Addressing the HIV Epidemic in Ghana through Open and Distance Education
Reuben Aggor, Institute of Adult Education, University of Ghana
The first two AIDS cases in Ghana were reported in 1986. The disease spread fast and by the end of 2003, a cumulative total of 76,139 cases had been recorded and about 395,000 had been infected with HIV (Ghana AIDS Commission, 2004). The figures do not give the true state of affairs in view of the fact that the majority of Ghanaians, especially those in rural areas where 60 percent of the population live, rely on traditional health practitioners whenever they all ill. These practitioners do not keep records. It is therefore impossible to know how many people with HIV/AIDS reported at these places. Many Ghanaians also do not know their HIV status since modern facilities are not used to diagnose diseases at health facilities run by the traditional practitioners. In view of the stigmatization associated with the disease in the country, patronage of voluntary testing is rather low. As a result, many people are not aware of their status and have continued to be sexually active, and unknowingly infecting others.
As indicated above, the true number of cumulative AIDS cases in Ghana is not known even though projections indicate that the figure could be more than 200,000. The Ghana AIDS Commission estimated in 2003 that 33,000 people would die of AIDS-related cases in 2004. This meant that 90 persons a day were going to die daily of the disease. This figure was in addition to the 200,000 that had been estimated to have died of the disease in Ghana since 1986.
Analysis of Ministry of Health sentinel surveillance data indicated that the median adult HIV prevalence in the 15-49 age group was 2.4 in 1994. The figure rose to 3.6 in 2003. The number of new AIDS cases rose dramatically from 5,500 in 1994 to 36,000 in 2004, and the projections were that a cumulative AIDS deaths were likely to reach 437,000 by 2010 (Ghana AIDS Commission,2004)
According to UNAIDS/World Health Organisation (WHO) any nation with an adult HIV prevalence of one percent or higher in the general population is characterised as experiencing a generalized epidemic. The prevalence rate in neighbouring West African states ranged between 2 percent and 10 percent (Centre de Cooperation International en Sante et Developpement (CCISD), 2004). The prevailing rates in East Africa and Southern Africa were much higher as the table below indicates.
Source: Population Reference Bureau, 2005
Undoubtedly, the above levels of infection were not reached in one or two years. If the HIV/AIDS problem had been tackled at an early stage in these countries, the alarming rates would not have been reached. The HIV/AIDS epidemic in Ghana required much more attention than had been given to it lest it reached the alarming levels in eastern and southern Africa. The problem was not one that medical science alone could solve; other means should be used to contain it (Irwin, Millen and Fallows, 2003). Education has been a tested means that has been used to address both personal and public issues of concern over the ages and needed to be used on a wide scale to reduce the rate of the spread of HIV/AIDS in Ghana.
Ghana government’s initial response was to address HIV/AIDS as a public health challenge. As a result, hardly did a day pass without a seminar, workshop, lecture and discussion led by experts being held to educate the people about the epidemic. It soon dawned on all that HIV/AIDS was a developmental issue since it had serious impact on national development. The educational activities should therefore go beyond health matters. The National AIDS/STI Control Programme which was established in 1987 came to work in partnership with other agencies such as the UNDP, UNFPA, USAID to establish the Ghana AIDS Commission (GAC) in 2001 as a supra-ministerial, multi-sectoral body to formulate policies, co-ordinate, supervise and mobilize resources to address the HIV/AIDS epidemic. Every Ministry, Department and Agency (MDA) and non-governmental agencies (NGOs) was asked to join the crusade to tackle the epidemic. HIV/AIDS should therefore be incorporated into all sector programmes and activities, be they agriculture, education, health, women and children’s affairs, sports and youth programmes.
The Institute of Adult Education, University of Ghana, carefully studied the national scene in relation to the epidemic and realised that the numerous educational activities benefited only a limited number of people. This was because the educational activities adopted the conventional, face-to-face method to reach the people at specific locations and at specific times. The activities included the Institute’s own mass media support for population education which had young adults as its target and its training programme for traditional birth attendants. These educational activities were held at Workers’ Colleges and involved the trainees travelling to the colleges. The trainees had to be provided travel allowances and at least one meal during training sessions that lasted even one day. The cost involved made it difficult to extend the activities to more people. Innovative approaches had to be adopted in order to reach more people and reduce costs.
The Institute therefore carried out a survey to find out if the open and distance learning (ODL) methodology would be accepted by the potential clientele. The result was positive so we decided to adopt the ODL mode to extend education on HIV/AIDS to many more people and make it possible for the learners learn at their own pace, at times convenient to them, and in the comfort of their homes.
In late 2003, the Institute of Adult Education made a proposal to the United
Nations Population Fund (UNFPA) to collaborate with them to develop and deliver
an ODL course on HIV/AIDS counselling and care-giving. The UNFPA had been involved
in several population and reproductive health educational activities and were
likely to support such an innovative approach to tackling the epidemic. Personnel
from the two agencies held a number of sessions to design the course to cover
the following areas:
The instructional package is made up of five modules of print materials. The participants were invited to the University for a one day orientation session. The orientation involved, among others, an introductory lecture on the havoc HIV/AIDS can cause a nation. Two film shows on the HIV/AIDS epidemic were also shown. This is followed by questions from the participants and answers were provided by experts who serve as tutors on the course.
The printed materials and supplementary CDs are distributed to the participants at the end of the orientation session. This is to avoid late arrival of the materials at their destination if sent by post. The distribution at the orientation sessions also makes gives the assurance that all participants receive their materials. Those absent could collect their materials at the centre at times convenient to them.
The participants are required to study one module a month and meet at a centre
once every month for tutorials, where specialists on HIV/AIDS explain points
raised by the participants as a result of studying the modules. The participants
could raise issues from the instructional materials or from their field experiences.
The modules have numerous activities and the participants are expected to go
out to practise them in the field. The exercises in the modules are also discussed.
The participants are also given the opportunity to share their experiences in
the field with one another.
The participants have varied backgrounds. Most of them are male (62%) and 82% of them fall between the age range of 20 -50. This is important since this is the age group that is most sexually active and most likely to be infected. A majority (59%) are married and most of them have secondary school education and above (78%); a few have PhD degrees. The relatively high level of education attained by the participants is an advantage since the better educated participants, the more likely they are to understand the issue at stake and heed the appeal to go back to teach others, which is the major objective of the course.
Teachers formed the largest profession group (32%), followed by social workers (24%) and health workers (11%) ministers of religion (10%). Student participation was significant (11%). Many of the students were sponsored by their parents. This is an important point; Ghanaian culture does not permit matters related to sex and sexuality to be discussed openly with young ones. Some parents who would like their children know about the disease took the opportunity to enrol their children on the course to avoid the situation where they learn from their peers, which is the main channel used by adolescent to acquire information about sex.
Other participants were farmers, trade unionists, housewives, pensioners and a few unemployed people. The wide range from which the participants came was an indication that HIV/AIDS was a concern to all sections of the population.
An important group of participants was the people living with HIV/AIDS who took advantage of the course to learn more about their condition. They did not pay the course fee nor was their HIV status disclosed to the other participants. While some of them registered as individuals, others some were registered by their associations.
The fee for the four month course was about US$70. Most participants (73%) paid the fee themselves. The others were sponsored by District Assemblies, NGOs, churches and parents.
Ghanaians value ‘certificates of merit’ but those who participated in the HIV/AIDS course took their studies seriously even though they were aware that they would earn only ‘certificates of participation’ at the end. Attendance at tutorials was high even though they took place on Saturdays which Ghanaians set aside for funerals; the average attendance was 85 percent. Most of the participants (79%) also did their assignments on time and took the practicum seriously. No one earned a certificate unless one completed the practicuum. The main aim of the course, which is to reach more people with relevant information on HIV/AIDS, was achieved as participants came from all regions. The previous population and reproductive health education programmes were carried out in only four regions, namely, the Northern, Upper East, Upper West and Volta Regions.
Partnerships were fostered with the UFPA, and with hospitals and clinics all
over the country that had “fevers” units that cater for AIDS patients.
Some NGOs lent a helping hand. For example, the West African AIDS Foundation offered a voluntary HIV test for all participants while others allowed their expert staff to be used as tutors.
The participants acquired knowledge about what HIV and AIDS are, how people get infected and also learned counselling and care giving skills. A special mention should be made of those with the disease who came on the course. They all learned much; the hospitals where the praticumm took place assessed the participants as follows: Outstanding 15.6%, Good 78.1%, Minimum 16.2%.
Some of the participants have been employed by public and private agencies involved in HIV/AIDS education. For example, a few have been taken on by the Ghana AIDS Commission and some were employed by a church to provide education on HIV/AIDS in remote areas of the Upper West Region. Several of the participants have established their own NGOs to carry out educational activities on the subject and thereby contribute their quota to tacking the problems associated with HIV/AIDS in Ghana.
Those members of staff who were involved in the HIV/AIDS project acquired skills in ODL. These skills became handy in designing a related programme on reducing HIV stigma through education. This is a one million Canadian dollar project being supported by CIDA in partnership with Simon Fraser University in Canada. Other Ghanaian institutions in the partnership are the University of Cape Coast and University of Education, Winneba. The project is aimed at delivering a 3-credit ODL course on reducing HIV stigma to teachers enrolled on an ODL diploma programme and to youth workers in various communities.
The experience has also enabled the Institute to obtain a US$200,000 grant in a competitive bid from the World Bank to design a programme to build the capacity of University of Ghana staff to mount a bachelor’s programme in the humanities to be delivered in the distance mode. The university had long planned to do this in order to increase access to its programmes but has not been able to do so until now. It is currently able to admit only about 40-50 percent of qualified applicants to its programmes in view of lack of academic and residential facilities. This figure will definitely increase appreciably when ODL methods and materials are introduced.
The surveillance report for 2005 indicated that infection rates have gone down to from 3.6 in 2004 to 3.2 percent. Even though we cannot attribute the modest reduction rates to the ODL methodology that was introduced to educate more people on the HIV/AIDS epidemic in Ghana, our view is that the contribution made by the ODL approach to that effort should not go down unrecognised. So far, 1,786 participants from all parts of Ghana have benefited from the course since 2004. They, in turn, have taught others. Assuming each one of the participants taught 20 others in their communities, over 350,000 people would have been reached directly or indirectly. These beneficiaries have all acquired some knowledge and are likely to have adopted positive behavioural change with regard to HIV/AIDS.
Some of the participants have also become full time workers with HIV/AIDS as their focus. We continue to receive enquires from prospective participants and will continue to mount the course; it has become part of the Institute’s extension activities to fulfil its function of providing service to the community by ‘carrying the gown to town’.
Ghana AIDS Commission (2004) HIV/AIDS in Ghana ,Accra, Ghana.