{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:00:37Z","timestamp":1793365237124,"version":"4.5.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although policies for adolescent health exist in Ghana, their implementation is challenging. Availability of services for adolescent sexual and reproductive health and adolescent mental health remains less than desired, with adolescent mental health being particularly neglected despite being an important contributor to poor health outcomes. This study presents an analysis of gaps in the implementation of the Ghana Adolescent Health Service Policy and Strategy (2016\u20132020), including how and why the context influenced the observed implementation gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data for this study is drawn from 17 in-depth interviews with purposefully identified key stakeholders in adolescent mental, sexual, and reproductive health across the national and subnational levels; four focus group discussions (FGDs) with district health management teams; and 11 FGDs with adolescents in and out of schools in four selected districts in the Greater Accra region. Data were analyzed using both inductive and deductive approaches. The deductive analysis drew on Leichter\u2019s conceptualization of context as structural, cultural, situational, and environmental factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 23 planned strategies and programs for implementing the policy, 13 (57%) were partially implemented, 6 (26%) were not implemented at all, and only 4 (17%) were fully implemented. Multiple contextual factors constrained the policy implementation and contributed to the majority of strategies not being implemented or partially implemented. These factors included a lack of financial resources for implementation at all levels of the health system and the related high dependence on external funding for policy implementation. Service delivery for adolescent mental health, and adolescent sexual and reproductive health, appeared to be disconnected from the delivery of other health services, which resulted in weak or low cohesion with other interventions within the health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Bottom-up approaches that engage closely with adolescent perspectives and consider structural and cultural contexts are essential for effective policy implementation. It is also important to apply systemic and multi-sectoral approaches that avoid fragmentation and synergistically integrate policy interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2023.1198150","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:02Z","timestamp":1702339202000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["\u201cWe have nice policies but\u2026\u201d: implementation gaps in the Ghana adolescent health service policy and strategy (2016\u20132020)"],"prefix":"10.3389","volume":"11","author":[{"given":"Emelia Afi","family":"Agblevor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha Afua","family":"Darko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla Ama","family":"Acquah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selasie","family":"Addom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolib","family":"Mirzoev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Akua","family":"Agyepong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"ref1","article-title":"UNICEF data. Adolescents statistics","year":"2022"},{"key":"ref2","article-title":"Adolescent girls in west and Central Africa. Data Brief","year":"2019"},{"key":"ref3","article-title":"2021 Population and Housing Census","year":"2021"},{"key":"ref4","article-title":"Adolescent health","year":"2022"},{"key":"ref5","article-title":"WHO | Health for the world\u2019s adolescents: A second chance in the second decade","year":"2021"},{"key":"ref6","article-title":"Investing in the sexual and reproductive health of adolescents in the Ouagadougou partnership countries","year":"2020"},{"key":"ref7","article-title":"About 80,000 girls in Ghana aged 12 to 17 years already married or living with a man","year":"2022"},{"key":"ref8","article-title":"Orientation manual for development of national strategies for adolescent ad youth health in Ecowas member states. West African health organization","year":"2016"},{"key":"ref9","article-title":"Adolescent Health Service Policy and Strategy (2016-2020) [Internet]","year":"2016"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s12960-015-0050-2","article-title":"Factors influencing the career choice and retention of community mental health workers in Ghana","volume":"13","author":"Agyapong","year":"2015","journal-title":"Hum Resour Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1752-4458-8-16","article-title":"An overview of Ghana\u2019s mental health system: results from an assessment using the World Health Organization\u2019s assessment instrument for mental health systems (WHO-AIMS)","volume":"8","author":"Roberts","year":"2014","journal-title":"Int J Ment Health Syst"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1016\/S0140-6736(07)60368-7","article-title":"Mental health of young people: a global public-health challenge","volume":"369","author":"Patel","year":"2007","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25646\/8863","article-title":"The effects of mental health problems in childhood and adolescence in young adults: results of the KiGGS cohort","volume":"6","author":"Schlack","year":"2021","journal-title":"J Health Monit"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.jadohealth.2012.12.016","article-title":"Social, demographic, and health outcomes in the 10 years following adolescent depression","volume":"52","author":"Naicker","year":"2013","journal-title":"J Adolesc Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e060576","DOI":"10.1136\/bmjopen-2021-060576","article-title":"Barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy in Ghana: an exploratory qualitative study","volume":"12","author":"Ahinkorah","year":"2022","journal-title":"BMJ Open"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/s10389-017-0883-3","article-title":"In-school adolescents\u2019 knowledge, access to and use of sexual and reproductive health services in metropolitan Kumasi","volume":"26","author":"Amankwaa","year":"2018","journal-title":"Ghana J Public Health (Berl)"},{"key":"ref17","first-page":"142","article-title":"Attitudes of gatekeepers towards adolescent sexual and reproductive health in Ghana","volume":"18","author":"Kumi-Kyereme","year":"2014","journal-title":"Afr J Reprod Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1108\/JHR-10-2018-0119","article-title":"Barriers on access to and use of adolescent health services in Ghana","volume":"33","author":"Abuosi","year":"2018","journal-title":"J Health Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0195163","DOI":"10.1371\/journal.pone.0195163","article-title":"Factors associated with sexual and reproductive health stigma among adolescent girls in Ghana","volume":"13","author":"Hall","year":"2018","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"105651","DOI":"10.1016\/j.childyouth.2020.105651","article-title":"Contraceptive use among migrant adolescent girl head porters in southern Ghana: policy implications for sexual and reproductive health education and promotion","volume":"120","author":"Alatinga","year":"2021","journal-title":"Child Youth Serv Rev"},{"key":"ref21","first-page":"62","volume-title":"Adolescents\u2019 sexual and reproductive health: Qualitative evidence from Ghana. 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Centre for Social Science Research. 2015 (CSSR Working Paper No. 360)","author":"Grebe","year":"2015","journal-title":"Soc Sci Res"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1080\/0305764X.2020.1789066","article-title":"An evaluation of the free senior high school policy in Ghana","volume":"51","author":"Mohammed","year":"2021","journal-title":"Camb J Educ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12939-019-1113-0","article-title":"The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation","volume":"19","author":"Kwarteng","year":"2019","journal-title":"Int J Equity Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12978-021-01177-w","article-title":"The missing link between legal age of sexual consent and age of marriage in sub-Saharan Africa: implications for sexual and reproductive health and rights","volume":"18","author":"Ahinkorah","year":"2021","journal-title":"Reprod Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2158244017731803","DOI":"10.1177\/2158244017731803","article-title":"Police views of suicidal persons and the law criminalizing attempted suicide in Ghana: a qualitative study with policy implications","volume":"7","author":"Osafo","year":"2017","journal-title":"SAGE Open"},{"key":"ref38","article-title":"Ghana decriminalizes attempted suicide","year":"2023"},{"key":"ref39","article-title":"World Bank Open Data","year":"2023"},{"key":"ref40","article-title":"The Abuja declaration: Ten years on. Report No.: WHO\/HSS\/HSF\/2010.01","year":""},{"key":"ref41","article-title":"Health budget brief [Internet]","year":"2022"},{"key":"ref42","article-title":"2021 population and housing census","year":"2023"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"15487","DOI":"10.3390\/ijerph192315487","article-title":"Conflicting HIV\/AIDS sex education policies and mixed messaging among educators and students in the lower Manya Krobo municipality, Ghana","volume":"19","author":"Ocran","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref44","article-title":"Ghana looks to retool its economy as it reaches middle-income status","year":"2023"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.1002\/hpm.3462","article-title":"Leveraging COVID-19 pandemic response for improved health system financing: lessons from Ghana","volume":"37","author":"Novignon","year":"2022","journal-title":"Int J Health Plann Manag"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5455\/ajpmph.20190311054601","article-title":"Determinants of adolescent sexual and reproductive health service quality in Ghana","volume":"6","author":"Anaba","year":"2020","journal-title":"Am J Prev Med Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1080\/03630242.2017.1306607","article-title":"Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana","volume":"58","author":"Challa","year":"2018","journal-title":"Women Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1186\/s12913-016-1576-2","article-title":"Technical analysis, contestation and politics in policy agenda setting and implementation: the rise and fall of primary care maternal services from Ghana\u2019s capitation policy","volume":"16","author":"Koduah","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"ref49","article-title":"Mental Health Policy. (2019-2030)","year":"2018"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13033-021-00457-z","article-title":"Situational analysis of service provision for adolescents with mental and neurological disorders in two districts of Ghana","volume":"15","author":"Formentos","year":"2021","journal-title":"Int J Ment Heal Syst"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"132","DOI":"10.4314\/ajpsy.v13i2.54360","article-title":"A situational analysis of child and adolescent mental health services in Ghana, Uganda, South Africa and Zambia","volume":"13","author":"Kleintjes","year":"2010","journal-title":"Afr J Psychiatry (Johannesburg)"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"99","DOI":"10.4314\/ajpsy.v13i2.54353","article-title":"A situation analysis of mental health services and legislation in Ghana: challenges for transformation","volume":"13","author":"Ofori-Atta","year":"2010","journal-title":"Afr J Psychiatry [Internet]"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/heapol\/czq078","article-title":"Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa","volume":"26","author":"Bird","year":"2011","journal-title":"Uganda Zambia Health Policy Plan"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4505-9-17","article-title":"An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia","volume":"9","author":"Faydi","year":"2011","journal-title":"Health Res Policy Syst"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1080\/08838151.2015.1054998","article-title":"Social Media for Social Change: social media political efficacy and activism in student activist groups","volume":"59","author":"Velasquez","year":"2015","journal-title":"J Broadcast Electron Media"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1186\/1471-2458-12-788","article-title":"The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation","volume":"12","author":"Wight","year":"2012","journal-title":"BMC Public Health"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1742-4755-7-25","article-title":"Generating demand and community support for sexual and reproductive health services for young people: a review of the literature and programs","volume":"7","author":"Kesterton","year":"2010","journal-title":"Reprod Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1198150\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:15Z","timestamp":1702339215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1198150\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,12]]},"references-count":57,"alternative-id":["10.3389\/fpubh.2023.1198150"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1198150","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,12]]},"article-number":"1198150"}}