The Ghana vasectomy initiative: facilitating client-provider communication on no-scalpel vasectomy.

Objective: In 2003-2004 and 2007-2008, an initiative was implemented to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) in Ghana.

Methods: At eight facilities, physicians were trained in NSV and staff received training in the provision of "male-friendly" services. Health promotion activities provided NSV information to prospective clients. Client-provider communication was assessed via a mystery client study (n=6). Knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys (each n=200) in 2003-2004 and three follow-up panel surveys in 2008 (each n=240).

Results: Trained health staff exhibited improved attitudes and knowledge regarding NSV. Mystery clients reported receiving accurate, nonjudgmental NSV counseling. Awareness of NSV among panel respondents doubled from 31% to 59% in 2003-2004 and remained high (44%) in 2008. The proportion of men who would consider NSV increased from 10% to 19% in 2007-2008. NSV procedures increased three-fold from 2003 (n=26) to 2004 (n=83) and 2007 (n=18) to 2008 (n=53).

Conclusion: Provider training in client-centered services, coupled with targeted health promotion, improved client and provider knowledge and acceptance of NSV in an African context.

Practice Implications: Complementary, sustained provider training and health promotion are needed to maintain NSV service quality and acceptance.