Contraception offers promising opportunities for addressing the high and growing demand
to limit births, space children, avoid unintended pregnancies and prevent unsafe
abortions.
1However, the provision of contraceptives – particularly implants – to expand
family planning options remains restricted in sub-Saharan Africa.2Nearly 1 in 3 women in
the sub-Saharan African region has an unmet need for family planning, the highest
proportion worldwide. 1
A key requirement for improving access to contraceptive service delivery is sufficient
health workforce availability and distribution within countries.
3
In sub-Saharan Africa,
expanding access to family planning services is further compounded by acute shortages in
human resources for health, especially in rural areas where access to modern contraceptive
methods is already limited.4 To mitigate these acute shortages, the World Health
Organization (WHO) recommends task sharing or task-shifting, a process that optimizes
health worker roles by “train[ing] cadres who do not normally have competencies for
specific tasks to deliver them and thereby increas[ing] levels of health care access”.5
Specifically, WHO recommends the use of auxiliary nurses to deliver insertion and removal
of contraceptive implants with targeted monitoring and evaluation.
6
This article chronicles the phases that led to a policy change allowing auxiliary nurses in
Ghana to share the task of providing implant services with midwives. First, we briefly
describe the socio-medical context in Ghana, with emphasis on reproductive health
indicators and national benchmarks; we then highlight the consequences of medical staff
shortages on provision of family planning services and argue the need for task-sharing in
Ghana; third, we outline the succession of donor-funded projects and related research
studies that generated the evidence needed to influence decision-makers to enact a change
in policy; relevant to the latter is an explicit account of the role of the Population Council, a
health research organization, in facilitating the policy change process; lastly, we describe
the level and type of advocacy required to implement and operationalize the policy change.