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Evaluation database

Evaluation report

2017 Ghana: End line Evaluation of the Project for Improving Access to Quality Health and Education Services in the Northern and Upper East Regions of Ghana

Author: Evelyn Sakeah, Paul Welaga, Dominic Anaseba, Hakim Abdallah, Raymond Aborigo, Daniel Azongo, Fabian Achana and Abraham Oduro

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 3’ of the report, and the executive feedback summary labelled as ‘Part 4’.


Reduction in newborn deaths within the first 30 days of life has stagnated in Ghana. Despite some improvement in maternal health services, maternal mortality has not seen the needed decline. Maternal mortality ratio (MMR) in Ghana was estimated at 319 per 100,000 live births in 2015. Consequently, the Ghana Health Service (GHS) with support from KOICA-UNICEF prioritized the implementation of newborn health care interventions to reduce newborn deaths in order to accelerate the attainment of MDGs 4 and 5 nationally.

Also, with the introduction of the free, compulsory and universal basic education in Ghana, there has been a remarkable increase in the net enrolment rate in pre-school and primary education. However, the quality of education has declined over the years as a result of the rapid increase in school enrolments over the past ten years

UNICEF, as part of its 2012-2017 programme of cooperation with the government of Ghana, supported the Ghana Health Service (GHS) and the Ghana Education Service (GES) in 6 selected districts in the Upper East and Northern Regions of Ghana to develop and implement a package of interventions aimed at improving maternal, newborn and child health as well as education within the framework of the life cycle approach.


The purpose of the evaluation was to determine to what extent the programme objectives have been met and the major lessons learnt going forward. To this end, the following four key questions of interest were examined:

To what extent have the interventions under the KOICA partnership been able to meet the overall programme objectives for health and education?

What were the conducive/enabling factors for achieving programme outputs/targets in health and education?

What were the barriers/bottlenecks that did not allow for achievement of programme outputs/targets in health and education?

What are some of the major lessons/recommendations that can be distilled from this partnership in relation to health and education?


The evaluation involved the use of both quantitative and qualitative research methods. We interviewed service providers and carried out a health facility assessment survey. There were in-depth interviews and focus group discussions with health and education professionals as well as community members. The primary data were supplemented by secondary data from routine records of the Ghana Health Service and the Ghana Education service.

The evaluation was limited to the interventions’ timeframe of July 2013 to December 2016 and the geographic focus of the evaluation covered two selected districts, the Builsa North district in the Upper East Region and Karaga district in the Northern Region. A multistage random sampling technique was used. First, four sub-districts in each study district were sampled. In each sampled sub-district, two CHPS zones were selected and health professionals (CHOs, CHNs, other nurses and midwives) randomly selected for in-depth interviews. We used the purposive sampling method to select other health professionals (District focal person, regional focal person) and community stakeholders for the focus group discussions (FGDs) and In-depth Interviews (IDIs) to explore their views about the interventions.

The Health Facility Assessment survey covered a total of 38 health facilities; 2 hospitals, 5 health centres and 31 CHPS compounds. A total of 29 MNCH service providers were interviewed; 17 midwives, 6 CHNs, 3 enrolled nurses, 1 CHO, 1 Medical Assistant and 1 other health professional.

Findings and Conclusions:

Below are the key findings of the evaluation:
•Most of the facilities offer MNCH services  namely antenatal care, delivery, postnatal care for mothers and newborns, child immunization, child welfare (weighing), family planning, counselling on HIV/AIDS and post abortion care

•There was vast improvement in the availability of basic equipment and consumables in the hospitals and health centres in the two districts involved in the endline evaluation compared to the baseline indicators.

•Newborn care units and corners were set up in health centres and CHPS compounds that had midwives and equipped with incubators, thermal warmers, oxygen, nasal prong, etc and basic logistics such as towels for wrapping the babies and keeping them warm.

•Over 72% of all the health staff interviewed received refresher training on basic emergency obstetric care with 78% of all health centre staff receiving training.

•Data from DHIMS showed increasing trends in the number of pregnant women who patronized ANC services from 2013 to 2016 in the two districts.

•The results after the implementation of the UNICEF interventions showed an improvement in access to basic education over the period.

•Parents reported that the community engagement processes with KOICA-UNICEF and the training sessions made them aware of their roles in promoting the academic wellbeing of their wards.

•The community, management of education services and focal persons of the UNICEF-KOICA initiatives viewed the interventions as relevant, appropriate and timely.

•The interventions helped to build the capacities of teachers as well as community stakeholders and provided equipment and supplies for efficient and effective service delivery.


The study yields key recommendations to further enhance program implementation and effectiveness:

•Continuous training by the Ghana Health Service is required to ensure that both old and newly posted health professionals receive the necessary information for newborn care.

•The Ghana Health Service should continue to provide equipment and logistics to sustain the gains made by the KOICA-UNICEF interventions.

•Continuous monitoring and supervision of MNCH service providers is critical to improve newborn care.

•Continuous community engagement is crucial in sustaining community participation in the programme.

•The Ghana Education Service should work to address the large Pupil-Classroom Ratio by building more classrooms in the two districts to cater for the increasing number of pupils being enrolled.

•The Ghana Education Service should increase the proportion of trained teachers to improve the Pupil Trained-Teacher Ratio in basic schools.

•The Ghana Education Service should make core textbooks available in primary schools to guarantee effective teaching and learning.

•Finally, leadership and commitment from the health and education authorities are required to ensure the sustainability of the KOICA-UNICEF intervention activities.

Lessons Learned:

•The capacity building workshops shows the need for routine in-service training for health and educational professionals and community stakeholders

•Community engagement is an important component of service delivery and utilization. Interaction between community members and health professionals could help to address pertinent health issues that relate to the community.

•Home visitation is necessary to avert complications, and intervening within one month after delivery is critical to preventing neonatal mortality. In addition, monitoring and supervision at the service delivery points is critical for effective and efficient service delivery.

Full report in PDF

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Report information






Navrongo Health Research Centre, Northern and Upper East Regional Health and Education Directorates and UNICEF



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