STRATEGIC OBJECTIVE 3 CLOSE-OUT REPORT 
USAID/GHANA – March 2005 
I. BASIC IDENTIFYING INFORMATION 
Strategic Objective: Improved Family Health 
SO Number: 641-003 (Project No. 641-0140) 
SO Approval Date: February 8, 1999 
Performance Period: FY 1999 to FY 2005 
Geographic Area: Ghana (countrywide program) 
Initial Obligation: $ 15,196,000 
Total Cost: $ 102,675,000 (see section IV for additional details) 
Estimated Host Country 
Contributions: $169,000 
Major Implementing
Partners: Ministry of Health (MOH)/Ghana Health Services (GHS) 
Ghana Social Marketing Foundation (GSMF) 
EngenderHealth (formerly AVSC International) 
Family Health International (FHI) 
 United Nations Children’s Fund (UNICEF)
The Ghana Registered Midwives Association (GRMA) 
Johns Hopkins University/Population Communication Services 
DELIVER 
AFRICARE 
Planned Parenthood Association Ghana (PPAG) 
JHPIEGO Corporation 
NetMark 
 
II. HISTORY OF STRATEGIC OBJECTIVE 3 
During the life of Strategic Objective 3 (SO3), USAID was one of the largest health donors in support of 
quality health care in Ghana, contributing to HIV/AIDS prevention and control, reproductive health, and 
child survival programs. SO3 was built around critical health challenges identified by the Ghanaian 
Government and USAID, including: 
• High under-five mortality rate – estimated at 108 deaths per 1,000 live births1
 in 1998 (although
this represented a 43% drop over the previous 20 years, the fact remained that one out of every 
10 children continued to die before their fifth birthday due to preventable diseases such as
malaria, measles, pneumonia, diarrhea, and malnutrition). 
• Relatively high fertility rate – estimated at 4.61
 in 1998, with a significant unmet need for family
planning and modern contraceptive (use of modern contraceptives was estimated at 10%). 
• HIV prevalence2
 (3.6% in 1998) was thought to be reaching a critical juncture in Ghana, and the 
need to accelerate interventions to prevent further spread of HIV was of paramount importance.3
 
1
 1
 1998 Ghana Demographic Health Survey (DHS) 2
 Re-adjusted values (WHO provided a new simplified method for calculating the national prevalence for standardized HIV 
prevalence - introduced in 2003)
3
 During the end of the SO, it was realized that the Ghanaian epidemic less virulently than those in countries in Eastern and 
Southern Africa. 
2
A number of other constraints inhibiting improved health services were identified as: lack of access to 
health care (due to geographic distances, limited basic service provision, financial barriers); lack of quality 
of services (resource management); inadequate funding of health services; and poor community, 
intersectoral and private sector linkages. 
In response, SO3 was created to support two key components: (1) increased use of reproductive health 
services, including family planning, safe motherhood and HIV/AIDS/STI (sexually transmitted infections) 
prevention, and (2) increased use of selected child survival services. The ultimate beneficiaries were 
children under five years of age, and men and women who would benefit from reductions in fertility and 
the spread of HIV/AIDS. This activity supported the U.S. Embassy Mission Performance Plan by 
stabilizing population growth, improving human health and reducing the spread of infectious disease. 
Details of the activities and interventions undertaken through USAID’s implementing partners are included 
in section V. Section IX and Annex 4 provide references to publications, which illustrate many of the 
activities not covered in this report. 
An overview of SO3 project results is provided in Annex 1 in table format, by year. In reviewing the “life of 
project” results, some significant accomplishments and results can be highlighted. For instance, the 
DPT3 coverage rose from 56% in 1997 (baseline) to 80% in 2004, whereas measles vaccine coverage 
increased from 52% in 1995 to 80% in 2003. The HIV prevalence rate has remained below 4%, under 
the target for this indicator (<5%). Over 6 million couple years of protection (CYP) were reached and over 
125 million condoms distributed or sold. The number of Insecticide Treated Nets (ITN) is approaching 
500,000 (if used appropriately by target populations, ITNs are a major contributor to reducing childhood 
deaths from malaria). Section VI provides an overview of the impact and sustainability of SO3 activities. 
III. CHANGES IN THE STRATEGIC FRAMEWORK 
The Strategic Objective was defined as “Improved Family Health” and designed to increase the use of 
reproductive health services, including population/family planning, safe motherhood and HIV/STI 
services; and to increase the use of selected child survival services, including immunization, oral 
rehydration therapy, care of the sick child and improved nutrition. The SO agreement, dated February 8, 
1999, was between the U.S. Government and the Government of Ghana (USAID Project No. 641-0140). 
Three SO–level indicators and targets were identified: 
(1) The fertility rate is to be reduced from 5.5 to 5.0; 
(2) The rate of increase in the spread of HIV (as measured by USAID-supported sentinel 
surveillance) is to be held to less than 1% increase per year; and 
(3) Full immunization coverage (as a proxy of child mortality) is to increase from 60% to 70% among 
children between 12 and 24 months of age. 
In order to achieve the SO, the parties agreed to work together to achieve following two Intermediate 
Results (IRs or Results) 
IR3.1 Increased Use of Reproductive Health Services, including population/family planning, safe 
motherhood, and HIV/Sexually Transmitted Diseases (STD) prevention. 
IR3.2 Increased Use of Selected Child Survival Services, including immunization, oral rehydration 
therapy, care of the sick child, and improved nutrition. 
The overall strategic objective did not change through the life of the agreement, though the SO-level 
targets were adjusted slightly based on updated baseline data. At the intermediate result-level, HIV/STD 
services were expanded to include “treatment.” 
3
IV. TOTAL SO3 COSTS 
The table below shows that over $102,000,000 was obligated under SO3, of which $31,902,000 (31%) 
was through the SOAg and $70,773,000 through Field Support (69%). The peak of funding for SO3 
occurred in 2002, with close to $19,000,000 obligated. 
Estimated amount (in thousands) obligated for SO3 through SOAg and Field Support: 
1997 1998 1999 2000 2001 2002 2003 Total 
 SOAg 6,385 7,456 4,503 2,500 4,288 4,405 2,365 31,902 
 Field Support 6,515 6,825 10,675 13,250 13,025 14,550 5,933 70,773 
Total 12,900 14,281 15,178 15,750 17,313 18,955 8,298 102,675
Accounts included Child Survival and Disease Fund (CSD), Child Survival and Health Fund (CSH), 
Development Assistance (DA), Development Fund for Africa (DFA), and Economic Support Fund (ESF). 
Estimated total obligated (in thousands) by focus area: 
1997 1998 1999 2000 2,001 2002 2003 Total 
HIV/AIDS prevention 1,900 3,700 4,000 4,000 4,950 5,500 3,812 27,862
Population 9,500 6,000 6,175 5,900 7,255 7,255 2,773 44,858
Child Survival 1,000 3,631 4,103 4,150 4,010 4,300 1,343 22,537
Infectious Diseases 0 500 500 700 1,098 1,900 370 5,068 
Micro-Nutrients/OH 500 450 400 1,000 0 0 0 2,350 
Total Annual OYB 12,900 14,281 15,178 15,750 17,313 18,955 8,298 102,675
The total cost share contribution of the Government of Ghana was estimated at more than $169,000 per 
Implementation Letter (IL) # 23 and included in-kind contributions (figures in the above tables do not 
include cost share from the partners nor the Government of Ghana). 
 
V. STRATEGIC OBJECTIVE PARTNERS AND ACTIVITIES 
Considering the scope and significant funding levels for SO3, only an abridged list of primary partners 
and key activities is included herein, a more comprehensive listing of partners can be found in Annex 3. 
The primary coordinator of health services in Ghana is the Ministry of Health (MOH), which establishes all 
health policies and program guidelines. The primary implementing agencies within MOH are under the 
MOH’s Ghana Health Service (GHS) and include Reproductive and Child Health Unit, Health 
Promotion Unit, National Aids Control Program, Ghana AIDS Commission and Disease Control 
Unit. Health data collection is coordinated through the Ghana Statistical Service. 
4
Reproductive Health: 
EngenderHealth (formerly AVSC International): USAID’s cooperative agreement with EngenderHealth 
addressed improving the quality of reproductive health services in the public and private sectors through 
clinical training of medical professionals (doctors, nurses, and nursing assistants) in minilaparotomy, 
Norplant implant insertion and removal, and vasectomy. EngenderHealth strengthened the counseling 
component of family planning services, and helped to integrate counseling into all aspects of health 
service delivery. In addition, EngenderHealth integrated other areas of reproductive health, such as 
infection prevention, STI/HIV prevention, men's reproductive health, and quality improvement into existing 
programs.
The Ghana Registered Midwives Association (GRMA): GRMA council members and regional 
representatives received training in family planning, life saving skills, proposal writing and management 
information systems (MIS), then GRMA trained all its members in the same skill areas. The MIS training 
was crucial in helping the GRMA improve midwifery standards, provide equitable high quality health 
services to women and children, and evaluate programs for future development. 
JHPIEGO Corporation: USAID’s program through JHPIEGO focused efforts on capacity building with 
the MOH to develop Pre-Service Reproductive Health training systems to increase the use of services 
through improved policies and quality, and increased access. JHPIEGO worked with the MOH to 
strengthen pre-service training in support of the Community-based Health Planning and Services (CHPS) 
project. 
Planned Parenthood Association Ghana (PPAG): PPAG was established in 1967 as a Non - 
Governmental Organization (NGO) affiliated with the International Planned Parenthood Federation 
(IPPF). In 1999, PPAG implemented a three-year USAID-sponsored program that initially targeted youth 
and provided health information to assist them in making healthy choices. By FY 2001, PPAG introduced 
a community-based family planning intervention implemented through community volunteers. 
Ghana Social Marketing Foundation (GSMF) International: GSMF is a Ghanaian private non-profit 
organization, which socially marketed, promoted and distributed USAID-financed contraceptives, and 
other health products. GSMF’s fertility management program, called “Life Choices”, promoted awareness 
and the use of modern methods of contraception. 
PRIME II: Prime II implemented USAID-supported safe motherhood activities including training of 
primary reproductive health providers, curricula development, and supervision and referral capacity 
strengthening of GHS Regional Resource Teams (RRTs). Training in safe motherhood consisted of a 
combination of theoretical and practical courses in the management of both routine and risk situations for 
antenatal care, labor and delivery, post abortion and postnatal care. PRIME II designed and implemented 
a self-paced learning (SPL) approach for low caseload practical training situations, and assessed its cost￾effectiveness. PRIME also helped revise the GHS’ in-service training curriculum to address CHPS￾specific needs. 
HIV/AIDS Prevention 
Family Health International (FHI): USAID’s FHI/IMPACT Project focused on efforts to combat 
HIV/AIDS. In collaboration with Ghana’s National AIDS Control program, activities included: surveillance 
and management of STIs; improving the availability and use of relevant research data; strengthening the 
ability of in-country agencies and organizations (including faith-based institutions) to deliver HIV/AIDS 
care and support; and reducing unsafe sexual behavior among those presumed to be more vulnerable to 
HIV infection (young people, the uniformed services, and commercial sex workers). In 2003, 
USAID/Ghana supported FHI to expand treatment and care from a rural pilot setting to the two teaching 
hospitals in the country. 
5
GSMF: USAID supported GSMF in its mandate to use social marketing and other behavior change 
techniques to effect behavior change among target audiences, including programs like HIV/AIDS 
prevention campaigns (e.g. commercial drivers program, workplace programs). Condom sales through 
private sector outlets increased dramatically. 
Johns Hopkins University/Population Communication Services (JHU/PCS): USAID funded the 
“Stop AIDS Love Life” Compassion Campaign, a national HIV/AIDS campaign implemented by JHU/PCS 
and its collaborating partners to: increase awareness about HIV/AIDS; increase the adoption of safer sex 
behavior; de-stigmatize HIV/AIDS; and encourage compassion, care and support for people living with 
HIV/AIDS (PLWA). The campaign was implemented in phases over the life of the SO and each phase 
had one overall theme: phase one emphasized shattering the silence on HIV and AIDS; phase two 
focused on caring communities through an initiative with traditional leaders and use of community 
mobilization tools: and phase three focused on facilitating collaboration with religious leaders and 
community groups throughout Ghana. Mass media components included music videos, television, and 
radio spots featuring traditional and religious leaders and PLWAs, and a popular television drama. 
Community mobilization included school activities, women's groups, community rallies, and the use of a 
participatory tool called “Journey of Hope” to teach abstinence, fidelity and condom use. JHU collaborated 
especially closely with GSMF in designing and implementing these campaigns. 
DELIVER (previously Family Planning Logistics Management/FPLM): DELIVER helped to establish 
effective and efficient logistics management systems for contraceptives, and later HIV/AIDs commodities 
and drugs. The motto—No Product, No Program—was a reminder that health programs cannot operate 
successfully without a continuous, reliable flow of essential commodities. DELIVER developed new 
approaches to supply chain management that promoted commodity security for contraceptives, HIV/AIDS 
commodities, and other essential health products. DELIVER provided technical assistance for 
strengthening logistics management information systems; developing streamlined procurement, inventory 
control and distribution systems; and training managers at all levels of those systems. 
Child Health: 
Basic Support for Institutionalizing Child Survival (BASICS) Project: Through BASICS, USAID 
assisted with the MOH’s efforts to improve child health at the community level through support of the 
national Community Health Planning and Services (CHPS) program, the national Roll Back Malaria 
(RBM) program, community-based growth promotion (CBGP), and improved communication to reduce 
immunization drop-out rates. CBGP activities were linked to the immunization, curative and supervisory 
services provided by CHPS and other health providers. 
GSMF: GSMF, in collaboration with NetMark, contributed to RBM efforts through the promotion of 
commercial sales of ITNs. This was the leading intervention for prevention of malaria among young 
children and women in Ghana. 
NetMark: NetMark supported two private local distributors of modern pre-treated ITNs to market their 
products on the Ghanaian market. NetMark supported establishing and scaling up the distribution 
system, improving stock management and brand promotion. NetMark also embarked on a generic 
demand creation campaign for ITNs.
JHU/PCS: JHU/PCS launched the “He Ha Ho” (Healthy Happier Homes) radio drama in January 2000. 
The show was a major component of a multi-media approach and aimed to educate listeners on issues 
related to malaria and other childhood illnesses, and reproductive health, particularly family planning and 
HIV/AIDS. The home-based care (HBC) communication campaign began in May 2002 and built on the 
success of the He Ha Ho radio magazine show. By developing synergy among various RBM 
interventions, the coordinated communication efforts on strengthening home treatment of malaria greatly 
improved caretakers’ ability to recognize and respond appropriately. 
6
LINKAGES: Through the LINKAGES program, USAID provided technical information, assistance, and 
training to organizations on breastfeeding, related complementary feeding and maternal dietary practices. 
Using research-based, Behavioral Change Communication (BCC) approach, LINKAGES focused on the 
3 northern regions. Assistance was provided to review pre-service curricula including training of lectures 
and tutors from 43 of the 45 medical and paramedical training institutions and institution-building at the 
University of Development Studies, Department of Nutrition. LINKAGES established a network of 
partners including the Ghana Health Services, UNICEF, World Vision, Red Cross, and Freedom from 
Hunger to promote best feeding practices. 
MOST: The project provided technical and financial assistance to the Nutrition Unit of the Ministry of 
Health to strengthen the national Vitamin A deficiency control program, especially efforts to scale up 
Vitamin A capsule distribution program nationally. MOST addressed promotion, program monitoring and 
evaluation, and helped develop training materials for the regional and district levels. Vitamin A capsule 
distribution was initially added on to National Immunization Days (NIDs) and later institutionalized in 
annual Child Health Weeks. MOST assisted in the development of an anemia control strategy and food￾based approaches to reduce micronutrient deficiencies and assisted the MOH in its preparation for GAIN 
funds to advance food fortification efforts in Ghana. 
PHRplus project: Through PHRplus, USAID implemented the WHO-developed concept of integrated 
disease surveillance and response (IDSR) in the three northern regions of Ghana, an area particularly 
prone to epidemics of infectious diseases. PHRplus secunded a GHS epidemiologist to supervise IDSR 
implementation. IDSR, consistently implemented, will have lasting impact on containing the threat of 
infectious diseases and serves as a prerequisite to eradicating polio and Guinea Worm in Ghana. 
PHRplus reinforced the capacity of existing Mutual Health Organizations in the areas of risk 
management, financial, and administrative management, and community mobilization. 
United Nations Children’s Fund (UNICEF): Throughout the implementation of SO3, USAID supported 
the expansion of the immunization cold chain (e.g. procurement of cold chain equipment) and social 
mobilization for EPI activities, particularly in underserved northern regions, through grants to UNICEF. 
USAID also supported, in collaboration with WHO and MOH, routine immunizations and provided 
supplemental funds for polio NIDs and intensified polio eradication efforts with Sub-National Immunization 
Days (SNIDs). 
AFRICARE: AFRICARE implemented a child and maternal health project in 2 districts in Volta region on 
family planning, safe motherhood and Integrated Management of Childhood Illnesses (IMCI) and trained 
Community Health Nurses and procured equipment (e.g. motorcycles) to implement a model approach for 
community based delivery of health services. 
VI. IMPACT AND SUSTAINABILITY OF STRATEGIC OBJECTIVE ACTIVITIES 
Overall, the numerous partners worked collaboratively with the MOH, hospitals, community health 
centers, Ghana AIDS commission and others to improve the health of Ghanaians. Effective interventions 
included training, workshops, media campaigns, direct assistance to hospitals, supplemental feeding 
programs, distribution of condoms, and technical assistance. Key indicators, as shown in Annex 1, reveal 
that SO3 has had a positive impact on family health in Ghana. 
Impact of Increased Use of Reproductive Health Services
USAID supported activities under the improved family health SO intermediate results focused on: 
increasing demand for reproductive and child health services; increasing access to health and care 
services; improving the quality of health care service delivery; and improving the policy environment. 
Furthermore, activities were aimed at repositioning family planning in people’s mind and to dispel rumors 
about methods of contraception by campaigns focused at the community level. 
7
•
•
•
•
 
Key impacts from USAID’s interventions include: 
Protection from pregnancy through contraception (measured in CYP) increased from 483,000 (1997) 
to 1,070,000 (2004). 
A steady increase in the use of modern methods from 13 percent in 1998 to 19 percent in 2003, with 
the pill and injectables being the most widely used (5% each). [Note, a major IEC campaign called 
Life Choices, which aimed at repositioning family planning from being a purely clinical or health 
issues to being a choice one makes in life, may have contributed significantly to the increased use of 
modern methods.] 
A significant increase in the capacity of 150 public health sector hospitals to provide family planning 
information and counseling as well as long-term methods of contraception. 
Activities to promote community participation and access to health care services initialized in 95 out of a 
total of 110 districts through the CPHS initiative. This was based on the Nkwanta experience, where 
women in CHPS areas were over five times more likely to have received antenatal care than those in 
non-CHPS areas; four times more likely to have received postnatal care; children were 1.6 times more 
likely to be immunized; and family planning was three times higher than in non-CHPS areas. 
Despite these accomplishments, total fertility did not change significantly (4.4, 2003 DHS). Although this 
does not correlate with the significant increase in contraceptive prevalence, it could reflect a possible 
decline in frequency of abortion in favor of contraceptive use, indicating that quality services for those 
who seek them improved. 
USAID’s long-term support to family planning service delivery and sustainability in Ghana reached a 
significant milestone with the adoption of a long-term contraceptive security strategy designed to address 
quality, accessibility and user preferences in family planning. USAID supported training for integrated 
supply chain management including family planning commodities, helped establish contraceptive need 
estimates and shipment scheduling and contributed roughly a half of the financing need. USAID‘s long￾term support to social marketing via GSMF has been now complemented by the first agreement with a 
commercial distributor for condoms in non-traditional outlets. In terms of research activities (which will 
guide the development of appropriate interventions essential for sustainability), USAID contributed to the 
information base on causes of adverse pregnancy outcome and primary determinants of pregnancy 
outcomes. 
HIV/Sexually Transmitted Diseases (STD) prevention 
The aim of increasing knowledge of HIV/AIDS transmission was to: change and/or modify behaviors 
through increased use of condoms; provide training of health workers in improved detection and 
treatment of STDs; and strengthen laboratory support and surveillance. The impact of these activities 
included: 
The rate of HIV/AIDS infection remained low at 3.6% (2002; HIV prevalence in 1993 was 3.4% and 
HIV prevalence (re-adjusted)4
 was 2.4% in 1994 and 3.4% readjusted in 2004). 
• Number of condoms distributed/sold rose from 7.8 million in 1997 to over 25 million in 2004. 
• Condom use at last risky sex among young urban youth increased from 51% (2000) to 60% 
(2002). 
• Number of outlets distributing condoms rose from 2,830 (1998) to 7,600 (2003). 
• Support, treatment and anti-retroviral therapy service availability was established. 
• Four regional public health laboratories and standard operating procedures for laboratories to monitor 
the HIV epidemic were established. 
4
 Re-adjusted values (WHO provided a new simplified method for calculating the national prevalence for standardized HIV 
prevalence - introduced in 2003) 
8
•
•
•
•
•
•
•
 
• Ghana AIDS Commission under the leadership of the President was established (the commission is 
the coordinating body for all HIV/AIDS-related activities and oversees an expanded response to the 
epidemic, publishing the National Strategic Framework on HIV/AIDS for 2001–2005). 
• A monitoring and evaluation plan for the National Strategic Framework was developed and published. 
Given that the Ghana Aids Commission was high-level support and a clear mandate, the National 
Strategic Framework for HIV/AIDS can realistically set targets for HIV/AIDS infection reduction, address 
service delivery needs and individual and societal vulnerability, and promote the establishment of a multi￾sectoral, multidisciplinary structure for coordinated implementation of HIV/AIDS programs. 
Impact of Increased Use of Selected Child Survival Services 
USAID focused its interventions on the integrated management of childhood illnesses, polio eradication, 
strengthening of routine immunizations, improved nutrition, exclusive breastfeeding and Vitamin A 
supplementation. Additional activities supported efforts to strengthen management systems, including 
disease surveillance. Some of the key impacts of these interventions were: 
DPT3 coverage of children 12 – 23 months increased from 56% (1997) to 80% (2004), and that for 
Measles vaccine increased from 52% (1995) to 80% (2003). 
Children between 6 – 11 months receiving appropriate solid foods increased from 67% (1998) to 77% 
(2003), which is a proxy for improved child nutrition. 
Exclusive breastfeeding in project areas rose from 31% (1998) to more than 75% (2002). 
Over 3 million people were covered by community-based breastfeeding promotion activity, compared 
to 36,000 in 1998. 
Vitamin A supplementation was integrated into regular health service delivery. 
Approximately 318,000 ITNs were sold in 2004 in an effort to reduce one of the major childhood 
killers, malaria. 
Through USAID’s integrated Disease Surveillance and Response activities, 376 health professionals 
were trained and 83 facilities were provided with adequate materials (2003). 
VII. SUMMARY OF PERFORMANCE INDICATORS 
Performance indicators for SO3 were established in 1999 and basically remained the same throughout 
the duration of the SO (see Annexes 1 and 2 for a complete list of indicators, results targets and results 
achieved). In reviewing the performance indicator reference sheets and other documentation, a couple of 
data quality issues and problems encountered in collecting the data were noted. If not stated otherwise, 
performance indicators were considered useful and relevant in measuring intermediate results and 
strategic objectives. 
SO 3 Improved Family Health 
• Indicator SO3.1 -- Total Fertility Rate (TFR)5
• Indicator SO3.2 -- DPT3 coverage 
• Indicator SO3.3 -- HIV prevalence (re-adjusted)6
 
The total fertility rate did not significantly drop throughout SO3, although positive results were measured 
in increased modern contraceptive use. This could reflect a possible decline in frequency of abortion in 
favor of contraceptive use. The denominator for DPT3 coverage first used based on projections from 
1983, then changed in 2003 and “produced a negative-drop out rate”, which is impossible. This could 
have resulted from the questionable quality of 2000 census data. Data on the HIV/AIDS prevalence rate 
5
 Measured only every five years 
6
 Re-adjusted values (WHO provided a new simplified method for calculating the national prevalence for standardized HIV 
prevalence - introduced in 2003) 
9
was collected at only 17 sentinel sites in 1998 then expanded to 29 sentinel sites by 2003. As footnoted, 
the prevalence calculation method was changed based on updated WHO guidance resulting in a higher 
data quality. 
¾ IR 3.1 Increased Use of Reproductive Health Services
• Indicators IR 3.1 -- CPR (Contraceptive Prevalence Rate)7
 -- CYP (Couple Years of Protection) 6
CYP was an effective means of relating the total volume of protection of all contraceptives dispensed or 
distributed. CYP was used as a proxy for CPR. However, a known data limitation was that social 
marketing data was calculated based on sales at warehouses/outlets, not on dispensed-to-client data, 
which is not available. 
¾ IR 3.1.1 Increased use of Family Planning (FP) & Safe Motherhood (SM) Services 
•
•
•
•
•
Indicator IR 3.1.1 -- Number of contraceptives (pills, indictables, Norplant, sterilization) distributed 
Indicator Sub-IR 3.1.1.1 -- Mean ideal # of children6
Indicator Sub-IR 3.1.1.2 – Percentage of long-term and permanent methods (LTPM), excluding 
condoms 
Indicator Sub-IR 3.1.1.3 -- Population covered by CHOs
Indicator Sub-IR 3.1.2.4 – Data for decision making available 
Like the total fertility rate under 3.1, measuring the “mean ideal number of children” was not that useful as 
an indicator because the change is minimal and the data is only measured once every 5 years. For the 
LTPM indicator, condoms were initially included in the denominator, then later excluded because 
tremendous increase in condom use and, therefore, in the denominator would have otherwise rendered 
this indicator of little use. Indicator 3.1.1.3 was not considered useful because it remained consistently 
low. It was determined that either the wrong denominator (total population) was used or a completely 
different indicator would have been better served to measure real progress in CHPS implementation. 
¾ IR 3.1.2 Increased Use of HIV/AIDS Services8
• Indicator IR 3.1.2 -- Number of condoms distributed/sold 
• Indicator Sub-IR 3.1.2.1 -- Condom use at last risky sex among young urban youth 
• Indicator Sub-IR 3.1.2.3 – Number of outlets distributing GSMF condoms 
• Indicator Sub-IR 3.1.2.4 -- Adoption of a national AIDS policy 
A significant data limitation for 3.1.2 was that it excluded commercially sold condoms in the measurement, 
which became significant when commercially marketed condoms were launched in Ghana. Indicator 
3.1.2.1 turned out to be very expensive to collect, and limited in that the indicator targeted only urban 
youth (which might have been too general as a target group). Although useful, a disadvantage 
nevertheless of indicator 3.1.2.3 was that it did not consider different types of outlets. It was clear that 
after a draft policy was prepared, USAID and its partners could no longer influence indicator 3.1.2.4, so its 
utility was limited. 
¾ IR 3.2 Increased Use of Selected Child Survival (CS) Services
• Indicator IR 3.2 -- Measles vaccine coverage 
• Indicator Sub-IR 3.2.1 – Percentage of 6-11 months fed solid and/or mushy food6
• Indicator Sub-IR 3.2.2 – Number covered by community-based breastfeeding promotion activities 
• Indicator Sub-IR 3.2.3 – Number of ITNs sold commercially 
• Indicator Sub-IR 3.2.4 – Number of districts implementing the IMCI 
 
7
 Measured only every five years 
8
 No indicator was used for SUB-IR 3.1.2.2 (Increased quality of HIV/AIDS services) 
10
Measles vaccine coverage, indicator 3.2, was perhaps unnecessary, given that DPT3 coverage was used 
as a proxy for childhood mortality). Though there was an immense increase in DPT3 coverage (and 
measles coverage likewise), this did not translate into the expected decrease in childhood mortality. 
Indicators 3.2.1 and 3.2.2 captured the activities of only one implementer; indicator 3.2.2 did not measure 
actual improvement of quality of CS services. Indicator 3.2.3 was changed to only commercial sales and 
as intended measured improved access. 
VIII. LESSONS LEARNED 
Systematic, program-wide data collection, monitoring and evaluation help ensure a coherent 
program: While monitoring and evaluation and performance management have always been central to 
SO3 implementation, these functions increased in rigor as the SO3 team became more confident in the 
use of data for decision-making. This focus led to a more comprehensive understanding of programmatic 
issues and brought more objectivity to management functions. An appreciation of the relevance of data 
to performance management engenders better data collection and use, and facilitates implementing 
partners’ conformance with SO priorities and directions. 
The use of the very best technical assistance (TA) from multiple, specialized partners has positive 
financial and management implications: With much of SO3’s resources going into field support (FS) 
programs, the USAID-supported TA was likely of very high quality for the tasks being undertaken. USAID 
TA was often positioned to be ahead of the curve, as in the example of logistics management planning for 
anti-retroviral distribution and security. The flexibility of FS mechanisms and the mix of local staff plus 
strategically infused international TA proved to be a good recipe for achieving results. However, this 
meant that many implementing partners, their field offices and respective staff were operating on the 
ground at any one time (see list section V), managing the in-and out-travel and consultancies of 
numerous external technical advisors, and coordinating it all with USAID and the GOG. While many SO 
achievements above and beyond targets and expectations can be cited, the cost-benefit/cost￾effectiveness of this arrangement is difficult to assess. 
The use of locally available and regional, quality expertise is highly advantageous: This develops 
local capability, strengthens regional institutions, brings additional credibility to the process, and 
contributes to cost containment. 
Verticality versus integration has its advantages and disadvantages: 
- The SO3 results framework was laid out along technical program/funding directive lines (CS, RH and 
HIV/AIDS). As a result, it presents a clear program structure that is relatively easy to work with and 
understand. Indicator identification and use also seemed to be made less cumbersome by virtue of 
parallel vertical program areas. 
- The vertical programming against a backdrop of a health system that provides services and support 
across all technical areas meant duplication of effort and less efficiency in use of resources in some 
instances. For example, various partners worked on similar efforts in, e.g., IEC/BCC, training, 
workplace programs, CHPS, etc., and/or in one or other of the technical areas. Consolidation of 
efforts would streamline activities and enhance implementation efficiency. 
The private sector can and does contribute to the achievement of public health sector goals: 
Various programs under SO3 directly supported the involvement of the private sector, including GSMF for 
the promotion of contraceptives and other health commodities; and public-private partnerships for 
insecticide-treated bednet promotion, anti-retroviral treatment service delivery, and work place HIV 
programs. The role assumed by the private sector also potentially diminishes the burden on the public 
sector of meeting the population’s health care needs. 
 
Implementing donor-managed earmarked funds in a SWAp environment that is increasingly 
moving to multi-donor budget support (MDBS) is labor intensive at best, and difficult to 
coordinate with other partners in any event: USAID’s contribution to Ghana’s health sector SWAp is 
11
important both for its size (among the top 3 contributing donors) and for being 100% earmarked (as 
opposed to common basket). Coordination with SWAp partners, many of which pursue dialogue at the 
highest level and monitor sector-wide financing, demands a significant investment of time and energy 
above and beyond that already required for donor coordination and USAID portfolio management. 
IX. RELATED STUDIES, ASSESSMENTS AND CLOSE-OUT REPORTING INSTRUMENTS 
Ghana Trend Analysis for Family Planning services 1993, 1996, 2002, Measure DHS, January 2005. 
Improving Access and Quality of Clinical Family Planning Services in the Public and Private 
Sectors in Ghana, submitted by EngenderHealth, September 2004. 
Ghana Demographic and Health Survey 2003, Ghana Statistical Service (GSS), Noguchi Memorial 
Institute for Medical Research (NMIMR), ORC Macro (Calverton, Maryland, USA). 
Ghana’s Attempt in Managing the HIV/AIDS Epidemic, A Review of Efforts, Phyllis M. Antwi, Yaa 
P.A. Opong, July 2003. 
Midterm evaluation Ghana Improved Family Health USAID/Ghana FY 2002 Annual Report, March 4, 
2002.
Examining the Success of the Ghana Social Marketing Foundation, Ilze Melngailis, Commercial 
Marketing Strategies, August 2002. 
Ghana Behavioral Surveillance Survey 2000, Research International, Family Health International, 
National AIDS Control Program, Ghana. 
The Economic Impact of AIDS in Ghana, The Futures Group International Dr. Lori Bollinger, John 
Stover, Dr. Martin Enock Palamuleni, September 1999. 
X. HUMAN RESOURCE CONTACTS 
Bethanne Moskov, Supervisory Health Officer, USAID/Ghana 
 Address: USAID/Ghana, P.O. Box 1630, Accra, Ghana 
Email: bmoskov@usaid.gov 
 Tel: +233-21-228440. 
Peter Wondergem, HIV/AIDS Advisor, USAID/Ghana 
 Address: USAID/Ghana, P.O. Box 1630, Accra, Ghana 
Email: pwondergem@usaid.gov
 Tel: +233-21-228440. 
Juliana Pwamang, Health Program Coordinator, USAID/Ghana 
 Address: USAID/Ghana, P.O. Box 1630, Accra, Ghana 
Email: jpwamang@usaid.gov
 Tel: +233-21-228440. 
12
Annex 2: List of Indicators 
Strategic Objective (SO) 3 -- Improved Family Health
• Indicator SO3.1 -- Total Fertility Rate9
 (TFR) 
• Indicator SO3.2 -- DPT3 coverage 
• Indicator SO3.3 -- HIV prevalence HIV prevalence (re-adjusted)10 
¾ Intermediate Result (IR) 3.1 Increased Use of Reproductive Health Services
• Indicators IR 3.1 -- CPR (Contraceptive Prevalence Rate)8
 -- CYP (Couple Years of Protection) 8
¾ IR 3.1.1 Increased use of Family Planning (FP) & Safe Motherhood (SM) Services 
• Indicator IR 3.1.1 -- Number of contraceptives distributed 
P = pills, I = Indictables, N = Norplant, S = Sterilization (in thousands) 
¾ Sub-IR 3.1.1.1 Improved Demand for FP/SM Services 
• Indicator Sub-IR 3.1.1.1 -- Mean ideal number of children8
¾ Sub-IR 3.1.1.2 Improved Quality of FP/SM Services 
• Indicator Sub-IR 3.1.1.2 – Percentage of LTPM (excl. condoms) 
¾ Sub-IR 3.1.1.3 Increased Access to FP/SM Services 
• Indicator Sub-IR 3.1.1.3 -- Population covered by Community Health Officers (CHOs) 
¾ Sub-IR 3.1.2.4 Improved Policies for FP/SM Services 
• Indicator Sub-IR 3.1.2.4 – Data for decision making available 
¾ IR 3.1.2 Increased Use of HIV/AIDS Services
• Indicator IR 3.1.2 -- Number of condoms distributed/sold 
¾ Sub-IR 3.1.2.1 Increased Demand for HIV/AIDS Services
• Indicator Sub-IR 3.1.2.1 -- Condom use at last risky sex among young urban youth 
¾ Sub-IR 3.1.2.2 Improved Quality of HIV/AIDS Services11
¾ Sub-IR 3.1.2.3 Increased Access to HIV/AIDS Services
• Indicator Sub-IR 3.1.2.3 – Number of outlets distributing GSMF condoms 
¾ Sub-IR 3.1.2.4 Improved Policies for HIV/AIDS Services
• Indicator Sub-IR 3.1.2.4 -- Adoption of a national AIDS policy 
¾ Intermediate Result (IR) 3.2 Increased Use of Selected Child Survival (CS) Services
• Indicator IR 3.2.1 -- Measles vaccine coverage 
¾ Sub-IR 3.2.1 Increased Demand for CS Services
• Indicator Sub-IR 3.2.1 – Percentage of 6-11 months fed solid and/or mushy food8
¾ Sub-IR 3.2.2 Improved Quality of CS Services 
• Indicator Sub-IR 3.2.2 –Number covered by community-based breastfeeding promotion 
activities 
¾ Sub-IR 3.2.3 Increased Access to CS Services 
• Indicator Sub-IR 3.2.3 – Number of ITNs sold commercially 
¾ Sub-IR 3.2.4 Improved Policies for CS Services 
• Indicator Sub-IR 3.2.4 – Number off districts implementing the IMCI (Integrated Management 
of Childhood Illnesses) protocol 
 
9
 Measured only every five years 
10 Re-adjusted values (WHO provided a new simplified method for calculating the national prevalence for standardized HIV 
prevalence - introduced in 2003) 
11 No indicator was used for this Sub-IR 
13
Annex 3: List of Implementers of SO3: 
Private non-profit Ghanaian Associations 
Ghana Social Marketing Foundation (GSMF) 
Planned Parenthood Association Ghana (PPAG) 
Ghana Registered Midwives Association (GRMA) 
U.S. private voluntary organizations 
Africare 
CARE (Cooperative for Assistance and Relief Everywhere, Inc.) 
Catholic Relief Services (CRS) 
Cooperating agencies 
University of North Carolina (PRIME) 
JHPIEGO cooperation (Johns Hopkins Program Providing Reproductive Health) 
Engender Health (formerly ASCV [Access for Voluntary Surgical Contraceptive]) 
Family Health International (IMPACT) 
Johns Hopkins University/Population Communication Services (JHU/PCS) 
Partnership for Child Health Care, Inc (BASICS) 
Linkages (the Academy for International Development) 
Macro International (Measure) 
Center for Development and Population Activities (CEDPA) 
Deliver JSI (John Snow Incorporation) 
Futures Group Policy Project 
Micronutrient Operational Strategies and Technologies (MOST) 
Population Council 
Partners for Health Reformplus (PHRplus) 
CMS (Commercial Markets Strategy) 
Others 
Global Alliance for Vaccines and Immunization (GAVI) 
United Nations Joint Program on HIV/AIDS (UNAIDS) 
United Nations Children’s Fund (UNICEF) 
United Nations Population Fund (UNFPA) 
World Health Organization (WHO) 
Plan International 
NetMark 
Annex 4: Publications 
I. Publications on the Health Sector Performance 
1. Ghana Health Sector Program of Work; MOH, 2002 
2. Medium Term Health Strategy towards Vision 2002; MOH, 1999 
3. The Health of the Nation: Reflections on the First Five-Year Health Sector Program of Work 
1997-2001; MOH, August 2001 
4. Community-Based Health Planning Services (CHPS): Lead District Readiness Assessment; 
MOH/GHS, December 2001 
II. Publications on Child Survival
1. Policy and Strategies for Improving the Health of Children Under-Five in Ghana; MOH, 1999 
2. Improving Child Health Services in Ghana – Assessment of Nutrition, Immunizations and 
Community-Level Programs; MOH, USAID, BASICS, LINKAGES, UNICEEF, WHO, 1998 
3. Integrated Health Facility Assessment Using Local Data to Improve the Quality of Child Health 
Care at the Health Facilities in Ghana; John Murray, Cynthia Bannerman, Isabella Sagoe 
Moses and Margreet Kamphorst, MOH with USAID/BASICS, 1998 
4. Nutrition of Young Children and their Mothers in Ghana, 1998; Macro, International Inc., 
USAID, 1999
5. Breastfeeding and Complementary Feeding Knowledge and Practices: A Baseline Survey 
Conducted in Linkages Partner Areas in Northern Ghana; Euncie Adjei, Joan Schubert, and 
Hannah Adjei, March 2001
6. Trials of Improved Feeding Practices in Infants and Young Children 0-24 Months: Consultative
Research in Northern Ghana; Joseph Mensah-Homiah, Gladys Gamor and Nancy Keith, June
2002 
7. Community Assessment in Improved Infant Feeding Practices in Northern Ghana; Joan
Schubert, Euncie Adjei, and Hannah Adjei, 2000 
8. Current Child Feeding Practices in Northern Ghana: Understanding the Issues through 
Formative Research; Margaret Armar-Klemesu, April 2000 
9. Review of Introductory and Early Implementation Phases of IMCI Implementation in Ghana; 
MOH, May 2002 
10. Case Study on the Cost and Financing of Immunization Services in Ghana; Ann Levin, Sarah 
England, Joanne Jorissen Bertha Garshong, and James Teprey, September 2001. 
11. Five Year EPI Strategic Plan 2000-2004; MOH, 2000. 
12. 2000 Annual Report; reproductive and Child Health Division, MOH, 2000 
III. Publications on Adolescent Health 
1. Adolescent Reproductive Health Policy; National Population Council, October 2002 
2. Baseline Study on the Status of Adolescent Health, National Report; Health Research Unit, 
MOH, October 1999 
3. Ghana Youth Reproductive Health Survey Report, GSMF, PPAG, JHU/PCS, Focus on Youth 
Project, USAID, December 2000 
IV. Publications on HIV/AIDS 
1. National HIV/AIDS and STI Policy; National AIDS/STDs Control Program, MOH, August 2000
2. HIV/AIDS in Ghana: Background, Projections, Impacts, Interventions and Policy; National 
AIDS/STDs Control Program, MOH, December 2001 
3. Ghana HIV/AIDS Strategic Framework 2001-2005; Ghana AIDS commission (not dated) 
4. Ghana Behavioral Surveillance Survey, 2000; Research International, Family Health 
International, National AIDS Control Program, 2000 
5. Estimating National HIV Prevalence in Ghana Using Sentinel Surveillance Data; National 
AIDS/STDs Control Program, MOH, August 2001 
6. HIV Sentinel Surveillance, 1999; National AIDS Control Program, Disease Control Unit, MOH, 
June 1999 
14
7. Situation Analysis of the Context and Vulnerability among Young Mobile Commercial Sex 
Workers in Ghana; The Department of Community Health, University of Ghana Medical 
School, March 2002 
8. Status of Care for Children that are Orphaned and/or Vulnerable due to HIV/AIDS in Ghana; 
Agnes Dzokoto, March 2002
V. Publications on Reproductive Health 
1. National Reproductive Health Service Policy and Standards; MOH, 1996 
2. Assessment of the Management of Sexually Transmitted Diseases in Ghana; Health Research 
Unit, MOH, Family Health International, USAID April 2001 
3. Family Planning Service Delivery in Ghana: Comparison Report of 1993 & 1996 Situation 
Analysis Study Results; Ghana Statistical Service, September 1998 
4. Study of the effects of Incorporating Selected Reproductive Health services on Family 
Planning Services: A Case Study in the Eastern region of Ghana; Judith T. Fullerton, 
Kulmindar Johal and Alfredo Fort, November 1999 
5. Implications of the Health Sector Reform for Contraceptive Logistics; Yasmin Chandani, et al, 
USAID, FPLM, JSI, 1999 
6. Community Based Distribution of FP Services by NGO in Ghana; PPAG and FRONTIERS, 
2000 
7. Community Based Distribution of Family Planning Services by PPAG; PPAG and 
FRONTIERS, 2000 
8. Estimates of the Maternal Mortality Ratio in Two Districts of Brong Ahafo Region of Ghana; JB
Smith, et al – Family Health International, 1995 
9. Assessment of Ghana Ministry of Health Contraceptive Logistics System; Linda Allain, Steve 
Kinzett and Sangeeta Raja, USAID, FPLM, JSI, 1999 
10. Evaluation of AVSC-supported Activities in Ghana; Martha Jacob, David Mandel, Marcia 
Mayfield, Manisha Mehta, AVSC, 1999 
11. Contraceptive pricing and Sustainability in Ghana; MOH, USAID,1998 
12. Assessment of the Social Marketing Component of the GHANAPA Project as Implemented by 
the Ghana Social Marketing Foundation; Frank R. Samaraweera, A.H.O. Mensah, USAID 
Ghana, August 1999 
VI. Publications on Surveillance & Malaria
1. Report and Assessment of National Communicable Disease Surveillance Epidemic 
Preparedness and Response System in Ghana; Ghana Health Service/MOH, WHO, CDC, 
August 2000
2. Roll Back Malaria: Strategic Plan for Ghana; MOH, 2000 
3. RBM Monitoring and Evaluation: Baseline Situation analysis of Malaria Control activities in the 
Kassena-Nankana District in Northern Ghana; Seth Owusu-Ageyi et al (WHO/AFRO, RBM 
initiative), July 2001 
4. Impact of Permethrin Impregnated Bed Nets on Child Mortality in Kassena-Nankana District, 
Ghana: a Randomized Controlled Trial; F.N. Binka et al, April 1996
VII. Other Publications
1. Ghana Water Supply and Sanitation: Country Fact Sheets; 2000 
2. Attracting and Retaining Health Staff: A Critical Analysis of Factors Influencing the Retention 
of Health Workers in Deprived/Hardship Areas; Kwadwo Mensah, February 
3. USAID Support to MOH/GHS Human Resource Development Report, Mary O’Neil, 
Management Sciences of Health, Sept 2002 
4. Community-based Health Planning and Service (CHPS) Costing Study, Ghana Health Service 
and the Prime II Project, October 2002 
15
Annex 5: List of Instruments/close-out reports for SO3
Cooperative Agreements (A) 
Grants (G) 
Contracts (C) & (S) 
• Planned Parenthood Association of Ghana – (PPAG) 641-A-00-00-00022 -- Jan 01, 2000 to Sept 
30, 2003 
• Ghana Registered Midwives Association – (GRMA) 641-0137-A-00-5017 -- July 28, 1995 to March 
05, 2004 
• Ghana Social Marketing Foundation – (GSMF) 641-A-00-00-00021-- Dec 01, 1999 to Sept 30, 2002 
• Africare – 641-G-00-00-00080 -- Sept 09, 1997 to Sept 08, 2003 
• AVSC/Engenderhealth – 641-G-00-97-000267 -- Feb 09, 2000 to Sept 30, 2004 
• Ghana Red Cross Society – 641-G-00-00-00023 – Oct 29, 1999 to Dec 31, 1999
• Unicef – 641-G-00-00-00290 – Sept 11, 2000 to Nov 26, 2000 
• Unicef – 641-G-00-00-00126 – June 02, 2000 to June 01, 2001 
• Unicef – 641-G-00-01-00111 – May 18, 2001 to Dec 31, 2002 
• Unicef – 641-G-00-02-00026 – Feb 25, 2002 to Dec 31, 2003 
• Unicef – 641-G-00-04-00262 - July 12, 2004 to Dec 31, 2004 
• Unicef – 641-G-00-04-00085 – Feb 19, 2004 to Sept 30, 2004 
• WHO – 641-G-00-04-00054 - Feb 03, 2004 to June 30, 2004 
• DIGITRONIX – 641-C-00-99-00474 – Oct 29, 1999 to Oct 11, 2000
• Laboratory & Clinical Supplies – 641-C-00-00-00137 – March 30, 2000 to April 17, 2000 
• Jan Paehler – 641-S-00-03-00228 – Oct 18, 2002 to July 24, 2004
• Peter Wondergem – 641-S-00-01-00199 – June 26, 2001 to August 06, 2004 
16
Annex 6: Abbreviations & Acronyms 
ABC Abstinence, Being Faithful and Using Condom Approach 
ADF African Development Foundation 
ADS Automated Directives System 
AED Academy for Educational Development
AFDB African Development Bank
AFDF Africa Development Fund
AIDS Acquired Immune Deficiency Syndrome 
AR Annual Report
ARI Acute Respiratory Infection 
ARV Anti-Retroviral Vaccines
ART Antiretroviral Therapy 
AVSC Access for Voluntary Surgical Contraceptive 
BASICS Basic Support for Institutionalized Child Support 
BCC Behavioral Change Communication 
CA Cooperating Agency 
CARE Cooperative for Assistance and Relief Everywhere, Inc. 
CBO Community-Based Organization 
CDC Centers for Disease Control and Prevention 
CEDPA Center for Development and Population Activities 
CHPS Community Based Health and Planning Services
CHEST Community Health Education Skills Toolkit 
CMR Child Mortality Rate 
CMS Commercial Markets Strategy 
CMSP Commercial Marketing Strategies Project 
CPR Contraceptive Prevalence Rate 
CRS Catholic Relief Services
CS Child Survival
CSD Child Survival and Diseases Fund (now Child Survival and Health Program 
Fund) 
CSH Child Survival and Health Programs Fund
CSM Contraceptive Social Marketing 
CSP Country Strategic Plan 
CSW Commercial Sex Workers
CWS Church World Services
CY Calendar Year
CYP Couple-Years' Protection
DA Development Assistance 
DAF Development Assistance Fund 
DFA Development Fund for Africa 
DfID Department for International Development, United Kingdom 
DHS Demographic Health Survey
DOD Department of Defense, U.S. Government 
DPT Diphtheria, Pertussis and Tetanus 
DPT3 Diphtheria, Pertussis, Tetanus Immunization Series
DSP Development Support Program 
ECOWAS Economic Community of West African States 
EPI Expanded Program of Immunization 
ESF Economic Support Fund 
FBO Faith-Based Organization
FFP Food for Peace 
FHA Family Health and AIDS (West and Central Africa) 
FHI Family Health International 
FPLM Family Planning Logistics Management 
17
FP Family Planning 
FR Fertility Rate
FY Fiscal Year 
GAI Global AIDS Initiative 
GAIN Global Alliance for Improved Nutrition 
GAVI Global Alliance for Vaccines and Immunization 
GBC Ghana Broadcasting Corporation 
GHS Ghana Health Services 
GSMF Ghana Social Marketing Foundation 
GPRTU Ghana Private Road Transport Union 
GRMA Ghana Registered Midwives Association 
GAC Ghana AIDS Commission 
GSS Ghana Statistical Service 
GTV Ghana Television
GOG Government of Ghana
Hib Haemophilus influencae type B 
HIV Human Immunodeficiency Virus 
HBC Home-Based Care
HPN Health, Population, and Nutrition 
ICDS Integrated Child Development Services
ID Infectious Diseases
IDSR Integrated Disease Surveillance and Response 
IEC Information, Education and Communication 
IFPS Innovations in Family Planning Services
IPPF International Planned Parenthood Federation 
IMCI Integrated Management of Childhood Illnesses 
IMR Infant Mortality Rate 
IPPF International Planned Parenthood Federation 
IR Intermediate Result 
ITM Insecticide Treated Materials 
ITN Insecticide Treated Net 
IUD Inter-Uterine Device
JHPIEGO Johns Hopkins Program Providing Reproductive Health 
JHU/PCS Johns Hopkins University/Population Communication Services
JSI John Snow Incorporation 
LTPM Long-Term and Permanent Methods 
MAC Malaria Action Coalition 
MCH Maternal and Child Health 
M&E Monitoring and Evaluation 
MHO Mutual Health Organizations 
MIS Management Information Systems 
MMR Maternal Mortality Rate 
MOC Ministry of Communication
MOE Ministry of Education 
MOF Minister of Finance 
MOH Ministry of Health 
MOI Ministry of Information 
MOST Micronutrient Operational Strategies and Technologies 
MSH Management Sciences for Health 
MTCT Mother-to-Child Transmission 
PMTCT Prevention of Mother to Child Transmission 
NACP National AIDS Control Program 
NGO Non-Governmental Organization 
NID National Immunization Day 
NIH National Institutes of Health 
NPC National Population Council 
18
NPA Non-Project Assistance 
NPI New Partnership Initiative
NPR National Performance Review 
NSV No-Scalpel Vasectomy
OPIN Online Presidential Initiatives Network 
ORS Oral Rehydration Salts 
ORS/T Oral Rehydration Salts/Therapy 
ORT Oral Rehydration Therapy 
OSCE Organization for Security and Cooperation in Europe
OVC Orphans and Vulnerable Children 
PHC Primary Health Care 
PHCI Primary Health Care Initiative 
PHN Population, Health and Nutrition 
PHRplus Partners for Health Reformplus 
PPAG Planned Parenthood Association Ghana 
PLACE Priorities for Local AIDS Control Efforts 
PLWHA People Living with HIV/AIDS 
PMTCT Prevention of Mother-to-Child AIDS Transmission 
PRIME Primary Providers' Training and Education in Reproduction 
PSI Population Services International 
PSO Private Sector Organization 
PVC Private Voluntary Cooperation 
PVO Private and Voluntary Organization
RBM Roll Back Malaria 
RH Reproductive Health 
RHS Reproductive Health Survey
SNIDs Sub-National Immunization Day 
SO Strategic Objective 
SRH Sexual and Reproductive Health 
SSH Special Self-Help Program
START Support, Treatment and Anti-Retroviral Therapy 
STD Sexually Transmitted Disease 
STI Sexually Transmitted Infection 
TAACS Technical Advisors for AIDS and Child Survival 
TFR Total Fertility Rate 
TREND Training Research and Networking for Development
UNAIDS United Nations Joint Program on HIV/AIDS 
UNFPA United Nations Population Fund 
UNICEF United Nations Children's Fund 
USAID United States Agency for International Development
VAC Vitamin A capsules 
VCT Voluntary Counseling and Testing 
VSC Voluntary Surgical Contraceptive 
WARP West African Regional Program 
WAPTCAS West Africa Project to Combat AIDS and STIs 
WFP World Food Program (United Nations) 
WHO World Health Organization
 
19