EVALUATION OF HEALTH SKILLS AND HEALTH EDUCATION TRAINING ACTIVITIES BY WOMEN VOCATIONAL TRAINING CENTERS IN GHANA

INTRODUCTION
Gender Inequalities: Differences between men and women which systematically empower one group to the detriment of the other Due to gender inequalities, women in poor populations often discover themselves even further disadvantaged within the deprived population, as a result of being the poorest among the poor and the least educated within the insufficiently educated Results in unequal access to use, benefit from or participate in decisions around protective laws and policies, health information, care and services as well as education and gainful employment Gender discrimination has detrimental effects on health of women and can leads to
Increased maternal and infant mortality Decreased contraceptive use, increased fertility and abortions Increased prevalence of communicable diseases like malaria, tuberculosis, and HIV/ AIDS Increased morbidity and mortality due to cardiovascular diseases, mental health disorders, cancer and gender based violence Poor access, affordability and utilization of health services
WHO report 2010

GHANA
Ghana has endorsed all the UN declarations that seek to promote gender equality and equity However, published literature into gender and poverty issues in Ghana suggests that gender disparities persist Gender differences in labor force participation and earnings, in time allocation, in schooling and literacy, in health and the impact of HIV/AIDS, and in access to and control of a wide range of human, economic, and social capital assets are impediments to growth and poverty reduction in Ghana In rural Ghana, women face a tough time as there is little in the way of health facilities, few health workers, and the women have to farm as well as raise children and keep house. Community male elders and the younger men in the community do not pay much attention to the reproductive health problems faced by women.
BRIDGE background paper on gender issues in Ghana 2004

ROLE OF WOMEN VOCATIONAL TRAINING INSTITUTE

The role of women vocational training institutes can not neglected in countries with cultural bias toward female unemployment, education and empowerment Various activities have been initiated and expanded in the community in collaboration and participation with community leaders and the residents In Ghana interventions are currently underway to enhance health skills among Ghanaian women. These projects and programes includes
Establishment and expansion of women vocational training centers The Ghana Reproductive Health Strategic Plan 2007-2011 Health education and capacity building projects with focus on
Maternal morbidity and mortality Contraceptive use and family planning services Environmental sanitation campaigns Breast cancer and cardiovascular diseases awareness among women Microcredit and Malaria Total empowerment of women and .

PURPOSE OF SCOPING EXERCISE

Providing information and education for health is the key to enable people to realize their needs and initiate joint community actions to achieve better health Purpose of this scoping exercise was to evaluate the effectiveness of health skills and health educations training activities by women vocational training institutes in Ghana

METHODOLOGY OF EXERCISE
The literature search was carried out by using the database of Medscape, Medline,and PubMed, without any language restriction with MeSH words as women empowerment and contraception, women empowerment and fertility and Women Empowerment and HIV/AIDS in Ghanian women. The relevant articles were obtained for review after examining all titles and abstracts (if available) from each of the searches. Bibliographies of those articles were examined for additional references. No restrictions were put on study design, location, or language of publication. Relevant government and international evaluation reports were also reviewed. Documents included:
Strategic documents Programmatic Reports and reviews Population based survey reports: Ghana Demographic and Health Survey Sub-populations survey reports

HEALTH EDUCATION AND CAPACITY BUILDING PROJECTS

The Planned Parenthood Association of Ghana has taken the approach of utilizing drama performances by their health volunteers The Gratis Fund: A Free Publications Program of the Hesperian Foundation (for disabled children, awareness related to HIV/ AIDS, Breast Cancer and reproductive health and rights) Health Education programes by Red Cross Society in Ghana Information and counseling on human sexuality, sexual behavior, parenting and sexual health by Ministry of Health The ILO implemented the project in collaboration with United Nations Industrial Development Organization (UNIDO)
Employment Generation, Improvement and Expansion of Safety Nets Decent work and local development through dialogue and partnership building Ghana - Decent Work Country Programme (DWCP) Promotion of an Enterprise Culture in Educational and Vocational Training Institutions in Ghana Infrastructure for jobs and prosperity in Ghana

CURRENT EVIDENCE
There are limited data from which to ascertain gender differentials in health status in Ghana The main relevant health related statistics are life expectancy rates and maternal mortality rates (350/100,000), nutrition-related indicators, and infant and child mortality rates Evidence suggests that improvement in Ghanas maternal mortality since 1990 has been negligible

The Ghana Ministry of Health reports attended deliveries increasing from 40 percent in 1988 to 59 percent in 2008 (MOH, 2008a)

CURRENT EVIDENCE
Environment and sanitation
Women are at greater risk than men of contracting water-borne diseases due to their greater contact with and use of water supplies Women time and energy, as well as cost, constraints on water and fuel wood collection limit the possibility of maintaining nutritional and hygiene standards

HIV/AIDS and Family Planning

Fertility rates in Ghana are high and there is no clear evidence to suggest that they are in decline due to women relative lack of education and economic opportunities Unequal gender relations manifest themselves in decision making patterns relating to fertility, which tend to reflect male rather than female preferences Data indicate a significant unmet demand for contraception among women

CURRENT EVIDENCE
Women make up almost 60 percent of those living with HIV, however, and the rate of newly infected women is still increasing Ghanas HIV rate peaked in 2003 with 3.6 percent of the population infected, and has since dropped to a 2.9 percent infection rate in 2009 (MOH, 2009) Prevalence rate among pregnant women, which jumped from 1.9 percent in 2008 to 2.6 percent in 2009 (National Development Planning Commission, 2010: 40) Only 32 percent of urban women, and a mere 19 percent of rural women were considered to have comprehensive knowledge. In contrast, 41 percent of urban men and 26 percent of rural men were considered to have comprehensive knowledge (GSS, 2009: 2-3)

CRITIQUE
Strengths Different approaches were tested and implemented to improve health status of women in Ghana by different organizations (governmental and non governmental). These approaches included

Spread of educational material to increase knowledge like hand washing manuals, and awareness regarding malaria Role play to increase knowledge and improve sexual practices Training of health workers particularly females so as to provide skilled birth attendant and to reduce pregnancy related complications

Weaknesses

Small scale/ Pilot projects No third party evaluation conducted Incorporation of research findings into policy and practice is an issue Limited impact of health education projects

RECOMMENDATION
High maternal mortality rates are priority issue in women's health, which can be addressed through encouraging longer birth spacing, improving access to and the quality of health care facilities and in the longer term, increased education of females is correlated with lower maternal and child mortality

Research is needed into gender differentials in mortality and morbidity and their operational implications
Greater involvement of men in family planning activities through male oriented health education programme is required and other measures to encourage joint decision making in family planning practice Strengthening women control over their sexuality by increasing their bargaining power within relationships, and giving them wider economic choices, is the key to reducing their risk of infection in the longer term.

CONCLUSION
Although expanding availability of health education and health skills services is a positive move for female health in Ghana, it fails to address the lack of rights that underlie womens health issues, including the inability to choose sexual encounters, and define their own roles within family and society

Going forward Ghana will need to place greater emphasis on female empowerment if it hopes to see substantial progress in measures of female reproductive health and meet its MDG commitments

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