Improving maternal and child health for the most vulnerable women in Ghana

In Ghana, only a minority of individuals with mental health needs have access to care and treatment. These mental health challenges, combined with barriers to care, lead to many women and girls missing out on essential maternal and child health services. Implemented by BasicNeeds, the project aims to strengthen community health systems to enhance integrated, people-centered HIV, tuberculosis, sexual and reproductive health, focusing on the most vulnerable women and adolescents. BasicNeeds’ executive director, Peter Badimak Yaro, discusses the project’s context, approach, and implementation.

What are the context and background of the project in Ghana?

Peter Badimak Yaro: In Ghana, mental health and social support services in healthcare facilities are inadequate. As a result, 90% of people with mental health care needs do not receive treatment, with women and adolescent girls being the most affected. This project aims to strengthen mental health support within maternal and child health facilities, as well as within the HIV and tuberculosis (TB) treatment clinics, to improve the overall quality of care.

The project specifically targets pregnant women, adolescents and postpartum mothers with children under the age of one, who are living with or at risk of HIV infection, as well as survivors of gender-based or domestic violence. These individuals often lack the psychosocial support necessary to help them cope with their conditions and adhere to their treatment.

There is a true need to enhance mental health support for women and girls in the reproductive health sector, especially given the persistently high maternal and child mortality rates that must be reduced. Additionally, integrating mental health care within HIV and TB services is essential in order to address these global pandemics. HIV remains a major public health concern in Ghana, with currently 334,095 people living with the virus and 17,774 new infections in 2024. The country is currently not on track to meet the Sustainable Development Goal of reducing new HIV infections by 75% by 2025, using 2010 as a baseline.

How does mental health impact both the management and transmission of HIV?

Peter Badimak Yaro: Living with HIV significantly increases the risk of experiencing mental health challenges. Many individuals struggle with anxiety after being diagnosed. Sometimes, some go through a phase of denial. They also face stigma, which can further impact their mental well-being. On the other hand, people suffering from depression are less likely to adhere to their treatment regimen. Research has shown that poor mental health negatively affects HIV management and overall health outcomes. Plus, individuals with mental health conditions are often at a higher risk of acquiring HIV, especially if they engage in high-risk behaviors such as drug use, injection drug use, or commercial sex work. That is why this project focuses on integrating mental health and social support into HIV and TB management, particularly for pregnant women, girls and postpartum mothers. This approach also strengthens mother-to-child transmission of HIV. Today, 12,108 pregnant women are on antiretroviral (ARV) treatment in Ghana.

Addressing mental health and psychosocial support is a crucial strategy in tackling HIV or TB. For a long time, the mental health aspect of these diseases has been overlooked, despite the fact they play a critical role in treatment adherence and general well-being. Additionally, maternal and child health is deeply affected by HIV and TB. Supporting the mental health of pregnant women is now increasingly recognized as essential for improving maternal and child health outcomes.

We are very grateful for the technical support and guidance provided by L’Initiative. Their feedback, along with their assistance in tracking and evaluating our progress in the project’s implementation, is invaluable in helping us address this critical issue in Ghana. 

How is the project being carried out on the ground?

Peter Badimak Yaro: The project began in May 2024 and is being implemented across 28 locations in 14 districts, including primary healthcare facilities, hospitals, and what we call “CHPS compounds” (CHPS = Community Health Planning and Services) in Ghana–community facilities. The implementation is based on areas with the greatest need. Most of the districts are in northern parts of the country, as well as in some of the poorer communities in the suburbs of Accra, where healthcare services need improvement. We aim to reach a total of 14,000 pregnant women, adolescent girls and post-partum mothers who are living with HIV or at risk of contracting it, as well as survivors of gender-based violence or intimate partner violence.

To do so, we developed a predefined protocol, which was submitted to the Ghana Health Service for approval. This allowed us to assess the existing situation and establish a baseline. Founded on these findings, we are refining our project targets and expected outcomes. Furthermore, we will develop a simple, practical manual to train community health workers in providing mental health support to the target population.

What is the project’s specific approach?

Peter Badimak Yaro: We work with community health workers, as well as CHPS and sub-district healthcare facilities, which operate at the basic and primary healthcare levels in Ghana. Moreover, we collaborate with district-level health facilities and regional hospitals as referral centers in the targeted locations. In some areas, the only available healthcare provider may be a community midwife or a nurse, so we engage with them, along with village health workers, to mobilize community support for mental health and psychosocial services.

BasicNeeds is a mental health and development advocacy organization with over 20 years of working experience supporting people with mental health conditions. Our method focuses on empowering people living with mental health conditions and primary caregivers and families to provide treatment needs and facilitate social and economic rehabilitation within their communities. We prioritize community-based support over psychiatric hospitalization, as our goal is to strengthen mental systems at grassroots level. Through this project, we aim to enhance care for individuals with mental health conditions, promote their integration into society, reduce stigma and discrimination, and advocate for inclusive policies that benefit poor and marginalized people.

How will the project provide care and support for the target population?

Peter Badimak Yaro: First, we conduct screenings using a validated tool to assess the mental health conditions and care needs of pregnant women and mothers. We can screen mothers at different stages of pregnancy or who have children from zero to one year. Mothers who score positive for mental health conditions will be referred for psychosocial counseling and support. For those undergoing antiretroviral or TB treatment, this assistance will help them to adhere to their medication regimens.

Furthermore, we will facilitate the formation of peer support groups among these women, fostering solidarity and mutual support. Peer support plays a crucial role in mitigating the impact of mental health challenges. It also improves adherence to treatment by helping women manage their antiretroviral therapy and keep up with antenatal and postnatal visits, including immunizations. These groups will also engage in public outreach to raise awareness, educate communities, and promote knowledge about mental health, HIV and TB. As a result, this will contribute to reducing the spread of HIV, increasing treatment adherence, and promoting healthier behaviors. Plus, we will carry out awareness campaigns using media and community engagement to improve public understanding of mental health and its link to HIV and TB.