Evaluation of immediate and sustained effects of transitioning quality long-acting reversible contraceptives (LARCs) services to public sector health facilities in Ghana: a pre-post intervention study

Background Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy and demonstrate favorable client satisfaction. However, limited knowledge, misconceptions, and concerns about side effects hinder LARC adoption. Marie Stopes International-Ghana collaborated with Ghana Health Service to implement a 5 year multifaceted intervention to transition quality LARC services from an outreach approach to being available in public sector health facilities. This study evaluates if the intervention resulted in immediate or sustained improvements in the provision of quality LARC services in the public sector. Methods Using a pre-post intervention design, facility structural quality, providers' training, practice, and knowledge on the provision of LARCs, and clients' perceived service quality were assessed in 8 Ghanaian regions. Analyses compared endline and baseline data, categorized into two groups based on the program phase: Recent Intervention facilities and GHS Support facilities. Facility records on a 3 month volume of LARC provision were compared between the last quarters of 2019 and 2022. Multivariate logistic regressions of any increase in the volume of LARC provision were conducted with associated endline facility and provider characteristics summarized at the facility level. Results Significant increases were found in the provision of IUD services among Recent Intervention facilities (CHPS facilities: T0 13%, T2 50%, p < 0.001; HC/Hospitals: T0 23%, T2 53%, p < 0.001), while almost all providers offered implant services across facility types and intervention phases. The proportion of providers ever been trained to insert LARCs increased. Immediate and sustained effects were found on knowledge of LARC provision. Although facilities had significant increases in usual IUD availability among those in Recent Intervention (CHPS: T0 13.0%, T2 50.0%, p < 0.001), availability of IUD decreased to pre-intervention level upon transition to GHS Support. Controlling for other factors, facilities which had transitioned to GHS support were far less likely than those in the Recent Intervention phase to have an increase in the volume of LARC provision. Conclusions This 5 year collaboration between MSI-Ghana and the Ghana Health Service increased the capacity of providers at 210 GHS facilities to provide high-quality LARC services. Future programs to improve LARC provision in the public sector may also consider including sustainable interventions to strengthen logistical management systems and targeting barriers to LARC access in the community.