Young people in parts of Northern Ghana have become more knowledgeable and confident about sexual and reproductive health and rights, but those gains have not translated into a significant increase in their use of health services, an evaluation of a five-year intervention has found.
The endline evaluation of the Sexual Health and Reproductive Education (SHARE) Project found statistically significant improvements in adolescents’ SRHR knowledge and confidence to seek information and services in intervention areas.
However, reported use of sexual and reproductive health services declined at endline, although service use in intervention areas remained higher than in comparison areas. The difference was not statistically significant.
The findings point to a persistent gap between providing young people with sexual and reproductive health knowledge and ensuring they can access services when needed.
Adolescents cited privacy and confidentiality concerns, embarrassment, financial difficulties, waiting times and limited availability of adolescent-friendly services among the barriers preventing them from seeking care.
Some also reported attitudes and restrictions from service providers that discouraged them from accessing services.
In Saboro, for example, boys aged 15 to 19 reported being refused condoms because they were considered too young to be sexually active.
Misinformation about contraception also remains a challenge. Some adolescents and caregivers believed using family planning methods before having a first child could result in permanent infertility.
The findings were presented during a regional dissemination of the SHARE Project’s endline evaluation.
SHARE Project Officer at Right To Play, Evans Gariba, said the results provide important lessons for future interventions aimed at improving adolescent sexual and reproductive health.
The project was implemented by a consortium led by Right To Play in partnership with FAWE Ghana, WaterAid Ghana and FHI 360, with funding from Global Affairs Canada.
In Ghana, the project ran from 2021 to 2026 in the Bongo District, Builsa North Municipality, Kassena-Nankana Municipality and Kassena-Nankana West District.
It targeted young people aged 10 to 24 and worked through schools, communities, health facilities and government structures to improve access to accurate SRHR information and responsive services.
The endline evaluation, conducted between March and May 2026, gathered evidence from 1,240 adolescents and young people, 351 teachers, 356 caregivers and stakeholders, as well as health facilities.
Teacher capacity improves, but challenges remain
Schools emerged as one area where the project recorded notable gains.
The evaluation found that 95% of teachers surveyed had received training from SHARE or its partners, while 91% were aware of national reproductive health education guidelines.
Another 84% reported being much more comfortable teaching reproductive health education.
Despite those gains, teachers identified inadequate resources and time as continuing obstacles.
About 87% reported inadequate teaching and learning materials, while 58% said they lacked sufficient time to deliver reproductive health education.
The evaluation also recorded increased participation by girls in SRHR advocacy activities in intervention areas, including peer and community mobilisation, school governance and action research.
There was also a statistically significant improvement in autonomous SRHR decision-making among women aged 15 to 24 who were married, cohabiting or in relationships and sexually experienced.
Qualitative findings pointed to increased confidence, voice and boundary-setting among some young women.
However, the evaluation found that most girls still did not participate in advocacy or social action activities, suggesting that opportunities for adolescent participation have yet to reach many potential beneficiaries.
Family support for adolescents seeking SRH information and services also improved.
The finding is particularly important because parents and caregivers can influence whether information young people receive through schools and community programmes is reinforced at home.
The evaluation found that adolescents sometimes returned home with information that conflicted with cultural, religious or parental expectations, highlighting the importance of continued engagement with caregivers.
Health facilities show mixed progress
The SHARE Project also sought to improve the responsiveness of health facilities to adolescents.
Facilities that received infrastructure support generally recorded stronger readiness indicators than those that did not.
However, gaps remained in waste management, standard operating procedures, supervision and the maintenance of adolescent-friendly services.
The findings identified privacy, confidentiality, respectful treatment and age-appropriate services as important factors influencing whether adolescents seek and return for care.
With the five-year project ending, attention is now turning to sustaining the gains recorded.
The Ghana Education Service in the Upper East Region says it plans to use technology to maintain engagement with teachers and monitor the continuation of SHARE-supported activities in schools.
Deputy Regional Director of Education John Ankoh said teacher mentors would be engaged through regular online meetings.
“Once in a month, our mentors in the various schools in the various locations will be met on Zoom to find out what they have been doing thereafter,” he said.
According to him, district education officials, including girl-child and training officers, will also engage mentors to assess progress.
“So, it is not ending here,” Mr. Ankoh said.
He said the project had contributed significantly to improving adolescents’ understanding of sexual and reproductive health and rights.
“The data shared with us points to a success story in helping adolescents and members of the community to know their sexual and reproductive rights and education issues,” he said.
Mr. Ankoh said improved knowledge could contribute to preventing sexually transmitted infections and teenage pregnancies.
The evaluation, however, warned that gains made under SHARE could be lost without continued institutional support.
It identified funding gaps for supervision and community mobilisation, staff transfers, inadequate refresher training, maintenance of WASH infrastructure and continued sensitivity surrounding SRHR education among potential risks to sustainability.
The evaluators recommended integrating effective SHARE interventions into routine education and health plans and budgets, continuing engagement with adolescents, providing refresher training for teachers and health workers, and strengthening community accountability mechanisms.
They also called for clearer reproductive health education content across schools, health facilities and communities.
The findings suggest that as SHARE ends its five-year implementation period, the next challenge will be ensuring that increased knowledge and confidence among young people are matched by health services they can access safely, affordably and without stigma.
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