PMA2016/Ghana Round 5 Indicators

Round 1 Sample Design

For the first round of data collection in Ghana, the project used a two-stage cluster design and drew a sample of 100 enumeration areas (EAs) throughout all regions in Ghana from the Ghana Statistical Service master sampling frame. The primary sampling units for the survey were the EAs, created during the 2010 census. The EAs were selected systematically with probability proportional to size within urban and rural strata. The Ghana Statistical Service provided the selection probabilities for the PMA2020 sampled clusters which were used to construct sample weights.

In each selected EA cluster, households and private health facilities were listed and mapped. Field supervisors randomly selected 42 households from the household listing using a random start method. A household roster was completed and all eligible women age 15-49 in selected households were approached and asked to provide informed consent (and assent if aged 15-17 years) to participate in the study.

For the SDP survey, up to three private SDPs, including pharmacies, within each sampled EA cluster boundary were randomly selected from the listing. In addition, three public health SDPs (lowest, second-lowest and third-lowest level) designated to serve each EA population were selected.
 

Round 5 Sample Design

In Ghana, the PMA2020 survey collects data at the national level to allow for the estimation of key indicators to monitor progress in family planning at the population and the service delivery points (SDPs) levels. The resident enumerator (RE), PMA’s female data collector, model enables replication of the surveys on an annual basis, or more frequently.

PMA2016/Ghana-R5, the fifth round of data collection in Ghana, used a two-stage cluster design with urban-rural, major ecological zones as the strata. A new sample of 100 enumeration areas (EA) was drawn by the Ghana Statistical Service from its master sampling frame. The same EAs were used for founds 1-4 of data collection. For each new EA, 42 households were selected. A random start method was used to systematically select households within the EA.

All households, health service delivery points and key landmarks in each EA were listed and mapped by the REs to create a frame for the second stage of the sampling process. Field supervisors randomly selected 42 households and up to 3 private SDPs using a phone-based random number-generating application.

All occupants in selected households were enumerated and from this list, all eligible women age 15-49 were approached and asked to give informed consent to participate in the study.

The final sample included 3,992 households (98.7% response rate), 3,663 females (97.4% response rate) and 154 SDPs (90.6% response rate). Data collection was conducted between August and November 2016.

The majority of SDPs are repeated in each round, forming a panel survey. If an EA had more than three private SDPs identified during the listing process, then a new, random sample of three private SDPs is selected during each round. With the newly selected EAs this round, the sample of private SDPs during this fifth survey round was a new, random sample that had not been selected in previous rounds.

PMA2020 uses standardized questionnaires to gather data about households, individual females, and service delivery points that are comparable across program countries and consistent with existing national surveys. Prior to launching the survey in each country, local experts review and modify these questionnaires to ensure all questions are appropriate to each setting. Three questionnaires were used to collect PMA2016/Ghana-R5 survey data: the household questionnaire, the female questionnaire and the service delivery point questionnaire.

The household, female and service delivery point questionnaires were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health, the Kwame Nkrumah University of Science & Technology (KNUST) School of Public Health in collaboration with University of Development Studies (UDS), and fieldwork materials of the Ghana Demographic and Health Survey (GDHS).

All PMA2020 questionnaires are administered using Open Data Kit (ODK) software and Android smartphones. The PMA2016/Ghana-R5 questionnaires were in English on the phone. The interviews were conducted in the local language or in English in a few cases when the respondent was not comfortable with the local language. Female resident enumerators (data collectors) in each enumeration area (EA) administered the household and female questionnaires in the selected households and the SDP questionnaire for sampled private SDPs. Field supervisors administered the SDP questionnaire in public SDPs.

The household questionnaire gathers basic information about the household, such as ownership of livestock and durable goods, as well as characteristics of the dwelling unit, including wall, floor and roof materials, water sources, and sanitation facilities. This information is used to construct a wealth index.

The first section of the household questionnaire, the household roster, lists basic demographic information about all usual members of the household and visitors who stayed with the household the night before the interview. This roster is used to identify eligible respondents for the female questionnaire. In addition to the roster, the household questionnaire also gathers data that are used to measure key water, sanitation, and hygiene (WASH) indicators, including regular sources and uses of WASH facilities used and prevalence of open defecation by household members.

The female questionnaire is used to collect information from all women age 15 to 49 who were listed on the household roster at selected households. The female questionnaire gathers specific information on: education; fertility and fertility preferences; family planning access, choice and use; quality of family planning services; and exposure to family planning messaging in the media.

The SDP questionnaire collected information about the provision and quality of reproductive health services and products, integration of health services, and water and sanitation within the SDP.

Training

The PMA2016/Ghana-R5 fieldwork training started in the summer of 2016 with training of field supervisors and central staff. The training was led by PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, with support from Kwame Nkrumah University of Science & Technology (KNUST) School of Medicine project staff. Field supervisors then became the trainers for subsequent resident enumerator (RE) training sessions, which were held in the following regions: Kumasi, Brong Ahafo and Eastern, Tamale UDS, and Accra.

Throughout the two-week training, REs and supervisors were evaluated based on their performance on several written and phone-based assessments, mock field exercises and class participation. The RE training sessions were conducted primarily in English, whereas small group sessions were all conducted in the local languages predominantly spoken in the selected EAs.

Supervisors received additional training prior to and after the RE training to further strengthen their supervisory skills, including instruction on conducting re-interviews, carrying out random spot checks, and engaging communities through local leaders.

Data Collection & Processing

Data collection was conducted between August and November 2016. Unlike traditional paper-and-pencil surveys, PMA2020 uses ODK Collect, an open-source software application, to collect data on mobile phones. All the questionnaires were programmed using this software and installed onto all project smartphones. The ODK questionnaire forms are programmed with automatic skip-patterns and built-in response constraints to reduce data entry errors.

The ODK application enabled REs and supervisors to collect and transfer survey data to a central ODK Aggregate cloud server. This instantaneous aggregation of data also allowed for concurrent data processing and course corrections while PMA2020 was still active in the field. Throughout data collection, the central staff at KNUST in Kumasi, Ghana and the data manager at Bill & Melinda Gates Institute at Johns Hopkins School of Public Health in Baltimore, Maryland routinely monitored the incoming data and notified field staff of any potential errors, missing data or problems found with form submissions on the central server.

The use of mobile phones combined data collection and data entry into one step; therefore, data entry was completed when the last interview form was uploaded at the end of data collection in November 2016.

Once all data were on the server, data analysts cleaned and de-identified the data, applied survey weights and prepared the final data set for analysis using Stata® version 14 software.

This table shows response rates for household and female respondents by residence (rural/urban) for PMA2016/Ghana-R5. A total of 4,182 households were selected for the PMA2016/Ghana-R5 survey; 4,118 households were found to be occupied at the time of the fieldwork. Of the occupied households, 4,062 (98.6%) consented to a household-level interview. The response rate at the household level was similar in urban (98.4%) relative to the rural (99.0%) enumeration areas (EAs).

In the occupied households that provided an interview, a total of 3,785 eligible women aged 15 to 49 years were identified. Overall, 97.0% of the eligible women were available and consented to the interview. The female response rate were 98.0% in the rural and 96.8% in the urban EAs. Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 3,663 (unweighted).

During the survey, 169 SDPs were identified of which 156 SDPs completed the survey (92.3% response rate).

Weights were adjusted for non-response at the household and individual levels and applied to all household and individual estimates in this report. SDP estimates are not weighted.

To view the sample errors for the PMA2020 indicators described above, download the full SOI report here (sample error estimates are found on the last page). For more information about PMA2020 indicators, including estimate type and base population, click here.