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As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS. Ghana's health insurance scheme has not eliminated financial barriers to healthcare for older adults. Older Ghanaians reported unmet healthcare needs, despite implementation of health insurance. Resource, substantive, bureaucratic, and political constraints impede the policy implementation process. Measures are needed to decentralize and depoliticize the NHIS implementation process. [ABSTRACT FROM AUTHOR]

The need to establish universal standards to protect children led to the development of the United Nations Convention on the Rights of the Child (UNCRC). I drew on literature exploring the UNCRC and children's rights to provision, protection, and participation. This paper aimed to ascertain challenges of enforcing children's rights to provision, protection, and participation in rural and urban Ghana drawing on the experiences and perceptions of 60 government officials, NGO representatives, and parents. Semistructured interviews were conducted with parents (10), stakeholders (10), focus groups (30); and participant observation techniques (10) were utilised to gather the required data and purposively sampled across rural and urban areas in Ghana. Interviews were recorded, and transcribed utilising a framework approach as the qualitative data analysis method. Acceptance of childhood as understood in the UNCRC is different from traditional child-rearing patterns in rural and urban Ghana. IMPLICATIONS Social workers' knowledge about dealing with dilemmas posed by rights to provision, protection, and participation for children may be enhanced. Social workers can improve their knowledge of factors that challenge the enforcement of children's rights for children engaged in child labour and the possible tension between children and parental rights in their everyday social work practice. Social workers can introduce culturally sensitive parenting programs and develop their own contribution towards monitoring and implementing the rights to provision, protection, and participation for children. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as “gbɛkɛfɔŋs” (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of “gbɛkɛfɔŋs” in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse. [ABSTRACT FROM AUTHOR]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]