
• Raise awareness on the work of the committee and what is required for the approval of 
SBCC materials
Core Membership: The membership of the committee shall comprise: 
• Director General GHS (Chair)
• Directors of HPD, PHD, ICD and FHD
• Deputy Director responsible for Health Communication (Coordinator) and shall perform 
secretarial support to the committee and the two other deputy directors of HPD
• Representative of MoH
• Deputy director/programme manager of subject areas to be reviewed (co-opted 
members)
• Three representatives of communication health partners, e.g., WHO, UNICEF, USAID, 
JICA, UNFPA
• Representative of academia 
• Representative of Coalition of NGOs in Health
• Representative of FDA
*The committee may co-opt any other agency/person depending on the material to be reviewed 
as and when necessary. 
Procedure: The following steps shall apply to the development, technical review, approval, and 
clearance of SBCC materials presented to the Committee:
1) Consumer dipstick/desktop review/analysis
2) Concept design (Committee review/approval)
3) Concept pre-testing
4) Development of draft materials (Committee review)
5) Pre-testing of revised draft materials 
6) Final approval of materials (Committee approval)
The Committee shall be involved in three of the six steps (2, 4, and 6) listed for all approval and 
clearance processes. The steps include approval of design concepts including creative briefs, 
approval of rough cuts or draft materials, and providing clearance for final products. 
31
1. Consumer dipstick/desktop review/analysis: This stage involves provision of evidence and 
rationale for the generation of the concept of the SBCC material. The role of the committee is to 
ensure that there is a basis for the generation of the content. 
2. Concept Design: This stage involves review of proposed draft concepts: rough cuts, scripts, 
story board, image holders, messages, mock-ups etc. The vendor shall submit the draft of a 
concept design to the Secretariat of the Committee. 
The Deputy Director
Health Communication shall constitute and convene the relevant technical sub-committee to 
review the draft concept, which shall comprise the head of the relevant subject area, technical 
officers, and representatives of the HP communication. The technical sub-committee of the 
relevant subject area shall review the concept developed and make recommendations to the 
Committee for approval. 
The Technical Sub-Committee must ensure: 
• Proposed concepts and messages meet both technical programme and communication 
objectives.
• Suggested materials address the barriers to change and are technically accurate and in 
line with current health policy documents including the GoodLife Brand Manual.. 
• Concept designs received are reviewed and submitted to the Committee within five (5) 
days, and three (3) days under exceptional situations. 
• The secretariat shall circulate reviewed materials and recommendations to Committee 
members at least 5 days prior to a meeting. 
Composition of the technical sub-committee 
• Head of the relevant subject area
• Other programme officers of the subject area
• Representatives of the Health Promotion Communication Department
• Any other coopted member from a relevant agency/partner
The Committee will not review any materials that have not been recommended by the received 
approval from the technical sub-committee.
3. Pre-Testing of Draft Concepts: Following approval of design concepts by the committee, pre￾testing of the concepts must be conducted immediately to ensure cultural relevance and 
appropriateness, comprehension and acceptability from the target audience. Pretesting should 
follow approved standard pretesting guidelines and protocols (Accessible at the Committee’s 
Secretariat).
 
Pretest reports of draft concepts shall be shared with the relevant Technical Sub-Committee and 
implementing partners for review and inputs after which pretested concepts should be 
transformed into rough cuts/draft materials. Target period: 3 weeks 
32
4. Development of draft materials (Committee review): Stage 4 involves the translation of the 
reviewed and pretested concepts into the appropriate materials. The Vendor shall submit the 
pretested reports and the draft materials through the secretariat to the Committee for review 
within 3 weeks. 
5. Pre-testing of draft materials: This shall be required if major changes are made by the 
Committee; otherwise the minor corrections shall be inputted into the draft material without a 
second pretesting.
6. Final approval of materials: After changes have been implemented on Draft material by 
HPD/Vendor/Agency, it shall be presented to the Committee for final approval and clearance. 
Approval of all materials shall be obtained when the Committee passes them for mass 
production. All finalized SBCC materials shall be shared with the National Health Promotion 
Resource Center for documentation. 
Branding of materials: All materials approved by the Committee shall conform to Ghana Health 
Service standards and branding (GoodLife Brand manual). 
• Materials for use on the GoodLife social media platforms shall conform to the GoodLife 
Brand Manual. 
Disclaimer: A disclaimer shall be boldly placed on all materials approved by the Committee.
The Committee shall not be held responsible for any material that does not bear its seal. 
Appendix 
Criteria for clearance/approval 
An SBCC material cleared should have the following elements:
1. Create a distinct look and personality — Effective SBCC materials are vivid, having an 
appealing personality that helps them stand out from other materials. They should 
stimulate the target audience with a distinctive look, sound, making them stand out from 
the "clutter" of competing materials and messages. Messages and design all must speak 
with the same voice — in design, color, text and narrative
2. Clarify the Message: Ensure the message is clear and easily understood. 
3. Stress the most compelling key benefit. SBCC materials should address real needs and 
problems facing the target audience. The information they provide should be specific and 
single–minded. The main message and benefit to the target population should be clear.
4. Consistency Counts: Repeat the same message consistently to avoid confusion and 
enhance the impact of the message. Ensure key messages form the core of what goes 
into the different mediums. 
5. Generate trust. Without trust and credibility, the message will go unheeded. SBCC 
materials that are simple, direct, and technically correct generate trust in what they say. 
Trust is generated by source, tone, presentation, believable images, and a solid 
information foundation.
33
6. Appeal to both the heart and the head. A decision on the part of the target audience to 
try something new is not made entirely in the mind — trials are often decided in part by 
an emotional response. Thus, effective SBCC materials and messages should be designed 
to appeal to both the heart or emotions, and the head or reason.
7. Call to Action: SBCC materials should include a clear call to action. Target audience 
should be told precisely what they should do.
Target: 1 week.
34
Appendix 3: Equipment, Furniture, and Supplies to HPD from USAID Communicate 
for Health 
Item No. Description Quantity 
EQUIPMENT FOR MATERIALS DEVELOPMENT UNIT
1 27 Inch MAC 1
2 HP LaserJet Pro MFP M225DW 1
3 APC UPS Pro 1000 1
4 2TB Western Digital 1
5 MACBOOK Pro 13 Inch 1
6 Coral Draw Graphic Suit 1
7 Adobe Creative Cloud 1
8 Quack Express 1
LAPTOPS/DESKTOP COMPUTERS AND ACCESSORIES
1 Dell Latitude Lap Top Computers and Accessories 10 pcs
2 Dell Back Pack 10 pcs
3 Dell Inspiron 24 7000 series 2 pcs
4 Microsoft Desktop Computers and accessories 2
5 Apple Laptop Computer and Accessories 1
FURNITURE FOR HEAD OF HPD
1 Meeting Table Round Top Leather 1
2 Visitors Chair Leather (CL915PU)PP Maroon 4
3 Swivel Chair Executive Mesh Back (Unclear)Black 1
4 L-Shaped Desk (LF-21118)PP LF-001 1
5 Cabinet Wooden (LF 85910A)TM-001 1
6 Cabinet 4 Drawer Metal 2
7 Cabinet Wooden 2
8 Workstation 4 in 1 for ICC -HP Secretariat 1
STATIONERY
1 Pen 20 pcs
2 Pencils 12 pcs
35
Appendix 4. Draft Standard Operation Procedures (SOP) for National Resource e￾Library 
Purpose 
The purpose of these Standard Operation Procedures is to provide guidelines and procedures for 
the archiving, retrieval, use of, adoption, modification, and adaptation of materials housed at the 
National SBCC Digital Library and Resource Center and the regional hubs. It also describes the 
rights, duties and responsibilities of users and managers of the Digital Library and Repository at 
the national and regional level, as well as procedures for obtaining authorization for uploads of 
materials.
Background 
Over the years, the Ghana Health Service has produced a range of technically sound and diverse 
health communication materials, tool kits, documentaries, and audio/video programs with 
support from a wide variety of partners and organizations (USAID, UNICEF, UNFPA, WHO, JICA, 
DFID and others). Unfortunately, many of these materials have been scattered all over the place, 
poorly catalogued, and a number are missing or damaged. This has made it difficult for 
academicians, researchers, students, and social and behavior change communication 
practitioners to have a one-stop repository for easy retrieval of SBCC materials. In 2016, the 
USAID Communicate for Health project supported the Ghana Health Service to create the 
National SBCC Resource Center at the office of the Health Promotion Department at Korle Bu, 
with hubs in the Greater Accra, Central, Western, Northern, and Volta Regions. 
The National SBCC Digital Library and Resource Center is an on-line platform that will house a 
broad range of selected technically sound, high quality SBCC materials produced in Ghana. The 
Resource Center is linked to the Health COMpass, GHS website and GHS/GoodLife social media 
platforms. A list of other SBCC resource sites will be provided at the Resource Center for the 
benefit of interested clients. 
Management of the National SBCC and Regional Resource Centers 
The National Digital Library and Resource Center will be managed by a team of three technical
people: a Resource Center Manager, an Information Technology Specialist and an SBCC or 
Materials Development Officer under the proposed Communication Department of a Health 
Promotion Division of Ghana Health Service. These officers shall jointly be responsible for 
cataloging approved materials (SBCC materials, toolkits and other health communication 
materials) and uploading same onto the repository of the National SBCC Digital and Resource 
Center. They will also provide access to onsite and online users including academicians, students, 
researchers and SBCC practitioners. Regional Health Promotion Officers shall manage the 
regional hubs which shall be connected to the National Center through a Virtual Private Network 
(VPN). Management of the Center and Regional Hubs are responsible for resolving all issues that 
may arise from the use of the facilities.
36
All persons needing to use the facilities shall register online, and only registered clients shall be 
given access by the Manager of the Resource Center. A register of users/clients shall be 
maintained at the Center and regional hubs for capturing data of all clients who use the facilities 
on site. The data shall also be automatically captured for all users who log onto the repository 
anytime online. 
Management shall provide code of ethics for the guidance of all clients, and this shall be 
prominently displayed onsite and be available as part of registration process.
Target Audience 
These guidelines are designed for use by individuals who will be managing the National SBCC 
Digital Library and Resource Center, staff of the regional resource center hubs and other clients 
who will be using the platform. It also includes staff of Health Promotion, in particular, and GHS 
in general. 
Guidelines/Criteria for selecting materials for the National Resource Center: 
• All materials for the SBCC Digital Library and Resource Center must be presented to and 
approved by the Health Sector SBCC Technical Review Committee before they can be 
accepted by the Resource Center. 
• The manager of the National SBCC Resource Center shall be the official administrator of 
the Digital Library and repository.
• The management of the Center shall establish a system for coding all approved materials.
• All materials shall be digitized as appropriate before uploading on to the Repository.
• Uploading of approved materials by the Health Sector SBCC-TRC shall be done only at the 
national level. 
• Materials that are later found to be defective shall be tagged as such but left for research 
purposes.
Rights and Responsibilities of Clients 
 SBCC practitioners, Health Promotion Technical Officers, academicians, researchers, and 
students can access materials from the repository for their use after registration. 
 Reproduction of the materials without further modification or adaptation is permitted. 
 The responsibility of the client is to ensure the optimal use of the equipment; in the 
event of damage to any equipment, this must be reported to the manager of the center. 
 Materials downloaded from the Repository are not to be used for commercial purposes
Care, Maintenance and Running Of The Center 
The Health Promotion Department shall be responsible for the care, maintenance and running of 
the Center at the National level. The Regional Directorate of Health Service shall be responsible 
for the care, maintenance and running of the regional hub. It is the responsibility of the Health 
Promotion Department and Regional Health Directorates to mobilize resources for the upkeep of 
the National Center and regional hubs. Regular planned preventive maintenance shall be 
performed, preferably on a quarterly basis.
37
Appendix 5: Organogram for Health Promotion Division 
 
DIRECTOR HEALTH PROMOTION DIVISION
HEALTH 
COMMUNICATION 
DEPT
ADVOCACY AND 
SOCIAL 
MOBILISATION 
DEPT
RESEARCH AND HEALTHY 
POLICY DEPT
MATERIAL
DEVELOPMEN
T 
UNIT
HEALTH
EDUCATIO
N 
UNIT
COMMUNITY 
EMPOWERMEN
T 
UNIT
HEALTHY 
SETTINGS
UNIT
RESEARCH
MONITORIN
G 
EVALUATION
UNIT
HEALTH
IN ALL
POLICY
UNIT
OFFICE OF 
DIRECTOR
USAID COMMUNICATE FOR HEALTH 
ASSESSING CO
USAID COMMUNICATE FOR HEALTH 
ASSESSING COMMUNICATION MESSAGES, BEHAVIOR 
DETERMINANTS AND BEHAVIORS AMONG TARGET 
AUDIENCES IN GHANA
FINAL SURVEY REPORT
November 2019
2
USAID COMMUNICATE FOR HEALTH
Final Mobile Phone Survey 2019
COOPERATIVE AGREEMENT: AID-641-A-15-00003
© FHI360
NOVEMBER 2019
RESEARCH TEAM
USAID COMMUNICATE FOR HEALTH: Joan Schubert; Edward Akolgo Adimazoya; Eunice Sefa, 
Emmanuel Ofori Yartey
FHI 360: Rachel Lenzi; Thaddeus Pennas, 
FAMILY HEALTH DIVISION, GHANA HEALTH SERVICE: Patrick Kuma-Aboagye
HEALTH PROMOTION DIVISION, GHANA HEALTH SERVICE: Yvonne Ampeh
UNIVERSITY OF SAN FRANCISCO: Kelly L'Engle
VIAMO: Nii Lante Heward-Mills; Yaa Amankwaa Owusu-Amoah
REPORT AND ANALYSIS
AUTHORS: Rachel Lenzi, Eunice Sefa, Kelly L’Engle, Mario Chen, Alissa Bernholc, Angie Wheeless,
Edward Adimazoya,
CONTRIBUTORS: Nii Lante Heward-Mills; Yaa Amankwaa Owusu-Amoah, Emmanuel Ofori Yartey, 
Joan Schubert, Thaddeus Pennas
CONTACT INFORMATION
USAID Communicate for Health, Marvel House
Box CT 4033, East Cantonments, Accra, Ghana
www.fhi360.org
DISCLAIMER
This report is made possible by the support of the American People through the United States 
Agency for International Development (USAID). The contents of this report are the sole 
responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States 
Government
3
Contents
List of Tables .................................................................................................................................................4
List of Figures................................................................................................................................................7
Acronyms......................................................................................................................................................9
Executive Summary.....................................................................................................................................10
Background .............................................................................................................................................10
Communicate for Health Programming..............................................................................................10
Objectives ...............................................................................................................................................10
Methods..................................................................................................................................................11
Study participants...............................................................................................................................11
Data Collection....................................................................................................................................11
Data Analysis.......................................................................................................................................12
Findings, Discussion and Recommendations..........................................................................................12
Background .................................................................................................................................................19
Communicate for Health Programming..................................................................................................19
Objectives ...................................................................................................................................................21
Methods......................................................................................................................................................21
Sample Size Estimation ...........................................................................................................................22
Data Collection........................................................................................................................................22
Data Analysis...........................................................................................................................................24
Data Weights.......................................................................................................................................24
Primary Outcomes ..............................................................................................................................25
Analysis Methods................................................................................................................................25
Secondary Outcomes and Analysis Methods......................................................................................27
Findings.......................................................................................................................................................27
Respondent Characteristics....................................................................................................................27
Objective 1: Exposure to Communication Messages..............................................................................29
Objective 2 Behavioral Determinants and Behaviors.............................................................................33
Bednets for Malaria Prevention..........................................................................................................33
Handwashing.......................................................................................................................................35
Pregnancy Prevention.........................................................................................................................38
Facility Delivery ...................................................................................................................................41
Equitable Gender Norms.....................................................................................................................42
4
Objective 3: Relationships between Exposure and Behaviors and Interpersonal Communication .......43
Dose-Response Relationships Among the Life Stage Sample.............................................................43
Dose-Response Relationships Among the National Sample...............................................................45
Secondary Analyses.................................................................................................................................48
Response Rates...................................................................................................................................48
Average Cost per Complete Survey Response....................................................................................48
Potential Limitations...............................................................................................................................49
Conclusions and Recommendations...........................................................................................................49
Annexes.......................................................................................................................................................52
Annex 1: T3 Questionnaire .....................................................................................................................52
Annex 2: T3 Data Dictionary ...................................................................................................................60
Annex 3: AAPOR Response Rates and Call Dispositions .........................................................................66
Annex 4: Supplementary Tables .............................................................................................................69
Sample Characteristics........................................................................................................................69
Objective 1 – Exposure Tables............................................................................................................73
Objective 2 Analyses...........................................................................................................................82
Objective 3 Analyses...........................................................................................................................84
List of Tables
Table 1 Approximate timeline of Communicate for Health Programming and Survey Administration.....11
Table 2 Overview of inclusion criteria and questionnaire domains by study population ..........................11
Table 3: Exposure to Messages About ITNs from Any Source in the Last Month at T1 & T3, national 
sample.........................................................................................................................................................13
Table 4 Individual report of ITN previous night, for self and others at T1 and T3, among national sample
....................................................................................................................................................................14
Table 5: Self-reported Gender Norms at T1 and T3, among combined life stage sample .........................15
Table 6: Health Practices by Level of Exposure to Health Messages at T3, Among Entire life stage Sample 
at T3 ............................................................................................................................................................16
Table 7: Comparison of Exposure versus No Exposure to GLLiW Messages and Interpersonal 
Communication and Behavior on Integrated Health Practices, among Entire life stage Sample at T3 .....16
Table 8 Adjusted Odds Ratios for the Association between Exposure Variables and all Children Under 
Five in the Household Sleeping under Bednet at T3, National Sample ......................................................17
Table 1 Approximate timeline of Communicate for Health Programming and Survey Administration.....21
Table 2 Overview of inclusion criteria and questionnaire domains by study population ..........................23
Table 3 Average survey completion time and number of questions by sample at T1 and T3....................24
Table 4 Comparison of age categories measured by Communicate for Health Survey and population 
estimates available from Ghana Statistical Service ....................................................................................24
5
Table 5: National and life stage Samples at T1 & T3...................................................................................27
Table 6: Demographic Characteristics of Unweighted National Sample at T1 & T3 ..................................28
Table 7: Exposure to Messages About ITNs, FP, Handwashing, Facility Delivery, Infant and Young Child 
Feeding from Any Source in the Last Month at T1 & T3.............................................................................30
Table 8 Behavioral Determinants Related to Self-Reported Use of ITN at T1 and T3 ................................33
Table 9 Individual report of ITN previous night, for self and others at T1 and T3......................................34
Table 10: Interpersonal Communication and intentions Related to Handwashing at T1 and T3, among life 
stage sample ...............................................................................................................................................35
Table 11: Availability of a Handwashing Station at T1 and T3, among life stage sample...........................36
Table 12: Interpersonal Communication Related to Pregnancy Prevention at T1 and T3, among life stage 
sample.........................................................................................................................................................38
Table 13: Behaviors related to Pregnancy Prevention at T1 and T3 Among Non-pregnant Adults...........39
Table 14: Reported Contraceptive Method at T1 and T3, among sexually active life stage respondents 
not currently pregnant or trying to become pregnant...............................................................................40
Table 15: Self-reported Facility Delivery Behavioral Determinants and Behaviors at T1 and T3 by 
Caregivers and Pregnant Couples...............................................................................................................41
Table 16: Self-reported Gender Norms at T1 and T3 by life stage .............................................................42
Table 17: Health Practices by Level of Exposure to Health Messages at T3, Among Entire life stage 
Sample at T3................................................................................................................................................43
Table 18: Comparison of Exposure versus No Exposure to GLLiW Messages and Interpersonal 
Communication and Behavior on Integrated Health Practices, among Entire life stage Sample at T3 .....44
Table 19 Exposure and Self-reported bednet use for National Sample at T3, by Priority Region Grouping
....................................................................................................................................................................46
Table 20 Adjusted Odds Ratio for the Association between Exposure Variables and Self-reported Bednet 
Use Previous Night at T3, National Sample ................................................................................................46
Table 21 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet 
use the previous night at T3 only for National Sample...............................................................................46
Table 22 Exposure and All children slept under bednet for National Sample at T3, by priority region 
grouping......................................................................................................................................................47
Table 23 Adjusted Odds Ratios for the Association between Exposure Variables and all Children Under 
Five in the Household Sleeping under Bednet at T3, National Sample ......................................................47
Table 24 Response, cooperation, refusal and contact rates for national and life stage sample (aggregate) 
at T1 and T3 ................................................................................................................................................48
Table 25 Cost inputs for life stage survey responses at T1 and T3.............................................................49
Table 26 Data Dictionary.............................................................................................................................60
Table 27 AAPOR response rates – National Sample and life stage Sample at T1 and T3...........................66
Table 28 Mapping Communicate for Health call outcomes to AAPOR codes – Life Stage Sample ............68
Table 29 Demographic characteristics of unweighted sample at T1 and T3, with and without respondents 
age 50+........................................................................................................................................................69
Table 30 Comparison of demographic characteristics of life stage sample at T1 and T3 ..........................70
Table 31 Demographic characteristics of unweighted Young Adult life stage sample at T1 and T3 by sex
....................................................................................................................................................................71
Table 32 Demographic Characteristics of unweighted Caregivers life stage Sample (age 18-49) at T1 & T3 
by Sex ..........................................................................................................................................................72
6
Table 33 Demographic Characteristics of unweighted Pregnant Couples life stage Sample (Age 18-49) at 
T1 & T3 by Sex.............................................................................................................................................72
Table 34 Exposure to messages about ITNs in last month at T1 & T3........................................................73
Table 35 Exposure to GLLiW Malaria Advertisements at T3.......................................................................74
Table 36 Exposure to messages about handwashing in last month at T1 & T3 .........................................75
Table 37 Exposure to GLLiW Handwashing Advertisement at T3...............................................................76
Table 38 Exposure to messages about pregnancy prevention in last month at T1 & T3 ...........................77
Table 39 Exposure to GLLiW Family Planning Advertisements at T3..........................................................78
Table 40 Exposure to messages about delivering at a health facility in last month at T1 & T3 .................78
Table 41 Exposure to messages about exclusive breast feeding (EBF) in last month at T1 & T3, among 
caregivers of children younger than 6 months...........................................................................................79
Table 42 Exposure to messages about complementary feeding in last month at T1 & T3, among 
caregivers of children younger ages 6-8 months........................................................................................79
Table 43 Recall of GLLiW messages about exclusive breast feeding (EBF) at T3, among caregivers of 
children younger than 6 months.................................................................................................................80
Table 44 General recall of GLLiW campaign at T1 & T3..............................................................................80
Table 45 Exposure to any GLLiW Advertisements asked about at T3 ........................................................81
Table 46 Behaviors and Behavioral Determinants Related to Self-Reported Use of ITN at T1 & T3..........82
Table 47 Exposure and self-reported bednet use at T3 only for life stage Sample....................................84
Table 48 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet 
use previous night at T3 only for life stage Sample....................................................................................85
Table 49 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet 
use previous night at T3 only for life stage Sample....................................................................................85
Table 50 Exposure and self-report that all children slept under bednet at T3 only for life stage Sample1 86
Table 51 Exposure and self-reported use of modern contraception method at T3 only for life stage 
Sample (sexually active, not pregnant/trying to become pregnant)..........................................................87
Table 52 Exposure and interpersonal communication about pregnancy prevention at T3 only for life 
stage Sample (sexually active, not pregnant/trying to become pregnant) ................................................88
Table 53 Adjusted Odds Ratios for the association between exposure and IPC about modern method use 
at T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant)....................88
Table 54 Adjusted Odds Ratios for the association between exposure and IPC about modern method use 
at T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds Ratios 
shown for each subgroup to interpret significant interaction effects........................................................88
Table 55 Exposure and intentions to use pregnancy prevention method at T3 only for life stage Sample 
(sexually active, not pregnant/trying to become pregnant).......................................................................89
Table 56 Adjusted Odds Ratios for the association between exposure and Intent to use modern method 
use at T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant) .............89
Table 57 Adjusted Odds Ratios for the association between exposure and Intent to use modern method 
use at T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds 
Ratios shown for each subgroup to interpret significant interaction effects.............................................89
Table 58 Adjusted Odds Ratios for the association between exposure and Use of modern method use at 
T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant)........................90
7
Table 59 Adjusted Odds Ratios for the association between exposure and Use of modern method use at 
T3 only for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds Ratios 
shown for each subgroup to interpret significant interaction effects........................................................90
Table 60 Exposure and interpersonal communication about pregnancy prevention at T3 only for life 
stage Sample (not sexually active, not pregnant).......................................................................................90
Table 61 Exposure and intentions to use pregnancy prevention method at T3 only for life stage Sample 
(not sexually active, not pregnant).............................................................................................................91
Table 62 Adjusted odds ratios for relationships between exposure and IPC about FP at T3 only for life 
stage Sample (not sexually active, not pregnant).......................................................................................91
Table 63 Adjusted odds ratios for relationships between exposure and IPC about FP at T3 only for life 
stage Sample (not sexually active, not pregnant) – Odds Ratios shown for each subgroup to interpret 
significant interaction effects .....................................................................................................................92
Table 64 Adjusted odds ratio for relationships between exposure and intention about FP at T3 only for 
life stage Sample (not sexually active, not pregnant).................................................................................92
Table 65 Adjusted odds ratio for relationships between exposure and intention about FP at T3 only for 
life stage Sample (not sexually active, not pregnant) – Odds Ratios shown for each subgroup to interpret 
significant interaction effects .....................................................................................................................92
Table 66 Exposure and interpersonal communication about post-partum pregnancy prevention at T3 
pregnant women or their partners.............................................................................................................93
Table 67 Exposure and intentions to use pregnancy prevention after child is born at T3 for pregnant 
women or their partners.............................................................................................................................93
Table 68 Exposure and IPC about handwashing at T3 only for life stage Sample ......................................94
Table 69 Exposure and intentions about handwashing at T3 only for life stage Sample...........................94
Table 70 Exposure and handwashing with soap after last using the toilet at T3 only for life stage Sample
....................................................................................................................................................................95
Table 71 Adjusted Odds Ratios for the association between exposure and IPC about handwashing at T3 
only for life stage Sample............................................................................................................................96
Table 72 Adjusted Odds Ratios for the association between exposure and IPC about handwashing at T3 
only for life stage Sample – Odds Ratios shown for each subgroup to interpret significant interaction 
effects .........................................................................................................................................................96
Table 73 Adjusted Odds Ratios for the association between exposure and intentions about handwashing 
at T3 only for life stage Sample...................................................................................................................96
Table 74 Adjusted Odds Ratios for the association between exposure and intentions about handwashing 
at T3 only for life stage Sample – Odds Ratios shown for each subgroup to interpret significant 
interaction effects.......................................................................................................................................96
Table 75 Adjusted Odds Ratios for the association between exposure and washing hands with soap after 
last use of toilet at T3 only for life stage Sample........................................................................................97
Table 76 Adjusted Odds Ratios for the association between exposure and washing hands with soap after 
last use of toilet at T3 only for life stage Sample – Odds Ratios shown for each subgroup to interpret 
significant interaction effects .....................................................................................................................97
List of Figures
Figure 1 Exposure to GLLiW Adverts among the entire life stage sample, T3............................................14
8
Figure 2 Distribution of Spots/Programs Aired...........................................................................................15
Figure 3 Distribution of Spots/Programs Aired...........................................................................................20
Figure 4 Distribution of Adverts Aired by Topic between T1 and T3..........................................................21
Figure 5 Exposure to GLLIW Adverts among all life stage respondents, T3 ...............................................31
Figure 6 Exposure to GLLIW Adverts among young adults, T3 ...................................................................32
Figure 7 Exposure to GLLIW Adverts among caregivers of children under five, T3....................................32
Figure 8 Exposure to GLLIW Adverts among pregnant couples, T3............................................................33
Figure 9: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, entire life 
stage sample at T3. .....................................................................................................................................37
Figure 10: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, young adult 
samples at T3. .............................................................................................................................................37
Figure 11: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, caregivers 
and pregnant couples’ samples at T3. ........................................................................................................37
Figure 12 Priority behaviors among young men and women, comparing exposure to health topic-specific 
GLLiW messages to no exposure or unsure................................................................................................44
Figure 13 Priority behaviors among pregnant couples, comparing exposure to health topic-specific 
GLLiW messages to no exposure or unsure................................................................................................45
Figure 14 Priority behaviors among caregivers of children under five, comparing exposure to health 
topic-specific GLLiW messages to no exposure or unsure .........................................................................45
9
Acronyms
AAPOR American Association of Public Opinion Research
AMEP Activity Monitoring and Evaluation Plan 
AOR Adjusted odds ratio
CHPS Community-Based Health Planning and Services 
CI Confidence Interval
DHIMS 2 District Health Information Management System
FHI 360 Family Health International
FP Family planning 
GHS Ghana Health Service 
GSS Ghana Statistical Service’s 
GLLiW “GoodLife, Live it Well” 
HIV/AIDS Human Immunodeficiency Virus
HPD Health Promotion Division
IPC Interpersonal communication
ITN Insecticide-treated net
IVR Interactive voice response 
IYCF Infant and young child feeding
MNCH Maternal, newborn, and child health 
M&E Monitoring and Evaluation 
OR Odds ratio
RDD Random Digit Dial 
RH Reproductive health
SBCC Social and behavior change communication 
T1 Timepoint 1
T2 Timepoint 2
T3 Timepoint 3
USAID United States Agency for International Development
WASH Water, sanitation, and hygiene 
YOLO You Only Live Once
10
Executive Summary
Background
The five-year cooperative agreement awarded to FHI 360 (prime) and its consortium of partners, 
Creative Storm Networks, Ghana Community Radio Network and Viamo1 sought to improve the health 
and well-being of Ghanaians through a broad range of “above the line” mass media communication 
campaigns. The project supported the Ghana Health Service (GHS) to increase demand for and use of 
key health services through sustained evidence-based social and behavior change communication (SBCC) 
and adoption of positive health behaviors across family planning (FP); maternal, newborn, and child 
health (MNCH); nutrition; water, sanitation, and hygiene (WASH); malaria prevention and case 
management; and HIV/AIDS. The project targeted four demographic life stage audiences comprised of 1) 
Adolescents ages 15-17; 2) Youth/Young adults in relationships ages 18-35; 3) Pregnant couples; and 4) 
Caregivers of children under five years. The life stages approach originated in consumer studies helps to 
identify and address evolving health needs over various stages of an individual’s life.
Communicate for Health Programming
As part of an interim measure while Communicate for Health developed its life stage programming, the 
project rebroadcast technically sound TV and radio spots inherited from the previous USAID Behavior 
Change Support program between 2015 and early 2016. During this period, the GHS health 
communication brand - “GoodLife, Live it Well” (GLLiW)- was refreshed and launched in July 2016.
Integrated mass media campaigns targeting audiences using a life stages approach and the GLLiW brand 
were subsequently developed and rolled out in phases through 2019. While the campaign had national 
reach, emphasis in programming targeted five USAID priority regions (Northern, Volta, Central, 
Western, Greater Accra). In total, over 77,000 spots and programs were broadcast during the life of the 
project on eight national TV, eight national and 26 regional radio stations and more than a dozen 
community radio stations during peak and prime time. Radio spots were in English and four or more 
local languages spoken in the USAID focus regions. Additionally, more than 270,00 print materials 
including posters, pull up banners, leaflets, and cue cards on project programming themes were printed 
and distributed to health facilities throughout the country.
Objectives
We leveraged Ghana’s high mobile phone ownership and voice subscriber penetration rates and 
prioritized an innovative mobile phone technology as the main approach to program evaluation. The 
primary objectives of the survey were to:
1. Monitor exposure to Communicate for Health campaigns among target audiences
2. Monitor progress toward Communicate for Health’s Intermediate Results (changes in behavioral 
determinants) and Strategic Objectives (changes in behaviors)
3. Examine dose-response relationships between exposure to health communication messages and 
behavioral determinants and behaviors
A secondary objective was to evaluate feasibility and efficacy of collecting project monitoring and 
evaluation data via mobile phone.
 
1 Viamo is a social enterprise that specializes in information and communications technology for development.
11
Methods
This evaluation utilized a non-experimental, repeat cross-sectional quantitative design. A new and 
independent sample was recruited during the third project year (2017) and again during the final project 
year (2019)—referred to as timepoints 1 and 3 (T1 and T3). Table 1 outlines the approximate timing of 
the surveys in relation to the Communicate for Health Programming trajectory. The protocol, informed 
consent forms, and any subsequent amendments to the protocol or consent forms were submitted to 
FHI 360’s Office of International Research Ethics and the Ghana Health Service Ethics Review 
Committee for review and approval.
Table 1 Approximate timeline of Communicate for Health Programming and Survey Administration
2015 2016 2017 2018 2019
Broadcasts of TV and radio spots from previous campaign
Refreshed and Launched GLLiW campaign
T1 Survey
Integrated GLLiW mass media campaigns
T3 Survey
Study participants
The target populations for this study included a “national sample” of mobile phone users from all regions 
in Ghana who were at least 18 years old and a smaller sample from any of the five USAID target regions 
who fell into one of the projects’ life stage target audiences. Life stage audiences comprised of 1) Male 
and female young adults ages 18-35; 2) Pregnant women and their male partners ages 18-49; and 3) Male 
and female caregivers of children under five years ages 18-49. The latter groups are referred to as the 
“life stage sample” or as individual life stages throughout this report. National sample respondents were 
asked to complete questions about demographic characteristics and a core set of questions about 
campaign exposure and bednet use (Table 2). The life stage sample respondents were asked to answer 
additional questions about health topics targeted to their specific life stage (Table 2).
Table 2 Overview of inclusion criteria and questionnaire domains by study population
National Sample Inclusion Criteria Topics assessed
Female Ages 18-49 Exposure to SBCC; bednet use
Male
Life Stage Samples Inclusion Criteria Topics assessed
Youth & young adults (Female)
• Ages 18-35
• Resides in target region
Exposure to SBCC; gender 
norms; bednet use; behaviors and 
determinants related to FP, 
WASH
Youth & young adults (Male)
Pregnant Women 
• Age 18-49
• Currently pregnant 
• Resides in target region
Exposure to SBCC; gender 
norms; behaviors and 
determinants related to bednet 
use, MNCH, FP, WASH
Partners of Pregnant Women 
• Age 18-49
• Male partner of currently pregnant woman
• Resides in target region
Female Caregivers of Children 
under 5
• Age 18-49
• Parent of child under the age of 5 years
Male Caregivers of Children • Resides in target region
under 5
Data Collection
Communicate for Health partnered with Viamo to conduct the surveys using mobile phones with 
Interactive Voice Response (IVR) technology. This technology involves placing phone calls to participants 
12
who then hear a pre-recorded voice read out questions in a variety of local languages, and then 
participants answer through keypad presses on their mobile phone. Participants who accepted the call 
and responded to the survey did not incur airtime charges. 
Respondents were sampled using random digit dialing (RDD). This technique uses random number 
generators to generate potential Ghanaian phone numbers using the basic structure of mobile phone 
numbers in Ghana. This yields a sample that is a random set of mobile phone owners where each SIM 
card has an equal chance of being selected into the sample. Five languages were supported including 
English and four major local languages - Twi, Ewe, Dagbani, and Ga. 
Data Analysis
We calculated weighted sample sizes to address disproportionate representation based on region, 
gender, and age compared to the Ghana Statistical Service’s (GSS) population projections. Separate 
weights were calculated for each wave of data collection. These weights were used only for the national 
sample, aggregate life stage sample, and young men and women when the sample size was sufficient 
based on our sample size estimates (at least 500 respondents per comparison group). Statistical analyses 
were done using weighted data. Primary outcomes for this evaluation were categorized into three 
groups: self-reported exposure variables—including TV and radio exposure, GLLiW exposure, and 
number of health messages heard or seen; behavior determinants—including self-reported interpersonal 
communication, gender norms, and intention to act; and self-reported behavior. These outcomes were 
assessed across five health topic areas: malaria prevention, pregnancy prevention, facility-based delivery, 
handwashing with soap and water, and infant and young child feeding (IYCF). 
The analysis of the main outcomes of this study were primarily descriptive. Limited inferential statistical 
analyses were conducted for exploratory purposes for samples and topics where the sample size was 
sufficient (at least 500 in both comparison groups) to assess the statistical significance of differences.
Statistical tests were conducted using two-sided comparisons and 5% significance levels. Comparisons 
between years considered the T1 and T3 samples to be independent. Bivariate (i.e., chi-square test) and 
multivariable analyses (i.e., logistic regression) used sampling weights and appropriate survey design 
adjusted methods including accounting for sampling stratification based on the weighting strata.
We ran multivariable analyses using logistic regression models to assess the adjusted association 
between exposure variables and binary behavior and behavior determinant variables. We ran separate 
models for each type of exposure variable (i.e., radio and TV, GLLiW, and number of messages). We 
applied two sets of models for the multivariable analyses. First, we ran the models for each type of
exposure variable including all relevant covariates. Second, we explored if the association between 
exposure and outcome varied according to the levels of the covariates by assessing interaction effects 
(i.e. effect modification). We included all exposure by covariate interactions and ran a backward 
selection process to remove non-significant interaction terms. 
Findings, Discussion and Recommendations
This section of the report summarizes key findings and recommendations and highlights some 
limitations. More thorough presentation of the findings is available in the main report and appendices.
Background characteristics: Respondents shared similar background characteristics across the two 
timepoints (more men, more young men, more urban dwellers, more single respondents and only one in 
13
four respondents had a child under five). There were minimal differences in education level and general 
media exposure between T1 and T3. At least seven in ten respondents had completed Middle/ Junior 
High School or higher level of education with a significantly higher proportion completing tertiary or 
higher level of education at T3 (25.6 percent) than T1 (20.0 percent). Overall, TV viewership increased 
(from 80 percent to 82 percent) while radio listenership declined at T3 (from 79 percent to 75 percent). 
The primary limitation of the evaluation is selection bias related to recruiting a convenience sample and 
conducting surveys via mobile phone. While Communicate for Health’s communication campaigns are 
promoted nationally through both TV and radio, the sampling frame is limited to mobile phone users. 
While mobile phone penetration is fairly high in Ghana2, use rates are lower among women and rural 
users, which is reflected in our larger sample of men and urban respondents in the national sample. 
Overall, we were unable to recruit adequate sample sizes among male caregivers of children under five, 
female caregivers of children under five, pregnant women, or partners of pregnant women to allow for 
statistical comparison across years within our project timeline and budget. The project prioritized 
English and four local languages spoken in the USAID priority regions (Northern - Dagbani, Western 
and Central -Twi, Greater Accra -Ga, Volta -Ewe) so it was possible that some language groups in non￾priority regions may not have been reached as effectively during the survey. 
Exposure to communication messages: As noted above, overall radio listenership declined across 
the two surveys, while TV viewership increased. Improvements in intensity of exposure to any health 
topic-specific advertisements in the previous month (i.e. number of messages or adverts seen or heard) 
were limited based on T1 and T3, with the exceptions of improvements in exposure to any ITN 
messages for the national sample (Table 3). As noted in the introduction, GLLiW broadcasts ended 
before the final survey due to program close out. The one-month recall period for questions on the 
total number of adverts heard or seen (which was utilized to match the reporting period at T1) might 
have contributed to lower reports of exposure at T3 and in part helps to explain any decreases and 
nonsignificant shifts in exposure observed at T3
Table 3: Exposure to Messages About ITNs from Any Source in the Last Month at T1 & T3, national sample
Health Topic Messages
heard or seen
T1 T3 X
2
, p
n % Weighted % n % Weighted % value
Malaria prevention 
using ITNs
0 2440 27.2 26.2 1527 23.4 22.3
16.89, 
<0.001
1-5 1925 21.4 21.9 1314 20.1 20.9
6-10 1568 17.4 17.6 1106 16.9 17.8
>10 3053 34.0 34.2 2588 39.6 39.0
Generally, exposure to GLLiW branded programming was high at T3 for all health topic areas (Figure 1).
Recall of these adverts were not time bound. Although not an explicit target of our analysis, there was 
some evidence that the life stage targeting of messages was effective, as recall of the YOLO program3
was highest among young adults-the intended audience of this campaign. Program monitoring reports 
show that from 2017 to 2019, YOLO received over 21 million YouTube views, 640,000 Facebook likes, 
 
2 Adult ownership of smartphone or basic phone estimated at 80% (Internet Connectivity Seen as Having Positive 
Impact on Life in Sub-Saharan Africa. Pew Research Center, 2018)
3 YOLO – You Only Live Once – was a reproductive health campaign targeted to young people. Branded materials 
were aired on radio, television, and social media.
14
460,000 Instagram and 63,000 Twitter followers, the majority of whom were young people. Use of life 
stage-based programs tailored to carefully segmented audiences may be critical for reach and impact.
Figure 1 Exposure to GLLiW Adverts among the entire life stage sample, T3
^Percentages are weighted
Changes in self-reported behavioral determinants and behaviors: Across most topics, 
improvements in interpersonal communication and intentions were limited, possibly because of the 
relatively high reports at T1. When looking at changes in self-reported behaviors, bednet use increased 
significantly across all regions between T1 and T3 (Table 4). Although bednet use appeared to improve 
among pregnant women, it remained unchanged among children under-five according to caregiver 
reports. However, GLLiW programming broadcast in 2018 and 2019 had minimal focus on malaria 
prevention in under-fives (Figure 2), and this might have impacted on the trend observed. 
Table 4 Individual report of ITN previous night, for self and others at T1 and T3, among national sample
Behavior T 1 T3 X
2
, p value
n % Weighted % n % Weighted %
Slept under net 3046 33.9 36.3 2475 37.9 41.8 18.86, <0.001
All children<5 years slept under net 1130 54.0 55.8 851 54.6 55.4 0.03, 0.867
93.6
80.1
44.2
79 77.8
0
20
40
60
80
100
All Groups
Percent Exposed^ 
Life stage
Any GLLiW message asked about Any GLLiW FP/RH YOLO Any Malaria Handwashing
15
Figure 2 Distribution of Spots/Programs Aired
The majority of respondents reported practicing handwashing after using the toilet at T3 (83.8 percent), 
although the availability of handwashing stations with soap and water didn’t increase substantially 
between T1 and T3 according to life stage respondents. Modest increases in use of modern FP methods 
to prevent or delay pregnancy were recorded between T1 and T3 for sexually active young men who 
said their partner was not currently pregnant or planning to become pregnant and among sexually active 
female caregivers who were not currently pregnant or trying to become pregnant. Some shifts in type of 
modern methods used were observed, including modest increases in use of condoms and long 
acting/permanent methods. The survey recorded significant improvements in agreement with equitable 
gender norms around joint responsibility for pregnancy prevention and child care (Table 5).
Table 5: Self-reported Gender Norms at T1 and T3, among combined life stage sample
Indicator Response
T 1 T3
X2, p value
n % Weighted % n % Weighted %
Pregnancy 
prevention
Disagree 1462 66.2 65.7 1356 71.1 69.6 3.72, 0.053 Agree, Unsure 746 33.8 34.3 551 28.9 30.4
Child care Disagree 1365 61.8 59.9 1244 65.2 62.2 1.25, 0.263 Agree, Unsure 843 38.2 40.1 663 34.8 37.8
Relationships between exposure and behavioral determinants and behaviors: This is one of 
the first studies to utilize IVR and RDD methods to demonstrate a dose response relationship between 
exposure to messaging, behavioral determinants and behaviors. In our survey, we looked at the 
relationships between three types of exposure variables (structural—TV or radio access; coverage of 
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2015 2016 2017 2018 2019
Number of spots/programs aired
Year
GLLiW FP Malaria Nutrition MNCH Handwashing
16
GLLiW programming; and intensity of messaging—number of messages heard or seen) with adoption of 
promoted behaviors, intentions to adopt behaviors, and interpersonal communication about promoted 
behaviors. We found a strong association between all three types of exposure variables and practicing 
the desired behaviors of sleeping under an ITN and handwashing after using the toilet among the 
combined life stage sample (Table 6). 
Table 6: Health Practices by Level of Exposure to Health Messages at T3, Among Entire life stage Sample at T3
Exposure Bednet use last night Handwashing after using toilet
Total, weighted % Total, weighted %
TV
None/few days 873, 37.9 873, 81.7
Most/every day 1034, 39.4 1034, 85.6
Radio
None/few days 1092, 33.8*** 1092, 82.8
Most/every day 815, 45.8 815, 85.2
Coverage
No/not sure 458, 18.9*** 432,72.1***
Yes 1449, 44.5 1475, 87.2
Intensity
0 messages 443, 29.6** 654, 76.0***
1-10 messages 694, 39.4 759, 86.3
>10 messages 770, 43.5 494, 89.8
***p<.0001; **p<.01; *p<.05. Chi-squared tests conducted for overall test of differences between exposure variable and health 
practice. Percentages are weighted.
These patterns largely remained significant after controlling for age, education, life stage, and residing in 
a rural vs. urban area (Table 7). For example, respondents in the life stage sample who were exposed to 
GLLiW handwashing programming were 2.53 times more likely to report washing their hands after last 
using the toilet. 
Table 7: Comparison of Exposure versus No Exposure to GLLiW Messages and Interpersonal Communication and 
Behavior on Integrated Health Practices, among Entire life stage Sample at T3
Variable Exposed versus not exposed
(adjusted OR1, 95% CI)
p value
Bednet use last night 3.61 (2.61, 5.00) <.001
Interpersonal communication about handwashing 3.37 (2.51, 4.51) <.001
Handwashing intentions 1.86 (1.42, 2.44) <.001
Handwash after using the toilet 2.53 (1.85, 3.47) <.001
Interpersonal communication about family planning 1.83 (1.17, 2.87) <.01
Intentions to use method for pregnancy prevention 1.27 (0.78, 2.06) 0.335
Modern family planning method use2 1.96 (0.96, 4.04) 0.066
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
2For this outcome, we had to combine no education with primary education for the model to run
When looking at the national sample, listening to the radio, recall of GLLiW malaria adverts, and 
exposure to higher numbers of messages about malaria were all significantly associated with self￾reported bednet use and caregiver reports of all children in the household sleeping under a bednet. Even 
though the proportion of children reportedly sleeping under a bednet did not improve significantly 
between T1 and T3 based on caregiver reports, our dose-response analysis showed that at T3
caregivers who were exposed to GLLiW malaria messages were 1.98 times more likely to report all 
17
their children under five slept under an ITN net than those not exposed, even after controlling for age, 
education, gender, and residence in rural vs. urban area or priority vs. non-priority region (Table 8).
Table 8 Adjusted Odds Ratios for the Association between Exposure Variables and all Children Under Five in the 
Household Sleeping under Bednet at T3, National Sample
Exposure Comparison aOR1 (95% CI) p value
Model 1: Structural Access
Radio Most/Every day vs 
None/Few days 1.83 (1.37, 2.45) <.001
TV Most/Every day vs 
None/Few days 0.90 (0.67, 1.21) 0.481
Model 2: Coverage
Exposed to any GLLiW malaria message Yes vs No/Unsure 1.98 (1.39, 2.82) <.001
Model 3: Intensity
Exposure to ITN/Malaria health messages
1-10 vs 0 messages 1.37 (0.95, 1.97) 0.094
>10 vs 0 messages 1.71 (1.18, 2.48) 0.005
1OR adjusted for age, education, urban/rural residence, gender, and priority region. No interaction models.
Overall, while we did not see large improvements in self-reported adoption of healthy behaviors 
between the two timepoints, those who reported enacting these behaviors at T3 were much more likely 
to have been exposed to the GLLiW programming developed and broadcasted by the Communicate for 
Health project. Likewise, although reported radio listenership declined between the two time periods, it 
appears to remain an effective media for behavior change, as listening to the radio every or most days 
was significantly associated with behaviors across most health topics promoted by the Communicate for 
Health project. USAID and GoG should sustain these patterns through the continued and intensified use 
of mass media to broadcast audience segmented programming on popular stations in local languages at 
prime time. 
Communicate for Health was limited to using “above the line” mass media programming to influence 
behavior change. To reach “last mile” audiences, future SBCC programs may need an approach that 
combines “above the line” and “below the line” interpersonal communication and community 
engagement using multiple channels targeting multiple audiences with behavior change programs. SBCC 
approaches should always be paired with appropriate structural interventions and health systems 
strengthening to ensure increased demand is commensurate with access to high quality services and that 
barriers that cannot be addressed through mass media alone (such as poverty, experience or threat of 
violence, or experience or fear of stigmatization) are tackled. 
Learning from IVR/RDD. Our results indicate that in Ghana, using IVR and RDD methodology was 
most suitable for reaching populations with higher access to mobile phones, especially people 35 and 
younger from urban or peri-urban areas and men. Response rates for both the national and life stage
samples declined at T3 due to varied factors. In the future, supplementing mobile phone surveys with
household surveys for rural areas and areas with low mobile penetration could address coverage bias. 
Audio bytes of adverts were included in the survey at T3, which may have helped to improve recall
across all health topics. To sharpen measurement of recall of health communication messages, programs 
need to include some identifiable aspects of their messaging (e.g., logo, character, audio byte etc.) in the 
survey questionnaire. However, comparing exposure to exact message clips at multiple timepoints can 
be challenging, as a true baseline would occur early in the life of projects (before exposure or messages 
are developed) and campaign materials may change over the course of the project. 
Additionally, prior experience shows that response rates decrease for IVR surveys with more than 20 
questions, and thus we could only ask a limited number of questions per participant. Furthermore, 
18
without a face-to-face interviewer we could not probe or ask clarifying questions of participants or vice 
versa, which may reduce the number of respondents consenting to complete the survey or increase the 
number of respondents who complete only part of the survey. While errors due to data reentry are 
eliminated by use of IVR technology, there is potential that respondents may enter the wrong key and 
thus give incorrect or unintelligible responses. 
19
Background
The five-year cooperative agreement awarded to FHI 360 (prime) and its consortium of partners, 
Creative Storm Networks, Ghana Community Radio Networks and Viamo4 sought to improve the 
health and well-being of Ghanaians through a broad range of “above the line” mass media 
communication campaigns and capacity building for HPD and a local SBCC organization. The project 
supported the GHS to increase demand for and use of key health services through sustained evidence￾based social and behavior change communication (SBCC) and adoption of positive health behaviors 
across FP; MNCH; nutrition; WASH; malaria prevention and case management; and HIV/AIDS. The 
project targeted four demographic life stage audiences comprised of 1) Adolescents ages 15-17; 2) 
Youth/Young adults in relationships ages 18-35; 3) Pregnant couples; and 4) Caregivers of children under 
five years. The life stages approach originated in consumer studies helps to identify and address evolving 
health needs over the various stages of an individual’s life.
The project has three key results areas:
• Improve behavior change in FP, MNCH, WASH, nutrition, malaria prevention and case 
management
• Strengthen the capacity of the GHS/HPD to lead design, development, coordinate and 
implement evidence-based social and behavior change campaigns
• Develop and strengthen the capacity of a local SBCC organization to be a potential direct 
recipient of USAID funding.
Communicate for Health Programming
As an interim measure to accelerate exposure of SBCC programming across a range of audiences while 
Communicate for Health developed its life stage programming, the project broadcast technically sound 
TV and radio spots it inherited from the previous USAID Behavior Change Support program in 2015 
and early 2016. Working collaboratively with the GHS and partners, an overarching health 
communication brand of the GHS - “GoodLife, Live it Well” (GLLiW) was refreshed and launched in July
2016. An integrated mass media campaign using the GLLiW brand on health themes described above 
was developed in 2017 and scaled up through 2019 targeting appropriate audiences using the life stages 
approach. While the campaign was rolled out nationwide, emphasis in programming targeted five USAID 
priority regions - Northern, Volta, Central, Western, and Greater Accra. Over the years, numerous 
health communication campaigns and programs were broadcast in multiple languages including the 
GoodLife Story Series, the Slice of Life campaign (which included personal endorsements by the First Lady 
of Ghana), the Maternal Health Channel and the television megahit YOLO - You Only Live Once 
(Seasons 3, 4 and 5). In total, over 77,000 spots and programs were broadcast during the life of the 
project on eight national TV, eight national and 26 regional radio stations and more than a dozen 
community radio stations during peak and prime time. Radio spots were in English and local languages 
spoken in the USAID priority regions while longer format TV programs were in English. Additionally, 
more than 270,00 print materials including posters, pull up banners, leaflets and cue cards on project 
 
4 Viamo is a social enterprise that specializes in information and communications technology for development.
20
technical areas were printed and distributed to health facilities throughout the country. The distribution 
of programming by health theme and year is presented in Figure 3.
Figure 3 Distribution of Spots/Programs Aired
Thousands of GLLIW adverts and programs were broadcast during prime and peak time on national TV 
and national and regional radio stations between T1 and T3 (Figure 4). In total, over 18,000 
adverts/programs were aired during this time frame on multiple stations, with 26 percent dedicated to 
malaria programming, 24 percent to nutrition, 19 percent to FP/RH, 14 percent to MNCH, 9 percent to 
handwashing and 8 percent to promoting the GoodLife brand as presented in Figure 3. It is worth nothing 
that major television and radio broadcasts by the Communicate for Health project came to an end 
about a month prior to the commencement of the IVR survey discussed in this report. This was in 
preparation for project closeout activities (Table 1). 
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2015 2016 2017 2018 2019
Number of spots/programs aired
Year
GLLiW FP Malaria Nutrition MNCH Handwashing
21
Figure 4 Distribution of Adverts Aired by Topic between T1 and T3
Table 9 Approximate timeline of Communicate for Health Programming and Survey Administration
2015 2016 2017 2018 2019
Broadcasts of TV and radio spots from previous campaign
Refreshed and Launched GLLiW campaign
T1 Survey
Integrated GLLiW mass media campaign
T3 Survey
Objectives
The project was not resourced for face-to-face household data collection. We instead leveraged 
Ghana’s high mobile phone ownership and voice subscriber penetration rates and prioritized an 
innovative mobile phone technology as our main approach to M&E in accordance with its Activity 
Monitoring and Evaluation Plan (AMEP). Data collected through this study were used to monitor 
exposure to Communicate for Health programming and improvements in determinants and adoption of 
health behaviors. The association between exposure and changes in determinants and health behaviors 
were explored with these data. 
The primary objectives of the survey were to:
1. Monitor exposure to Communicate for Health campaigns among target audiences
2. Monitor progress toward Communicate for Health’s Intermediate Results (changes in behavioral 
determinants) and Strategic Objectives (changes in behaviors)
3. Examine dose-response relationships between exposure to health communication messages and 
behavioral determinants and behaviors
A secondary objective was to evaluate feasibility and efficacy of collecting project monitoring and 
evaluation data via mobile phone.
Methods
8%
19%
26%
24%
14%
9%
GoodLife Brand
Family Planning
Malaria
Nutrition
MNCH
Handwashing
N=18,055
22
This evaluation utilized a non-experimental, repeat cross-sectional quantitative design. A new and 
independent sample was recruited during the third project year (2017) and again during the final project 
year (2019)—referred to as timepoints 1 and 3 (T1 and T3). A complete report on the results of T1 and 
a smaller follow up survey conducted in 2018 with life stage respondents from T1—referred to as 
timepoint 2 (T2)—are reported elsewhere5,6. The surveys were designed to gather information on the 
number of times each respondent had seen or heard programming around the Communicate for Health 
topics (dosing), the number of regions the campaigns reached (reach), determinants of respondents’
behavior—including interpersonal communication, information seeking, gender norms, and behavioral 
intentions, and respondent health behaviors related to the interventions Communicate for Health 
promoted. The target populations for this study included a national sample of mobile phone users from 
all ten regions in Ghana and a smaller sample from the five target regions who fell into one of the 
projects’ life stage target audiences. Any person who answered the phone was eligible for survey 
participation at T1 or T3 if they were at least 18 years old. The protocol, informed consent forms, and 
any subsequent amendments to the protocol or consent forms were submitted to FHI 360’s Office of 
International Research Ethics and the Ghana Health Service Ethics Review Committee for review and 
approval.
Sample Size Estimation
To detect a 10-point minimum difference (e.g. from 50-60 percent) in the indicators of interest (e.g., 
exposure) with 90 percent power for a two-sided comparison (e.g. Time 1 versus Time 3) with 5
percent significance, we estimated a minimum of 519 completed surveys from each panel of respondents
would be required. Based on similarity of questionnaire content and pilot results, the youth (18-24) and 
young adult (25-35) life stages were combined into one stratum for data analysis purposes. Based on 
pilot testing, we anticipated that pregnant couples and caregivers would be more difficult to reach than 
young adults; therefore, recruitment quotas were linked to a target sample size of 700 female and male 
youth & young adults for each panel, meaning data collection ended for each survey wave when the 
quotas of youth and young adults were met. 
Data Collection
Communicate for Health partnered with Viamo (formerly Voto Mobile) to conduct the surveys using 
mobile phones with Interactive Voice Response (IVR) technology. This technology involves placing 
phone calls to participants who then hear a pre-recorded voice in a variety of local languages read out 
questions, and then participants answer through keypad presses on their mobile phone. Surveys were
initiated by the Viamo platform as outgoing calls. Thus, participants who accepted the call and responded
to the survey did not incur airtime charges. 
Respondents were sampled using random digit dialing (RDD). This technique uses random number 
generators to generate potential Ghanaian phone numbers using the basic structure of mobile phone 
numbers in Ghana. This yields a sample that is truly a random set of mobile phone owners where each 
SIM card has an equal chance of being selected into the sample. During T1, each randomly selected 
 
5 USAID Communicate for Health. Assessing Communication Messages, Behavior Determinants and Behaviors 
among Target Audiences in Ghana. Baseline Report September 2017. FHI 360: Accra, Ghana.
6 USAID Communicate for Health. Assessing Communication Messages, Behavior Determinants and Behaviors 
among Target Audiences in Ghana. Follow-up Survey Report September 2018. FHI 360: Accra, Ghana.
23
number was attempted up to three times and respondents had the option to call back if the call was 
disconnected or the time was inconvenient. Based on budgetary limitations, during the final T3 wave, 
each number was attempted only one time and participants were not able to call into the system. At T1, 
calls were made on 27 days, between 7 February-16 March. T3 survey data collection took place over 
52 days, between July 6 – August 31, 2019. At T1 calls were dialed between 8 AM and 8 PM daily; at T3, 
numbers were dialed within the hours of 10 AM and 8 PM daily. A complete write up of the T1 data 
collection is available in the baseline report.
At both timepoints, each successful dial began with a brief introduction, language selection, and informed 
consent. Respondents were told the call was free, names would not be collected, data were confidential, 
and participants must be 18 or older. Informed consent was indicated by asking respondents to press ‘1’ 
to continue with the call. Five languages were supported: English, and four local languages –Twi, Ewe, 
Dagbani, and Ga. These languages were selected based on the major ethnicities represented in the 
USAID priority regions. The survey instrument underwent several design iterations including 
adjustments to enhance the presentation via mobile phone. The final version was translated and 
recorded by native speakers of each language. Translations were subsequently verified independently, 
and adjustments incorporated into the audio recordings. For each language, the audio recordings were 
made by the person who participated in translation of the survey instrument, thus ensuring full 
familiarity with the survey phrasing. Female voice talents were utilized for all languages. 
All adult participants who consented to participate in the survey were asked to complete questions 
about demographic characteristics and a core set of questions about campaign exposure and bednet use 
(referred to as participants from the “national sample”—Table 2). A subset of participants from five 
target regions in Ghana who met demographic criteria based on Communicate for Health’s life stages
were asked to answer additional questions about health topics targeted to one of the following 
audiences (referred to as the “life stage sample”):
Table 10 Overview of inclusion criteria and questionnaire domains by study population
National Sample Inclusion Criteria Topics assessed
Female Ages 18-49 Exposure to SBCC; bednet use
Male
Life Stage Samples Inclusion Criteria Topics assessed
Youth & young adults (Female)
• Ages 18-35
• Resides in target region
Exposure to SBCC; gender 
norms; bednet use; behaviors and 
determinants related to FP, 
WASH
Youth & young adults (Male)
Pregnant Women 
• Age 18-49
• Currently pregnant 
• Resides in target region
Exposure to SBCC; gender 
norms; behaviors and 
determinants related to bednet 
use, MNCH, FP, WASH
Partners of Pregnant Women 
• Age 18-49
• Male partner of currently pregnant woman
• Resides in target region
Female Caregivers of Children 
under 5
• Age 18-49
• Parent of child under the age of 5 years
Male Caregivers of Children • Resides in target region
under 5
The Viamo platform supports complex branching logic that allows a survey to be tailored based on a 
respondent’s answers to one or more questions. This survey took advantage of this feature, offering an 
extended set of questions to respondents who met the study’s eligibility requirements. As a result, the 
24
number of questions comprising a completed survey varied from 16-50 questions at T1 and 17-47 at T3 
depending upon the respondent’s eligibility and participation in the life stage survey (Table 3). All
questions and responses were presented in the same order for all respondents within an eligibility 
group. The table below shows the average amount of time taken to complete the survey and the 
number of questions asked of each respondent; total number of questions differed within samples due to 
skip patterns. The complete questionnaire is available in Annex 1.
Table 11 Average survey completion time and number of questions by sample at T1 and T3
T1 T3
Sample Total 
questions
Avg. completion 
time (mins.)
Total 
questions
Avg. completion 
time (mins.)
National Sample 16-19 7:18 17-22 11:50
Young Adult 31-36 14:06 33-37 13:24
Caregivers of Children under 5 34-50 17:26 44-47 17:56
Pregnant women and male partners 37-42 15:53 38-40 16:01
At T1 and T3, Communicate for Health team offered an airtime incentive of five Ghanaian Cedis 
(approximately $.87 US) to female caregivers of children under 5 and pregnant women who completed 
the extended life stage survey. At T1, incentives were also offered to young women. The offer was 
communicated at the point of formal consent to participate in the life stage study and informed the 
participant that the airtime would be awarded after completion of the survey. This approach was 
approved by the Ghana Health Service Ethics Review Committee. All airtime awards were transferred 
to qualifying participants within 1 week after survey completion. 
Data Analysis
Data Weights
We calculated weighted sample sizes to address disproportionate representation based on region, 
gender, and age compared to the Ghana Statistical Service’s (GSS) population projections7. Separate 
weights were calculated for each wave of data collection (T1 and T3). To calculate the sample sizes for 
the T1 and T3 national surveys by weighting strata, only respondents who completed the national 
sample survey were included. Originally, weights were calculated for the entire completed sample using 
80 strata (four age categories); upon reviewing the data, respondents aged 50 years or older were 
excluded from analyses because of their small representation in the dataset and because they are not a 
primary audience for many of the promoted behaviors (i.e. pregnancy prevention/family planning 
behaviors are targeted toward respondents 49 years or younger). T1 sample weights were constructed 
using the GSS projected population estimates for 2017 for each of 60 strata (10 regions X 2 sexes X 3 
age categories); T3 sample weights were constructed using the GSS projected population estimates for 
2019 for the same strata. Note the GSS age categories are slightly different than the Communicate for 
Health categories, as shown in Table 4 below.
Table 12 Comparison of age categories measured by Communicate for Health Survey and population estimates 
available from Ghana Statistical Service
Ghana Statistical 
Service
Communicate 
for Health
15-24 18-24
 
25
Ghana Statistical 
Service
Communicate 
for Health
25-34 25-35
35-49 36 to 49
To avoid additional complexity in the analysis, we applied the same weights for the analysis of the data in 
the life stage survey for participants in the National Sample also meeting the criteria for a life stage
sample and completing this part of the survey. It should be noted that these weights were not adjusted 
for the sub-sampling occurring due to exclusions prior to the life stage survey in some groups. A total 
of 1357 young men and 14 young women at T1 and 486 young men at T3 who completed the national 
sample and were otherwise eligible for the life stage sample were excluded from participation because 
the recruitment target of 700 participants had already been met for that life stage sample. Also, for 
simplicity, no additional adjustments were made to account for dropouts in the different life 
stage samples. These weights were used only for the national sample, aggregate life stage sample, and 
young men and women when the sample size had been met based on our sample size estimates. 
Statistical analyses were done using weighted data, but tables present both weighted and unweighted 
percentages when possible.
Primary Outcomes 
Primary outcomes for this evaluation were categorized into three groups: 
1. Exposure: Self-reported level of campaign exposure, stratified by life stage, health topic, and
other sociodemographic variables. Exposure was further defined as “structural access” 
(frequency of TV viewing, frequency of radio listening), “coverage” (heard specific GLLiW 
messages), and “intensity” (number of messages about a health topic heard or seen) for the 
purposes of analyzing dose response relationships (Evaluation Objective 3).
2. Behavior Determinants: Self-reported interpersonal communication, gender norms, and 
intention to act, stratified by level of exposure, life stage, and other sociodemographic variables.
3. Behavior: Self-reported behavior, stratified by level of exposure, life stage, and other 
sociodemographic variables.
These outcomes were assessed across five health topic areas: malaria prevention, pregnancy prevention, 
facility-based delivery, handwashing with soap and water, and infant and young child feeding (IYCF). 
Definitions of variables are provided in Annex 2 (data dictionary). 
Analysis Methods
The analysis of the main outcomes of this study were primarily descriptive and exploratory. Limited 
inferential statistical analyses were conducted for exploratory purposes when sample size was sufficient 
to assess the statistical significance of differences between comparison groups (at least 500 per 
comparison group). Statistical tests were conducted using two-sided comparisons and 5% significance 
level. Comparisons between years considered the T1 and T3 samples to be independent. Bivariate (i.e., 
chi-square test) and multivariable analyses (i.e., logistic regression) used sampling weights and 
appropriate survey design adjusted methods including accounting for sampling stratification based on the 
weighting strata. We present the weighted and unweighted proportions where possible; weighted 
percentages are never presented or discussed for caregivers or pregnant couples due to the small
sample size.
26
Evaluation Objective 1: Monitor exposure to Communicate for Health campaigns among target audiences 
In order to achieve the first objective, frequencies, weighted and unweighted percentages, and weighted 
and unweighted means were calculated for all Outcome 1 variables for T1 and T3 in a tabular format, 
stratified by priority region for the national sample and by life stage. Weighted percentages were 
computed only for national sample results and for youth and young adult life stages. 
Chi-squared tests were utilized to assess whether changes in exposure between T1 and T3 were
statistically significant. We used weighted data for these analyses. Observations of trends in exposure 
for caregivers and pregnant couples are intended to be descriptive only due to the limited sample sizes 
achieved and the difficulty of obtaining accurate population estimates for weighting calculations.
Evaluation Objective 2: Monitor progress toward Communicate for Health’s Intermediate Results (changes 
in behavioral determinants) and Strategic Objectives (changes in behaviors)
In order to achieve the second objective, frequencies and weighted and unweighted percentages were 
calculated for all Outcome 2 and 3 variables in a tabular format at T1 and T3. Weighted percentages
were only computed for national sample results and for youth and young adult life stages.
For variables related to bednet use, handwashing, family planning/pregnancy prevention, and gender 
norms that were available at both timepoints, we used chi-squared tests to assess the significance of 
differences between groups at T1 and T3 if an adequate number of responses were available based on 
our sample size estimates. Statistical analysis accounts for sampling weights and survey design. These 
variables were prioritized for statistical testing for Objective 2 based on Communicate for Health 
program priorities.
Evaluation Objective 3: Examine dose-response relationships between exposure to health communication 
messages and behavioral determinants and behaviors 
We conducted bivariate analyses to assess the crude association between Outcome 1 exposure 
variables and Outcome 3 behavior variables. We included chi-squared tests for these associations when 
the sample size was sufficient (at least 500). Tables are presented by priority/non-priority regions for the 
national sample and by life stages for the life stages sample. Only T3 data is used in the dose-response 
analyses because exposure to messaging prior to T1 baseline is likely due to campaigns and information 
other than the GLLiW campaign.
We also ran multivariable analyses using logistic regression models to assess the adjusted association 
between Outcome 1 exposure and binary Outcome 2 and 3 behavior and behavior determinant 
variables. We ran separate models for each type of exposure variable (i.e., structural access, coverage, 
and intensity). Models included the following covariates (unless otherwise noted in the table):
• Age (18-24; 25-35; 36-49)
• Education (None; Primary; Middle School; Secondary; Tertiary or Higher) 
• Urban/rural residence
• Gender (national sample) or life stages (life stage sample)
• Priority/non-priority region (national sample only)
We ran two sets of models for the multivariable analyses. First, we ran the models for each type of 
exposure variable including all relevant covariates. Second, we explored if the association between 
exposure and outcome varied according to the levels of the covariates by assessing interaction effects 
27
(i.e. effect modification). We included all exposure by covariate interactions and ran a backward 
selection process to remove non-significant interaction terms. In Annex 4, we present Odds Ratios 
(OR) for the adjusted model with no interactions, and a second set of ORs only if significant interaction 
terms were identified. In such cases, adjusted ORs for each level of the interacting covariates are given. 
ORs are presented with 95 percent confidence intervals and corresponding p-values.
Secondary Outcomes and Analysis Methods
We conducted descriptive analyses to assess the success and limitations of utilizing IVR and mobile 
phone methods for monitoring and evaluation, including engagement levels from calls made, pick-up 
rates, and survey completion rates using the American Association for Public Opinion Research8
standards. We also analyzed cost per completed survey.
Findings
This section of the report discusses results of the IVR survey comparing data between T1 and T3 where 
available. The presentation starts with a summary of background characteristics of respondents, 
followed by findings from objective 1, objective 2, objective 3, call outcomes and response rates. The 
national sample refers to participants from any region in Ghana who completed questions about 
demographic characteristics and a core set of questions about campaign exposure and bednet use. The 
national sample is sometimes disaggregated by priority region and non-priority region in our results. A 
subset of participants from any of the five USAID priority regions in Ghana who met demographic 
criteria based on Communicate for Health’s life stages were asked to answer additional questions about 
health topics are referred to as the “life stage sample” (in the aggregate) or by their individual life stage 
groups.
Respondent Characteristics
At T3, a national sample of 6,838 respondents ages 18-50+ was recruited; among these, a total of 1,923 
met segmentation criteria for inclusion in the life stage sample. In comparison, more respondents were 
reached at T1 than T3; 9,469 for the national sample and 2,249 for the life stage sample at T1 (Table 5). 
The reduction in sample numbers between T1 and T3 could be attributed to more questions introduced 
at T3 to elicit information on exposure to Communicate for Health GLLiW programming. At both 
timepoints, the majority of national and life stage respondents were males. The Youth/Young Adult 
group formed the highest number of life stage segments recruited at both timepoints, followed by 
Caregivers of children under five and then Pregnant couples. In accordance with the survey analysis plan, 
persons 50 years or older are excluded from all analyses going forward in this report because of their 
low representation in the dataset and because they are not a primary audience for many of the 
behaviors promoted by the Communicate for Health project. 
Table 13: National and life stage Samples at T1 & T3
Survey Wave Sex National 
Sample
Life Stage Sample
Life Stage (All) Young Adult Pregnant 
Couples Caregivers
T1 (2017) Female 3176 998 700 89 209
 
8 The American Association for Public Opinion Research’s standardized response rate calculator allows for 
comparisons of response and non-response rates across surveys of different topics and organizations. Calculator 
and definitions are available online https://www.aapor.org
28
Survey Wave Sex National 
Sample
Life Stage Sample
Life Stage (All) Young Adult Pregnant 
Couples Caregivers
Male 6293 1251 701 221 329
Total 9,469 2,249 1,401 310 538
T3 (2019)
Female 2314 741 511 75 155
Male 4524 1182 700 197 285
Total 6,838 1,923 1, 211 272 440
Table 6 presents background characteristics of national sample respondents disaggregated by sex at T1 
and T3. Changes across the two timepoints were minimal, although chi squared tests revealed significant 
differences in education level and general media exposure (TV/radio) between T1 and T3. As expected
based on our pretesting, the samples at both timepoints included more men and urban dwellers (66.4 
percent at T1 and 64.5 percent at T3) compared to Ghana’s most recent Population and Housing 
Census, where men accounted for 48.8 percent of the population and there was an almost even 
urban/rural population divide (50.9 percent urban and 49.1 percent rural).9 However, due to the nature 
of mobile surveying, our urban/rural characteristics are based on individual self-report rather than 
household location or enumeration area as would be recorded with census data, so this may help to 
explain the differences. Female respondents were more likely to be from urban areas (71.1 percent at 
T1 and 67.3 percent at T3) compared to male respondents at both timepoints (66.4 percent at T1 and 
63.0 percent at T3), which may reflect lower phone ownership/access among rural women. 
Greater Accra and Ashanti regions recorded approximately half of the national sample respondents at 
both timepoints. Upper East and Upper West regions recorded the lowest regional share; this finding 
aligns with Ghana’s latest Population and Housing Census data that shows approximately 4.2 percent of 
Ghanaians live in Upper East and 2.8 percent in Upper West. USAID priority regions--which received 
focused Communicate for Health intervention efforts—accounted for over 55 percent of the national 
sample survey. With respect to education, at least seven in ten respondents (77.7 percent at T1 and 
80.9 percent at T3) had completed middle/ Junior High School or higher level of education. The majority 
of respondents (90.3 percent at T1 and 88.3 percent at T3) were ages 18-35. More than one half of 
respondents were single (58.3 percent at T1 and 58.8 percent at T3) while about four in ten were 
married or living with a partner (37.9 percent at T1 and 38.0 percent at T3). Similar to T1, only one in 
four respondents were caregivers of a child under five at T3. Overall, radio listenership declined across 
the two surveys, while TV viewership increased.
Table 14: Demographic Characteristics of Unweighted National Sample at T1 & T3
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Residence
Rural 879 (28.9%) 2143 (36.1%) 3022 (33.6%) 736 (32.8%) 1586 (37.0%) 2322 (35.5%)
Urban 2163 (71.1%) 3801 (63.9%) 5964 (66.4%) 1508 (67.2%) 2705 (63.0%) 4213 (64.5%)
Region10
Ashanti 796 (26.2%) 1269 (21.3%) 2065 (23.0%) 560 (25.0%) 841 (19.6%) 1401 (21.4%)
Greater Accra 988 (32.5%) 1716 (28.9%) 2704 (30.1%) 687 (30.6%) 1214 (28.3%) 1901 (29.1%)
Eastern 249 (8.2%) 537 (9.0%) 786 (8.7%) 208 (9.3%) 382 (8.9%) 590 (9.0%)
Western 146 (4.8%) 392 (6.6%) 538 (6.0%) 129 (5.7%) 275 (6.4%) 404 (6.2%)
 
9 Ghana Statistical Service, 2010 Population and Housing Census. Summary Report of Final Results. May, 2012.
10 At the time of our surveys, Ghana was divided into 10 regions.
29
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Brong Ahafo 222 (7.3%) 476 (8.0%) 698 (7.8%) 144 (6.4%) 329 (7.7%) 473 (7.2%)
Northern 178 (5.9%) 474 (8.0%) 652 (7.3%) 144 (6.4%) 412 (9.6%) 556 (8.5%)
Central 201 (6.6%) 389 (6.5%) 590 (6.6%) 140 (6.2%) 290 (6.8%) 430 (6.6%)
Volta 145 (4.8%) 366 (6.2%) 511 (5.7%) 135 (6.0%) 294 (6.9%) 429 (6.6%)
Upper East 59 (1.9%) 140 (2.4%) 199 (2.2%) 41 (1.8%) 125 (2.9%) 166 (2.5%)
Upper West 58 (1.9%) 185 (3.1%) 243 (2.7%) 56 (2.5%) 129 (3.0%) 185 (2.8%)
Region
Non-priority Region 1384 (45.5%) 2607 (43.9%) 3991 (44.4%) 1009 (45.0%) 1806 (42.1%) 2815 (43.1%)
Priority Region 1658 (54.5%) 3337 (56.1%) 4995 (55.6%) 1235 (55.0%) 2485 (57.9%) 3720 (56.9%)
Education***
None 300 (9.9%) 603 (10.1%) 903 (10.0%) 196 (8.7%) 330 (7.7%) 526 (8.0%)
Primary 373 (12.3%) 731 (12.3%) 1104 (12.3%) 271 (12.1%) 451 (10.5%) 722 (11.0%)
Middle school 725 (23.8%) 1478 (24.9%) 2203 (24.5%) 470 (20.9%) 943 (22.0%) 1413 (21.6%)
Secondary 1028 (33.8%) 1955 (32.9%) 2983 (33.2%) 750 (33.4%) 1450 (33.8%) 2200 (33.7%)
Tertiary or higher 616 (20.2%) 1177 (19.8%) 1793 (20.0%) 557 (24.8%) 1117 (26.0%) 1674 (25.6%)
Age
18-24 1925 (63.3%) 3375 (56.8%) 5300 (59.0%) 1384 (61.7%) 2158 (50.3%) 3542 (54.2%)
25-35 887 (29.2%) 1922 (32.3%) 2809 (31.3%) 658 (29.3%) 1570 (36.6%) 2228 (34.1%)
36-49 230 (7.6%) 647 (10.9%) 877 (9.8%) 202 (9.0%) 563 (13.1%) 765 (11.7%)
Relationship Status
Single 1790 (58.8%) 3445 (58.0%) 5235 (58.3%) 1324 (59.0%) 2517 (58.7%) 3841 (58.8%)
Married or living with partner 1102 (36.2%) 2302 (38.7%) 3404 (37.9%) 834 (37.2%) 1649 (38.4%) 2483 (38.0%)
Separated or divorced 99 (3.3%) 158 (2.7%) 257 (2.9%) 59 (2.6%) 98 (2.3%) 157 (2.4%)
Widowed 51 (1.7%) 39 (0.7%) 90 (1.0%) 27 (1.2%) 27 (0.6%) 54 (0.8%)
Age of Youngest Child
No children 1703 (56.0%) 3628 (61.0%) 5331 (59.3%) 1223 (54.5%) 2664 (62.1%) 3887 (59.5%)
Under 5 years 786 (25.8%) 1432 (24.1%) 2218 (24.7%) 607 (27.0%) 1015 (23.7%) 1622 (24.8%)
5-17 years 463 (15.2%) 729 (12.3%) 1192 (13.3%) 356 (15.9%) 507 (11.8%) 863 (13.2%)
18 or older 90 (3.0%) 155 (2.6%) 245 (2.7%) 58 (2.6%) 105 (2.4%) 163 (2.5%)
Listened to Radio in last 7 
days***
Not at all 722 (23.7%) 1149 (19.3%) 1871 (20.8%) 647 (28.8%) 975 (22.7%) 1622 (24.8%)
A few days 949 (31.2%) 1783 (30.0%) 2732 (30.4%) 704 (31.4%) 1340 (31.2%) 2044 (31.3%)
Most days 544 (17.9%) 1227 (20.6%) 1771 (19.7%) 368 (16.4%) 836 (19.5%) 1204 (18.4%)
Every day 827 (27.2%) 1785 (30.0%) 2612 (29.1%) 525 (23.4%) 1140 (26.6%) 1665 (25.5%)
Watched TV in last 7 days*
Not at all 499 (16.4%) 1259 (21.2%) 1758 (19.6%) 387 (17.2%) 813 (18.9%) 1200 (18.4%)
A few days 742 (24.4%) 1766 (29.7%) 2508 (27.9%) 520 (23.2%) 1213 (28.3%) 1733 (26.5%)
Most days 515 (16.9%) 1101 (18.5%) 1616 (18.0%) 329 (14.7%) 706 (16.5%) 1035 (15.8%)
Every day 1286 (42.3%) 1818 (30.6%) 3104 (34.5%) 1008 (44.9%) 1559 (36.3%) 2567 (39.3%)
Chi-square conducted for overall test of differences between total sample at T1 and T3 using weighted data. Asterisks indicate 
statistically significant differences. ***p<0.001. *p<0.05
Objective 1: Exposure to Communication Messages
In assessing exposure to communication messages, survey participants at T1 and T3 were asked about 
how many adverts or messages they had heard or seen in the last month from any source. These 
sources might or might not include Communicate for Health project efforts. The number of adverts 
seen or heard were categorized into zero, one to five, six to ten and ten or more messages. While 
some questions were asked to all respondents, including malaria prevention through the use of ITNs, FP, 
and handwashing with soap under running water, questions about facility delivery, breastfeeding, and 
complementary feeding only were asked to selected life stage segments in accordance with planned 
programming. Specifically, questions on facility delivery were asked of caregivers of under-fives and 
pregnant couples, while questions on breastfeeding were asked among only caregivers of children less 
30
than six months of age. Questions on complementary feeding were asked of all caregivers with children 
six to eight months of age. 
Table 7 presents message exposure from any source across several health topics. Discussions in this and 
subsequent sections of this report will focus on only weighted percentages when available (i.e. number 
of respondents at least 500 at both timepoints) and unweighted percentages for caregivers and pregnant 
couples (and other populations when fewer than 500 respondents available). Of all topics, exposure to 
ITN messages recorded a statistically significant increase between T1 and T3 (p<0.001); fewer 
respondents at T3 (22.3 percent) reported no exposure to ITN messages compared to T1 (26.2 
percent) while the proportion who heard or saw ten or more ITN messages increased from 34.2
percent at T1 to 39.0 percent at T3. While improvements were reported on exposure to handwashing, 
facility delivery, breastfeeding and complementary feeding messages between T1 and T3, these 
differences were not statistically significant. Quite an interesting finding was exposure to FP messages 
from any source declined significantly: more respondents at T3 (47.0 percent) reported no exposure to 
FP messages compared to T1 (43.8 percent). The proportion of respondents who heard or saw ten or 
more FP messages declined from 20.6 percent at T1 to 18.2 percent at T3. Conversely, as discussed 
below, at T3 all respondents were asked if they had ever heard or seen three different GLLiW family 
planning advertisements; across all respondents in the national sample 80.1 percent reported exposure 
to at least one of the three adverts (See Annex 4 for additional tables). 
Table 15: Exposure to Messages About ITNs, FP, Handwashing, Facility Delivery, Infant and Young Child Feeding 
from Any Source in the Last Month at T1 & T3 
Health Topic
Messages
heard or 
seen
T1 T3 X
2
, p
value
n %
Weighted
%
n %
Weighted
%
National Sample (All)
Malaria prevention using ITNs
0 2440 27.2 26.2 1527 23.4 22.3
16.89, 
<0.001
1-5 1925 21.4 21.9 1314 20.1 20.9
6-10 1568 17.4 17.6 1106 16.9 17.8
>10 3053 34.0 34.2 2588 39.6 39.0
Pregnancy prevention
0 4049 45.1 43.8 3014 46.1 47.0
8.08, 
0.044
1-5 1771 19.7 21.3 1383 21.2 21.5
6-10 1305 14.5 14.3 858 13.1 13.3
>10 1861 20.7 20.6 1280 19.6 18.2
Hand washing
0 3485 38.8 36.9 2475 37.9 36.8
5.68, 
0.128
1-5 1852 20.6 22.5 1509 23.1 23.9
6-10 1456 16.2 16.4 955 14.6 14.3
>10 2193 24.4 24.2 1596 24.4 25.0
Life Stage Samples
Facility Delivery
(Caregivers of children less 
than five; pregnant couples)
0 322 39.9 253 36.4
1-5 147 18.2 132 19.0
6-10 138 17.1 108 15.5
>10 200 24.8 203 29.2
Breastfeeding
(Caregivers of children less 
than 6 months)
0 31 24.4 19 18.1
1-5 21 16.5 13 12.4
6-10 27 21.3 14 13.3
>10 48 37.8 59 56.2
Complementary feeding
(Caregivers of children 6-8 
months)
0 19 29.7 16 30.8
1-5 12 18.8 10 19.2
6-10 14 21.9 9 17.3
31
>10 19 29.7 17 32.7
In addition to exposure to communication messages from any source, the T3 survey assessed exposure 
to specific GLLiW branded messages produced and aired by the project between 2017 and 2019 on 
FP/reproductive health (RH) including YOLO, malaria prevention, handwashing and breastfeeding. Here, 
no restriction on recall period was given. Also, to aid recognition, audio bytes of adverts broadcasted by 
the Communicate for Health project were featured as part of the survey. For FP/RH, exposure was 
measured to any of three audio bytes featured; 1) FP Slice of Life production, 2) FP Short Story Series spot
and 3) YOLO. In the case of malaria, recognition was measured for any two malaria adverts: 1) malaria 
prevention Slice of Life production, and 2) malaria Short Story spot. Handwashing and breastfeeding 
featured only one Slice of Life advert for each topic—these were only asked of appropriate life stage 
audiences. A composite measure “Any GLLIW asked about” was computed for exposure to any of the 
four health topics: FP/RH, malaria, handwashing and breastfeeding (for caregivers of children under 6 
months in the life stage sample) or general awareness of the GLLiW brand. Overall, the project 
reported high exposure to GLLiW messages across all life stages as shown in Figure 4. Among all 
groups, nine in 10 respondents (93.6 percent) reported being exposed to at least one GLLiW health 
topic. The highest recall of 96.1 percent was reported among female caregivers and female youth/young 
adults, followed by male youth/young adults (94.1 percent) and the least exposure was for pregnant 
women (91.9 percent). Among all GLLiW topics, FP/RH recorded the highest exposure (80.1 percent)
followed by malaria prevention (79.0 percent), handwashing (77.8 percent) and the least, breastfeeding 
(66.7 percent).
Stratifying by life stage and health topic (Figures 5-7), pregnant women (83.8 percent) and female 
youth/young adults (83.0 percent) reported the highest exposure to any GLLiW FP/RH message and the 
least by partners of pregnant women (70.1 percent). As expected, exposure to YOLO messaging was 
highest among youth/young adults (males-57.5 percent, females-55.2 percent) in comparison with other 
life stage audiences (pregnant women-45.9 percent, partners of pregnant women-41.8 percent, female 
caregivers-39.0 percent, male caregivers-32.5 percent). On exposure to any GLLiW malaria prevention 
messages, female and male caregivers recorded the highest recall of 79.9 percent, followed by 
youth/young adult life stage (76.6 percent for males and 75.4 percent for females) while the least 
exposure was among pregnant couples (74.3 percent for women and 70.1 percent for male partners). 
Message exposure on GLLiW handwashing was highest among pregnant women (82.4 percent), followed 
by the caregiver life stage segment (81.8 percent for females and 81.4 percent for males), the least by 
partners of pregnant women (73.7 percent). As expected, female caregivers reported a higher GLLiW 
breastfeeding message exposure (72.2 percent) than men (63.8 percent).
Figure 5 Exposure to GLLIW Adverts among all life stage respondents, T3
32
^Percentages are weighted
Figure 6 Exposure to GLLIW Adverts among young adults, T3
^Percentages are weighted
Figure 7 Exposure to GLLIW Adverts among caregivers of children under five, T3
^Percentages are unweighted
*Exposure to GLLiW breastfeeding messages only assessed among caregivers of children aged younger than six months.
0
20
40
60
80
100
All Groups
Percent Exposed^ 
Life stage
Any GLLiW message asked about Any GLLiW FP/RH YOLO Any Malaria Handwashing
0
20
40
60
80
100
Young Women Young Men
Percent Exposed^ 
Life stage
Any GLLiW message asked about Any GLLiW FP/RH YOLO Any Malaria Handwashing
0
20
40
60
80
100
Female Caregivers of Children under 5 Male Caregivers of Children under 5
Percent Exposed^ 
Life stage
Any GLLiW message asked about Any FP/RH
YOLO Any Malaria
Handwashing Breastfeeding*
33
Figure 8 Exposure to GLLIW Adverts among pregnant couples, T3
^Percentages are unweighted
Objective 2 Behavioral Determinants and Behaviors 
Bednets for Malaria Prevention 
Data on interpersonal communication (IPC)—operationally defined as discussing specific health topics 
with other people such as a friend, partner or family—and intentions to use or support a pregnant 
partner to use a bednet every night for malaria prevention in the future were gathered from pregnant 
couples and intentions to have all children under five in the household sleep under a bednet every night
were gathered from caregivers of children under five. As presented in Table 8, the trend generally 
suggests marginal improvements in IPC about bednet use at T3. The highest increase of 16.3 percent in 
IPC was observed among pregnant women, followed by male care givers (9.7 percent) and the least by 
partners of pregnant women (2.7 percent). The trend in intentions for future bednet use by children
under five years of age and pregnant women did not show major shifts between the two time points.
Table 16 Behavioral Determinants Related to Self-Reported Use of ITN at T1 and T3
Indicator Response T 1 T3
n % n %
Male caregivers
IPC Discussed ITNs 140 49.5 155 59.2
Has not discussed ITNs 143 50.5 107 40.8
Intention Every night 175 61.8 170 64.9
Not every night 108 38.2 92 35.1
Female caregivers
IPC Discussed ITNs 95 48.5 82 56.2
Has not discussed ITNs 101 51.5 64 43.8
Intention Every night 133 67.9 97 66.4
Not every night 63 32.1 49 33.6
Partners of pregnant women
IPC Discussed ITNs 114 54.0 110 56.7
Has not discussed ITNs 97 46.0 84 43.3
Intention to support partner
Every night 130 61.6 126 64.9
Not every night 81 38.4 68 35.1
Pregnant women
IPC Discussed ITNs 51 58.0 55 74.3
Has not discussed ITNs 37 42.0 19 25.7
0
20
40
60
80
100
Pregnant Women Partners of Pregnant Women
Percent Exposed^ 
Life stage
Any GLLiW message asked about Any FP/RH YOLO Any Malaria Handwashing
34
Indicator Response T 1 T3
n % n %
Intention Every night 52 59.1 46 62.2
Not every night 36 40.9 28 37.8
Self-reported bednet use was assessed among all adult respondents; adult respondents who said they 
had a child under five were also asked about the bednet use of all children under five in their household
for the previous night. Among the life stage sample, partners of pregnant women were asked about their 
female partner’s use of a bednet the previous night. Showing a significant increase over T1 estimates, at 
T3 41.8 percent of adults in the national sample reported using a bednet the previous night compared to 
36.3 percent at T1 (p<0.001). Significantly, bednet use increased from 34.7 percent at T1 to 39.5
percent at T3 among adults in USAID priority regions (p<0.01) and similarly in non-priority regions 
(from 38.2 percent at T1 to 44.5 percent at T3, p<0.001). While the trend suggests improvements in 
bednet use especially among pregnant women (38.6 percent at T1 to 47.3 percent at T3), partners of 
pregnant women and male caregivers (36.5 percent at T1 to 42.8 percent at T3), ITN use by 
youth/young adults and female caregivers did not record any major shifts. Past bednet use among under￾fives in the national sample remained approximately the same across the two timepoints with 55 percent
of caregivers reporting that all children under five slept under an ITN. A marginal increase was however 
observed in under five bednet use in non-priority regions from 55.5 percent in T1 to 57.2 percent at T3. 
Consistently, marginal increases in under-five bednet use were reported by caregivers in the life stage 
sample.
Table 17 Individual report of ITN previous night, for self and others at T1 and T3
Behavior T 1 T3 X
2
, p value
n % Weighted % n % Weighted %
National Sample (All)
Slept under net 3046 33.9 36.3 2475 37.9 41.8 18.86, <0.001
Did not sleep under net 5940 66.1 63.7 4060 62.1 58.2
All children<5 years slept under net 1130 54.0 55.8 851 54.6 55.4 0.03, 0.867
Not all children<5 years slept under net 961 46.0 44.2 709 45.4 44.6
Priority Regions
Slept under net 1618 32.4 34.7 1339 36.0 39.5 8.14, 0.004 Did not sleep under net 3377 67.6 65.3 2381 64.0 60.5
All children<5 years slept under net 607 53.5 56.0 460 53.9 53.7 0.53, 0.467
Not all children<5 years slept under net 528 46.5 44.0 393 46.1 46.3
Non-Priority Regions
Slept under net 1428 35.8 38.2 1136 40.4 44.5 10.94, <0.001
Did not sleep under net 2563 64.2 61.8 1679 59.6 55.5
All children<5 years slept under net 523 54.7 55.5 391 55.3 57.2 0.23, 0.634
Not all children<5 years slept under net 433 45.3 44.5 316 44.7 42.8
Life Stage (All)
Slept under net 739 33.5 36.3 693 36.3 38.7 1.40, 0.237 Did not sleep under net 1469 66.5 63.7 1214 63.7 61.3
Young men
Slept under net 223 31.8 34.1 232 33.1 34.7 0.04, 0.836 Did not sleep under net 478 68.2 65.9 468 66.9 65.3
Young women
Slept under net 202 28.9 30.9 154 30.1 32.5 0.26, 0.613
Did not sleep under net 498 71.1 69.1 357 69.9 67.5
Male caregivers
Slept under net 112 36.5 116 42.3
35
Behavior T 1 T3 X
2
, p value
n % Weighted % n % Weighted %
Did not sleep under net 195 63.5 158 57.7
All children<5 years slept under net 145 51.2 132 50.4
Not all children<5 years slept under net 138 48.8 130 49.6
Female caregivers
Slept under net 85 42.3 69 44.8
Did not sleep under net 116 57.7 85 55.2
All children<5 years slept under net 96 49.0 78 53.4
Not all children<5 years slept under net 100 51.0 68 46.6
Partners of pregnant women
Slept under net 83 39.3 87 44.8
Did not sleep under net 128 60.7 107 55.2
Partner slept under net 110 52.1 99 51.0
Partner did not sleep under net 101 47.9 95 49.0
Pregnant women
Slept under net 34 38.6 35 47.3
Did not sleep under net 54 61.4 39 52.7
Handwashing
Information on handwashing behavior determinants (IPC and intentions to always wash hands with soap 
and water) was assessed at both timepoints. The trend shows improvement in handwashing IPC among 
caregivers and pregnant couples at T3. A decline was however observed among youth/young adults with 
IPC decreasing significantly in males from 56.5 percent in T1 to 49.9 percent at T3 (p<0. 05) as 
presented in Table 10. Increases in behavioral intentions to always wash hands with soap and water 
were reported across all life stages (p<0.001). Among young men ages 18-35, intentions to use soap 
every time they wash their hands increased significantly from 52.1 percent in T1 to 61.5 percent at T3 
(p<0.001) as shown in Table 10. 
Table 18: Interpersonal Communication and intentions Related to Handwashing at T1 and T3, among life stage
sample
Sample Response T 1 T3 X
2
, p value
n % Weighted % n % Weighted %
Life Stage (All)
IPC Discussed handwashing 1327 60.1 62.4 1120 58.7 64.1 0.72, 0.394 Did not discuss 881 39.9 37.6 787 41.3 35.9
Intentions Every time 1333 60.4 60.1 1261 66.1 68.0 16.43, <0.001
Not every time 875 39.6 39.9 646 33.9 32.0
Young men
IPC Discussed handwashing 389 55.5 56.5 344 49.1 49.9 5.30, 0.021 Did not discuss 312 44.5 43.5 356 50.9 50.1
Intentions Every time 374 53.4 52.1 431 61.6 61.5 11.00, <0.001
Not every time 327 46.6 47.9 269 38.4 38.5
Young women
IPC Discussed handwashing 462 66.0 67.7 318 62.2 64.5 0.92, 0.338 Did not discuss 238 34.0 32.3 193 37.8 35.5
Intentions Every time 456 65.1 63.5 343 67.1 65.0 0.21, 0.646 Not every time 244 34.9 36.5 168 32.9 35.0
Male caregivers
IPC Discussed handwashing 173 56.4 170 62.0
Did not discuss 134 43.6 104 38.0
Intentions Every time 178 58.0 186 67.9
36
Sample Response T 1 T3 X
2
, p value
n % Weighted % n % Weighted %
Not every time 129 42.0 88 32.1
Female caregivers
IPC Discussed handwashing 135 67.2 122 79.2
Did not discuss 66 32.8 32 20.8
Intentions Every time 135 67.2 122 79.2
Not every time 66 32.8 32 20.8
Partners of pregnant women
IPC Discussed handwashing 115 54.5 116 59.8
Did not discuss 96 45.5 78 40.2
Intentions Every time 131 62.1 136 70.1
Not every time 80 37.9 58 29.9
Pregnant women
IPC Discussed handwashing 53 60.2 50 67.6
Did not discuss 35 39.8 24 32.4
Intentions Every time 63 71.6 57 77.0
Not every time 25 28.4 17 23.0
Availability of a designated place for handwashing were elicited from all life stage segments at both 
timepoints. Respondents who indicated they had a handwashing station were asked about the availability 
of soap and water at this station. Additionally, at T3 data were collected from all life stage respondents 
about washing of hands with soap and water after last using the toilet. Overall, the trend suggests
marginal increases in self-reported availability of handwashing stations for all life stage respondents (44.1 
percent at T1 and 46.8 percent at T3) as well as young men (38.3 percent at T1 and 41.0 percent at T3), 
male caregivers (43.0 percent at T1 and 46.0 percent at T3), female caregivers (44.8 percent at T1 and 
53.2 percent at T3) and pregnant women (50.0 percent at T1 and 63.5 percent at T3). Young women 
and partners of pregnant women reported minimal decreases in the availability of a handwashing station 
in their households, presented in Table 11. About one-third of respondents (32.9 percent) at T3 
reported having soap and water at a designated place for handwashing in their household, showing a 
marginal increase over baseline (29.8 percent). Increases were greatest among young women, as 
presented in Table 11. 
Table 19: Availability of a Handwashing Station at T1 and T3, among life stage sample
Sample Indicator T 1 T3
n % Weighted % n % Weighted %
Life Stage (All)
Station available in household1 958 43.4 44.1 846 44.4 46.8
Soap and water always available 
at station2
280 29.2 29.8 262 31.0 32.9
Young men
Station available in household3 274 39.1 38.3 292 41.7 41.0
Soap and water always available 
at station 79 28.8 71 24.3
Young women
Station available in household4 322 46.0 43.8 213 41.7 40.3
Soap and water always available 
at station 95 29.5 87 40.8
Male caregivers
Station available in household 132 43.0 126 46.0
Soap and water always available 
at station 35 26.5 38 30.2
Female caregivers
Station available in household 90 44.8 82 53.2
Soap and water always available 
at station 27 30.0 27 32.9
Station available in household 96 45.5 86 44.3
37
Sample Indicator T 1 T3
n % Weighted % n % Weighted %
Partners of pregnant 
women
Soap and water always available 
at station 28 29.2 25 29.1
Pregnant women
Station available in household 44 50.0 47 63.5
Soap and water always available 
at station 16 36.4 14 29.8
1 Chi square test conducted for aggregate life stage sample. X2=1.55, p=0.213. 
2 Chi square test conducted for aggregate life stage sample. X2=0.98, p=0.323. 
3 Chi square test conducted for young men. X2=0.98, p=0.323. Sample size insufficient for statistical analyses for availability of 
soap and water.
4 Chi square test conducted for young women. X2=0.98, p=0.323. Sample size insufficient for statistical analyses for availability 
of soap and water.
Although only three in ten respondents of those who reported having a handwashing station had both 
soap and water available at this station at T3, 83.8 percent of life stage audiences reported washing their 
hands with soap and water the last time they used the toilet (Figure 8). In general, female respondents
reported handwashing at higher proportions, as shown in Figures 9-10.
Figure 9: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, entire life stage sample 
at T3. 
^Percentage is weighted
Figure 10: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, young adult samples 
at T3. 
^Percentage is weighted
Figure 11: Self-reported Handwashing Behavior the Last Time Respondent Used the Toilet, caregivers and 
pregnant couples’ samples at T3. 
83.8
0 10 20 30 40 50 60 70 80 90
All groups
Percent^ 
Life stage
89.7
76.8
0 10 20 30 40 50 60 70 80 90 100
Young Women
Young Men
Percent^ 
Life stage
38
^Percentage is unweighted
Pregnancy Prevention
Interpersonal communication and intentions about delaying or preventing pregnancy were monitored 
across all life stage respondents, including post-partum prevention for pregnant couples. The trend 
shows that IPC about pregnancy prevention remained mostly unchanged between T1 and T3 except for
young men and pregnant women who reported 6.2 and 6.5 percentage-point increases over baseline 
estimates (Table 12). The trend in intentions to use a method to prevent pregnancy in the future did not 
show significant shifts between T1 and T3 (Table 12). Again, the greatest increases were reported by 
pregnant women and young men, while other life stages reported only slight changes. 
Table 20: Interpersonal Communication Related to Pregnancy Prevention at T1 and T3, among life stage sample
Sample Response
T 1 T3 X2, p value
n %
Weighted 
%
n %
Weighted 
%
All non-pregnant adults (among those not trying to become pregnant)
IPC Discussed pregnancy prevention 679 40.3 43.6 658 45.3 44.4 0.12, 0.732 Has not discussed 1007 59.7 56.4 795 54.7 55.6
Intentions Intends to use method 956 56.7 56.1 839 57.7 57.1 0.17, 0.676 Does not intend to use method 730 43.3 43.9 614 42.3 42.9
Young men (among those not trying to become pregnant)
IPC Discussed pregnancy prevention 222 35.5 37.4 268 42.6 43.6 4.30, 0.038
Has not discussed 404 64.5 62.6 361 57.4 56.4
Intentions Intends to use method 331 52.9 53.6 351 55.8 55.8 0.54, 0.464 Does not intend to use method 295 47.1 46.4 278 44.2 44.2
Young women (among those not trying to become pregnant)1
IPC Discussed pregnancy prevention 248 40.3 200 44.8
Has not discussed 368 59.7 246 55.2
Intentions Intends to use method 332 53.9 237 53.1
Does not intend to use method 284 46.1 209 46.9
Male caregivers (among those not trying to become pregnant)
IPC Discussed pregnancy prevention 112 42.9 110 46.2
Has not discussed 149 57.1 128 53.8
Intentions Intends to use method 169 64.8 160 67.2
Does not intend to use method 92 35.2 78 32.8
Female caregivers (among those not trying to become pregnant)
IPC Discussed pregnancy prevention 97 53.0 80 57.1
Has not discussed 86 47.0 60 42.9
Intentions Intends to use method 124 67.8 91 65.0
Does not intend to use method 59 32.2 49 35.0
Partners of pregnant women
90.1
78.3
87.3
77.8
0 10 20 30 40 50 60 70 80 90 100
Female Caregivers
Male Caregivers
Pregnant Women
Partners of Pregnant Women
Percent^ 
Life stage
39
Sample Response
T 1 T3 X2, p value
n %
Weighted 
%
n %
Weighted 
%
IPC
Discussed post-partum pregnancy 
prevention
118 55.9 101 52.1
Has not discussed 93 44.1 93 47.9
Intentions
Intends to use method 132 62.6 123 63.4
Does not intend to use method after 
delivery 79 37.4 71 36.6
Pregnant women
IPC
Discussed post-partum pregnancy 
prevention
49 55.7 46 62.2
Has not discussed 39 44.3 28 37.8
Intentions
Intends to use method 61 69.3 54 73.0
Does not intend to use method after 
delivery 27 30.7 20 27.0
1 Sample size at T3 was insufficient to assess statistical significance of changes.
Pregnancy prevention behavior (i.e. the use of modern and traditional methods) was assessed among 
sexually active life stage respondents who did not say they were planning to get pregnant. Modest 
increases in use of modern methods to prevent or delay pregnancy were recorded between T1 and T3
for sexually active young men who said their partner was not currently pregnant or planning to become 
pregnant and among sexually active female caregivers who were not currently pregnant or trying to 
become pregnant (Table 13). When sample size was less than 500 at one or both timepoints, tests of 
significance were not conducted, and weighted percentages are not shown.
Table 21: Behaviors related to Pregnancy Prevention at T1 and T3 Among Non-pregnant Adults
Indicator Response T 1 T3 X2, p value
n % Weighted % n % Weighted %
All non-pregnant adults
Sexually Active Yes 1166 61.1 64.1 1059 64.6 66.1 0.94, 0.334
No 743 38.9 35.9 580 35.4 33.9
Planning Pregnancy (among 
sexually active)
Yes 223 19.1 18.7 186 17.6 17.2 0.53, 0.467
No 943 80.9 81.3 873 82.4 82.8
Using Modern Method (among 
sexually active, not planning 
pregnancy)
Yes 540 57.3 57.9 495 56.6 57.3
0.03, 0.852 No, Unsure 403 42.7 42.1 379 43.4 42.7
Young men
Sexually Active Yes 374 53.4 54.6 401 57.3 57.0 0.71, 0.398 No 327 46.6 45.4 299 42.7 43.0
Planning Pregnancy (among 
sexually active)
Yes 75 20.1 71 17.7
No 299 79.9 330 82.3
Using Modern Method (among 
sexually active, not planning 
pregnancy)
Yes 158 52.8 188 57.0
No, Unsure 141 47.2 142 43.0
Young women
Sexually Active Yes 400 57.1 58.3 311 60.9 60.8 0.52, 0.471 No 300 42.9 41.7 200 39.1 39.2
Planning Pregnancy (among 
sexually active)
Yes 84 21.0 65 20.9
No 316 79.0 246 79.1
Using Modern Method (among 
sexually active, not planning 
pregnancy)
Yes 186 58.9 139 56.5
No, Unsure 130 41.1 107 43.5
Male caregivers
Sexually Active Yes 252 82.1 224 81.8
40
Indicator Response T 1 T3 X2, p value
n % Weighted % n % Weighted %
No 55 17.9 50 18.2
Planning Pregnancy (among 
sexually active)
Yes 46 18.3 36 16.1
No 206 81.7 188 83.9
Using Modern Method (among 
sexually active, not planning 
pregnancy)
Yes 125 60.7 103 54.5
No, Unsure 81 39.3 86 45.5
Female caregivers
Sexually Active Yes 140 69.7 123 79.9
No 61 30.3 31 20.1
Planning Pregnancy (among 
sexually active)
Yes 18 12.9 14 11.4
No 122 87.1 109 88.6
Using Modern Method (among 
sexually active, not planning 
pregnancy)
Yes 71 58.2 65 59.6
No, Unsure 51 41.8 44 40.4
Across all non-pregnant adults in the life stage sample who said they or their partner were using a
method to prevent pregnancy, condoms were the most common method at both time points, followed 
by emergency contraception and shorter acting hormonal methods (pills or injectables) (Table 14).
Reported use of condoms increased across all samples except male caregivers. The most notable 
increase was recorded among young men. Reported use of emergency contraception declined across 
the total sample but increased marginally among female respondents. Reported use of long acting and 
permanent methods increased from 10.1 percent at T1 to 14.4 percent at T3. The sample size was 
insufficient to test the statistical significance of differences for individual life stages, as not all young 
people reported being sexually active in the last 12 months.
Table 22: Reported Contraceptive Method at T1 and T3, among sexually active life stage respondents not currently 
pregnant or trying to become pregnant
Method T 1 T3
n % Weighted % n % Weighted %
Life Stage (All)
1
Male or Female condoms 195 28.3 25.7 208 35.4 29.2
Emergency contraception 152 22.1 19.6 124 21.1 18.0
Injectables or pills 101 14.7 16.8 81 13.8 16.2
Implants/IUCD/sterilization 58 8.4 10.1 63 10.7 14.4
Calendar/lactational amenorrhea 34 4.9 7.4 19 3.2 5.3
Natural/traditional/withdrawal/other 95 13.8 13.1 80 13.6 14.3
Don't know 53 7.7 7.1 12 2.0 2.6
Young men
Male or Female condoms 78 36.3 117 55.2
Emergency contraception 45 20.9 42 19.8
Injectables or pills 23 10.7 15 7.1
Implants/IUCD/sterilization 6 2.8 10 4.7
Calendar/lactational amenorrhea 6 2.8 4 1.9
Natural/traditional/withdrawal/other 34 15.8 21 9.9
Don't know 23 10.7 3 1.4
Young women
Male or Female condoms 59 25.3 45 26.6
Emergency contraception 80 34.3 59 34.9
Injectables or pills 27 11.6 19 11.2
Implants/IUCD/sterilization 15 6.4 13 7.7
Calendar/lactational amenorrhea 5 2.1 3 1.8
Natural/traditional/withdrawal/other 32 13.7 26 15.4
Don't know 15 6.4 4 2.4
41
Method T 1 T3
n % Weighted % n % Weighted %
Male caregivers
Male or Female condoms 44 28.8 31 24.0
Emergency contraception 16 10.5 11 8.5
Injectables or pills 34 22.2 31 24.0
Implants/IUCD/sterilization 19 12.4 26 20.2
Calendar/lactational amenorrhea 12 7.8 4 3.1
Natural/traditional/withdrawal/other 21 13.7 22 17.1
Don't know 7 4.6 4 3.1
Female caregivers
Male or Female condoms 14 16.1 15 19.5
Emergency contraception 11 12.6 12 15.6
Injectables or pills 17 19.5 16 20.8
Implants/IUCD/sterilization 18 20.7 14 18.2
Calendar/lactational amenorrhea 11 12.6 8 10.4
Natural/traditional/withdrawal/other 8 9.2 11 14.3
Don't know 8 9.2 1 1.3
1 Chi square test conducted for aggregate life stage. X2=10.56, p=0.103. Sample size insufficient for statistical analyses among 
any individual life stage group.
Facility Delivery
One critical strategy for reducing maternal morbidity and mortality is ensuring every baby is delivered 
with the assistance of a skilled birth attendant which generally includes a medical doctor, nurse or 
midwife in health care facilities. Caregivers and pregnant couple life stage segments were asked about 
place of delivery for their last birth, and future intentions for delivery place. Additionally, IPC around 
facility delivery was assessed among pregnant couples. Reports of delivery in health facility or maternity 
home increased among all respondents apart from the male caregiver group at T3 (Table 15). Intention 
to deliver in a health facility also recorded increases across all life stage segments. Generally, minimal 
increases in IPC about facility delivery were recorded between the two time points with a higher 
proportion among pregnant women. It should be noted that facility delivery behavior determinants and 
behaviors were already generally high at T1.
Table 23: Self-reported Facility Delivery Behavioral Determinants and Behaviors at T1 and T3 by Caregivers and 
Pregnant Couples 
Indicator Response T1 T3
n % n %
Male caregivers
Intentions
Plans to give birth in health facility or maternity home 261 89.7 242 93.4
Other location, unsure 30 10.3 17 6.6
Does not intend to have another child 16 5.2 15 5.5
Behavior Delivered in health facility or maternity home 265 92.0 229 90.5
Other location, unsure 23 8.0 24 9.5
Female caregivers
Intentions
Plans to give birth in health facility or maternity home 175 91.1 136 94.4
Other location, unsure 17 8.9 8 5.6
Does not intend to have another child 9 4.5 10 6.5
Behavior Delivered in health facility or maternity home 173 88.7 145 94.2
Other location, unsure 22 11.3 9 5.8
Partners of pregnant women
Intentions
Plans to give birth in health facility or maternity home 173 84.8 165 85.9
Other location, unsure 31 15.2 27 14.1
Does not intend to have another child 7 3.3 2 1.0
Delivered in health facility or maternity home 82 79.6 77 81.1
42
Indicator Response T1 T3
n % n %
Behavior (among those with 
previous birth) Other location, unsure 21 20.4 18 18.9
IPC Discussed facility delivery 103 48.8 102 52.6
Has not discussed 108 51.2 92 47.4
Pregnant women
Intentions
Plans to give birth in health facility or maternity home 77 89.5 66 89.2
Other location, unsure 9 10.5 8 10.8
Does not intend to have another child 2 2.3 0 0
Behavior (among those with 
previous birth)
Delivered in health facility or maternity home 53 84.1 37 86.0
Other location, unsure 10 15.9 6 14.0
IPC Discussed facility delivery 56 63.6 52 70.3
Has not discussed 32 36.4 22 29.7
Equitable Gender Norms
Indicators on agreement with two inequitable gender norms were assessed among life stage sample 
respondents at both T1 and T3; results are shown in Table 16. The proportion of respondents 
disagreeing with the statements increased across the overall sample, with a statistically significant 
improvement in the case of norms around joint responsibility for pregnancy prevention.
Table 24: Self-reported Gender Norms at T1 and T3 by life stage
Indicator Response
T 1 T3
X2, p value
n % Weighted % n % Weighted %
All Life Stage
Pregnancy
prevention
Disagree 1462 66.2 65.7 1356 71.1 69.6 3.72, 0.053 Agree, Unsure 746 33.8 34.3 551 28.9 30.4
Child care Disagree 1365 61.8 59.9 1244 65.2 62.2 1.25, 0.263 Agree, Unsure 843 38.2 40.1 663 34.8 37.8
Young men
Pregnancy
prevention
Disagree 473 67.5 67.3 522 74.6 73.7 5.97, 0.014 Agree, Unsure 228 32.5 32.7 178 25.4 26.3
Child care Disagree 487 69.5 69.5 503 71.9 71.1 0.34, 0.557 Agree, Unsure 214 30.5 30.5 197 28.1 28.9
Young women
Pregnancy
prevention
Disagree 461 65.9 67.0 356 69.7 68.9 0.36, 0.550 Agree, Unsure 239 34.1 33.0 155 30.3 31.1
Child care Disagree 414 59.1 58.1 324 63.4 61.0 0.66, 0.415 Agree, Unsure 286 40.9 41.9 187 36.6 39.0
Male caregivers
Pregnancy
prevention
Disagree 231 75.2 211 77.0
Agree, Unsure 76 24.8 63 23.0
Child care Disagree 213 69.4 198 72.3
Agree, Unsure 94 30.6 76 27.7
Female caregivers
Pregnancy
prevention
Disagree 118 58.7 85 55.2
Agree, Unsure 83 41.3 69 44.8
Child care Disagree 91 45.3 66 42.9
Agree, Unsure 110 54.7 88 57.1
Partners of pregnant women
Pregnancy
prevention
Disagree 141 66.8 134 69.1
Agree, Unsure 70 33.2 60 30.9
Child care Disagree 124 58.8 120 61.9
Agree, Unsure 87 41.2 74 38.1
Pregnant women
43
Indicator Response
T 1 T3
X2, p value
n % Weighted % n % Weighted %
Pregnancy
prevention
Disagree 38 43.2 48 64.9
Agree, Unsure 50 56.8 26 35.1
Child care Disagree 36 40.9 33 44.6
Agree, Unsure 52 59.1 41 55.4
Objective 3: Relationships between Exposure and Behaviors and Interpersonal 
Communication
Dose-Response Relationships Among the Life Stage Sample
Although changes in behavior and behavior determinants were marginal between T1 and T3, cross 
tabulation of structural exposure (i.e. radio or TV viewership), GLLiW coverage (i.e. exposure to 
GLLiW health ads), and exposure intensity (i.e. number of messages heard or seen in the last month) 
variables with behaviors showed that performance of three promoted behaviors was generally higher 
among life stage sample respondents who reported exposure to GLLiW messages and among those 
reporting increasing exposure to messages in the previous month (regardless of branding) (Table 17).
These associations reached statistical significance for bednet use the previous night and handwashing 
after using the toilet. Use of modern family planning showed a trend in higher use with increasing 
exposure, but this analysis did not reach statistical significance. 
Table 25: Health Practices by Level of Exposure to Health Messages at T3, Among Entire life stage Sample at T3
Exposure Bednet use last night Handwashing after using 
toilet
Using modern family 
planning method^
Total, weighted % Total, weighted % Total, weighted %
TV
None/few days 873, 37.9 873, 81.7 259, 85.3
Most/every day 1034, 39.4 1034, 85.6 328, 81.3
Radio
None/few days 1092, 33.8*** 1092, 82.8 329, 82.7
Most/every day 815, 45.8 815, 85.2 258, 83.6
Coverage
No/not sure 458, 18.9*** 432,72.1*** 89, 75.0
Yes 1449, 44.5 1475, 87.2 498, 84.7
Intensity
0 messages 443, 29.6** 654, 76.0*** 208, 80.5
1-10 messages 694, 39.4 759, 86.3 238, 84.2
>10 messages 770, 43.5 494, 89.8 141, 85.1
***p<.0001; **p<.01; *p<.05. Chi-squared tests conducted for overall test of differences between exposure variable and health 
practice. Percentages are weighted.
^Among life stage respondents who are sexually active, not pregnant or trying to become pregnant
As shown in Table 18, multivariable logistic regression showed that respondents in the life stage sample 
who reported exposure to GLLiW health-topic specific advertising were more likely to have discussed 
promoted behaviors with others, intend to perform the behavior in the future, and to have performed 
promoted behaviors within the recall period, even after adjusting for covariates. These associations 
were significant for bednet use. Significant interactions were observed, however, between the coverage 
variable and education for IPC and intentions related to modern FP method use (Annex 4, Tables 54 and 
57).
44
Table 26: Comparison of Exposure versus No Exposure to GLLiW Messages and Interpersonal Communication and 
Behavior on Integrated Health Practices, among Entire life stage Sample at T3
Variable Exposed versus not exposed
(adjusted OR1, 95% CI)
p value
Bednet use last night 3.61 (2.61, 5.00) <.001
Interpersonal communication about handwashing 3.37 (2.51, 4.51) <.001
Handwashing intentions 1.86 (1.42, 2.44) <.001
Handwash after using the toilet 2.53 (1.85, 3.47) <.001
Interpersonal communication about family planning 1.83 (1.17, 2.87) <.01
Intentions to use method for pregnancy prevention 1.27 (0.78, 2.06) 0.335
Modern family planning use2 1.96 (0.96, 4.04) 0.066
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
2For this outcome, we had to combine no education with primary education for the model to run
Figures 11-13 provide further detail on the proportion of life stage respondents who reported exposure 
to GLLiW health-specific messaging who also reported practicing promoted behaviors. Bednet use the 
previous night and washing hands with soap and water after the last time using the toilet was reported 
among higher percentages of those exposed to GLLiW messages than among those who did not report 
exposure to GLLiW messages (Figures 11-13). These associations were significant among young men for 
both outcomes and among young women for bednet use (Figure 11); statistical testing was not 
conducted for other life stages due to insufficient sample size (Figure 12). Modern FP method use was 
reported more frequently by young women and male caregivers exposed to GLLiW than among those 
not exposed, although sample sizes were insufficient to assess statistical significance even among young 
men and young women because of the relatively large proportion of youth reporting they were not 
sexually active in the last 12 months (Objective 2, Table 13). Differences were marginal among young 
men and female caregivers (Figure 13).
Figure 12 Priority behaviors among young men and women, comparing exposure to health topic-specific GLLiW 
messages to no exposure or unsure
^All percentage are weighted. 
^^Among sexually active young men and young women; sample size insufficient to assess statistical significance.
0
10
20
30
40
50
60
70
80
90
100
Modern
Method
Use^^
Bednet
use***
Handwashing
after using
toilet
Modern
Method
Use^^
Bednet
use***
Handwashing
after using
toilet***
Percentage^
Young Women Young Men
Not exposed, unsure Exposed
45
***p<0.001. Chi square conducted using weighted data for handwashing behavior and bednet use. Asterisks indicate statistically 
significant differences between exposed/not exposed.
Figure 13 Priority behaviors among pregnant couples, comparing exposure to health topic-specific GLLiW 
messages to no exposure or unsure
^All percentage are unweighted. Sample sizes insufficient for statistical comparisons.
Figure 14 Priority behaviors among caregivers of children under five, comparing exposure to health topic-specific
GLLiW messages to no exposure or unsure
^All percentage are unweighted. Sample sizes insufficient for statistical comparisons.
Dose-Response Relationships Among the National Sample
While most questions about behaviors were limited to respondents who were part of the life stage
sample, self-reported bednet use and adult report of children under five in the household sleeping under 
0
10
20
30
40
50
60
70
80
90
100
Bednet use Handwashing after
using toilet
Bednet use Handwashing after
using toilet
Percentage^
Pregnant Women Partners of Pregnant Women
Not exposed, unsure Exposed
0
10
20
30
40
50
60
70
80
90
100
Modern
method use
Bednet use Handwashing
after using
toilet
Modern
method use
Bednet use Handwashing
after using
toilet
Percentage^
Female Caregivers Male Caregivers
Not exposed, unsure Exposed
46
a bednet were assessed among all respondents who were part of the national sample. Bednet use was 
significantly higher in both priority and non-priority regions among respondents who reported listening 
to the radio most days or every day, among respondents who reported hearing or seeing a GLLiW 
message about ITNs, and among those who were exposed to greater intensity of messages about ITNs
(Table 19).
Table 27 Exposure and Self-reported bednet use for National Sample at T3, by Priority Region Grouping
Exposure Priority Region Non-Priority Region All Regions
Total, weighted % Total, weighted % Total, weighted %
TV
None/few days 1672, 39.6 1261, 43.7 2933, 41.5
Most/every day 2048, 39.5 1554, 45.0 3602, 42.1
Radio
None/few days 2075, 35.4*** 1591, 42.1* 3666, 38.5***
Most/every day 1645, 44.9 1224, 47.5 2869, 46.1
Coverage
No/not sure 919, 20.1*** 567, 28.1*** 1486, 23.4***
Yes 2801, 45.3 2248, 48.2 5049, 46.7
Intensity
0 messages 868, 32.7*** 659, 32.9*** 1527, 32.8***
1-10 messages 1391, 35.6 1029, 45.9 2420, 40.4
>10 messages 1461, 47.3 1127, 49.5 2588, 48.4
Chi-square test conducted for test of differences between exposure variable and health practice. Asterisks indicate statistically 
significant differences. ***p<.001; *p<.05.
These trends remained after controlling for age, education, urban/rural residence, gender and priority 
region (Table 20). There was a significant interaction between the coverage variable (exposure to any 
GLLiW message about ITNs) and level of education; the different levels of association between coverage 
and bednet use across different levels of education are shown in Table 21. All respondents except those 
reporting completion of primary school as the highest level of education had higher odds of reporting 
bednet use if they were exposed to any GLLiW messaging. No other interactions were found.
Table 28 Adjusted Odds Ratio for the Association between Exposure Variables and Self-reported Bednet Use 
Previous Night at T3, National Sample
Exposure Comparison aOR1 (95% CI) p value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.38 (1.18, 1.61) <.001
TV Most/Every day vs None/Few days 0.97 (0.83, 1.12) 0.649
Model 2: Coverage
Exposed to any GLLiW malaria message Yes vs No/Unsure 2.73 (2.24, 3.34) <.001
Model 3: Intensity
Exposure to ITN/Malaria health messages 1-10 vs 0 messages 1.47 (1.19, 1.80) <.001
>10 vs 0 messages 2.12 (1.73, 2.60) <.001
1OR adjusted for age, education, urban/rural residence, gender, and priority region. No interactions tested in this model.
Table 29 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet use the
previous night at T3 only for National Sample
Exposure Comparison aOR1 (95% CI) p value
Coverage
Education
No education Yes vs No/Unsure 5.14 (2.61,10.09) <.001
Primary Yes vs No/Unsure 1.27 (0.70, 2.29) 0.432
47
Exposure Comparison aOR1 (95% CI) p value
Middle/JSS/JHS Yes vs No/Unsure 2.80 (1.73, 4.53) <.001
Secondary Yes vs No/Unsure 3.53 (2.61, 4.77) <.001
Tertiary Yes vs No/Unsure 2.37 (1.67, 3.35) <.001
1OR adjusted for age, education, urban/rural residence, gender, and priority region. Models with significant interactions only.
Similar patterns were seen when looking at respondents who reported children who slept in their 
household the previous night used a bednet. This question was asked of all respondents in the national 
sample who reported having a child under the age of five and at least one child under five sleeping in 
their household the previous night. As shown in Table 22, respondents who listened to the radio most 
or every day, who reported being exposed to at least one of the GLLiW ITN-messages, and higher 
intensity of malaria messages-regardless of branding were more likely to report that all children slept 
under a bed the previous night. Note that while the outcome (all children sleeping under a bednet vs 
not all) is at the household level, the exposures were reported at the individual level.
Table 30 Exposure and All children slept under bednet for National Sample at T3, by priority region grouping
Exposure Priority Region Non-Priority Region All Regions
Total, weighted % Total, weighted % Total, weighted %
TV
None or a few days 334, 50.1 283, 62.0 617, 55.6
Most or every day 519, 56.1 424, 54.3 943, 55.2
Radio
None or a few days 445, 47.5** 390, 52.2* 835, 49.8***
Most or every day 408, 61.2 317, 63.8 725, 62.4
Coverage
No, Not sure 176, 38.8*** 117, 43.5** 293, 40.9***
Yes 677, 57.5 590, 60.1 1267, 58.8
Intensity
0 190, 51.0 164, 46.6* 354, 48.9*
1-10 354, 51.5 263, 56.8 617, 53.9
>10 309, 58.0 280, 63.8 589, 61.0
Chi-square test conducted for test of differences between exposure variable and health practice. Asterisks indicate statistically 
significant differences. ***p<.001; **p<.01; *p<.05.
After controlling for covariates (age, education, urban versus rural residence, gender and priority 
region), radio exposure on most or every day, exposure to any GLLiW malaria messages, and exposure 
to more than 10 malaria messages remained significantly associated with child bednet use (Table 23). No 
interactions were observed between any exposure variables and the control variables.
Table 31 Adjusted Odds Ratios for the Association between Exposure Variables and all Children Under Five in the 
Household Sleeping under Bednet at T3, National Sample
Exposure Comparison aOR1 (95% CI) p value
Model 1: Structural Access
Radio Most/Every day vs 
None/Few days 1.83 (1.37, 2.45) <.001
TV Most/Every day vs 
None/Few days 0.90 (0.67, 1.21) 0.481
Model 2: Coverage
Exposed to any GLLiW malaria message Yes vs No/Unsure 1.98 (1.39, 2.82) <.001
Model 3: Intensity
Exposure to ITN/Malaria health messages
1-10 vs 0 messages 1.37 (0.95, 1.97) 0.094
>10 vs 0 messages 1.71 (1.18, 2.48) 0.005
1OR adjusted for age, education, urban/rural residence, gender, and priority region. No interaction models.
48
Secondary Analyses
Response Rates
Call outcomes and response rates were calculated using American Association for Public Opinion 
Research (AAPOR) standards using unweighted data from all respondents (including those who 
reported their age as 50 or above). Due to complex branching within the survey, a total of 16 call 
outcomes were possible (see Annex 3). 
At T3 the overall response rate for the national sample survey was 20.2 percent, as compared to 31.3
percent at T1 (Response Rate 4, Table 24). The response rate for the combined life stages at T3 was 8.1 
percent, compared to 18.6 percent at T1 (Response Rate 4, Table 24). The cooperation rate remained 
above 80 percent for the national sample at T3 but declined among the life stage sample (Cooperation 
Rate 2,4, Table 24). 
Table 32 Response, cooperation, refusal and contact rates for national and life stage sample (aggregate) at T1 and 
T3
National Sample Life Stage Sample
T1 T3 T1 T3
Response Rate 1 0.211 0.095 0.062 0.030
Response Rate 2 0.290 0.186 0.084 0.038
Response Rate 3+ 0.228 0.104 0.138 0.064
Response Rate 4+ 0.313 0.202 0.186 0.081
Cooperation rate 1,3 0.592 0.427 0.393 0.285
Cooperation rate 2,4 0.813 0.832 0.530 0.358
Refusal Rate 1 0.067 0.037 0.074 0.068
Refusal Rate 2+ 0.072 0.041 0.165 0.145
Refusal Rate 3 0.187 0.168 0.470 0.642
Contact Rate 1 0.357 0.223 0.158 0.106
Contact Rate 2+ 0.385 0.243 0.350 0.226
Contact Rate 3 1.000 1.000 1.000 1.000
+Indicates these rates were adjusted for ‘e’ following the AAPOR guidelines. ‘e’ was computed as follows: National 
Sample T1=.888 and T3=.894; Life Stage Sample T1=.349 and T3=.406.
For the life stage calculations, the outcomes that had the greatest impact on response rates include: 
• Completed Interview – Answered the last substantive question (Gender Norms for all 
respondents)
• Partial Interview – Consented to participate in the life stage portion of the survey and answered 
at least one substantive question but dropped off before answering the final substantive question.
• Eligibility Unknown – In order to determine eligibility, a participant must have provided responses 
to questions on age, gender, region, age of the youngest child, and pregnancy status. Respondents 
who did complete these questions were treated as unknown eligibility for response rate purposes. 
• Not Eligible – Includes respondents who are explicitly ineligible based on age and target region, as 
well young men who would have been eligible, but the life stage sample quota was already filled. 
Average Cost per Complete Survey Response
The average cost complete national sample survey at T3 was $5.84 and $20.80 per completed life stage
interview (106 Ghanaian Cedis as of market close August 15, 2019). This figure includes setup costs for 
the finalized survey instrument (translations, audio recordings, labor to setup the IVR survey) and data 
49
collection costs (mobile airtime, airtime incentives for female participants, labor to execute the survey). 
Additional project costs for post-collection data analysis are not included. Further discussion of the cost 
per survey at T1 is included in the baseline report. Overall, costs of airtime increased between survey 
waves and more calls were required to locate eligible respondents and to achieve a complete survey 
(Table 25).
Table 33 Cost inputs for life stage survey responses at T1 and T3
T1 T3
Telephone numbers used to get an eligible contact 188 142
Telephone numbers used to get a full (complete) interview 478 590
Average survey length (mins) 15.62 15.60
Average cost per completed life stage sample interview 55 cedis 106 cedis
Potential Limitations
The primary limitation of the evaluation is selection bias related to recruiting a convenience sample and 
conducting surveys via mobile phone. While Communicate for Health’s communication campaigns are 
promoted nationally through mass media such as radio and TV, the sampling frame is limited to mobile 
phone users. While mobile phone penetration is fairly high in Ghana11, use rates are lower among 
women and rural users, which is reflected in our larger sample of men and urban respondents in the 
national sample. Overall, we were unable to recruit adequate sample sizes among male caregivers of 
children under five, female caregivers of children under five, pregnant women, or partners of pregnant 
women to allow for statistical comparison across years within our project timeline and budget. The 
project prioritized English and four local languages spoken in the USAID priority regions (Northern -
Dagbani, Western and Central -Twi, Greater Accra -Ga, Volta -Ewe) so it was possible that some 
language groups in non-priority regions may not have been reached as effectively during the survey. 
Additionally, prior experience shows that response rates decrease for IVR surveys with more than 20 
questions, and thus we could only ask a limited number of questions per participant. Furthermore, 
without a face-toface interviewer we could not probe or ask clarifying questions of participants or vice 
versa, which may reduce the number of respondents consenting to complete the survey or increase the 
number of respondents who complete only part of the survey. While errors due to data reentry are 
eliminated by use of IVR technology, there is potential that respondents may enter the wrong key and 
thus give incorrect or unintelligible responses. 
Conclusions and Recommendations
USAID Communicate for Health conducted a final cross-sectional IVR survey from July 6, 2019 to 
August 31, 2019 to assess behavioral outcomes for the project’s GoodLife, Live it Well campaigns rolled 
out since 2015. The analysis had three main objectives: 1) monitor exposure to project campaign 
messages among target audiences; 2) monitor shifts in self-reported behavioral determinants and 
behaviors; and 3) examine dose-response relationships between exposure to messages and self-reported 
 
11 Adult ownership of smartphone or basic phone estimated at 80% (Internet Connectivity Seen as Having Positive 
Impact on Life in Sub-Saharan Africa. Pew Research Center, 2018)
50
behavioral determinants and behaviors. This section of the report summarizes key findings and 
recommendations from the baseline (T1) and follow on (T3) surveys. 
Background characteristics: Respondents shared similar background characteristics across the two 
timepoints (more men, more young men, more urban dwellers, more single respondents and only one in 
four respondents had a child under 5). There were minimal differences in education level and general 
media exposure between T1 and T3. At least seven in ten respondents had completed middle/ Junior 
High School or higher level of education with a significantly higher proportion completing tertiary or 
higher level of education at T3 (25.6 percent) than T1 (20.0 percent). Overall, TV viewership increased 
(from 80 percent to 82 percent) while radio listenership declined at T3 (from 79 percent to 75 percent).
Exposure to communication messages: Generally, exposure to programming was high for all 
health topic areas especially for FP/RH (80.1 percent). Exposure to any ITN messages improved 
significantly from 74 percent at T1 to 78 percent at T3 across the national sample. Although not an 
explicit target of our analysis, there was some evidence that the life stage targeting of messages was 
effective, as recall of the YOLO program was highest among young adults-the intended audience of this 
campaign. From 2017 to 2019, YOLO received over 21 million YouTube views, 640,000 Facebook likes, 
460,000 Instagram and 63,000 Twitter followers, the majority of whom were young people. Use of life 
stage-based programs tailored to carefully segmented audiences may be critical for reach and impact.
Behavioral determinants and behaviors: Across most topics, interpersonal communication and 
behavioral intentions saw minimal improvements, possibly because reports were high at T1. Self￾reported bednet use increased significantly across all regions from 36.3 percent to 41.8 percent. 
Although bednet use improved among pregnant women, it remained unchanged among children under￾five according to caregiver reports. Malaria programming (S and short stories) broadcasted in 2018 and 
2019 had minimal focus on malaria prevention in under-fives and this might have impacted on the trend 
observed. Majority of respondents reported practicing handwashing after using the toilet although the 
availability of handwashing stations with soap and water didn’t increase substantially among life stage 
audiences. Modest increases in use of modern methods to prevent or delay pregnancy were recorded 
between T1 and T3 for sexually active young men who said their partner was not currently pregnant or 
planning to become pregnant and among sexually active female caregivers who were not currently 
pregnant or trying to become pregnant. The survey recorded modest changes in the types of modern 
methods being used, particularly in use of condoms and long acting/permanent methods. Facility delivery 
and intentions surrounding the behavior remained high at both time points. The survey recorded 
significant improvements in equitable gender norms around joint responsibility (both males and female) 
for pregnancy prevention increasing from 66 percent at T1 to 70 percent at T3.
Relationships between exposure and behavioral determinants and behaviors: For the first 
time IVR and RDD was used to demonstrate a dose response relationship between exposure to 
messaging, behavioral determinants and behaviors. Although we generally did not see large changes in 
behavior determinants or behaviors over time, we found radio consumption, recall of GLLiW 
programming, and greater intensity of messaging (number of messages heard or seen) were significantly 
associated with behavior adoption and determinants for most health topics at T3. In particular, there 
was a strong association between exposure variables and practicing the desired behaviors of sleeping 
under an ITN and handwashing after using the toilet. Respondents exposed to GLLiW ITN messaging 
were more likely to sleep under an ITN than those not exposed (3.61 for life stage sample and 2.73 for 
national sample). Similarly, caregivers who were exposed to ITN adverts were 1.93 times more likely to 
report all their children under five slept under an ITN net than those not exposed. Again, audiences 
51
exposed to GLLiW hand washing programming were 2.53 times more likely to wash their hands after 
last using the toilet. Although radio listenership declined across the two time periods, it appears to 
remain an effective media for behavior change, as listening to the radio every or most days was 
significantly associated with behaviors across most health topics promoted by the Communicate for 
Health project. 
Overall, the GLLiW programming developed and broadcast by the Communicate for Health project was 
associated with positive behaviors. USAID and GoG should sustain these patterns through the 
continued and intensified use of mass media especially radio to broadcast audience segmented 
programming on popular stations in local languages at prime time. The project was limited to using 
“above the line” mass media programming to influence behavior change but future SBCC programs may 
need an approach that combines “above the line” and “below the line” interpersonal communication and 
community engagement using a variety of channels targeting multiple audiences with behavior change 
programs to reach “last mile” audiences. SBCC approaches should always be paired with appropriate 
structural interventions and health systems strengthening to ensure increased demand is commensurate 
with access to high quality services and that barriers that cannot be addressed through mass media alone 
(such as poverty, experience or threat of violence, or experience or fear of stigmatization) are tackled. 
Learning from IVR/RDD. In Ghana, USAID Communicate for Health found that using IVR and RDD 
methodology was most suitable for reaching populations with higher access to mobile phones, especially 
people 35 and younger from urban or peri-urban areas and men. Response rates for both the national 
and life stage samples declined at T3 due to varied factors. In the future, supplementing mobile phone 
surveys with household surveys for rural areas and areas with low mobile penetration could address 
coverage bias. 
Audio bytes of adverts were included in the survey at T3, which may have helped to improve recall
across all health topics. To sharpen measurement of recall of health communication messages, programs 
need to include some identifiable aspects of their messaging (e.g., logo, character, audio byte etc.) in the 
survey questionnaire. However, the comparing exposure to exact message clips at multiple timepoints 
can be challenging, as a true baseline would occur early in the life of projects (before exposure) and 
campaign materials may change over the course of the project. As noted in the introduction, GLLiW 
broadcasts ended before the final survey due to program close out. Restricting respondents’ exposure 
to a one-month time frame (to match the reporting period at T1) might have lowered reports of 
intervention exposure, at T3 and in part helps to explain any decreases and nonsignificant shifts in 
exposure observed at T3.
52
Annexes
Annex 1: T3 Questionnaire
LANGUAGE SELECTOR
Hello, I am calling from Ghana Health Service. I also speak Ga, Ewe, Dagbani, and English. (In Twi)
To continue in English, press 1. To continue in Ga, press 2. To continue in Twi, press 3. To continue in Ewe, press 
4. To continue in Dagbani, press 5. To repeat this question, press [*] at any time.
INTRO
Hello, we are conducting research for the Ghana Health Service and USAID to learn more about Ghanaians 
health practices. This call is free, confidential, and voluntary. We will never ask for your name. I would like to ask 
you a few questions about your health. The questions I will ask are pre-recorded and you will answer by [pressing 
the numbers] on your phone. Please listen to all the answer options; you can press [*] to repeat the question at 
any time. You must be 18 or older to participate.
Press 1 to give your input now. 
Press 2 if you cannot talk now. You are welcome to call me back at this number at any time in the next few days 
to give your input.
1 →Screening & Demographics
Q# Question Responses Directions
D.1 How old are you? 1. <18
2. 18-24
3. 25-35
4. 36 to 49 
5. 50 and older
→Ineligible: Closing message
D.2 Are you female or male? 1. Female 
2. Male 
All = D3
D.3 In which region do you primarily 
reside?
1. Ashanti
2. Greater Accra
3. Eastern
4. Western
5. Brong Ahafo
6. Northern
7. Central
8. Volta
9. Upper East
0. Upper West
Focus regions (2, 4, 6, 7 & 8) 
= D4 to end
Other regions (1, 3, 5, 9, 10) 
= D4 to SO6 and SO5.1. 
SO5.2 if has child under 5)
D.4 How old is your youngest child? 1. I don’t have any children 
2. Under five years
3. 5 and 17 years
4. 18 or older
If female → D5a
If male → D5b
D.5a [Women only] Are you currently 
pregnant?
1. Yes
2. No
All →D7
D.5b [Men only] Do you have a female 
partner who is currently 
pregnant?
1. Yes
2. No
All → D7
D.7 What is the highest level of 
education you have completed?
1. No education 
2. Primary
All → D8
53
3. Middle/JSS/JHS
4. Secondary/SSS/SHS/ 
Vocational/Technical
5. Tertiary or higher
D.8 Are you currently single, married 
or living with a partner, separated 
or divorced, or widowed?
1. Single
2. Married or living with a 
partner
3. Separated or divorced
4. Widowed
All →D9
D.9 Do you live in an urban or rural 
community?
1. Urban
2. Rural
All → E1
Exposure–all respondents
Q# Question Responses Directions
E.1 In the last 7 days, how often did you listen to the radio? 1. Every day
2. Most days
3. A few days
4. Not at all
All → E2
E.2 In the last 7 days, how often did you watch television? 1. Every day
2. Most days
3. A few days
4. Not at all
All → E3
E.3 Have you heard of the GoodLife Live it Well campaign? The 
campaign has messages like this: (include an audio clip with new 
branding)
1. Yes
2. No
3. Not sure
All → SO4
SO4 In the past month, about how many messages or adverts have 
you seen or heard about handwashing, including on the radio, 
TV, posters, billboards, or other channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages 
or adverts
3. 1-5 messages or 
adverts
4. Zero messages 
or adverts
All → SO3
SO3 In the past month, about how many messages or adverts have 
you seen or heard about preventing or delaying pregnancy, 
including on the radio, TV, posters, billboards, or other channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages 
or adverts
3. 1-5 messages or 
adverts
4. Zero messages 
or adverts
All →
SO3b.1
SO3b.1 Have you heard or seen this message on family planning (Audio clip) 1. Yes
2. No
3. Not sure
All →
SO3b.2
SO3b.2 Have you heard or seen this message on family planning (Audio clip) 1. Yes
2. No
3. Not sure
All →
SO3b.3
54
SO3b.3 Have you heard or seen any message on YOLO? YOLO has 
messages like (Include YOLO sound track)
1. Yes
2. No
3. Not sure
All →
SO5/6
SO5/6 In the past month, about how many messages or adverts have 
you seen or heard about using insecticide treated nets to 
prevent malaria, including on the radio, TV, posters, billboards, 
or other channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages 
or adverts
3. 1-5 messages or 
adverts
4. Zero messages 
or adverts
All →
SO5a
SO5a Have you heard or seen this message about malaria? (Audio clip) 1. Yes
2. No
3. Not sure
All → SO5b
SO5b Have you heard or seen this message about malaria? (Audio clip) 1. Yes
2. No
3. Not sure
All → SO6
SO6 Last night, did you sleep under an insecticide 
treated net?
1. Yes
2. No
If D.4 =2 → SO5.1
If not and D.3 = 1, 3, 5, 9 & 10 
→ closure message
If not and D.3 = 2, 4, 6, 7, & 8 
→ continue to informed 
consent
Parents of children under five only
SO5.1 How many children under five live in your 
household?
1. 1
2. 2.
3. 3
4. 4
5. 5 or more
6. None
All to next
SO5.2 Last night, how many of the children under 5 in 
your household slept under an insecticide 
treated net?
1. 1
2. 2
3. 3
4. 4
5. 5 or more
6. None
All to next 
[Branching] 1. Eligible, quota 
not met
2. Eligible, quota 
met
3. Ineligible
→Informed Consent
→Ineligible: Closing message
→Ineligible: Closing message
Ineligible/Quota Met Closing 
Thank you for taking time to tell us about yourself. Your information and feedback will ultimately improve the 
health and well-being of Ghanaians. If you have any questions, please call the toll free number 030-708-2151 or 
I can send you a text with this information. 
55
Press 1 if you would like a text copy of this information. Press 2 if you do not want a copy.
Youth/Young Adult Informed Consent
Thanks for telling us a little more about you. Young people are the future of Ghana. Ghana Health Service needs 
your input to make sure their efforts are reaching people like you. We would like you to be part of a group of 
young people who provide us information about young people’s health beliefs and behaviors. 
If you would like to be part of this important group, press 1 now. 
You can finish the questions now or call back any time in the next few days to pick up where you leave off.
Press 1 to finish now. 
Press 2 if you cannot talk now. You are welcome to call me back at this number at any time in the next few days
to finish.
Pregnant Women/Female Caregivers Informed Consent 
Thanks for telling us a little more about you. Mothers are so important to the future of Ghana. Ghana Health 
Service needs your input to make sure their efforts are reaching people like you. We would like you to be part of 
a group of pregnant women and mothers of young children who provide us information about health beliefs and 
behaviors. You will receive free airtime within 7 days if you complete the survey. 
If you would like to be part of this important group, press 1 now. 
You can finish the questions now or call back any time in the next few days to pick up where you leave off.
Press 1 to finish now. 
Press 2 if you cannot talk now. You are welcome to call me back at this number at any time in the next few days 
to finish.
Partners of Pregnant Women/Male Caregivers Informed Consent
Thanks for telling us a little more about you. Fathers are so important to the future of Ghana. Ghana Health 
Service needs your input to make sure their efforts are reaching people like you. We would like you to be part of 
a group of fathers of young children and expectant fathers who provide us information about health beliefs and 
behaviors. 
If you would like to be part of this important group, press 1 now. 
You can finish the questions now or call back any time in the next few days to pick up where you leave off.
Press 1 to finish now. 
Press 2 if you cannot talk now. You are welcome to call me back at this number at any time in the next few days 
to finish.
LIFE STAGE QUESTIONNAIRE
SO2: Facility-based birth –pregnant women; female caregivers of children under 5
Q# Question Responses-Keypad 
entry code
Directions
56
SO2.1.1 The last time you gave birth, where did you give birth? 1. At a health facility 
or maternity 
home
2. At home 
3. At a prayer camp
4. Have not given 
birth yet
5. Not sure
SO2.1.3 [Pregnant women only] In the past 3 months, have you talked 
to anyone about giving birth at a health facility, like a friend, 
your partner, or a family member?
1. Yes
2. No
Do not ask 
C<5
SO2.1.4 In the past month, about how many messages or adverts have 
you seen or heard about giving birth at a health facility, 
including on the radio, TV, posters, billboards, or other 
channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages or 
adverts
3. 1-5 messages or 
adverts
4. Zero messages or 
adverts
SO2.1.5 When you next give birth, where do you plan to deliver? 1. At a health facility 
or maternity 
home
2. At home
3. At a prayer camp
4. Do not plan to 
give birth again
5. Not sure
SO2: Facility-based birth –partners of pregnant women; male caregivers of children under 5
Q# Question Responses-Keypad 
entry code
Directions
SO2.2.1 The last time your wife or partner gave birth, where did she 
give birth?
1. Have not given 
birth yet
2. At a health facility 
or maternity 
home
3. At home 
4. At a prayer camp
5. Not sure
SO2.2.3 [Partners of pregnant women only] In the past 3 months, 
have you talked to anyone about giving birth at a health 
facility, like a friend, your partner, or a family member?
1. Yes
2. No
Do not ask 
C<5
SO2.2.4 In the past month, about how many messages or adverts have 
you seen or heard about giving birth at a health facility, 
including on the radio, TV, posters, billboards, or other 
channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages or 
adverts
3. 1-5 messages or 
adverts
57
4. Zero messages or 
adverts
SO2.2.6 When your wife or partner next gives birth, where do you 
plan to deliver?
1. At a health facility 
or maternity 
home
2. At home 
3. At a prayer camp
4. Do not plan to 
have a child again 
5. Not sure
SO4: Availability of handwashing materials – youth/young adult; pregnant women; mothers of children under 5
Q# Question Responses-Keypad 
entry code
Directions
SO4.1 In your household, do you have a designated place for handwashing? 1. Yes
2. No
→SO4.2
→SO4.8
SO4.2 At your handwashing station, how often do you have both soap and 
water available?
1. Never 
2. A few times
3. Most of the 
time
4. Every time
SO4.8 Did you wash your hands with soap under water the last time you 
used the toilet?
1. Yes
2. No
SO4.4 In the past three months, have you talked to anyone about 
handwashing with soap and water, like a friend, your partner, or a 
family member?
1. Yes
2. No
SO4.6 Have you heard or seen this message about handwashing? (audio clip) 1. Yes
2. No
3. Not sure
SO4.7 In the next three months, when you wash your hands, how often do 
you plan to use both soap and water?
1. Every time
2. Most of the 
time
3. A few times
4. Not at all
SO3: Sexual Activity—Youth, young adult; Caregivers of C<5
Q# Question Responses-Keypad entry code Directions
SO1.0.1 In the last 12 months, have you had sex? 1. Yes
2. No
→SO3.1.1
→SO3.3.2
SO3: Use of modern contraception – sexually active youth/young adult; sexually active caregiver of children under 
5
Q# Question Responses-Keypad entry code Directions
SO3.1.1 Are you or your partner currently doing 
anything to delay or prevent pregnancy?
1. Yes I am using a method
2. No because I am trying to 
get pregnant
3. No I am not using a method
4. Don’t know
→SO3.1.2
→SO3.1.4 only 
then go to next 
section
→SO3.1.4
→SO3.1.4
58
SO3.1.2 What is the main method you or your 
partner use for preventing or delaying 
pregnancy?
1. Male or female condoms 
2. Emergency contraception
3. Injectables or daily pills 
4. Implants, IUCD, or 
permanent sterilization
5. Calendar method or 
lactation amenorrhea
6. Natural or traditional 
methods, withdrawal, herbs, 
or something else
7. Don’t know
SO3.1.4 In the past three months, have you talked to 
anyone about preventing or delaying 
pregnancy, like a friend, your partner, or a 
family member?
1. Yes
2. No
SO3.1.5 In the next 3 months, do you plan to use a 
method to prevent or delay pregnancy?
1. Yes
2. No
SO3: Use of modern contraception – pregnant women and partners of pregnant women
Q# Question Responses-Keypad 
entry code
Directions
SO3.2.2 In the past three months, have you talked to anyone about 
delaying pregnancy after your baby is born, like a friend, your 
partner, or a family member?
1. Yes
2. No
SO3.2.3 After your child is born, do you plan to use a method to delay or 
prevent pregnancy?
1. Yes
2. No
SO3: Use of modern contraception – not sexually active youth/young adult; not sexually active caregiver of 
children under 5
Q# Question Responses-Keypad 
entry code
Directions
SO3.3.2 In the past three months, have you talked to anyone about 
preventing or delaying pregnancy, like a friend, your partner, or a 
family member?
1. Yes
2. No
SO3.3.3 In the next 3 months, do you plan to use a method to prevent or 
delay pregnancy?
1. Yes 
2. No
SO5: Children under 5 sleep under bednet – caregivers of children under 5
Q# Question Responses Directions
SO5.2b In the past three months, have you talked to anyone about using 
insecticide treated nets to prevent malaria in children under five, like a 
friend, your partner, or a family member?
1. Yes
2. No
SO5.3 In the next three months, how often do you plan for your children under 
five to sleep under an insecticide treated net?
1. Every 
night
2. Most 
nights
59
3. A few 
nights
3. Not at 
all
SO6: Pregnant women sleep under bednet –pregnant women
Q# Question Responses￾Keypad entry 
code
Directions
SO6.1.2 In the last three months, have you talked to anyone about using an 
insecticide treated net to prevent malaria during pregnancy, like a 
friend, your partner, or a family member?
1. Yes
2. No
SO6.1.3 In the next three months, how often do you plan to sleep under an 
insecticide treated net?
1. Every night
2. Most nights
3. A few nights
3. Not at all
SO6: Pregnant women sleep under insecticide treated net –partners of pregnant women
Q# Question Responses￾Keypad entry 
code
Directions
SO6.2.1 Last night, did your pregnant partner sleep under an insecticide 
treated net?
1. Yes
2. No
SO6.2.3 In the last three months, have you talked to anyone about using an 
insecticide treated net to prevent malaria during pregnancy, like a 
friend, your partner, or a family member?
1. Yes
2. No
SO6.2.5 In the next three months, how often do you plan to assist your 
pregnant partner to sleep under an insecticide treated net?
1. Every night
2. Most nights
3. A few nights
4. Not at all
SO7: Exclusive Breastfeeding – – Caregivers of children <6 months
Q# Question Responses-Keypad 
entry code
Directions
SO7.0 How old is your youngest child in months? 1. Less than 6 
months
2. 6-8 months
3. More than 8 
months
<6 mo→SO7.6
6-8mo→SO8.5
>8mo→IR1.5.1
SO7.6 In the past month, about how many messages or adverts have 
you seen or heard about feeding only breastmilk within the 
first six months, including on the radio, TV, posters, billboards, 
or other channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages 
or adverts
3. 1-5 messages 
or adverts
4. Zero messages 
or adverts
60
SO7.8 Have you heard or seen this message about breastfeeding? 
(audio clip)
1. Yes
2. No
3. Not sure 
SO8: Complementary Feeding – Caregivers of Children 6-8 months 
Q# Question Responses-Keypad 
entry code
Directions
SO8.5 In the past month, about how many messages or adverts have you 
seen or heard about introducing semi solid and soft foods to 
children over six months, in addition to breastmilk, including on the 
radio, TV, posters, billboards, or other channels?
1. More than 10 
messages or 
adverts
2. 6-10 messages 
or adverts
3. 1-5 messages 
or adverts
4. Zero messages 
or adverts
IR1.5: Gender – youth/young adult; pregnant women and partners; caregivers of children under 5
Q# Question Responses-Keypad 
entry code
Directions
IR1.5.1 Do you agree or disagree that the daily care of children is only 
a woman’s responsibility?
1. Agree
2. Disagree 
3. Not sure
IR1.5.2 Do you agree or disagree that it is only a woman’s 
responsibility to avoid getting pregnant.
1. Agree
2. Disagree
3. Not sure
Closing
This survey came to you by kind courtesy of the USAID. 
If you have any questions, please call the toll number 030-708-2151 or I can send you a text with this 
information. 
Thank you for participating.
Annex 2: T3 Data Dictionary
Table 34 Data Dictionary
T3 Variable Question/ Coding
d1_age 17 or younger, 1 
between 18 and 24, 2 
between 25 and 35 3 
between 36 and 49, 4 
50 or older, 5
d2_gender female, 1 
male, 2
d3_region Ashanti, 1 
Greater Accra, 2 
Eastern, 3 
Western, 4 
61
T3 Variable Question/ Coding
Brong Ahafo, 5 
Northern, 6 
Central, 7 
Volta, 8 
Upper East, 9 
Upper West, 0
PriorityRegion D3_region = 2, 4, 6, 7, 8 
D4_Youngest_Child don't have any children, 1 
under 5 years old, 2 
between 5 and 17 years old, 3 
18 years or older, 4 
D5a_Pregnant [Women only] 
yes, 1
no, 2
D5b_Partner_Pregnant [Men only] 
yes, 1
no, 2
Cohort Pregnant Woman: D1_age =2, 3, 4, 5; d2_gender=1; D3_region = 2, 4, 6, 7, 8; 
D5b_Partner_Pregnant=1
Partner of Pregnant Woman: D1_age =2, 3, 4, 5; d2_gender=2; D3_region = 2, 4, 
6, 7, 8; D5a_Pregnant=1
Female Caregiver: D1_age =2, 3, 4, 5; d2_gender=1; D3_region = 2, 4, 6, 7, 8; 
D4_Youngest_Child=2
Male Caregiver: D1_age =2, 3, 4, 5; d2_gender=2; D3_region = 2, 4, 6, 7, 8;
D4_Youngest_Child=2
Young Woman: D1_age =2; d2_gender=1; D3_region = 2, 4, 6, 7, 8
Young Man: D1_age =2; d2_gender=2; D3_region = 2, 4, 6, 7, 8
D7_Education have not completed any formal education, 1
primary school , 2
JHS or middle school, 3
SHS or vocational training , 4
University or higher, 5
D8_MaritalStatus single, 1 
currently married or living with a partner, 2 
separated or divorced, 3 
widowed, 4 
D9_Urban_Rural urban area or city, 1 
rural area or small town, 2 
E1_Listen_Radio every day, 1 
most days, 2 
just a few days, 3 
did not listen at all, 4 
E2_Watch_TV In the last 7 days, how often did you watch television?
every day, 1 
most days, 2 
just a few days, 3 
did not listen at all, 4
E3_Know_GLLiW Have you heard of the GoodLife Live it Well campaign? The campaign has 
messages like this: (include an audio clip with old branding)
yes, 1
no, 2
not sure, 3
IR1_5_1_Child_Care Do you agree or disagree that it is only a woman’s responsibility to care for 
children.
agree, 1
62
T3 Variable Question/ Coding
disagree, 2 
not sure, 3
IR1_5_2_AvoidPreg Do you agree or disagree that it is only a woman’s responsibility to avoid getting 
pregnant.
agree, 1
disagree, 2 
not sure, 3
SO1_0_1_PastSexActiv In the last 12 months, have you had sex?
yes, 1
no, 2
SO2_1_1_PastBirthLoc_Female The last time you gave birth, where did you give birth?
not yet given birth, 1 
health facility or maternity home, 2 
at home, 3 
prayer camp, 4 
not sure, 5
SO2_1_3_TalkedBirthLoc_Female (Among pregnant women) In the past 3 months, have you talked to anyone about 
giving birth at a health facility, like a friend, your partner, or a family member?
yes, 1
no, 2
SO2_1_4_Adverts_BirthLoc_Female In the past month, about how many messages or adverts have you seen or heard 
about giving birth at a health facility, including on the radio, TV, posters, 
billboards, or other channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't seen or heard any, 4
SO2_1_5_FutureBirthLoc_Female When you next give birth, where do you plan to deliver?
health facility or maternity home, 1 
at home, 2 
prayer camp, 3 
do not plan to give birth again, 4 
not sure, 5 
SO2_2_2_1_PastBirthLocPart_Male The last time your wife or partner gave birth, where did she give birth?
not yet given birth, 1 
health facility or maternity home, 2 
at home, 3 
prayer camp, 4 
not sure, 5
SO2_2_3_TalkedBirthLocPart_Male (Among partners of pregnant women) In the past 3 months, have you talked to 
anyone about giving birth at a health facility, like a friend, your partner, or a family 
member?
yes, 1
no, 2
SO2_2_4_Adverts_BirthLocPart_Male In the past month, about how many messages or adverts have you seen or heard 
about giving birth at a health facility, including on the radio, TV, posters, 
billboards, or other channels
more than 10, 1 
6-10, 2 
1-5, 3 
haven't seen or heard any, 4
SO2_2_6_FutureBirthLocPart_Male When your wife or partner next gives birth, where do you plan to deliver?
health facility or maternity home, 1 
at home, 2 
prayer camp, 3 
63
T3 Variable Question/ Coding
do not plan to give birth again, 4 
not sure, 5
SO3_Adverts_Contraception In the past month, about how many messages or adverts have you seen or heard 
about preventing or delaying pregnancy, including on the radio, TV, posters, 
billboards, or other channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't seen or heard any, 4
*SO_3b_1_FamilyPlanning_GLLiW Have you heard or seen this message on family planning (Audio clip)
yes, 1
no, 2 
not sure, 3
*SO_3b_2_FamilyPlanning_GLLiW Have you heard or seen this message on family planning (Audio clip)
yes, 1
no, 2 
not sure, 3
*SO_3b_3_YOLO Have you heard or seen this message on YOLO (Audio clip)
yes, 1
no, 2 
not sure, 3
*GLLiW_Exp_FP Exposure to ANY GLLiW FP message
SO_3b_1_FamilyPlanning_GLLiW, SO_3b_2_FamilyPlanning_GLLiW, OR 
SO_3b_3_YOLO = 1
SO3_1_1_Current_Contra_Use_SA (Among those sexually active, self/partner not currently pregnant) Are you or 
your partner currently doing anything to delay or prevent pregnancy?
using a method, 1 
trying to get pregnant, 2 
not using a method, 3 
don’t know, 4 
SO3_1_2_Contra_Method_SA (Among those using a method) What is the main method you or your partner use 
for preventing or delaying pregnancy?
Male or female condoms, 1 
Emergency contraception, 2 
Injectables or daily pills, 3 
Implants, IUCD, or permanent sterilization, 4 
Calendar method or lactation amenorrhea, 5 
Natural or traditional methods, withdrawal, herbs or something else, 6 
If you don’t know, 7 
SO3_1_4_TalkedContra_SA (Among those sexually active, self/partner not currently pregnant or trying to 
become pregnant) In the past three months, have you talked to anyone about 
preventing or delaying pregnancy, like a friend, your partner, or a family member
yes, 1
no, 2
SO3_1_6_FutureContra_Use_SA (Among those sexually active, self/partner not currently pregnant or trying to 
become pregnant) In the next 3 months, do you plan to use a method to prevent 
or delay pregnancy?
yes, 1
no, 2
SO3_2_2_TalkedContra_PPFP (Among those currently pregnant/partner currently pregnant) In the past three 
months, have you talked to anyone about delaying pregnancy after your baby is 
born, like a friend, your partner, or a family member?
yes, 1
no, 2
64
T3 Variable Question/ Coding
SO3_2_3_FutureContra_Use_PPFP (Among those currently pregnant/partner currently pregnant) After your child is 
born, do you plan to use a method to delay or prevent pregnancy?
yes, 1
no, 2
SO3_3_2_TalkedContra_NSA (Among those not sexually active, self/partner not currently pregnant) In the past 
three months, have you talked to anyone about preventing or delaying pregnancy, 
like a friend, your partner, or a family member?
yes, 1
no, 2
SO3_3_4_FutureContra_Use_NSA (Among those not sexually active, self/partner not currently pregnant) In the next 
3 months, do you plan to use a method to prevent or delay pregnancy?
yes, 1
no, 2
SO4_Adverts_HW In the past month, about how many messages or adverts have you seen or heard 
about handwashing, including on the radio, TV, posters, billboards, or other 
channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't seen or heard any, 4
SO4_1_HW_Station In your household, do you have a designated place for handwashing?
yes, 1
no, 2
SO4_2_HW_SoapWater (Among those with handwashing station) At your handwashing station, how often 
do you have both soap and water available?
not at all, 1 
a few times, 2 
most of the time, 3 
every time, 4 
SO4_4_TalkedHW In the past three months, have you talked to anyone about handwashing with soap 
and water, like a friend, your partner, or a family member?
yes, 1
no, 2
*SO4_6_Message_HW_GLLiW Have you heard or seen this message about handwashing? (audio clip)
yes, 1
no, 2 
not sure, 3
SO4_7_FutureHW In the next three months, when you wash your hands, how often do you plan to 
use both soap and water
every time, 1 
most of the time, 2 
a few times, 3 
not at all, 4 
*SO4_8_WashWithSoapAfterToilet Did you wash your hands with soap under water the last time you used the toilet?
yes, 1
no, 2
SO5_Adverts_NetUse In the past month, about how many messages or adverts have you seen or heard 
about using insecticide treated nets to prevent malaria, including on the radio, TV, 
posters, billboards, or other channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't seen or heard any, 4
*SO_5a_Malaria_GLLiW Have you heard or seen this message about malaria? (Audio clip)
yes, 1
65
T3 Variable Question/ Coding
no, 2 
not sure, 3
*SO_5b_Malaria_GLLiW Have you heard or seen this message about malaria? (Audio clip)
yes, 1 
no, 2 
not sure, 3
* GLLiW_exp_ITN Exposure to ANY GLLiW Malaria message
SO_5a_Malaria_GLLiW OR SO_5b_Malaria_GLLiW = 1
SO5_1_Children_Under_5 (Among those with child under five) How many children under age five live in 
your household
1, 1
2, 2
3, 3 
4, 4 
5 or more, 5 
none, 6
SO5_2_Past_Net_Use_CU5 (Among those with + children under five living in house) Last night, how many of 
the children under age 5 in your household slept under an insecticide treated net?
1, 1
2, 2
3, 3 
4, 4 
5 or more, 5 
None, 6
All children under five slept under net (Among those with + children under five living in house) 
SO5_2_Past_Net_Use_CU5 is ≥ SO5_1_Children_Under_5
SO5_4_2b_Talked_CU5NetUse In the past three months, have you talked to anyone about using insecticide 
treated nets to prevent malaria in children under five, like a friend, your partner, 
or a family member?
yes, 1
no, 2
SO5_6_Future_CU5NetUse In the next 3 months how often do you plan for your children under 5 to sleep 
under an insecticide treated net?
every night, 1
most nights, 2
a few nights, 3
not at all, 4
SO6_Past_Net_Use Last night, did you sleep under an insecticide treated net?
yes, 1 
no, 2
SO6_1_3_Talked_PregNetUse_Female In the last three months, have you talked to anyone about using an insecticide 
treated net to prevent malaria during pregnancy, like a friend, your partner, or a 
family member?
yes, 1
no, 2
SO6_1_6_Future_PregNetUse_Female In the next 3 months how often do you plan to sleep under an insecticide treated 
net?
every night, 1
most nights, 2
a few nights, 3
not at all, 4
SO6_2_1_Past_PregNetUse_Male Last night, did your pregnant partner sleep under an insecticide treated net?
yes, 1
no, 2
66
T3 Variable Question/ Coding
SO6_2_3_Talked_PregNetUse_Male In the last three months, have you talked to anyone about using an insecticide 
treated net to prevent malaria during pregnancy, like a friend, your partner, or a 
family member?
yes, 1
no, 2 
SO6_2_6_Future_PregNetUse_Male In the next three months, how often do you plan to assist your pregnant partner 
to sleep under an insecticide treated net?
every night, 1 
If most nights, 2 
If a few nights, 3 
If not at all, 4 
SO7_0_Youngest_Child_Age How old is your youngest child in months?
less than 6 months, 1
between 6-8 months, 2
more than 8 months, 3 
SO7_6_Adverts_BM (Among caregivers of children less than six months) In the past month, about how 
many messages or adverts have you seen or heard about feeding only breastmilk 
within the first six months, including on the radio, TV, posters, billboards, or 
other channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't heard any messages or adverts, 4
*SO7_8_Message_BF_GLLiW (Among caregivers of children less than six months) Have you heard or seen this 
message about breastfeeding? (audio clip)
yes, 1
no, 2 
not sure, 3
SO8_5_Adverts_SemiSolid (Among caregivers of children between 6-8 months) In the past month, about 
how many messages or adverts have you seen or heard about introducing semi 
solid and soft foods to children over six months, in addition to breastmilk, 
including on the radio, TV, posters, billboards, or other channels?
more than 10, 1 
6-10, 2 
1-5, 3 
haven't heard any, 4
*GLLiW_exp_any Any GLLiW health specific ad asked about at T3=1
National Sample (S0_5a; S0_5b; S0_3b_1; S0_3b_2; S0_3b_3; E_3)
Life Stage (all) (S0_5a; S0_5b; S04_6; S0_3b_1; S0_3b_2; S0_3b_3; E_3)
Young Adults (S0_5a; S0_5b; S04_6; S0_3b_1; S0_3b_2; S0_3b_3; E_3)
Pregnant couples (S0_5a; S0_5b; S04_6; S0_3b_1; S0_3b_2; S0_3b_3; E_3)
Caregivers of children under five years (S0_5a; S0_5b; S04_6; S0_3b_1; S0_3b_2; 
S0_3b_3; E_3)
Caregivers of children under six months (S0_5a; S0_5b; S04_6; S0_3b_1; 
S0_3b_2; S0_3b_3; S07_8; E_3)
* Asked at T3 only
Annex 3: AAPOR Response Rates and Call Dispositions
Table 35 AAPOR response rates – National Sample and life stage Sample at T1 and T3
National Sample Life Stage Sample
Definition T1 T3 Definition T1 T3
Interview (Category 1)
Complete Reached final question (bednet 
use) 9469 6838 Reached final question (gender 
norms) 2250 1923
67
National Sample Life Stage Sample
Definition T1 T3 Definition T1 T3
Partial
Answered ≥1 exposure 
question, did not complete final 
bednet question
3547 6479
Answered 1≥1 health topic 
question, did not reach final 
gender question
790 490
Eligible, non-interview (Category 2)
Break off Age 18+, did not answer 1st 
exposure question 2987 2691 Consented, did not answer any 
health topic questions 1875 3800
Refusal N/A Declined at consent 701 349
Implicit refusal N/A Reached consent, did not 
respond 116 185
Unknown eligibility, non-interview (Category 3)
Unknown if valid No response at intro 27626 54902 No response at intro 27626 54902
Incomplete 
screener 
Agreed at Intro, did not answer 
age question 1196 869 Agreed at Intro, did reach 
pregnancy status
2807 2119
Not eligible (Category 4)
Non-working 
number Language Selector did not play 918277 936254 Language Selector did not play 918277 936254
Other No language selection/invalid 
selection 111402 125277 No language selection/invalid 
selection 111402 125277
No eligible 
respondent Under age 2024 1891 Under age or did not meet 
eligibility criteria for a life stage 9312 9059
Quota filled N/A 1372 843
Total numbers 
dialed
10765
28
11352
01
10765
28
11352
01
Calculating e: A 0.888 0.894 0.349 0.406
Response Rate 1 I/(I+P)+(R+NC+O)+(UH+UO)B 0.211 0.095 I/(I+P)+(R+NC+O)+(UH+UO) 0.062 0.030
Response Rate 2 (I+P)/(I+P)+(R+NC+O)+(UH+
UO) 0.290 0.186 (I+P)/(I+P)+(R+NC+O)+(UH+
UO) 0.084 0.038
Response Rate 3 I/((I+P)+(R+NC+O)+e(UH+U
O)) 0.228 0.104 I/((I+P)+(R+NC+O)+e(UH+U
O)) 0.069 0.034
Response Rate 4 (I+P)/((I+P)+(R+NC+O)+e(UH
+UO)) 0.313 0.203 (I+P)/((I+P)+(R+NC+O)+e(UH
+UO)) 0.093 0.042
Cooperation rate 
1,3 I/((I+P)+R+O) 0.592 0.427 I/((I+P)+R+O) 0.393 0.285
Cooperation rate 
2,4 (I+P)/((I+P)+R+O)) 0.813 0.832 (I+P)/((I+P)+R+O)) 0.530 0.358
Refusal Rate 1 
R/((I+P)+(R+NC+O)+UH+UO)
)
0.067 0.037 R/((I+P)+(R+NC+O)+UH+UO)
)
0.074 0.068
Refusal Rate 2 
R/((I+P)+(R+NC+O)+e(UH+U
O)) 0.072 0.041 R/((I+P)+(R+NC+O)+e(UH+U
O)) 0.082 0.076
Refusal Rate 3 R/((I+P) +(R+NC+O)) 0.187 0.168 R/((I+P) +(R+NC+O)) 0.470 0.642
Contact Rate 1 (I+P)+R+O/(I+P)+R+O+NC+(
UH+UO) 0.357 0.223 (I+P)+R+O/(I+P)+R+O+NC+(
UH+UO) 0.158 0.106
Contact Rate 2 (I+P)+R+O/(I+P)+R+O+NC+e(
UH+UO) 0.385 0.244 (I+P)+R+O/(I+P)+R+O+NC+e(
UH+UO) 0.175 0.118
Contact Rate 3 (I+P)+R+O/(I+P)+R+O+NC 1.000 1.000 (I+P)+R+O/(I+P)+R+O+NC 1.000 1.000
A We calculated e as the proportion of all callers screened who were known eligible for the national sample; this computation 
yielded a value of ‘e’ that was more conservative than the AAPOR-calculated rate. However, this computation and application 
of ‘e’ may change in future reporting as additional data and expertise are obtained.
B I=Complete Interviews; P=Partial Interviews; R=Refusal and break off; NC=Non Contact; O=Other; UH=Unknown 
Household; UO=Unknown other
68
Table 36 Mapping Communicate for Health call outcomes to AAPOR codes – Life Stage Sample
Communicate 
for Health
Reference Code
Call Outcome AAPOR
Category
AAPOR 
Code
0 
Call did not dial - technical error at mobile network 
operator level as never placed a call to a handset. Received 
a technical error to assign this code. 
N/A. Exclude 
entirely from 
sample. Calls were 
never dialed. 
N/A 
1 
Call dialed, but nobody picked up phone. We know this 
because the language selector never played. Don't know if 
unanswered because (1) was not a valid number or (2) 
person was not in network range or (3) phone was off. No 
contact was made with a live person. 
Category 4 – Not 
Eligible 4.31 
2
Call connected but no valid selection was made when 
Language Selector was played. We know this is a valid 
phone number, but we don't know if the call connected at 
the network level and did not ring at the person's handset, 
or it went to voicemail, or it was picked up and hung up 
immediately.
Category 4 – Not 
Eligible 4.9
3
Valid choice made at Language Selector and Intro started 
to play but person either (1) hung up, or (2) chose "not a 
convenient time" at 
Category 3 – 3.3
Intro. First point at which we know that a person picked 
up the phone.
Unknown 
Eligibility
4.1
Selects "under 18" at Age question. Under Age (immediate 
Ineligible). Receives a final goodbye message then system 
hangs up.
Category 4 – Not 
Eligible 4.7
4.2 Selects a non-target Region. Call continues until 
respondent hangs up or Opt-in/Opt-out question (E1). 
Category 4 – Not 
Eligible 4.7 
5
Call back after Completed Interview. Caller receives a 
goodbye message and system hangs up. These will never 
factor into calculations because the BEST response will 
always be a completed Interview. 
Category 4 – Not 
Eligible 4.81
6 Drop off after Intro and before eligibility criteria answered 
(before D5a/6a or D5b/6b). 
Category 3 –
Unknown 
Eligibility 
3.21 
7.1 Reached final eligibility question (D5a/6a or D5b/6b) -
Eligible but quota is already full. 
Category 4 – Not 
Eligible 4.8 
7.2 Reached final eligibility question (D5a/6a or D5b/6b) -
Ineligible.
Category 4 – Not 
Eligible 4.7
8 
Reached final eligibility question (D5a/6a or D5b/6b) -
Eligible and quota not full but drop off before Informed 
Consent. 
Category 2 -
Eligible Non￾Respondent 
2.12 
9.1 
Reached Informed Consent but does not make a selection. 
So made it through demographic questions and national 
survey but dropped off call rather than explicit decline. 
Category 2 -
Eligible Non￾Respondent 
2.113 
9.2 Reached Informed Consent and selects "decline". Receives 
a final goodbye message then system hangs up. 
Category 2 -
Eligible Non￾Respondent 
2.112 
9.3 Reached Informed Consent and selects "agree" but drops 
off at 1st Q after Consent. 
Category 2 -
Eligible Non￾Respondent 
2.12 
69
10
Reached Informed Consent and selects "agree" and 
answers at least 1 cohort behavior Q but drops off before 
responding to IR1.5.2.
Category 1 -
Interview 1.2
11 
Reached Informed Consent and selects "agree" and 
answers IR1.5.2. May or may not have answered the final 
question on format of reminders. 
Category 1 -
Interview 1.1 
Annex 4: Supplementary Tables
Sample Characteristics
Table 37 Demographic characteristics of unweighted sample at T1 and T3, with and without respondents age 50+
T1 T3
With 50+
n (%)
Without 50+
n (%)
With 50+
n (%)
Without 50+
n (%)
Gender
Female 3176 (33.5%) 3042 (33.9%) 2314 (33.8%) 2244 (34.3%)
Male 6293 (66.5%) 5944 (66.1%) 4524 (66.2%) 4291 (65.7%)
Residence
Urban 6307 (66.6%) 5964 (66.4%) 4411 (64.5%) 4213 (64.5%)
Rural 3162 (33.4%) 3022 (33.6%) 2427 (35.5%) 2322 (35.5%)
Region
Ashanti 2174 (23.0%) 2065 (23.0%) 1464 (21.4%) 1401 (21.4%)
Greater Accra 2885 (30.5%) 2704 (30.1%) 2006 (29.3%) 1901 (29.1%)
Eastern 825 (8.7%) 786 (8.7%) 625 (9.1%) 590 (9.0%)
Western 567 (6.0%) 538 (6.0%) 425 (6.2%) 404 (6.2%)
Brong Ahafo 746 (7.9%) 698 (7.8%) 491 (7.2%) 473 (7.2%)
Northern 668 (7.1%) 652 (7.3%) 561 (8.2%) 556 (8.5%)
Central 616 (6.5%) 590 (6.6%) 458 (6.7%) 430 (6.6%)
Volta 530 (5.6%) 511 (5.7%) 446 (6.5%) 429 (6.6%)
Upper East 205 (2.2%) 199 (2.2%) 171 (2.5%) 166 (2.5%)
Upper West 253 (2.7%) 243 (2.7%) 191 (2.8%) 185 (2.8%)
Priority Region
Non-priority Region 4203 (44.4%) 3991 (44.4%) 2942 (43.0%) 2815 (43.1%)
Priority Region 5266 (55.6%) 4995 (55.6%) 3896 (57.0%) 3720 (56.9%)
Education
None 980 (10.3%) 903 (10.0%) 552 (8.1%) 526 (8.0%)
Primary 1166 (12.3%) 1104 (12.3%) 762 (11.1%) 722 (11.0%)
Middles chool 2347 (24.8%) 2203 (24.5%) 1506 (22.0%) 1413 (21.6%)
Secondary 3092 (32.7%) 2983 (33.2%) 2259 (33.0%) 2200 (33.7%)
Tertiary or higher 1884 (19.9%) 1793 (20.0%) 1759 (25.7%) 1674 (25.6%)
Age
18-24 5300 (56.0%) 5300 (59.0%) 3542 (51.8%) 3542 (54.2%)
25-35 2809 (29.7%) 2809 (31.3%) 2228 (32.6%) 2228 (34.1%)
36-49 877 (9.3%) 877 (9.8%) 765 (11.2%) 765 (11.7%)
50+ 483 (5.1%) . (. %) 303 (4.4%) . (. %)
Relationship Status
Single 5348 (56.5%) 5235 (58.3%) 3910 (57.2%) 3841 (58.8%)
Married or living with partner 3717 (39.3%) 3404 (37.9%) 2683 (39.2%) 2483 (38.0%)
Separated or divorced 292 (3.1%) 257 (2.9%) 177 (2.6%) 157 (2.4%)
Widowed 112 (1.2%) 90 (1.0%) 68 (1.0%) 54 (0.8%)
Age of Youngest Child
No children 5435 (57.4%) 5331 (59.3%) 3942 (57.6%) 3887 (59.5%)
Under 5 years 2340 (24.7%) 2218 (24.7%) 1673 (24.5%) 1622 (24.8%)
5-17 years 1338 (14.1%) 1192 (13.3%) 946 (13.8%) 863 (13.2%)
18 or older 356 (3.8%) 245 (2.7%) 277 (4.1%) 163 (2.5%)
Pregnancy Status - Self
Yes 421 (13.3%) 402 (13.2%) 268 (11.6%) 263 (11.7%)
No 2755 (86.7%) 2640 (86.8%) 2046 (88.4%) 1981 (88.3%)
70
T1 T3
With 50+
n (%)
Without 50+
n (%)
With 50+
n (%)
Without 50+
n (%)
Pregnancy Status - Partner
Yes 934 (14.8%) 885 (14.9%) 608 (13.4%) 593 (13.8%)
No 5359 (85.2%) 5059 (85.1%) 3916 (86.6%) 3698 (86.2%)
Listened to Radio, last 7 days
Not at all 1937 (20.5%) 1871 (20.8%) 1669 (24.4%) 1622 (24.8%)
A few days 2848 (30.1%) 2732 (30.4%) 2103 (30.8%) 2044 (31.3%)
Most days 1871 (19.8%) 1771 (19.7%) 1262 (18.5%) 1204 (18.4%)
Every day 2813 (29.7%) 2612 (29.1%) 1804 (26.4%) 1665 (25.5%)
Watched TV in last 7 days
Not at all 1832 (19.3%) 1758 (19.6%) 1263 (18.5%) 1200 (18.4%)
A few days 2633 (27.8%) 2508 (27.9%) 1799 (26.3%) 1733 (26.5%)
Most days 1700 (18.0%) 1616 (18.0%) 1086 (15.9%) 1035 (15.8%)
Every day 3304 (34.9%) 3104 (34.5%) 2690 (39.3%) 2567 (39.3%)
Table 38 Comparison of demographic characteristics of life stage sample at T1 and T3
T1 T3
p-value
n % Weighted % n % Weighted %
Life Stage
Young men 701 31.7 19.4 700 36.7 24.2
0.005
Young women 700 31.7 37.5 511 26.8 29.5
Male caregivers 307 13.9 13.7 274 14.4 14.4
Female caregivers 201 9.1 15.7 154 8.1 16.0
Partners of pregnant women 211 9.6 7.6 194 10.2 8.5
Pregnant women 88 4.0 6.1 74 3.9 7.4
Residence
Urban 1525 69.1 63.8 1278 67.0 63.7 0.953 Rural 683 30.9 36.2 629 33.0 36.3
Region
Greater Accra 1170 53.0 33.4 927 48.6 29.7
0.068
Western 246 11.1 18.5 217 11.4 19.4
Northern 276 12.5 17.5 317 16.6 19.8
Central 275 12.5 16.4 207 10.9 13.8
Volta 241 10.9 14.3 239 12.5 17.2
Education
None 186 8.4 7.9 152 8.0 8.2
0.065
Primary 235 10.6 9.9 202 10.6 9.7
Middleschool 525 23.8 24.3 358 18.8 19.3
Secondary 778 35.2 31.9 689 36.1 34.0
Tertiary or higher 484 21.9 26.0 506 26.5 28.8
Age
18-24 1347 61.0 47.3 1037 54.4 42.4
25-35 755 34.2 39.9 738 38.7 39.7 0.015
36-49 106 4.8 12.8 132 6.9 17.9
Relationship Status
Single 1283 58.1 51.6 1131 59.3 50.7
0.810 Married or living with partner 864 39.1 45.5 729 38.2 46.4
Separated or divorced 40 1.8 2.0 35 1.8 2.2
Widowed 21 1.0 1.0 12 0.6 0.6
Age of Youngest Child
No children 1324 60.0 52.4 1161 60.9 50.4
0.779 Under 5 years 604 27.4 34.1 517 27.1 36.0
5-17 years 233 10.6 11.6 198 10.4 11.4
18 or older 47 2.1 1.9 31 1.6 2.2
Listened to Radio in last 7 days
Not at all 479 21.7 22.3 517 27.1 27.2 0.032
71
T1 T3
p-value
n % Weighted % n % Weighted %
A few days 682 30.9 31.5 575 30.2 31.6
Most days 439 19.9 19.3 353 18.5 17.5
Every day 608 27.5 26.9 462 24.2 23.7
Watched TV in last 7 days
Not at all 443 20.1 20.3 339 17.8 17.8
0.323 A few days 593 26.9 24.7 534 28.0 27.3
Most days 375 17.0 16.0 295 15.5 15.5
Every day 797 36.1 38.9 739 38.8 39.5
Table 39 Demographic characteristics of unweighted Young Adult life stage sample at T1 and T3 by sex
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Residence
Urban 532 (76.0%) 486 (69.3%) 1018 (72.7%) 376 (73.6%) 479 (68.4%) 855 (70.6%)
Rural 168 (24.0%) 215 (30.7%) 383 (27.3%) 135 (26.4%) 221 (31.6%) 356 (29.4%)
Region
Greater Accra 416 (59.4%) 352 (50.2%) 768 (54.8%) 299 (58.5%) 336 (48.0%) 635 (52.4%)
Western 59 (8.4%) 97 (13.8%) 156 (11.1%) 49 (9.6%) 86 (12.3%) 135 (11.1%)
Northern 75 (10.7%) 76 (10.8%) 151 (10.8%) 64 (12.5%) 120 (17.1%) 184 (15.2%)
Central 82 (11.7%) 78 (11.1%) 160 (11.4%) 50 (9.8%) 78 (11.1%) 128 (10.6%)
Volta 68 (9.7%) 98 (14.0%) 166 (11.8%) 49 (9.6%) 80 (11.4%) 129 (10.7%)
Education
None 48 (6.9%) 46 (6.6%) 94 (6.7%) 38 (7.4%) 47 (6.7%) 85 (7.0%)
Primary 61 (8.7%) 65 (9.3%) 126 (9.0%) 45 (8.8%) 71 (10.1%) 116 (9.6%)
Middle school 155 (22.1%) 162 (23.1%) 317 (22.6%) 81 (15.9%) 125 (17.9%) 206 (17.0%)
Secondary 275 (39.3%) 295 (42.1%) 570 (40.7%) 199 (38.9%) 300 (42.9%) 499 (41.2%)
Tertiary or higher 161 (23.0%) 133 (19.0%) 294 (21.0%) 148 (29.0%) 157 (22.4%) 305 (25.2%)
Age
18-24 492 (70.3%) 493 (70.3%) 985 (70.3%) 349 (68.3%) 432 (61.7%) 781 (64.5%)
25-35 208 (29.7%) 208 (29.7%) 416 (29.7%) 162 (31.7%) 268 (38.3%) 430 (35.5%)
Relationship Status
Single 540 (77.1%) 545 (77.7%) 1085 (77.4%) 396 (77.5%) 571 (81.6%) 967 (79.9%)
Married or living with partner 138 (19.7%) 144 (20.5%) 282 (20.1%) 106 (20.7%) 119 (17.0%) 225 (18.6%)
Separated or divorced 14 (2.0%) 9 (1.3%) 23 (1.6%) 6 (1.2%) 7 (1.0%) 13 (1.1%)
Widowed 8 (1.1%) 3 (0.4%) 11 (0.8%) 3 (0.6%) 3 (0.4%) 6 (0.5%)
Age of Youngest Child
No children 574 (82.0%) 606 (86.4%) 1180 (84.2%) 416 (81.4%) 613 (87.6%) 1029 (85.0%)
5-17 years 110 (15.7%) 73 (10.4%) 183 (13.1%) 85 (16.6%) 74 (10.6%) 159 (13.1%)
18 or older 16 (2.3%) 22 (3.1%) 38 (2.7%) 10 (2.0%) 13 (1.9%) 23 (1.9%)
Listened to Radio, last 7 days
Not at all 167 (23.9%) 142 (20.3%) 309 (22.1%) 175 (34.2%) 178 (25.4%) 353 (29.1%)
A few days 229 (32.7%) 220 (31.4%) 449 (32.0%) 154 (30.1%) 219 (31.3%) 373 (30.8%)
Most days 121 (17.3%) 145 (20.7%) 266 (19.0%) 74 (14.5%) 132 (18.9%) 206 (17.0%)
Every day 183 (26.1%) 194 (27.7%) 377 (26.9%) 108 (21.1%) 171 (24.4%) 279 (23.0%)
Watched TV, last 7 days
Not at all 150 (21.4%) 149 (21.3%) 299 (21.3%) 89 (17.4%) 137 (19.6%) 226 (18.7%)
A few days 185 (26.4%) 221 (31.5%) 406 (29.0%) 145 (28.4%) 228 (32.6%) 373 (30.8%)
Most days 94 (13.4%) 128 (18.3%) 222 (15.8%) 66 (12.9%) 106 (15.1%) 172 (14.2%)
Every day 271 (38.7%) 203 (29.0%) 474 (33.8%) 211 (41.3%) 229 (32.7%) 440 (36.3%)
72
Table 40 Demographic Characteristics of unweighted Caregivers life stage Sample (age 18-49) at T1 & T3 by Sex
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Residence
Urban 132 (65.7%) 191 (62.2%) 323 (63.6%) 96 (62.3%) 172 (62.8%) 268 (62.6%)
Rural 69 (34.3%) 116 (37.8%) 185 (36.4%) 58 (37.7%) 102 (37.2%) 160 (37.4%)
Region
Greater Accra 106 (52.7%) 156 (50.8%) 262 (51.6%) 68 (44.2%) 118 (43.1%) 186 (43.5%)
Western 21 (10.4%) 37 (12.1%) 58 (11.4%) 21 (13.6%) 31 (11.3%) 52 (12.1%)
Northern 25 (12.4%) 38 (12.4%) 63 (12.4%) 20 (13.0%) 47 (17.2%) 67 (15.7%)
Central 35 (17.4%) 42 (13.7%) 77 (15.2%) 16 (10.4%) 42 (15.3%) 58 (13.6%)
Volta 14 (7.0%) 34 (11.1%) 48 (9.4%) 29 (18.8%) 36 (13.1%) 65 (15.2%)
Education
None 16 (8.0%) 29 (9.4%) 45 (8.9%) 13 (8.4%) 21 (7.7%) 34 (7.9%)
Primary 26 (12.9%) 46 (15.0%) 72 (14.2%) 20 (13.0%) 34 (12.4%) 54 (12.6%)
Middle school 54 (26.9%) 70 (22.8%) 124 (24.4%) 38 (24.7%) 57 (20.8%) 95 (22.2%)
Secondary 57 (28.4%) 71 (23.1%) 128 (25.2%) 48 (31.2%) 61 (22.3%) 109 (25.5%)
Tertiary or higher 48 (23.9%) 91 (29.6%) 139 (27.4%) 35 (22.7%) 101 (36.9%) 136 (31.8%)
Age
18-24 100 (49.8%) 89 (29.0%) 189 (37.2%) 66 (42.9%) 63 (23.0%) 129 (30.1%)
25-35 90 (44.8%) 148 (48.2%) 238 (46.9%) 66 (42.9%) 133 (48.5%) 199 (46.5%)
36-49 11 (5.5%) 70 (22.8%) 81 (15.9%) 22 (14.3%) 78 (28.5%) 100 (23.4%)
Relationship Status
Single 56 (27.9%) 47 (15.3%) 103 (20.3%) 42 (27.3%) 40 (14.6%) 82 (19.2%)
Married or living with partner 135 (67.2%) 253 (82.4%) 388 (76.4%) 106 (68.8%) 221 (80.7%) 327 (76.4%)
Separated or divorced 6 (3.0%) 3 (1.0%) 9 (1.8%) 5 (3.2%) 11 (4.0%) 16 (3.7%)
Widowed 4 (2.0%) 4 (1.3%) 8 (1.6%) 1 (0.6%) 2 (0.7%) 3 (0.7%)
Listened to Radio, last 7 days
Not at all 50 (24.9%) 54 (17.6%) 104 (20.5%) 46 (29.9%) 52 (19.0%) 98 (22.9%)
A few days 73 (36.3%) 78 (25.4%) 151 (29.7%) 41 (26.6%) 83 (30.3%) 124 (29.0%)
Most days 28 (13.9%) 85 (27.7%) 113 (22.2%) 35 (22.7%) 59 (21.5%) 94 (22.0%)
Every day 50 (24.9%) 90 (29.3%) 140 (27.6%) 32 (20.8%) 80 (29.2%) 112 (26.2%)
Watched TV, last 7 days
Not at all 35 (17.4%) 57 (18.6%) 92 (18.1%) 21 (13.6%) 47 (17.2%) 68 (15.9%)
A few days 41 (20.4%) 77 (25.1%) 118 (23.2%) 34 (22.1%) 70 (25.5%) 104 (24.3%)
Most days 30 (14.9%) 62 (20.2%) 92 (18.1%) 26 (16.9%) 51 (18.6%) 77 (18.0%)
Every day 95 (47.3%) 111 (36.2%) 206 (40.6%) 73 (47.4%) 106 (38.7%) 179 (41.8%)
Table 41 Demographic Characteristics of unweighted Pregnant Couples life stage Sample (Age 18-49) at T1 & T3 
by Sex
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Residence
Urban 59 (67.0%) 125 (59.2%) 184 (61.5%) 39 (52.7%) 116 (59.8%) 155 (57.8%)
Rural 29 (33.0%) 86 (40.8%) 115 (38.5%) 35 (47.3%) 78 (40.2%) 113 (42.2%)
Region
Greater Accra 48 (54.5%) 92 (43.6%) 140 (46.8%) 29 (39.2%) 77 (39.7%) 106 (39.6%)
Western 8 (9.1%) 24 (11.4%) 32 (10.7%) 7 (9.5%) 23 (11.9%) 30 (11.2%)
Northern 16 (18.2%) 46 (21.8%) 62 (20.7%) 16 (21.6%) 50 (25.8%) 66 (24.6%)
Central 12 (13.6%) 26 (12.3%) 38 (12.7%) 7 (9.5%) 14 (7.2%) 21 (7.8%)
Volta 4 (4.5%) 23 (10.9%) 27 (9.0%) 15 (20.3%) 30 (15.5%) 45 (16.8%)
Education
None 13 (14.8%) 34 (16.1%) 47 (15.7%) 8 (10.8%) 25 (12.9%) 33 (12.3%)
Primary 11 (12.5%) 26 (12.3%) 37 (12.4%) 8 (10.8%) 24 (12.4%) 32 (11.9%)
73
T1 T3
Female
n (%)
Male
n (%)
Total
n (%)
Female
n (%)
Male
n (%)
Total
n (%)
Middle school 23 (26.1%) 61 (28.9%) 84 (28.1%) 17 (23.0%) 40 (20.6%) 57 (21.3%)
Secondary 24 (27.3%) 56 (26.5%) 80 (26.8%) 21 (28.4%) 60 (30.9%) 81 (30.2%)
Tertiary or higher 17 (19.3%) 34 (16.1%) 51 (17.1%) 20 (27.0%) 45 (23.2%) 65 (24.3%)
Age
18-24 54 (61.4%) 119 (56.4%) 173 (57.9%) 38 (51.4%) 89 (45.9%) 127 (47.4%)
25-35 29 (33.0%) 72 (34.1%) 101 (33.8%) 30 (40.5%) 79 (40.7%) 109 (40.7%)
36-49 5 (5.7%) 20 (9.5%) 25 (8.4%) 6 (8.1%) 26 (13.4%) 32 (11.9%)
Relationship Status
Single 34 (38.6%) 61 (28.9%) 95 (31.8%) 28 (37.8%) 54 (27.8%) 82 (30.6%)
Married or living with partner 52 (59.1%) 142 (67.3%) 194 (64.9%) 44 (59.5%) 133 (68.6%) 177 (66.0%)
Separated or divorced 1 (1.1%) 7 (3.3%) 8 (2.7%) 2 (2.7%) 4 (2.1%) 6 (2.2%)
Widowed 1 (1.1%) 1 (0.5%) 2 (0.7%) . (. %) 3 (1.5%) 3 (1.1%)
Age of Youngest Child
No children 38 (43.2%) 106 (50.2%) 144 (48.2%) 38 (51.4%) 94 (48.5%) 132 (49.3%)
Under 5 years 26 (29.5%) 70 (33.2%) 96 (32.1%) 21 (28.4%) 68 (35.1%) 89 (33.2%)
5-17 years 18 (20.5%) 32 (15.2%) 50 (16.7%) 13 (17.6%) 26 (13.4%) 39 (14.6%)
18 or older 6 (6.8%) 3 (1.4%) 9 (3.0%) 2 (2.7%) 6 (3.1%) 8 (3.0%)
Listened to Radio, last 7 days
Not at all 24 (27.3%) 42 (19.9%) 66 (22.1%) 25 (33.8%) 41 (21.1%) 66 (24.6%)
A few days 16 (18.2%) 66 (31.3%) 82 (27.4%) 21 (28.4%) 57 (29.4%) 78 (29.1%)
Most days 16 (18.2%) 44 (20.9%) 60 (20.1%) 11 (14.9%) 42 (21.6%) 53 (19.8%)
Every day 32 (36.4%) 59 (28.0%) 91 (30.4%) 17 (23.0%) 54 (27.8%) 71 (26.5%)
Watched TV, last 7 days
Not at all 13 (14.8%) 39 (18.5%) 52 (17.4%) 14 (18.9%) 31 (16.0%) 45 (16.8%)
A few days 15 (17.0%) 54 (25.6%) 69 (23.1%) 7 (9.5%) 50 (25.8%) 57 (21.3%)
Most days 17 (19.3%) 44 (20.9%) 61 (20.4%) 11 (14.9%) 35 (18.0%) 46 (17.2%)
Every day 43 (48.9%) 74 (35.1%) 117 (39.1%) 42 (56.8%) 78 (40.2%) 120 (44.8%)
Objective 1 – Exposure Tables
Table 42 Exposure to messages about ITNs in last month at T1 & T3
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
0 2440 27.2 26.2 1527 23.4 22.3
16.89, <0.001 1-5 1925 21.4 21.9 1314 20.1 20.9
6-10 1568 17.4 17.6 1106 16.9 17.8
>10 3053 34.0 34.2 2588 39.6 39.0
Priority Regions
0 1334 26.7 26.3 868 23.3 22.7
7.50, p=0.058
1-5 1073 21.5 21.4 763 20.5 20.8
6-10 868 17.4 16.4 628 16.9 17.4
>10 1720 34.4 35.9 1461 39.3 39.1
Non-Priority Regions
0 1106 27.7 26.0 659 23.4 21.9
10.98, 0.012 1-5 852 21.3 22.6 551 19.6 20.9
6-10 700 17.5 19.1 478 17.0 18.1
>10 1333 33.4 32.3 1127 40.0 39.0
Life Stage (All)
0 548 24.8 24.0 443 23.2 23.1
0.70, 0.874 1-5 489 22.1 21.0 375 19.7 20.7
6-10 378 17.1 16.3 319 16.7 17.5
>10 793 35.9 38.7 770 40.4 38.8
Young men
0 180 25.7 26.2 166 23.7 23.1 4.98, 0.173
74
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
1-5 158 22.5 21.2 132 18.9 19.6
6-10 119 17.0 17.0 107 15.3 15.6
>10 244 34.8 35.7 295 42.1 41.8
Young women
0 156 22.3 23.3 115 22.5 23.4
0.43, 0.935 1-5 152 21.7 19.6 102 20.0 21.3
6-10 137 19.6 17.6 92 18.0 16.8
>10 255 36.4 39.5 202 39.5 38.6
Male caregivers
0 89 29.0 56 20.4
1-5 74 24.1 70 25.5
6-10 54 17.6 51 18.6
>10 90 29.3 97 35.4
Female caregivers
0 34 16.9 29 18.8
1-5 53 26.4 31 20.1
6-10 28 13.9 25 16.2
>10 86 42.8 69 44.8
Partners of pregnant women
0 60 28.4 65 33.5
1-5 35 16.6 25 12.9
6-10 33 15.6 30 15.5
>10 83 39.3 74 38.1
Pregnant women
0 29 33.0 12 16.2
1-5 17 19.3 15 20.3
6-10 7 8.0 14 18.9
>10 35 39.8 33 44.6
Table 43 Exposure to GLLiW Malaria Advertisements at T3
Malaria Clip 1 Malaria Clip 2 Any Malaria Clip
n % Weighted % n % Weighted % n % Weighted %
National Sample (All)
Yes 4127 63.2 64.5 4470 68.4 70.3 5049 77.3 79.0
No 1760 26.9 25.2 1509 23.1 21.3 948 14.5 12.9
Not Sure 648 9.9 10.4 556 8.5 8.4 538 8.2 8.0
Priority Regions
Yes 2266 60.9 62.4 2492 67.0 69.0 2801 75.3 77.0
No 1031 27.7 26.3 876 23.5 21.8 558 15.0 13.8
Not Sure 423 11.4 11.3 352 9.5 9.3 361 9.7 9.1
Non-Priority Regions
Yes 1861 66.1 66.8 1978 70.3 71.8 2248 79.9 81.4
No 729 25.9 24.0 633 22.5 20.8 390 13.9 11.9
Not Sure 225 8.0 9.2 204 7.2 7.4 177 6.3 6.7
Life Stage (All)
Yes 1169 61.3 62.4 1281 67.2 69.3 1449 76.0 77.5
No 535 28.1 27.7 439 23.0 21.3 280 14.7 13.5
Not Sure 203 10.6 9.9 187 9.8 9.4 178 9.3 9.0
Young men
Yes 421 60.1 61.7 466 66.6 67.5 528 75.4 76.6
No 204 29.1 28.4 176 25.1 24.2 112 16.0 15.2
Not Sure 75 10.7 9.9 58 8.3 8.2 60 8.6 8.1
Young women
Yes 299 58.5 58.1 347 67.9 66.6 388 75.9 75.4
75
Malaria Clip 1 Malaria Clip 2 Any Malaria Clip
n % Weighted % n % Weighted % n % Weighted %
No 141 27.6 26.9 117 22.9 24.1 76 14.9 15.1
Not Sure 71 13.9 15.0 47 9.2 9.3 47 9.2 9.5
Male caregivers
Yes 184 67.2 192 70.1 219 79.9
No 64 23.4 53 19.3 29 10.6
Not Sure 26 9.5 29 10.6 26 9.5
Female caregivers
Yes 105 68.2 110 71.4 123 79.9
No 42 27.3 29 18.8 19 12.3
Not Sure 7 4.5 15 9.7 12 7.8
Partners of pregnant women
Yes 116 59.8 121 62.4 136 70.1
No 58 29.9 46 23.7 31 16.0
Not Sure 20 10.3 27 13.9 27 13.9
Pregnant women
Yes 44 59.5 45 60.8 55 74.3
No 26 35.1 18 24.3 13 17.6
Not Sure 4 5.4 11 14.9 6 8.1
Table 44 Exposure to messages about handwashing in last month at T1 & T3
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
0 3485 38.8 36.9 2475 37.9 36.8
5.68, 0.128 1-5 1852 20.6 22.5 1509 23.1 23.9
6-10 1456 16.2 16.4 955 14.6 14.3
>10 2193 24.4 24.2 1596 24.4 25.0
Priority Regions
0 1823 36.5 35.5 1321 35.5 34.6
1.79, 0.617
1-5 1057 21.2 23.0 873 23.5 23.3
6-10 831 16.6 16.4 563 15.1 15.3
>10 1284 25.7 25.1 963 25.9 26.8
Non-Priority Regions
0 1662 41.6 38.6 1154 41.0 39.3
6.27, 0.099 1-5 795 19.9 21.9 636 22.6 24.6
6-10 625 15.7 16.4 392 13.9 13.1
>10 909 22.8 23.1 633 22.5 23.0
Life Stage All
0 794 36.0 34.7 654 34.3 32.9
2.02, 0.569 1-5 472 21.4 22.5 465 24.4 25.0
6-10 357 16.2 16.4 294 15.4 16.4
>10 585 26.5 26.5 494 25.9 25.7
Young men
0 260 37.1 36.3 249 35.6 35.7
6.18, 0.103 1-5 143 20.4 20.4 172 24.6 25.5
6-10 123 17.5 18.4 105 15.0 14.8
>10 175 25.0 24.9 174 24.9 23.9
Young women
0 241 34.4 33.4 162 31.7 30.5
1.73, 0.630 1-5 165 23.6 23.2 130 25.4 26.9
6-10 102 14.6 15.5 85 16.6 15.7
>10 192 27.4 27.9 134 26.2 26.9
76
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
Male caregivers
0 112 36.5 100 36.5
1-5 64 20.8 72 26.3
6-10 56 18.2 37 13.5
>10 75 24.4 65 23.7
Female caregivers
0 71 35.3 43 27.9
1-5 46 22.9 38 24.7
6-10 28 13.9 22 14.3
>10 56 27.9 51 33.1
Partners of pregnant women
0 79 37.4 76 39.2
1-5 39 18.5 36 18.6
6-10 33 15.6 34 17.5
>10 60 28.4 48 24.7
Pregnant women
0 31 35.2 24 32.4
1-5 15 17.0 17 23.0
6-10 15 17.0 11 14.9
>10 27 30.7 22 29.7
Table 45 Exposure to GLLiW Handwashing Advertisement at T3
Handwashing clip
n % Weighted %
Life Stage (All)
Yes 1475 77.3 77.8
No 311 16.3 16.5
Not Sure 121 6.3 5.7
Young men
Yes 527 75.3 75.2
No 118 16.9 17.4
Not Sure 55 7.9 7.4
Young women
Yes 395 77.3 75.1
No 94 18.4 21.0
Not Sure 22 4.3 3.9
Male caregivers
Yes 223 81.4
No 33 12.0
Not Sure 18 6.6
Female caregivers
Yes 126 81.8
No 17 11.0
Not Sure 11 7.1
Partners of pregnant women
Yes 143 73.7
No 39 20.1
Not Sure 12 6.2
Pregnant women
Yes 61 82.4
No 10 13.5
Not Sure 3 4.1
77
Table 46 Exposure to messages about pregnancy prevention in last month at T1 & T3
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
0 4049 45.1 43.8 3014 46.1 47.0
8.08, 0.044 1-5 1771 19.7 21.3 1383 21.2 21.5
6-10 1305 14.5 14.3 858 13.1 13.3
>10 1861 20.7 20.6 1280 19.6 18.2
Priority Regions
0 2238 44.8 43.4 1716 46.1 47.2
9.03, 0.029 1-5 998 20.0 21.1 813 21.9 22.1
6-10 735 14.7 14.5 493 13.3 13.0
>10 1024 20.5 21.0 698 18.8 17.8
Non-Priority Regions
0 1811 45.4 44.2 1298 46.1 46.7
1.50, 0.682
1-5 773 19.4 21.6 570 20.2 20.9
6-10 570 14.3 14.1 365 13.0 13.6
>10 837 21.0 20.1 582 20.7 18.7
Life Stage (All)
0 986 44.7 44.8 872 45.7 46.6
6.63, 0.085
1-5 443 20.1 20.1 419 22.0 22.1
6-10 302 13.7 13.1 251 13.2 13.6
>10 477 21.6 21.9 365 19.1 17.7
Young men
0 337 48.1 47.6 326 46.6 46.5
3.51, 0.320 1-5 126 18.0 18.3 155 22.1 22.4
6-10 91 13.0 13.2 86 12.3 12.3
>10 147 21.0 21.0 133 19.0 18.8
Young women
0 298 42.6 44.1 236 46.2 49.2
3.73, 0.296
1-5 151 21.6 19.9 111 21.7 20.7
6-10 90 12.9 13.8 63 12.3 12.8
>10 161 23.0 22.1 101 19.8 17.2
Male caregivers
0 135 44.0 118 43.1
1-5 68 22.1 65 23.7
6-10 47 15.3 39 14.2
>10 57 18.6 52 19.0
Female caregivers
0 85 42.3 59 38.3
1-5 46 22.9 40 26.0
6-10 26 12.9 25 16.2
>10 44 21.9 30 19.5
Partners of pregnant women
0 101 47.9 95 49.0
1-5 33 15.6 37 19.1
6-10 34 16.1 27 13.9
>10 43 20.4 35 18.0
Pregnant women
0 30 34.1 38 51.4
1-5 19 21.6 11 14.9
6-10 14 15.9 11 14.9
>10 25 28.4 14 18.9
78
Table 47 Exposure to GLLiW Family Planning Advertisements at T3
Family Planning Clip 1 Family Planning Clip 2 YOLO (Clip 3) Any FP/RH Clip
n % Weighted % n % Weighted % n % Weighted % n % Weighted %
National Sample (All)
Yes 3344 51.2 53.7 3620 55.4 57.6 3251 49.7 44.2 5238 80.2 80.1
No 2266 34.7 31.8 2212 33.8 31.0 2687 41.1 45.3 711 10.9 10.3
Not Sure 925 14.2 14.5 703 10.8 11.4 597 9.1 10.5 586 9.0 9.6
Priority Regions
Yes 1883 50.6 53.1 1988 53.4 56.1 1838 49.4 43.4 2927 78.7 78.6
No 1318 35.4 32.8 1308 35.2 32.0 1528 41.1 46.2 414 11.1 10.6
Not Sure 519 14.0 14.2 424 11.4 11.9 354 9.5 10.5 379 10.2 10.9
Non-Priority Regions
Yes 1461 51.9 54.5 1632 58.0 59.4 1413 50.2 45.2 2311 82.1 81.9
No 948 33.7 30.7 904 32.1 29.8 1159 41.2 44.3 297 10.6 10.1
Not Sure 406 14.4 14.8 279 9.9 10.8 243 8.6 10.5 207 7.4 8.1
Life Stage Sample (All)
Yes 981 51.4 52.8 1030 54.0 56.4 958 50.2 46.5 1506 79.0 78.7
No 685 35.9 33.5 663 34.8 31.9 778 40.8 43.6 207 10.9 10.6
Not Sure 241 12.6 13.7 214 11.2 11.7 171 9.0 9.9 194 10.2 10.7
Young men
Yes 339 48.4 48.9 362 51.7 52.6 405 57.9 57.5 562 80.3 80.1
No 280 40.0 38.9 276 39.4 38.2 236 33.7 34.4 74 10.6 10.8
Not Sure 81 11.6 12.2 62 8.9 9.2 59 8.4 8.1 64 9.1 9.1
Young women
Yes 280 54.8 54.4 270 52.8 53.7 289 56.6 55.2 427 83.6 83.0
No 163 31.9 32.1 181 35.4 33.4 183 35.8 36.5 41 8.0 8.2
Not Sure 68 13.3 13.5 60 11.7 12.9 39 7.6 8.3 43 8.4 8.7
Male caregivers
Yes 145 52.9 148 54.0 89 32.5 200 73.0
No 95 34.7 92 33.6 156 56.9 41 15.0
Not Sure 34 12.4 34 12.4 29 10.6 33 12.0
Female caregivers
Yes 88 57.1 98 63.6 60 39.0 119 77.3
No 41 26.6 37 24.0 79 51.3 17 11.0
Not Sure 25 16.2 19 12.3 15 9.7 18 11.7
Partners of pregnant women
Yes 87 44.8 104 53.6 81 41.8 136 70.1
No 82 42.3 62 32.0 94 48.5 29 14.9
Not Sure 25 12.9 28 14.4 19 9.8 29 14.9
Pregnant women
Yes 42 56.8 48 64.9 34 45.9 62 83.8
No 24 32.4 15 20.3 30 40.5 5 6.8
Not Sure 8 10.8 11 14.9 10 13.5 7 9.5
Table 48 Exposure to messages about delivering at a health facility in last month at T1 & T3
T1 T3
n % n %
Life Stage (All caregivers and pregnant couples)
0 322 39.9 253 36.4
1-5 147 18.2 132 19.0
6-10 138 17.1 108 15.5
>10 200 24.8 203 29.2
Male caregivers
0 127 41.4 105 38.3
1-5 60 19.5 57 20.8
6-10 57 18.6 43 15.7
>10 63 20.5 69 25.2
79
T1 T3
n % n %
Female caregivers
0 73 36.3 56 36.4
1-5 40 19.9 26 16.9
6-10 28 13.9 20 13.0
>10 60 29.9 52 33.8
Partners of pregnant women
0 86 40.8 68 35.1
1-5 33 15.6 36 18.6
6-10 40 19.0 28 14.4
>10 52 24.6 62 32.0
Pregnant women
0 36 40.9 24 32.4
1-5 14 15.9 13 17.6
6-10 13 14.8 17 23.0
>10 25 28.4 20 27.0
Table 49 Exposure to messages about exclusive breast feeding (EBF) in last month at T1 & T3, among caregivers of 
children younger than 6 months
T1 T3
n % n %
Life Stage (All)
0 31 24.4 19 18.1
1-5 21 16.5 13 12.4
6-10 27 21.3 14 13.3
>10 48 37.8 59 56.2
Male caregivers
0 19 28.4 16 23.2
1-5 10 14.9 10 14.5
6-10 17 25.4 7 10.1
>10 21 31.3 36 52.2
Female caregivers
0 12 20.0 3 8.3
1-5 11 18.3 3 8.3
6-10 10 16.7 7 19.4
>10 27 45.0 23 63.9
Table 50 Exposure to messages about complementary feeding in last month at T1 & T3, among caregivers of 
children younger ages 6-8 months
T1 T3
n % n %
Life Stage (All)
0 19 29.7 16 30.8
1-5 12 18.8 10 19.2
6-10 14 21.9 9 17.3
>10 19 29.7 17 32.7
Male caregivers
0 14 36.8 12 35.3
1-5 7 18.4 7 20.6
6-10 8 21.1 6 17.6
>10 9 23.7 9 26.5
Female caregivers
0 5 19.2 4 22.2
1-5 5 19.2 3 16.7
80
T1 T3
n % n %
6-10 6 23.1 3 16.7
>10 10 38.5 8 44.4
Table 51 Recall of GLLiW messages about exclusive breast feeding (EBF) at T3, among caregivers of children 
younger than 6 months
T3
n %
Life Stage (All)
Yes 70 66.7
No 24 22.9
Not Sure 11 10.5
Male caregivers
Yes 44 63.8
No 17 24.6
Not Sure 8 11.6
Female caregivers
Yes 26 72.2
No 7 19.4
Not Sure 3 8.3
Table 52 General recall of GLLiW campaign at T1 & T3
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
Yes 4746 52.8 53.3 3617 55.3 55.0
No 2734 30.4 29.9 1790 27.4 28.0 2.59, 0.273
Not Sure 1506 16.8 16.9 1128 17.3 16.9
Priority Regions
Yes 2770 55.5 55.4 2112 56.8 55.4
No 1466 29.3 29.3 1029 27.7 29.5 0.04, 0.979
Not Sure 759 15.2 15.3 579 15.6 15.1
Non-Priority Regions
Yes 1976 49.5 50.6 1505 53.5 54.6
No 1268 31.8 30.6 761 27.0 26.3 5.95, 0.051
Not Sure 747 18.7 18.8 549 19.5 19.1
Life Stage (All)
Yes 1288 58.3 58.3 1087 57.0 57.3
No 590 26.7 26.9 525 27.5 27.5 0.22, 0.895
Not Sure 330 14.9 14.8 295 15.5 15.1
Young men
Yes 373 53.2 54.0 396 56.6 56.0
No 201 28.7 28.0 187 26.7 27.5 0.62, 0.732
Not Sure 127 18.1 18.0 117 16.7 16.5
Young women
Yes 463 66.1 64.3 329 64.4 65.3
No 162 23.1 24.2 114 22.3 21.8 0.87, 0.647
Not Sure 75 10.7 11.5 68 13.3 12.9
Male caregivers
Yes 167 54.4 147 53.6
No 96 31.3 87 31.8
Not Sure 44 14.3 40 14.6
Female caregivers
Yes 115 57.2 85 55.2
81
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
No 49 24.4 51 33.1
Not Sure 37 18.4 18 11.7
Partners of pregnant women
Yes 115 54.5 88 45.4
No 62 29.4 65 33.5
Not Sure 34 16.1 41 21.1
Pregnant women
Yes 55 62.5 42 56.8
No 20 22.7 21 28.4
Not Sure 13 14.8 11 14.9
Table 53 Exposure to any GLLiW Advertisements asked about at T3
T3
n % Weighted %
National Sample (All)
Yes 6108 93.5 93.6
No 158 2.4 2.3
Not Sure 269 4.1 4.1
Priority Regions
Yes 3473 93.4 93.3
No 85 2.3 2.1
Not Sure 162 4.4 4.6
Non-Priority Regions
Yes 2635 93.6 93.9
No 73 2.6 2.5
Not Sure 107 3.8 3.6
Life Stage (All)
Yes 1813 95.1 95.1
No 29 1.5 1.4
Not Sure 65 3.4 3.5
Young men
Yes 660 94.3 94.1
No 13 1.9 2.2
Not Sure 27 3.9 3.7
Young women
Yes 493 96.5 96.1
No 8 1.6 1.6
Not Sure 10 2.0 2.3
Male caregivers
Yes 263 96.0
No 0 .
Not Sure 11 4.0
Female caregivers
Yes 148 96.1
No 1 0.6
Not Sure 5 3.2
Partners of pregnant women
Yes 181 93.3
No 5 2.6
Not Sure 8 4.1
Pregnant women
Yes 68 91.9
No 2 2.7
Not Sure 4 5.4
82
Objective 2 Analyses
Table 54 Behaviors and Behavioral Determinants Related to Self-Reported Use of ITN at T1 & T3
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
National Sample (All)
Behavior (self) Yes 3046 33.9 36.3 2475 37.9 41.8 18.86, <0.001 No 5940 66.1 63.7 4060 62.1 58.2
Behavior (self-pregnant women) Yes 179 44.5 126 47.9
No 223 55.5 137 52.1
Behavior (children) All children 1130 54.0 55.8 851 54.6 55.4 0.03, 0.867
Less than all children 961 46.0 44.2 709 45.4 44.6
Priority Regions
Behavior (self) Yes 1618 32.4 34.7 1339 36.0 39.5 8.14, 0.004 No, Unsure 3377 67.6 65.3 2381 64.0 60.5
Behavior (self-pregnant women) Yes 78 38.6 67 48.9
No 124 61.4 70 51.1
Behavior (children) All children 607 53.5 56.0 460 53.9 53.7 0.53, 0.467
Less than all children 528 46.5 44.0 393 46.1 46.3
Non-Priority Regions
Behavior (self) Yes 1428 35.8 38.2 1136 40.4 44.5 10.94, <0.001 No 2563 64.2 61.8 1679 59.6 55.5
Behavior (self-pregnant women) Yes 101 50.5 59 46.8
No 99 49.5 67 53.2
Behavior (children) All children 523 54.7 55.5 391 55.3 57.2 0.23, 0.634
Less than all children 433 45.3 44.5 316 44.7 42.8
Life Stage (All)
Behavior (self) Yes 739 33.5 36.3 693 36.3 38.7 1.40, 0.237
No 1469 66.5 63.7 1214 63.7 61.3
Young men
Behavior (self) Yes 223 31.8 34.1 232 33.1 34.7 0.04, 0.836 No 478 68.2 65.9 468 66.9 65.3
Young women
Behavior (self) Yes 202 28.9 30.9 154 30.1 32.5 0.26, 0.613
No 498 71.1 69.1 357 69.9 67.5
Male caregivers
Behavior (self) Yes 112 36.5 116 42.3
No, Unsure 195 63.5 158 57.7
Behavior (children) All children 145 51.2 132 50.4
Less than all children 138 48.8 130 49.6
IPC Yes 140 49.5 155 59.2
No 143 50.5 107 40.8
Intention Every night 175 61.8 170 64.9
Less than every night 108 38.2 92 35.1
Female caregivers
Behavior (self) Yes 85 42.3 69 44.8
No 116 57.7 85 55.2
Behavior (children) All children 96 49.0 78 53.4
Less than all children 100 51.0 68 46.6
IPC Yes 95 48.5 82 56.2
No 101 51.5 64 43.8
Intention Every night 133 67.9 97 66.4
Less than every night 63 32.1 49 33.6
Partners of pregnant women
Behavior (self) Yes 83 39.3 87 44.8
No 128 60.7 107 55.2
IPC Yes 114 54.0 110 56.7
No 97 46.0 84 43.3
Intention Every night 130 61.6 126 64.9
83
T 1 T3 X2, p-value
n % Weighted % n % Weighted %
Less than every night 81 38.4 68 35.1
Behavior (partner) Yes 110 52.1 99 51.0
No 101 47.9 95 49.0
Pregnant women
Behavior (self) Yes 34 38.6 35 47.3
No 54 61.4 39 52.7
IPC Yes 51 58.0 55 74.3
No 37 42.0 19 25.7
Intention Every night 52 59.1 46 62.2
Less than every night 36 40.9 28 37.8
84
Objective 3 Analyses
Table 55 Exposure and self-reported bednet use at T3 only for life stage Sample
Young men Young women Male caregiver Female 
caregiver
Partner of 
pregnant woman
Pregnant 
woman
All
Total slept 
under net %
1 P 
value
Total slept 
under net %
1 P 
value
Total slept 
under net
%
2 Total slept 
under net
%
2 Total slept 
under net %
2 Total slept 
under net %
2 Total slept 
under net %
1 P 
value
Structural Access
TV
None or a 
few days 365 33.2
0.428
234 33.6
0.699
117 48.7 55 43.6 81 34.6 21 47.6 873 37.9
0.613 Most or 
every day 335 36.3 277 31.6 157 37.6 99 45.5 113 52.2 53 47.2 1034 39.4
Radio
None or a 
few days 397 31.8
0.079
329 26.5
<.001
135 41.5 87 41.4 98 34.7 46 37.0 1092 33.8
<.001 Most or 
every day 303 38.6 182 44.4 139 43.2 67 49.3 96 55.2 28 64.3 815 45.8
Coverage
Exposed to any GLLiW malaria message
No, Not 
sure
172 17.6 <.001 123 14.3 <.001 55 32.7 31 22.6 58 24.1 19 31.6 458 18.9 <.001
Yes 528 39.9 388 38.5 219 44.7 123 50.4 136 53.7 55 52.7 1449 44.5
Intensity
Exposure to ITN/Malaria health messages
0 166 24.2
0.002
115 19.9
0.021
56 33.9 29 37.9 65 35.4 12 41.7 443 29.6
1-10 239 33.4 194 35.9 121 41.3 56 37.5 55 41.8 29 44.8 694 39.4 0.004
>10 295 41.5 202, 36.8 97 48.5 69 53.6 74 55.4 33 51.5 770 43.5
1Total is unweighted row total number in sample. Percentage is weighted
1Total is unweighted row total number in sample. Percentage is unweighted. Sample size insufficient to perform statistic testing
85
Table 56 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet use 
previous night at T3 only for life stage Sample
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.68 (1.28, 2.21) <.001
TV Most/Every day vs None/Few days 0.96 (0.74, 1.26) 0.788
Model 2: Coverage
Exposed to any GLLiW malaria message Yes vs No/Unsure 3.61 (2.61, 5.00) <.001
Model 3: Intensity
Exposure to ITN/Malaria health messages 1-10 vs 0 messages 1.82 (1.23, 2.69) 0.003
>10 vs 0 messages 2.24 (1.53, 3.29) <.001
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 57 Adjusted Odds Ratios for the association between exposure variables and self-reported bednet use 
previous night at T3 only for life stage Sample
Exposure Comparison aOR1 (95% CI) P value
Structural Access
TV
Young men Most/Every day vs None/Few days 0.99 (0.69, 1.41) 0.937
Young women Most/Every day vs None/Few days 0.75 (0.46, 1.22) 0.244
Male caregivers Most/Every day vs None/Few days 0.54 (0.29, 0.99) 0.047
Female caregivers Most/Every day vs None/Few days 0.77 (0.34, 1.71) 0.517
Partners of pregnant women Most/Every day vs None/Few days 2.28 (1.09, 4.77) 0.029
Pregnant women Most/Every day vs None/Few days 6.46 (1.63,25.57) 0.008
Radio
Age 18-24 Most/Every day vs None/Few days 1.70 (1.24, 2.34) <.001
Age 25-35 Most/Every day vs None/Few days 2.87 (1.89, 4.36) <.001
Age 36-49 Most/Every day vs None/Few days 0.59 (0.27, 1.30) 0.189
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
86
Table 58 Exposure and self-report that all children slept under bednet at T3 only for life stage Sample1
Male caregiver Female caregiver Partner of pregnant 
woman
Pregnant woman All
Total slept 
under net2 %
2 Total slept 
under net2
%
2 Total slept 
under net2 %
2 Total slept 
under net2 %
2 Total slept 
under net2 %
2
Structural Access
TV
None or a
few days 114 5.6 53 47.2 22 13.6 7 42.9 196 46.4
Most or 
every day 148 48.6 93 57 46 54.3 14 71.4 301 53.2
Radio
None or a 
few days 129 42.6 83 50.6 37 24.3 15 53.3 264 43.2
Most or 
every day 133 57.9 63 57.1 31 61.3 6 83.3 233 58.8
Coverage
Exposed to any GLLiW 
malaria message
No, Not 
sure
51 41.2 29 37.9 18 22.2 7 42.9 105 37.1
Yes 211 52.6 117 57.3 50 48 14 71.4 392 54.1
Intensity
Exposure to ITN/Malaria 
health messages
0 54 50 27 44.4 20 30 5 40 106 44.3
1-10 117 43.6 54 44.4 23 43.5 9 77.8 203 45.3
>10 91 59.3 64 64.6 25 48 7 57.1 188 59.6
1No Young Men or Young Women in life stage sample had a child under 5 living in household
2Total is unweighted total number in sample. Percentage is unweighted. Sample size insufficient to perform statistic testing
87
Table 59 Exposure and self-reported use of modern contraception method at T3 only for life stage Sample (sexually active, not pregnant/trying to become 
pregnant)
Young men Young women Male caregiver Female caregiver All
Use modern
contraception
Total
%1
Use modern
contraception
Total
%1
Use modern
contraception
Total
%1
Use modern
contraception
Total
%1
Use modern
contraception
Total
Weighted 
%
P value
Structural Access
TV
None or a few 
days
105 87.2 79 81.1 49 79.6 26 92.3 259 85.3
0.323 Most or every 
day
107 89.7 90 79.9 80 80.0 51 80.4 328 81.3
Radio
None or a few 
days
112 89.6 110 77 63 79.4 44 90.9 329 82.7
0.827 Most or every 
day
100 87.1 59 88.4 66 80.3 33 75.8 258 83.6
Coverage
Exposed to any GLLiW FP message
No, Not sure 27 89.6 17 53.8 30 63.3 15 80.0 89 75.0 0.077 Yes 185 88.3 152 83.2 99 84.8 62 85.5 498 84.7
Intensity
Exposure to FP health messages
0 77 82.8 53 77.7 51 72.5 27 81.5 208 80.5
1-10 84 88.9 72 87 51 84.3 31 80.6 238 84.2 0.638
>10 51 95.9 44 73.6 27 85.2 19 94.7 141 85.1
1Total is unweighted row total number in sample. Percentage is weighted. Sample size insufficient to perform statistical testing.
88
Table 60 Exposure and interpersonal communication about pregnancy prevention at T3 only for life stage Sample
(sexually active, not pregnant/trying to become pregnant)
Young men Young women Male 
caregiver
Female 
caregiver All
IPC about
contraception
Total, Weighted 
%1
IPC about
contraception
Total, Weighted 
%1
IPC about
contraception
Total, %2
IPC about
contraception
Total, %2
IPC about
contraception
Total, Weighted 
%1
P 
value
Structural Access
TV
None or a few 
days 167, 46.0 115, 46.5 76, 44.7 39, 59.0 397, 46.6 0.121
Most or every day 163, 50.1 131, 50.6 112, 52.7 70, 64.3 476, 53.3
Radio
None or a few 
days 179, 45.7 161, 45.6 93, 46.2 65, 58.5 498, 47.4 0.105
Most or every day 151, 50.8 85, 56.0 95, 52.6 44, 68.2 375, 54.7
Coverage
Exposed to any GLLiW FP message
No, Not sure 53, 32.9 33, 39.7 43, 41.9 25, 40.0 154, 38.4 0.009 Yes 277, 51.0 213, 50.1 145, 51.7 84, 69.0 719, 53.3
Intensity
Exposure to FP health messages
0 151, 37.7 102, 32.7 77, 37.7 46, 56.5 376, 39.7
1-10 113, 55.6 91, 61.8 76, 61.8 40, 60.0 320, 58.2 <.001
>10 66, 58.0 53, 59.5 35, 48.6 23, 78.3 177, 58.7
1Total is unweighted total number in sample. Percentage is weighted. Sample size insufficient to perform statistical testing.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 61 Adjusted Odds Ratios for the association between exposure and IPC about modern method use at T3 
only for life stage Sample (sexually active, not pregnant/trying to become pregnant)
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.52 (1.05, 2.19) 0.026
TV Most/Every day vs None/Few days 1.20 (0.84, 1.71) 0.314
Model 2: Coverage
Exposed to any GLLiW FP message Yes vs No/Unsure 1.83 (1.17, 2.87) 0.009
Model 3: Intensity
Exposure to FP health messages 1-10 vs 0 messages 2.20 (1.49, 3.25) <.001
>10 vs 0 messages 2.11 (1.33, 3.34) 0.001
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 62 Adjusted Odds Ratios for the association between exposure and IPC about modern method use at T3 
only for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds Ratios shown for each 
subgroup to interpret significant interaction effects
Exposure Comparison aOR1 (95% CI) P value
Coverage Yes vs No/Unsure
Education
No education Yes vs No/Unsure 1.95 (0.38,10.01) 0.423
Primary Yes vs No/Unsure 17.78 (3.12,101.4) 0.001
Middle/JSS/JHS Yes vs No/Unsure 3.08 (1.04, 9.08) 0.042
Secondary Yes vs No/Unsure 2.12 (0.98, 4.57) 0.056
Tertiary Yes vs No/Unsure 0.73 (0.34, 1.56) 0.414
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
89
Table 63 Exposure and intentions to use pregnancy prevention method at T3 only for life stage Sample (sexually 
active, not pregnant/trying to become pregnant)
Young men Young women Male 
caregiver
Female 
caregiver All
Intend to use
method
Total, Weighted 
%1
Intend to use 
method
Total, Weighted 
%1
Intend to use 
method
Total, %2
Intend to use 
method
Total, %2
Intend to use 
method
Total, Weighted 
%1
P 
value
Structural Access
TV
None or a few 
days 167, 71.6 115, 62.4 76, 73.7 39, 59.0 397, 63.3 0.218
Most or every day 163, 64.9 131, 70.7 112, 71.4 70, 70.0 476, 68.5
Radio
None or a few 
days 179, 69.0 161, 64.5 93, 68.8 65, 64.6 498, 65.1 0.515
Most or every day 151, 67.5 85, 72.3 95, 75.8 44, 68.2 375, 67.9
Coverage
Exposed to any GLLiW FP message
No, Not sure 53, 58.8 33, 55.4 43, 69.8 25, 60.0 154, 60.1 0.179 Yes 277, 70.2 213, 68.6 145, 73.1 84, 67.9 719, 67.7
Intensity
Exposure to FP health messages
0 151, 65.2 102, 51.1 77, 71.4 46, 71.7 376, 61.4
1-10 113, 75.8 91, 83.7 76, 67.1 40, 55.0 320, 69.3 0.126
>10 66, 62.3 53, 69.8 35, 85.7 23, 73.9 177, 71.1
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 64 Adjusted Odds Ratios for the association between exposure and Intent to use modern method use at T3 
only for life stage Sample (sexually active, not pregnant/trying to become pregnant)
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.20 (0.81, 1.79) 0.357
TV Most/Every day vs None/Few days 1.22 (0.83, 1.79) 0.311
Model 2: Coverage
Exposed to any GLLiW FP message Yes vs No/Unsure 1.27 (0.78, 2.06) 0.335
Model 3: Intensity
Exposure to FP health messages 1-10 vs 0 messages 1.44 (0.95, 2.19) 0.088
>10 vs 0 messages 1.43 (0.87, 2.35) 0.164
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 65 Adjusted Odds Ratios for the association between exposure and Intent to use modern method use at T3 
only for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds Ratios shown for each 
subgroup to interpret significant interaction effects
Exposure Comparison aOR1 (95% CI) P value
Coverage
Education
No education Yes vs No/Unsure 0.41 (0.08, 1.97) 0.263
Primary education Yes vs No/Unsure 0.12 (0.02, 0.89) 0.038
Middle school education Yes vs No/Unsure 2.12 (0.75, 5.97) 0.154
Secondary school education Yes vs No/Unsure 3.86 (1.82, 8.22) <.001
Tertiary or higher education Yes vs No/Unsure 0.78 (0.32, 1.91) 0.591
Intensity
Life Stage
Young men 1-10 vs 0 messages 1.73 (0.96, 3.09) 0.066
Young men >10 vs 0 messages 0.92 (0.49, 1.72) 0.789
90
Exposure Comparison aOR1 (95% CI) P value
Young women 1-10 vs 0 messages 4.81 (2.15,10.74) <.001
Young women >10 vs 0 messages 2.07 (0.80, 5.35) 0.132
Male caregivers 1-10 vs 0 messages 0.72 (0.31, 1.68) 0.442
Male caregivers >10 vs 0 messages 2.29 (0.59, 8.81) 0.230
Female caregivers 1-10 vs 0 messages 0.63 (0.20, 1.98) 0.428
Female caregivers >10 vs 0 messages 1.07 (0.30, 3.86) 0.921
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
Table 66 Adjusted Odds Ratios for the association between exposure and Use of modern method use at T3 only 
for life stage Sample (sexually active, not pregnant/trying to become pregnant)
Exposure Comparison aOR1,2 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.08 (0.61, 1.91) 0.796
TV Most/Every day vs None/Few days 0.80 (0.46, 1.41) 0.447
Model 2: Coverage
Exposed to any GLLiW FP message Yes vs No/Unsure 1.96 (0.96, 4.04) 0.066
Model 3: Intensity
Exposure to FP health messages 1-10 vs 0 messages 1.22 (0.65, 2.31) 0.537
>10 vs 0 messages 1.32 (0.57, 3.05) 0.519
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
2For this outcome, we had to combine no education with primary education for the model to run
Table 67 Adjusted Odds Ratios for the association between exposure and Use of modern method use at T3 only 
for life stage Sample (sexually active, not pregnant/trying to become pregnant) – Odds Ratios shown for each 
subgroup to interpret significant interaction effects
Exposure Comparison aOR1.2 (95% CI) P value
Structural Access
TV
Age 18-24 Most/Every day vs None/Few days 2.57 (0.93, 7.08) 0.069
Age 25-35 Most/Every day vs None/Few days 0.81 (0.37, 1.77) 0.596
Age 36-49 Most/Every day vs None/Few days 0.15 (0.03, 0.87) 0.035
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
2For this outcome, we had to combine no education with primary education for the model to run
Table 68 Exposure and interpersonal communication about pregnancy prevention at T3 only for life stage Sample
(not sexually active, not pregnant)
Young men Young women Male 
caregiver
Female 
caregiver All
IPC about 
contraception
Total, Weighted 
%1
IPC about 
contraception
Total, Weighted 
%1
IPC about 
contraception
Total, %2
IPC about 
contraception
Total, %2
IPC about 
contraception
Total, Weighted 
%1
P 
value
Structural Access
TV
None or a few 
days 173, 35.1 95, 40.2 27, 29.6 14, 35.7 309, 33.6 0.643
Most or every day 126, 43.7 105, 34.3 23, 39.1 17, 41.2 271, 35.8
Radio
None or a few 
days 181, 35.2 126, 40.8 28, 35.7 15, 40.0 350, 35.1 0.824
Most or every day 118, 44.6 74, 30.5 22, 31.8 16, 37.5 230, 34.0
Coverage
Exposed to any GLLiW FP message
No, Not sure 66, 31.8 38, 32.8 22, 27.3 6, 33.3 132, 32.4 0.622 Yes 233, 40.8 162, 38.1 28, 39.3 25, 40.0 448, 35.3
Intensity
91
Young men Young women Male 
caregiver
Female 
caregiver All
IPC about 
contraception
Total, Weighted 
%1
IPC about 
contraception
Total, Weighted 
%1
IPC about 
contraception
Total, %2
IPC about 
contraception
Total, %2
IPC about 
contraception
Total, Weighted 
%1
P 
value
Exposure to FP health messages
0 146, 32.3 101, 31.5 24, 29.2 10, 10.0 281, 29.6
1-10 100, 36.1 58, 44.1 17, 41.2 16, 50.0 191, 36.1 0.066
>10 53, 62.2 41, 43.5 9, 33.3 5, 60.0 108, 45.9
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 69 Exposure and intentions to use pregnancy prevention method at T3 only for life stage Sample (not 
sexually active, not pregnant)
Young men Young women Male 
caregiver
Female 
caregiver All
Intend to use 
method
Total, Weighted 
%1
Intend to use 
method
Total, Weighted 
%1
Intend to use 
method
Total, %2
Intend to use 
method
Total, %2
Intend to use 
method
Total, Weighted 
%1
P 
value
Structural Access
TV
None or a few 
days 173, 41.1 95, 31.3 27, 51.9 14, 64.3 309, 42.0 0.928
Most or every day 126, 43.9 105, 38.2 23, 43.5 17, 58.8 271, 42.5
Radio
None or a few 
days 181, 41.0 126, 36.7 28, 50.0 15, 73.3 350, 44.1 0.416
Most or every day 118, 44.3 74, 31.8 22, 45.5 16, 50.0 230, 39.5
Coverage
Exposed to any GLLiW FP message
No, Not sure 66, 39.1 38, 28.3 22, 45.5 6, 66.7 132, 39.5 0.561 Yes 233, 43.2 162, 36.6 28, 50.0 25, 60.0 448, 43.0
Intensity
Exposure to FP health messages
0 146, 36.2 101, 31.7 24, 58.3 10, 60.0 281, 39.7
1-10 100, 46.6 58, 36.5 17, 35.3 16, 62.5 191, 45.7 0.638
>10 53, 51.5 41, 42.6 9, 44.4 5, 60.0 108, 42.7
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 70 Adjusted odds ratios for relationships between exposure and IPC about FP at T3 only for life stage Sample
(not sexually active, not pregnant)
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.04 (0.68, 1.58) 0.873
TV Most/Every day vs None/Few days 1.14 (0.75, 1.73) 0.530
Model 2: Coverage
Exposed to any GLLiW FP message Yes vs No/Unsure 1.33 (0.80, 2.20) 0.272
Model 3: Intensity2
Exposure to FP health messages
1-10 vs 0 messages 1.51 (0.93, 2.44) 0.093
>10 vs 0 messages 2.07 (1.18, 3.62) 0.011
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
2Due to limited sample size of Age group (36-49) by intensity, two age groups (25-35) and (36-49) are combined in model 3
92
Table 71 Adjusted odds ratios for relationships between exposure and IPC about FP at T3 only for life stage Sample
(not sexually active, not pregnant) – Odds Ratios shown for each subgroup to interpret significant interaction 
effects
Exposure Comparison aOR1 (95% CI) P value
Intensity
Education
No education 1-10 vs 0 messages 2.57 (0.37,18.04) 0.341
>10 vs 0 messages 23.96 (2.78,206.3) 0.004
Primary education 1-10 vs 0 messages 2.72 (0.64,11.60) 0.176
>10 vs 0 messages 2.79 (0.64,12.04) 0.170
Middle school education 1-10 vs 0 messages 2.02 (0.70, 5.85) 0.194
>10 vs 0 messages 2.84 (0.84, 9.60) 0.093
Secondary school education 1-10 vs 0 messages 0.75 (0.35, 1.61) 0.461
>10 vs 0 messages 0.62 (0.25, 1.53) 0.297
Tertiary or higher education 1-10 vs 0 messages 2.62 (0.98, 7.00) 0.055
>10 vs 0 messages 4.93 (1.35,18.01) 0.016
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
Table 72 Adjusted odds ratio for relationships between exposure and intention about FP at T3 only for life stage
Sample (not sexually active, not pregnant) 
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 0.74 (0.46, 1.21) 0.231
TV Most/Every day vs None/Few days 1.14 (0.72, 1.81) 0.565
Model 2: Coverage
Exposed to any GLLiW FP message Yes vs No/Unsure 1.20 (0.72, 2.01) 0.485
Model 3: Intensity2
Exposure to FP health messages 1-10 vs 0 messages 1.15 (0.69, 1.91) 0.590
>10 vs 0 messages 1.08 (0.58, 1.99) 0.814
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
2Due to limited sample size of Age group (36-49) by intensity, two age groups (25-35) and (36-49) are combined in model 3
Table 73 Adjusted odds ratio for relationships between exposure and intention about FP at T3 only for life stage
Sample (not sexually active, not pregnant) – Odds Ratios shown for each subgroup to interpret significant 
interaction effects
Exposure Comparison aOR1 (95% CI) P value
Structural Access – Radio
Age
Age 18-24 Most/Every day vs None/Few days 1.16 (0.69, 1.96) 0.573
Age 25-35 Most/Every day vs None/Few days 0.34 (0.16, 0.74) 0.007
Age 36-49 Most/Every day vs None/Few days 0.52 (0.04, 6.50) 0.613
Structural Access – TV
Education
No education Most/Every day vs None/Few days 0.41 (0.09, 1.92) 0.255
Primary education Most/Every day vs None/Few days 0.50 (0.16, 1.58) 0.240
Middle school education Most/Every day vs None/Few days 1.67 (0.65, 4.33) 0.290
Secondary school education Most/Every day vs None/Few days 0.82 (0.40, 1.70) 0.597
Tertiary or higher education Most/Every day vs None/Few days 3.21 (1.28, 8.03) 0.013
Intensity
Life Stage
Young men 1-10 vs 0 messages 1.63 (0.93, 2.85) 0.089
>10 vs 0 messages 1.92 (0.97, 3.79) 0.062
Young women 1-10 vs 0 messages 1.30 (0.57, 2.98) 0.529
>10 vs 0 messages 1.54 (0.62, 3.82) 0.350
Male caregivers 1-10 vs 0 messages 0.23 (0.05, 0.99) 0.049
>10 vs 0 messages 0.18 (0.03, 1.02) 0.052
93
Exposure Comparison aOR1 (95% CI) P value
Female caregivers 1-10 vs 0 messages 0.66 (0.08, 5.65) 0.701
>10 vs 0 messages 0.19 (0.02, 2.20) 0.186
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
Table 74 Exposure and interpersonal communication about post-partum pregnancy prevention at T3 pregnant 
women or their partners
Partner of
pregnant woman Pregnant woman All
IPC about
contraception
Total, %1
IPC about
contraception
Total, %1
IPC about
contraception
Total, %1
Structural Access
TV None or a few days 81, 46.9 21, 47.6 102, 47.1
Most or every day 113, 55.8 53, 67.9 166, 59.6
Radio None or a few days 98, 46.9 46, 60.9 144, 51.4
Most or every day 96, 57.3 28, 64.3 124, 58.9
Coverage
Exposed to any GLLiW FP 
message
No, Not sure 58, 36.2 12, 58.3 70, 40.0
Yes 136, 58.8 62, 62.9 198, 60.1
Intensity
Exposure to FP health 
messages
0 95, 43.2 38, 55.3 133, 46.6
1-10 64, 54.7 22, 63.6 86, 57.0
>10 35, 71.4 14, 78.6 49, 73.5
1Total is unweighted total number in sample. Percentage is unweighted.
Table 75 Exposure and intentions to use pregnancy prevention after child is born at T3 for pregnant women or 
their partners
Partner of
pregnant woman
Pregnant woman All
Intent to use
method
Total, %1
Intent to use
method
Total, %1
Intent to use
method
Total, %1
Structural Access
TV None or a few days 81, 60.5 21, 76.2 102, 63.7
Most or every day 113, 65.5 53, 71.7 166, 67.5
Radio None or a few days 98, 59.2 46, 65.2 144, 61.1
Most or every day 96, 67.7 28, 85.7 124, 71.8
Coverage
Exposed to any GLLiW FP 
message
No, Not sure 58, 53.4 12, 50.0 70, 52.9
Yes 136, 67.6 62, 77.4 198, 70.7
Intensity
Exposure to FP health 
messages
0 95, 60.0 38, 63.2 133, 60.9
1-10 64, 71.9 22, 86.4 86, 75.6
>10 35, 57.1 14, 78.6 49, 63.3
1Total is unweighted total number in sample. Percentage is unweighted.
94
Table 76 Exposure and IPC about handwashing at T3 only for life stage Sample
Young men Young women Male caregiver Female 
caregiver
Partner of 
pregnant woman
Pregnant 
woman
All
IPC
about HW
Total, %1
P 
value
IPC
about HW
Total, %1
P value
IPC
about HW
Total, %2
IPC
about HW
Total, %2
IPC
about HW
Total, %2
IPC
about HW
Total, %2
IPC
about HW
Total, %1
P value
Structural Access
TV
None or a few days 365, 45.8 0.030 234, 60.7 0.876 117, 58.1 55, 70.9 81, 54.3 21, 52.4 873, 59.0 0.001 Most or every day 335, 54.4 277, 67.9 157, 65.0 99, 83.8 113, 63.7 53, 73.6 1034, 68.2
Radio
None or a few days 397, 46.4 0.041 329, 60.3 0.016 135, 61.5 87, 72.4 98, 52.0 46, 71.7 1092, 61.5 0.033 Most or every day 303, 54.7 182, 72.8 139, 62.6 67, 88.1 96, 67.7 28, 60.7 815, 67.7
Coverage
Exposed to any GLLiW HW message
No, Not sure 173, 24.1 <.001 116, 53.2 0.011 51, 37.3 28, 53.6 51, 33.3 13, 46.2 432, 41.0 <.001 Yes 527, 58.5 395, 68.3 223, 67.7 126, 84.9 143, 69.2 61, 72.1 1475, 70.6
Intensity
Exposure to HW health messages
0 249, 38.4
<.001
162, 56.4
0.048
100, 54.0 43, 69.8 76, 44.7 24, 45.8 654, 52.6
1-10 277, 50.2 215, 65.3 109, 60.6 60, 80.0 70, 74.3 28, 78.6 759, 65.9 <.001
>10 174, 66.8 134, 72.6 65, 76.9 51, 86.3 48, 62.5 22, 77.3 494, 75.7
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 77 Exposure and intentions about handwashing at T3 only for life stage Sample
Young men Young women Male caregiver Female 
caregiver
Partner of 
pregnant woman
Pregnant 
woman
All
Intends to 
use soap 
every time
Total, %1
P 
value
Intends to 
use soap 
every time
Total, %1
P value
Intends to use 
soap every time
Total, %2
Intends to use 
soap every time
Total, %2
Intends to use soap 
every time
Total, %2
Intends to use 
soap every 
time
Total, %2
Intends to 
use soap 
every time
Total, %1
P value
Structural Access
TV
None or a few days 365, 56.7 0.011 234, 61.6 0.217 117, 68.4 55, 70.9 81, 66.7 21, 81.0 873, 66.1 0.205 Most or every day 335, 66.6 277, 68.0 157, 67.5 99, 69.7 113, 72.6 53, 75.5 1034, 69.6
Radio
None or a few days 397, 54.9 <.001 329, 64.4 0.741 135, 60.7 87, 73.6 98, 61.2 46, 80.4 1092, 66.0 0.081 Most or every day 303, 70.3 182, 66.2 139, 74.8 67, 65.7 96, 79.2 28, 71.4 815, 70.9
Coverage
Exposed to any GLLiW HW message
95
Young men Young women Male caregiver Female 
caregiver
Partner of 
pregnant woman
Pregnant 
woman
All
Intends to 
use soap 
every time
Total, %1
P 
value
Intends to 
use soap 
every time
Total, %1
P value
Intends to use 
soap every time
Total, %2
Intends to use 
soap every time
Total, %2
Intends to use soap 
every time
Total, %2
Intends to use 
soap every 
time
Total, %2
Intends to 
use soap 
every time
Total, %1
P value
No, Not sure 173, 46.9 <.001 116, 55.5 0.034 51, 54.9 28, 71.4 51, 45.1 13, 76.9 432, 56.7
<.001 Yes 527, 66.2 395, 68.2 223, 70.9 126, 69.8 143, 79.0 61, 77.0 1475, 71.3
Intensity
Exposure to HW health messages
0 249, 53.7
0.004
162, 64.0
0.899
100, 63.0 43, 69.8 76, 68.4 24, 75.0 654, 65.7
1-10 277, 63.1 215, 64.6 109, 64.2 60, 71.7 70, 67.1 28, 64.3 759, 66.4 0.050
>10 174, 70.3 134, 66.9 65, 81.5 51, 68.6 48, 77.1 22, 95.5 494, 73.6
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
Table 78 Exposure and handwashing with soap after last using the toilet at T3 only for life stage Sample
Young men Young women Male caregiver Female 
caregiver
Partner of 
pregnant woman
Pregnant 
woman
All
Washed 
hands with 
soap
Total, %1
P 
value
Washed 
hands with 
soap
Total, %1
P value
Washed hands 
with soap
Total, %2
Washed hands 
with soap
Total, %2
Washed hands with 
soap
Total, %2
Washed hands 
with soap
Total, %2
Washed 
hands with 
soap
Total, %1
P value
Structural Access
TV
None or a few days 365, 74.7 0.189 234, 85.8 0.014 117, 76.1 55, 85.5 81, 74.1 21, 81.0 873, 81.7 0.061 Most or every day 335, 79.1 277, 93.0 157, 80.3 99, 91.9 113, 80.5 53, 84.9 1034, 85.6
Radio
None or a few days 397, 73.9 0.046 329, 88.3 0.216
135, 71.1 87, 89.7 98, 74.5 46, 93.5 1092, 82.8 0.266 Most or every day 303, 80.7 182, 92.4 139, 85.6 67, 89.6 96, 81.3 28, 67.9 815, 85.2
Coverage
Exposed to any GLLiW HW message
No, Not sure 173, 63.0 <.001 116, 86.3 0.204 51, 54.9 28, 75.0 15, 80.0 51, 58.8 432, 72.1 <.001 Yes 527, 81.4 395, 90.8 223, 83.9 126, 92.9 62, 85.5 143, 84.6 1475, 87.2
Intensity
Exposure to HW health messages
0 249, 72.3
0.047
162, 82.5
0.010
100, 71.0 43, 74.4 76, 68.4 24, 79.2 654, 76.0
1-10 277, 77.0 215, 93.1 109, 79.8 60, 95.0 70, 84.3 28, 85.7 759, 86.3 <.001
>10 174, 83.2 134, 92.4 65, 87.7 51, 96.1 48, 83.3 22, 86.4 494, 89.8
1Total is unweighted total number in sample. Percentage is weighted.
2Total is unweighted total number in sample. Percentage is unweighted.
96
Table 79 Adjusted Odds Ratios for the association between exposure and IPC about handwashing at T3 only for 
life stage Sample
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.30 (1.00, 1.68) 0.047
TV Most/Every day vs None/Few days 1.37 (1.06, 1.77) 0.015
Model 2: Coverage
Exposed to any GLLiW handwashing message Yes vs No/Unsure 3.37 (2.51, 4.51) <.001
Model 3: Intensity
Exposure to handwashing health messages 1-10 vs 0 messages 1.62 (1.23, 2.14) <.001
>10 vs 0 messages 2.78 (2.04, 3.79) <.001
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 80 Adjusted Odds Ratios for the association between exposure and IPC about handwashing at T3 only for 
life stage Sample – Odds Ratios shown for each subgroup to interpret significant interaction effects
Exposure Comparison aOR1 (95% CI) P value
Structural Access – Radio
Age
Age 15-24 Most/Every day vs None/Few days 1.50 (1.10, 2.04) 0.010
Age 25-35 Most/Every day vs None/Few days 1.63 (1.11, 2.39) 0.013
Age 36-49 Most/Every day vs None/Few days 0.49 (0.21, 1.16) 0.105
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
Table 81 Adjusted Odds Ratios for the association between exposure and intentions about handwashing at T3 
only for life stage Sample
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.19 (0.91, 1.54) 0.206
TV Most/Every day vs None/Few days 1.10 (0.85, 1.41) 0.478
Model 2: Coverage
Exposed to any GLLiW handwashing message Yes vs No/Unsure 1.86 (1.42, 2.44) <.001
Model 3: Intensity
Exposure to handwashing health messages 1-10 vs 0 messages 0.97 (0.74, 1.28) 0.851
>10 vs 0 messages 1.45 (1.06, 1.97) 0.018
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 82 Adjusted Odds Ratios for the association between exposure and intentions about handwashing at T3 
only for life stage Sample – Odds Ratios shown for each subgroup to interpret significant interaction effects
Exposure Comparison aOR1 (95% CI) P value
Structural Access – Radio
Life Stage
Young men Most/Every day vs None/Few days 1.85 (1.32, 2.60) <.001
Young women Most/Every day vs None/Few days 1.09 (0.68, 1.75) 0.724
Male caregivers Most/Every day vs None/Few days 1.23 (0.65, 2.31) 0.520
Female caregivers Most/Every day vs None/Few days 0.55 (0.23, 1.30) 0.174
Partners of pregnant women Most/Every day vs None/Few days 2.54 (1.15, 5.58) 0.021
Pregnant women Most/Every day vs None/Few days 0.38 (0.10, 1.40) 0.146
Intensity
Urban/Rural Residence
Urban 1-10 vs 0 messages 0.83 (0.59, 1.18) 0.301
>10 messages 1.04 (0.71, 1.52) 0.859
Rural 1-10 vs 0 messages 1.22 (0.78, 1.92) 0.388
>10 messages 2.62 (1.54, 4.44) <.001
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
97
Table 83 Adjusted Odds Ratios for the association between exposure and washing hands with soap after last use 
of toilet at T3 only for life stage Sample
Exposure Comparison aOR1 (95% CI) P value
Model 1: Structural Access
Radio Most/Every day vs None/Few days 1.31 (0.94, 1.82) 0.117
TV Most/Every day vs None/Few days 1.20 (0.88, 1.66) 0.253
Model 2: Coverage
Exposed to any GLLiW handwashing message Yes vs No/Unsure 2.53 (1.85, 3.47) <.001
Model 3: Intensity
Exposure to handwashing health messages 1-10 vs 0 messages 1.81 (1.27, 2.56) <.001
>10 vs 0 messages 2.62 (1.75, 3.92) <.001
1OR adjusted for age, education, urban/rural residence, and life stage. No interaction models
Table 84 Adjusted Odds Ratios for the association between exposure and washing hands with soap after last use 
of toilet at T3 only for life stage Sample – Odds Ratios shown for each subgroup to interpret significant interaction 
effects
Exposure Comparison aOR1 (95% CI) P value
Structural Access – TV
Age
Age 18-24 Most/Every day vs None/Few days 1.73 (1.19, 2.51) 0.004
Age 25-35 Most/Every day vs None/Few days 1.38 (0.83, 2.29) 0.219
Age 36-49 Most/Every day vs None/Few days 0.36 (0.11, 1.18) 0.092
Structural Access – Radio
Education
No education Most/Every day vs None/Few days 1.56 (0.63, 3.84) 0.332
Primary education Most/Every day vs None/Few days 0.43 (0.20, 0.92) 0.029
Middle school education Most/Every day vs None/Few days 1.04 (0.51, 2.13) 0.912
Secondary school education Most/Every day vs None/Few days 1.90 (1.13, 3.19) 0.016
Tertiary or higher education Most/Every day vs None/Few days 1.56 (0.75, 3.23) 0.235
1OR adjusted for age, education, urban/rural residence, and life stage. Models with significant interactions only
98
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