Commentary: China's changing health system: Implications for sexual and reproductive health

By centralising sexual and reproductive health (SRH) and rights, gender equality and adolescent empowerment within sustainable development, the 1994 International Conference on Population and Development (ICPD) marked a turning point in the struggles of Nigerian women, adolescents and youth for improved access to quality maternal health, sexually transmitted infections (STIs) and HIV, contraceptive and post-abortion care services. Prior to the late 1990s, the focus of policy action at the national and sub-national levels was maternal and child survival, and slowing of the population growth rate to enhance economic growth, with near-total state inaction on youth sexuality, violence against women, quality and choice in family planning services, maternal morbidity and unsafe abortion (Esiet & Whitaker, 2002; National Population Commission & UNFPA, 2013). From 1998 to 2008, local NGO-led advocacy and pilot projects aided by several global initiatives to fast-track achievement of the Millennium Development Goals (MDGs) e.g., Global Fund to Fight AIDS, Tuberculosis and Malaria; Make Poverty History Campaign; catalysed a flurry of ICPD-informed national policies and strategic implementation plans, especially in relation to population and sustainable development; trafficking in women and children; gender equality; adolescent SRH; maternal, newborn and child health; girl-child education; control of HIV and STIs; and family planning and reproductive health (RH) commodity security (British Council & UKaid, 2013; Esiet & Whitaker, 2002; Mandara, 2012; USAID, 2010). Yet, Nigeria (together with India) presently contributes one-third of the global burden of maternal deaths (WHO, UNICEF, UNFPA, & The World Bank, 2012), and has the second largest burden of HIV in the world (USAID, 2010). Further, contraceptive prevalence has risen to only 14% in 20 years, and unmet need for family planning has remained unchanged at 21% (Alkema, Kantorova, Menozzi, & Biddlecom, 2013). The yawning gap between policies and their implementation through high-quality, large-scale programmes and services explains these unwholesome national statistics, as well as huge regional and rural–urban disparities. For instance, the SRH status of women and girls in rural northern Nigeria is among the worst in the world (Shittu et al., 2010). Moreover, the SRH needs of 15- to 24-year-olds, who represent over a quarter of the country's population and its most valuable resource, remain poorly addressed (USAID, 2010). Most of the ICPD-aligned policies, programmes and services have simply not had adequate resources (funding, personnel, infrastructure and supplies), especially at the sub-national level (Mandara, 2012; USAID, 2010). Instead, the country is dotted with exemplary small-scale pilot projects that demonstrate how to deliver high-impact programmes and services to vulnerable women, adolescents and youth. Institutional actors including government, private health services and donors have ignored NGO-led advocacy for massive scale-up of these pilots (Esiet & Whitaker, 2002; Shittu et al., 2010; USAID, 2010). One notable exception is increased attention to maternal health since 2005 by the federal government, exemplified by its Midwives Services Scheme, and by a few state governments, such as Ondo in the south-west and Kano in the north-west, which have fairly comprehensive, strategic and free safe motherhood programmes (Cooke & Tahir, 2013). But few interventions by NGOs or government adequately respond to the many demand-side barriers to universal access to SRH, especially extreme poverty among rural women and such practices as child marriage and women's need for husbands’ permission to seek emergency obstetric care (British Council & UKaid, 2013; Shittu et al., 2010). By comparison, the national HIV response has made unprecedented progress (National Agency for the Control of AIDS, 2013). Since 2003, persons accessing antiretroviral therapy have increased from fewer than 50,000 to nearly 600,000 in 2013, and curriculum-driven family life education (FLE) and HIV education, initiated by a few youth-serving NGOs in the late 1990s, are now taught in public junior secondary schools throughout the country. Though beneficial, these efforts rely heavily on international donor assistance and the treatment programme is overly vertical, both serious challenges to national ownership and sustainability. Moreover, these characteristics have hindered the integration of SRH and rights in primary health care (PHC) and have neglected women survivors of sexual violence, those desiring safe abortion and adolescents in need of contraceptives and STI prevention and treatment (Esiet & Whitaker, 2002; National Population Commission & UNFPA, 2013; USAID, 2010). Several simultaneous actions are sorely needed. First, more concrete collaborations among relevant NGOs, government, and donors are required to generate evidence and intensive advocacy for strong community and policy responses to key neglected aspects of the ICPD agenda. Second, capitalising on increased global and local attention to family planning, maternal and newborn health and girl-child education, PHC should be strengthened as the main vehicle to deliver SRH and rights services for poor women, adolescents and youth. Such strengthening entails higher priority for scaling up, and adopting the lessons of NGO-managed SRH interventions, while also sustaining the large-scale, externally funded HIV services and augmenting them with other SRH services. Financial resourcing and the management of integrated SRH and HIV services will have to be improved by all levels of government: local, state and federal. Finally, all stakeholders need to more seriously address persistent demand- and supply-side barriers to good quality SRH services for vulnerable adolescents and disadvantaged women.

Evidence for the implementation of contraceptive services in humanitarian settings

The provision of comprehensive sexuality education (CSE) accords opportunities for scientifically accurate information about sexual and reproductive health (SRH). We used a mixed-methods study to characterise adolescent SRH knowledge, attitudes and service utilisation experiences in the context of CSE implementation in Zambia. In-school young people aged 12–24 years (N = 1,612) in the North-Western Province were randomly surveyed. A 29-item index was constructed to measure alignment of knowledge, attitudes and values (KAV) with the CSE curriculum. Logistic regression, stratifying by sexual debut status, modelled associations of past-year HIV counselling and testing and family planning service access, respectively, with CSE-KAV index scores. Focus group discussions further explored perceptions of and experiences accessing SRH services. Despite moderate SRH knowledge and acceptability of SRH services, fewer than half of sexually experienced young people reported accessing SRH services. Among sexually experienced youth, neither HIV testing nor family planning service utilisation in the previous year were associated with higher CSE-KAV index scores. Salient barriers to SRH service uptake included limited perceived benefits, unsupportive household and community environments, and negative interactions with health providers. To increase accessibility and uptake of youth SRH services, linking school-based CSE to SRH services is recommended.

Introduction: Perinatally HIV-infected adolescents have the right to healthy sexual and reproductive lives like their HIV uninfected counterparts. The study assessed the quality of care of sexual and reproductive health (SRH) services in antiretroviral therapy (ART) clinics attended by perinatally-infected HIV adolescents. Methods: The study was guided by Judith Bruce and Anrudh Jain framework for conceptualizing quality as “client-oriented” care. Qualitative and quantitative methods were used to assess quality of care. We conducted facility assessment, evaluation of providers' perspectives regarding the quality of SRH care, and evaluation of experiences of perinatally-infected HIV adolescents about the quality of SRH care provided in the ART clinics. We conducted 24 in-depth interviews with adolescents and 12 interviews with service providers. Furthermore, a survey of 624 adolescents aged 10-19 y was conducted, where information on socio-demographic profiles and access and utilisation of RH services were collected. Survey data was analysed descriptively to provide frequencies and percentages while qualitative data was analyzed by content analysis. Results: Most adolescents (84.5%) were dissatisfied with SRH services provided by the clinics. None of the ART clinics offered comprehensive SRH services, which limited choices of clients. All units offered SRH information and education except post-abortion care and mental health. Only three units had trained their staff in SRH and adolescent friendly services which impacts on technical competence of the service providers in provision of SRH services. The structure of the clinics was based on adult and pediatric care implying there were no adolescentspecific services. Conclusion: The lack quality of care of SRH services in ART clinics is both an organisational and resource issue. For health systems to achieve universal access to high-quality sexual and reproductive health the ART clinics is dependent on rational decisions regarding investments in and allocation of human resources for health. There is need for in-service training of Health Workers in adolescent health. The Ministry of Health needs to engage partners for support to increase the numbers of health facilities which are adolescent friendly.

ObjectivesThe study aimed to assess the prevalence of reproductive health problems among youths and the utilisation of services and associated factors in urban Ethiopia.DesignThis paper presents findings related to sexual...

BackgroundVarious countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia.MethodsA community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data analysis. Logistic regression analysis was employed to assess the association between outcomes and explanatory variables. Odds ratios at 95% CI were also computed and reported.ResultsOf 833 respondents, 43.9% had good knowledge of SRHR, and 37% had used at least one sexual and reproductive health (SRH) service. Variables that had a statistically significant association with SRHR knowledge in multivariable analysis were: had formal education, household with the highest income, having information sources for SRH services, and knowing about SRH services and providing institutions. SRH services utilization was associated with: having information sources for SRH services, had formal education, household with the highest income, and knowing about SRH services and providing institutions.ConclusionIn this study demographic and economic factors, such as education and household monthly income were positively identified as independent predictors for knowledge of SRHR and SRH services utilization. Therefore, responsible government sectors and NGOs should design and implement programs to promote women’s educational status and household economic status to enhance women’s SRHR knowledge and SRH services utilization.

Ethiopia has made significant improvements to sexual and reproductive health (SRH) in recent decades, yet the COVID-19 pandemic brought new challenges to SRH service delivery. In the early months of the pandemic, health facility and health management information system data showed reductions in SRH service utilization, however more evidence is needed on ongoing SRH impacts to inform policy and program decision-making. Our study aimed to assess the impacts of COVID-19 on SRH service utilization and access from the perspective of providers, clients, and stakeholders in Addis Ababa and Amhara Regional State. We collected data from May through July 2021 via six focus group discussions with health service providers, 50 in-depth interviews with SRH service clients and 15 key informant interviews with policy and programmatic stakeholders. All audio recordings were transcribed and translated from Amharic into English. Data were coded and analyzed for content and themes using Excel and NVivo 10. We found that COVID-19 and associated public health mitigation measures had consequences on SRH prioritization, funding, and service delivery. Efforts to halt the spread of COVID-19, such as gathering and transportation restrictions, also reduced access to SRH services. Fear of infection, costly and inaccessible transportation, commodity stockouts, and limited service availability all impeded access to and use of SRH services. For some women, this meant losing timely access to contraception and subsequently facing unwanted pregnancies. Providers experienced increased workloads, anxiety, and stigma as possible sources of infection. Our findings offer useful learnings for program and policy stakeholders aiming to meet SRH needs during the pandemic, and during times of crisis more broadly.

Youths in sub-Saharan Africa, particularly Nigeria, face significant barriers to accessing sexual and reproductive health (SRH) information and services because of limited awareness, confidentiality concerns, restrictive policies, and provider attitudes. These barriers contribute to poor SRH knowledge and high rates of HIV infection, unintended pregnancies, and unsafe sexual practices. Digital interventions offer a promising approach to improve SRH outcomes, but evidence of their effectiveness in Nigerian university settings remains limited. This study assessed the impact of a mobile health (mHealth), internet-based, comprehensive sexuality education (CSE) intervention on SRH knowledge, sexual behavior, and service utilization among university students in Lagos, Nigeria. A quasi-experimental study was conducted among 600 undergraduate students (300 in intervention group and 300 in control group) who were selected from two public universities in Lagos, Nigeria, via multistage sampling. The intervention consisted of weekly live CSE webinars via Google Meets, peer-led WhatsApp discussions, and digital linkages to youth-friendly SRH services. Quantitative data were collected through self-administered digital questionnaires before and after the intervention. Data analysis included baseline and end-line comparisons via Pearson chi-square tests and difference-in-differences (DID) analysis to estimate intervention effects. At baseline, 57.7% of the participants in the intervention group and 49.7% of the participants in the control group had good knowledge of SRH (p = 0.05). A total of 41.0% of the respondents in the intervention group and 37.0% in the control group had ever had sex, and consistent condom use was low (23.6% in the intervention group and 28.8% in the control group). Only 26.0% of the intervention group and 23.3% of the control group respondents had access to SRH services. Post-intervention, SRH knowledge improved by 10.2% in the intervention group compared with 2.6% in the control group. Condom use during the last sexual encounter increased significantly by 11.7% (from 32.5% to 44.2%, p < 0.05), in the intervention group but decreased by 7.5% in the control group. Uptake of SRH services in the intervention group rose by 9% (from 26.0% to 35.0%, p < 0.05), alongside increased use of teaching hospitals and primary health care centres (PHCs). Sexual behaviour outcomes were mixed, with some indicators (e.g., multiple sexual partners) worsening post-intervention. The mHealth CSE intervention improved SRH knowledge, increased condom use, and enhanced the utilisation of SRH services among university students. However, its effect on risky sexual behaviours was mixed. For greater effectiveness, digital CSE should be integrated with broader SRH services.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Background: Significant challenges regarding maternal and reproductive health persist in Pakistan, with the country facing substantial obstacles in accessing and utilizing services associated with reproductive, maternal, neonatal and child health (RMNCH). Despite various initiatives, Pakistan continues to grapple with an alarming maternal mortality rate due to biological, socioeconomic, cultural factors, as well as inadequate sexual and reproductive health (SRH) services. Persistent challenges such as a shortage of trained workforce, inadequate infrastructure, educational limitations, and societal restrictions, pose major roadblocks to improving maternal and reproductive health outcomes. This analysis aims to address the existing gaps in research and provide actionable recommendations for policy and practice. Methods: A comprehensive analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, encompassing peer-reviewed journals and grey literature published between 2010 and 2024. The review focused on studies in English on maternal and reproductive health topics, sourced from databases including PubMed, Google scholar, Web of Science, Embase, Cochrane and MeSH terms. A total of 20 original, peer-assessed studies, comprising quantitative and qualitative research, were reviewed. Two authors independently screened the titles, abstracts and full-texts from the studies. Results: This systematic review synthesizes findings from 20 major studies on maternal and reproductive health issues in Pakistan. This review is qualitative in nature. Qualitative design were predominant comprising 35% (n= 7) of studies whereas quantitative approaches accounted for 10% (n=2). Cross-sectional surveys constituted 20% (n=4) of the studies, mixed-methods 15% (n=3), and other methodologies 20%. Most notably, no case-control or cohort studies were included. All studies were conducted in Pakistan focusing on maternal and reproductive health challenges such as maternal and child mortality, antenatal care, delivery, postnatal care, obstetric care barriers and socio-cultural factors. Of the studies, 70% (n=14) assessed maternal and reproductive health issues in Pakistan, while 30% (n=6) examined obstetric care barriers. Study populations included females of reproductive age, pregnant women, and postnatal women. Additionally, 60% (n=12) of studies focused on maternal and child mortality rates and 40% (n=8) addressed reproductive, maternal, newborn, and child health (RMNCH). Studies on access barriers from maternal healthcare providers examined knowledge and competences, quality of care, and training gaps. Conclusion: This systematic review sheds light on a multifaceted landscape characterized by high maternal, fetal, and child mortality rates and persistent reproductive health issues in resource-limited countries like Pakistan. It highlights the impacts of educational gaps, socioeconomic status, cultural norms, political instability and systemic constraints that further complicate healthcare delivery. The review identifies significant barriers and opportunities for improvement, advocating for community-based programs, women’s empowerment, integrated healthcare frameworks, and strengthened healthcare provider training and supervision to improve maternal and newborn health outcomes and ensure a healthier future for mothers and children in Pakistan. Key words: Maternal Health, Reproductive Health, Pakistan, RMNCH, Maternal Mortality, Socioeconomic factors, SRH services, Healthcare barriers, Qualitative Research, PRISMA guidelines

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years; 80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

BackgroundCisgender lesbian, bisexual, and queer (LBQ+) women of color experience barriers to accessing sexual and reproductive health (SRH) services in the United States. Barriers, including limited provider access and poor patient-provider communication, contribute to SRH service underutilization and poorer outcomes among these women than their heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and chatbots enabled by artificial intelligence (AI), offer potential to expand access to SRH information and services among these women.ObjectiveThis study investigated the influencing factors, acceptability, and concerns regarding the use of digital health modalities (video calls, SMS text messaging, and mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ women of color in the United States. It also assessed their awareness and knowledge of human papillomavirus (HPV) and cervical cancer prevention, and attitudes toward HIV prevention medication.MethodsA self-administered online survey was conducted from November 2020 to March 2021 with 285 LBQ+ women of color (aged ≥18 years) residing in the United States. The 88-item survey assessed digital health use, SRH knowledge and awareness, and acceptability of and concerns about digital health use for SRH information and services. Data were analyzed using descriptive statistics, Fisher exact tests, multivariable logistic regression, and thematic analysis.ResultsMost respondents (233/285, 81.8%) were comfortable using video calls to communicate with health care providers for SRH support. Respondents with a bachelor’s degree or higher (95% CI 0.00‐0.24), with health insurance (95% CI 56.1‐1025.7), and without a usual place of care (95% CI 0.07‐0.43) were significantly (P<.001) more likely to agree with using video calls. Respondents with a bachelor’s degree or higher (95% CI 0.23‐0.74), aged <45 years (95% CI 0.07‐0.25), and with health insurance (95% CI 3.23‐12.45) were significantly (P<.001) more likely to agree with using mobile apps. Respondents aged ≥45 years (95% CI 0.14‐0.53), without health insurance (95% CI 0.01‐0.06), and with an income of <US $49,000 (95% CI 1.32‐3.93) were significantly (P<.001) more likely to agree with the use of SMS text messaging. There was high acceptance of using chatbots for self-assessing sexually transmitted infection risk (229/285, 80.3%) but lower acceptance for self-assessing cervical cancer risk (136/285, 47.7%). Key concerns included data privacy and confidentiality, lack of affective communication, and technology connectivity and digital literacy issues. Respondents also demonstrated low knowledge of HPV and cervical cancer prevention.ConclusionsDigital health was highly acceptable for supporting access to SRH information and services among LBQ+ women of color. Culturally tailored digital tools and interventions could improve awareness, knowledge, and attitudes toward SRH services. Addressing various digital literacy levels, data privacy concerns, and technology access and communication issues when developing digital health solutions may advance SRH equity among LBQ+ women of color.

Commentary: Thailand: Sexual and reproductive health before and after universal health coverage in 2002

BackgroundDespite being fundamental to the health and well-being of women, menstrual health is often overlooked as a health priority and access to menstrual health education, products, and support is limited. Consequently, many young women are unprepared for menarche and face challenges in accessing menstrual health products and support and in managing menstruation in a healthy and dignified way. In this paper, we examine the acceptability of a comprehensive menstrual health and hygiene (MHH) intervention integrated within a community-based sexual and reproductive health (SRH) service for young people aged 16–24 years in Zimbabwe called CHIEDZA.MethodsWe conducted focus group discussions, that included participatory drawings, with CHIEDZA healthcare service providers (N = 3) and with young women who had attended CHIEDZA (N = 6) between June to August 2020. Translated transcripts were read for familiarisation and thematic analysis was used to explore acceptability. We applied Sekhon’s thematic framework of acceptability that looks at seven key constructs (affective attitudes, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy). Data from FGDs and meeting minutes taken during the study time period were used to triangulate a comprehensive understanding of MHH intervention acceptability.ResultsThe MHH intervention was acceptable to participants as it addressed the severe prevailing lack of access to menstrual health education, products, and support in the communities, and facilitated access to other SRH services on site. In addition to the constructs defined by Sekhon’s thematic framework, acceptability was also informed by external contextual factors such as sociocultural norms and the economic environment. Providers highlighted the increased burden in their workload due to demand for MHH products, and how sociocultural beliefs around insertable menstrual products compromising virginity can negatively affect acceptability among young people and community members.ConclusionsMHH interventions are acceptable to young women in community-based settings in Zimbabwe as there is great unmet need for comprehensive MHH support. The integration of MHH in SRH services can serve as a facilitator to female engagement with SRH services. However, it is important to note that contextual external factors can affect the implementation and acceptability of integrated SRH and MHH services within communities.Trial registrationRegistry: Clinicaltrials.gov, Registration Number: NCT03719521, Registration Date: October 25, 2018.

BackgroundAdolescent sexual and reproductive health is recognized as a key developmental issue of international concern. However, adolescents’ access to sexual and reproductive health (SRH) information and services is largely inadequate in sub-Saharan Africa. With increasing enrollment in schools, this could be an avenue to reach adolescents with SRH information and services. This study was therefore conducted to assess the acceptability and stakeholders’ perspectives on the feasibility of using health workers and trained psychologists to provide school-based SRH services in Ghana.MethodsFourteen (14) focus group discussions (N = 136) were conducted; 8 among adolescents aged 12–17 years (4 boys, 4 girls groups), 4 among parents (2 males, 2 females groups) and two among mixed teacher groups. We also conducted 18 in-depth interviews with teachers, managers of schools, health workers, clinical psychologists, as well as adolescent SRH program managers in the Ghana Health Service, Ghana Education Service, UNICEF, UNESCO and National Population Council, Ghana. We audio-recorded all interviews and took field notes. Interviews were transcribed and transcripts imported into NVivo 11 for analysis using grounded theory approach to qualitative data analysis.ResultsMany respondents reported that it was challenging for parents and/or teachers to provide adolescents with SRH information. For this reason, they agreed that it was a good idea to have health workers and psychologists provide SRH information and services to adolescents in school. Although, there was general agreement about providing SRH services in school, many of the respondents disagreed with distribution of condoms in schools as they believed that availing condoms would encourage adolescents to experiment with sex. While majority of respondents thought it was acceptable to use psychologists and health workers to provide school-based sexual and reproductive health to adolescents, some teachers and education managers thought the implementation of such a program would oppose practical challenges. Key among the challenges were how to pay for the services that health workers and trained psychologists will render, and the availability of psychologists to cater for all schools.ConclusionStakeholders believe it is feasible and acceptable to use trained psychologists and health workers to deliver school-based SRH information and services in the Ghanaian school context. However, provisions must be made to cater for financial and other logistical considerations in the implementation of school-based SRH programs.