SNAPSHOT OF INDICATORS
Summary of the sample design for PMA2015/Ghana-R4:
PMA2020 is designed to create sentinel sites for data collection both at the population-level and among service delivery points (SDPs). Enumeration areas (EAs) selected in Round 1 are generally used for data collection in Rounds 2-4. Households within the EA are randomly sampled during each round, however the EA is consistent across rounds. For clarity, the original Round 1 sample design summary is provided below.
PMA2020 uses a two-stage cluster design with residential area (urban and rural) and regions as sampling domains. Within the strata, clusters were selected with probability proportional to size. The final sample of 100 EAs and 4,200 households is designed to generate national estimates of all women modern contraceptive prevalence rate (mCPR) with less than 2% margin of error and urban/rural estimates at less than 3% margin of error.
The table below provides a summary of key family planning indicators and their breakdown by background characteristics.
Round 1 Sample Design
The PMA2020 survey collects data annually at the national (urban and rural) and regional levels to allow for the estimation of key indicators to monitor progress in family planning. The resident enumerator (RE) model enables replication of the surveys twice a year for the first two years, and annually each year after that, to track progress.
In Ghana, survey resources allowed targeting a sample size of 100 enumeration areas (EAs) and a final sample size of 4,200 households. A total of 100 EAs were sampled throughout all regions in Ghana and selected from the Ghana Statistical Service’s 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, field supervisors randomly selected up to three private SDPs to be interviewed by a RE using the SDP questionnaire. The field supervisors themselves administered the service delivery point (SDP) questionnaires at an additional three public SDPs that serve each EA; the lowest, second-lowest, and third-lowest level public health facilities designated to serve each EA.
Round 4 Sample Update
Data collection for Round 4 continued in the same EAs as Round 3. As Round 4 was approximately six months after the previous mapping and listing activity, mapping and listing was not repeated. Rather, the Round 3 household list was used for selection into the sample.
Field supervisors randomly selected 42 households from the household listing. 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.
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 three private SDPs are randomly selected in each round.
PMA2020 uses standardized questionnaires for households and service delivery points (SDPs) to gather data that are comparable across program countries and consistent with existing national surveys. Prior to launching the survey in each country, these questionnaires are reviewed and modified by local experts to ensure all questions are appropriate to each setting. Three questionnaires were used to collect data from the PMA2015/Ghana-R4 survey: the household questionnaire, the female questionnaire and the service delivery point (SDP) questionnaire. These questionnaires were based on model surveys designed by PMA2020 staff at the Bill & Melinda Gates Institute for Population and Reproductive Health in Baltimore at the Johns Hopkins Bloomberg School of Public Health, 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 (DHS).
All PMA2020 questionnaires are administered using Open Data Kit software and Android smartphones. The PMA2015/Ghana-R4 questionnaires were in English on the phone and had to be translated into local languages using available translations from similar population surveys and experts in translation. The interviews were conducted in the local language or English in a few cases when the respondent was not comfortable with the local language. Female resident enumerators in each enumeration area administered the household questionnaire and female questionnaire in selected households.
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 quintile 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 water, sanitation 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; exposure to family planning messaging in the media; and the burden of collecting water on women.
The SDP questionnaire collected information about the provision and quality of reproductive health services and products, integration of health services, and WASH within the health facility.
The PMA2015/Ghana-R4 fieldwork refresher training started on April 16, 2015, with a training of 15 field supervisors and 3 central staff. PMA2020 staff from the Bill & Melinda Gates Institute for Population and Reproductive Health of the Johns Hopkins Bloomberg School of Public Health led the training, with support from Kwame Nkrumah University of Science & Technology (KNUST) School of Medicine project staff. The one-day training of field supervisors on April 16th focused on updates to the survey protocol since the previous round. The field supervisors then became the trainers for the four subsequent resident enumerator (RE) refresher training sessions that also took place in January 2014. Four groups of training were organized for REs. Four groups of training were organized for REs. Two training workshops were held in Kumasi - the first for REs from Volta, Brong Ahafo and Eastern regions and the second for REs from Ashanti region. A third training was organized in Tamale-UDS for Northern, Upper East and Upper West regions, and a fourth in Accra for REs from Western region, Central region, and Greater Accra.
As this was a refresher training for continuing staff, the training focused on a handful of newly added questions to the household questionnaire and review of the service delivery point (SDP) questionnaire and review of survey content and protocol.
Throughout the trainings, REs and supervisors were evaluated based on their performance on several written and phone-based assessments, practical field exercises and class participation. The RE trainings 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 and Processing
Data collection was conducted between May and September 2015. Unlike traditional paper-and-pencil surveys, PMA2020 uses Open Data Kit (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 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, central staff at KNUST and the data manager at the Gates Institute in Baltimore 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 September.
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. Data analysis for the national dissemination of preliminary findings was conducted between September and October 2015.
This table shows response rates for household and female respondents by residence (rural/urban) for PMA2015/Ghana-R4. A total of 4,185 households were selected for the PMA2015 Round 4 survey; 4,142 households were found to be occupied at the time of the fieldwork. Of the occupied households, 4,053 (97.9%) consented to a household-level interview. The response rate at the household level was equitable in rural (97.9%) and in urban (97.8%) areas.
In the occupied households that provided an interview, a total of 5,291 eligible women aged 15 to 49 years were identified. Overall, 98.0% of the eligible women were available and consented to the interview. The female response rate was equitable between the rural (98.3%) and urban (97.7%) enumeration areas (EAs). Only de facto females are included in the PMA analyses; the final completed de facto female sample size was 5,185 (unweighted).
The final SDP sample included 239 facility interviews, of which 233 were completed for a response rate of 97.5%.
Kwame Nkrumah University of Science & Technology School of Medicine and The Bill & Melinda Gates Institute for Population and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. Performance Monitoring and Accountability 2020 (PMA2020) Survey Round 4, PMA2015/Ghana-R4 Snapshot of Indicators. 2015. Ghana and Baltimore, Maryland, USA.