Integrative Analysis

This section includes an integrated analysis of the preliminary assessment findings and

internship outcomes and observations within the context of the competency areas below.

Recommendations for each area are provided here, as well as in the Agency Report provided to

CFHI (Appendix C).

CFHI prioritizes evidence-based approaches in public health through the guidance of several entities including, The World Health Organization (WHO), UNAIDS, and UNICEF. Since the service population was in Ghana, it was advised to only use global health organizations, rather than national public health agencies like the CDC. An example of their evidence-based approach can be seen in the development of the Grant Proposal Draft (Appendix A). The purpose of the Grant Proposal Draft was to reduce transmission of HIV and to improve the quality of lives for those who are living with HIV/AIDS. First, evidence was found to determine specific barriers and challenges. It then used evidence-based best practices to target the barriers and challenges in order to reduce the number of HIV rates and improve the quality of lives for those that are living with HIV/AIDS. Another example of this evidence-based approach is in the development of the Injectable PrEP PowerPoint Presentation (Appendix B). This was demonstrated through providing culturally sensitive material to achieve HIV education and prevention. This culturally appropriate material was relevant to Ghana and the service population targeted.

While I was able to assess the population’s needs and capacities through evidence found while conducting literature reviews, it is important to hear from the community members. I would recommend that the organization allows for surveys to be conducted to determine barriers and challenges that the community members struggle with so that interventions can be catered to their specific needs. The surveys can be created utilized online resources, such as Survey Monkey or Qualtrics so that they can be completed virtually.

Integration of health care and public health is an essential component of the way CFHI addresses HIV in Ghana. This is seen through the development of grant proposal drafts and planning intervention programs within local hospitals. Fostering existing partnerships to improve public health interventions can help further integrate health care and public health in addressing HIV/AIDS. It could also be beneficial to work on an intervention for staff training and development programs to help with the workforce shortage in Ghana. Three scientists at the WHO conducted a study finding that Ghana has only sixty-seven percent of its needed health care workers (Mohammed-Nurudeen, 2021).

This severe work shortage can lead to many serious issues. Without proper training and limited employees, it will be difficult to tackle HIV. The Grant Proposal Draft (Appendix A) proposes a partnership with community health workers and sexual reproductive health nurses to offer educational programs as well as treatment delivery for PLWHA that are unable to receive their medicine at the clinics.

CFHI adapts efforts to the cultural values and practices of the Ghanian population by partnering with governmental and non-governmental agencies that provide care and services that emphasize this. The internship project focused on two separate organizations, including PMLCH in Accra, and the Planned Parenthood Association of Ghana (PPAG) in Cape Coast. They both partner with both local and governmental organizations, which is necessary for these organizations to succeed in adequately addressing the ever-changing needs of their service populations and ensuring sustainability. PMLCH’s partnerships include BlueNet and Little Angel’s Trust (LAT), both non-governmental organizations, and several local organizations. PPAG partners with a number of organizations, including International Planned Parenthood Federation (IPPF), Department for International Development, United Nations Population Fund (UNFPA). Salin+, The Global Fund, Japanese Organization for International Cooperation in Family Planning (JOICFP), JTF, Access, Services, and Knowledge (ASK), Get Up Speak Out (GUSO), and Ghana Adolescent Reproductive Health Project (GHARH).

As discussed earlier, one way to enhance the way that CFHI plans and manages their planning and management to promote health is through conducting needs assessments and analyzing the data to improve their impact by targeting populations with greater need during intervention planning.

The National HIV and AIDS policy is guided by four pillars: 1) greater involvement of PLWHA, 2) alignment with global concepts and frameworks, 3) decentralized multisector planning, and 4) partnership and collaborative with public, private, local, and international institutions. This policy is aimed to support efforts addressing the issue in Ghana. Their main objectives they hope to achieve are to empower the population to prevent HIV rates from increasing, ensure the availability and accessibility to prevention, treatment, care, and support services, to mitigate the social and economic effect of HIV on persons infected and/or affected, and to ensure the availability of funding so that these policy strategies may be developed and implemented (Ghana AIDS Commission, 2019).

While there are many policies addressing HIV/AIDS in Ghana, there are also policies that impede the health issue. Section 104: Unnatural Carnal Knowledge has made same sex conduct illegal in Ghana since 1960 and is punishable up to three years of imprisonment. There was a new bill introduced in Ghana last year that will criminalize LGBTQ+ people, along with rights groups and anyone coming out in their support. Given that men who have sex with men are a key population that struggle with HIV/AIDS, this bill will largely impact many in Ghana. If this bill is passed, it will likely lead to many ramifications including further discrimination and stigma towards the LGBTQ+ community. It is imperative that healthcare administrators in Ghana take a no-tolerance policy against discriminating the LGBTQ+ community members through ensuring equal care is provided to all patients.

The leadership structure of CFHI consists of an elected Board of Directors, Advisory Circle, Advisory Committee, Alumni Advisory Board, and a Collaborating Partners. Most of the decision making for the organization is made by the Board of Directors, including the founder, nine chairmen, a secretary, and a treasurer. However, each of the collaborating partners are the medical professionals that work as Program Directors for their specific service population. Dr. Charles Nwobu is the collaborating partner in Ghana that will work with the students to create intervention programs for the community members in Ghana.

One recommendation is to create a longer practicum for students so that they could have a 1-2 week professional and team development workshop to allow for more interprofessional collaboration. This could also be done during the week in between students working on their projects to enhance team building.

There are several effective communication strategies that are being used in Ghana to address HIV/AIDS in their community, including HIV/AIDS education, access to prevention and control methods, and access to treatment. This information is disseminated through a variety of communication avenues such as social media campaigns, community health workers, sexual health doctors and nurses, radio announcements, and flyers.

It is essential to communicate with the key populations affected including adolescent girls, young adults, men who have sex with men, and female sex-workers. I believe that this information is communicated effectively to the older demographics, but since HIV rates are on the rise for young girls, I would recommend an intervention program at school so that they can better service that population to help prevent rates from rising further.

CFHI participates in several ongoing collaboration groups that consist of interprofessional teams to address HIV/AIDS in Ghana. As previously discussed, they are partners with PMLCH and PPAG. They also partner with The Cape Coast Teaching Hospital, Community Health-Based Planning Services (CHPS) compounds, NKWA Foundation, and Livelihood Empowerment Against Poverty (LEAP). The Cape Coast Teaching Hospital serves as a facility for training medical students from the University of Cape Coast, allied health students from various institutions and nursing students from several nurses' training colleges, catering to patients from all socioeconomic backgrounds. CHPS is intended for the delivery of essential community-based health services and provides planning services primarily to communities in resource-poor and remote areas. NKWA is a privately-owned social entrepreneur organization and non-profit that focuses on health promotion in Cape Coast and other neighboring villages in the Central Region, Ghana. LEAP is a national social cash transfer program that provides a cash grant to extremely poor households across Ghana in an effort to alleviate poverty in the short term.

Although CFHI is involved in several interprofessional teams, there are ways to further enhance their interprofessional strategies. As mentioned earlier, it is essential to leverage community partnerships to improve their programs. Potential community partnerships include Cedaku Foundation of Ghana, a non-profit organization created to increase awareness in HIV/AIDS, The Global Network of Sex Work Projects (NSWP), which advocates the rights for sex workers, which is a key population in Ghana, or local schools to help target the young girls and adolescent demographic.

Systems thinking is another one of the many strengths of CFHI. Systems thinking is understanding that no organization will thrive with a holistic approach, looking at it in terms of wholes and relationships, rather than by splitting it down into its parts. Systems thinking stresses the importance of identifying and understanding how varying factors may influence certain health behaviors and health outcomes. A prime example of systems thinking is the concept of social determinants of health (SDOH). Through thorough reading and analysis of peer-reviewed journals, it was easier to target specific challenges and barriers so that a proper intervention could be drafted, as shown in the Grant Proposal Draft (Appendix A). This included access to healthcare and education. Additionally, systems thinking was used when developing the Injectable PrEP PowerPoint Presentation. Approving a roll-out of a new HIV prevention method nation-wide would require collaboration at multiple levels with the local and national government and multiple stakeholders.

I would recommend that CFHI has students create logic models during the evaluation portion developing intervention. They present a concise, graphic of what the program is intended to do to help strengthen the program for stakeholders by analyzing inputs, activities, outputs, and short-term and long-term outcomes.