Adolescent mental, sexual, and reproductive health in Ghana: a stakeholder analysis of actors' influence over policy formulation and implementation.

One in five adolescents (aged 10-19 years) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be underwhelming. Stakeholders or actors are architects of policy, bringing their ideological values, interests, power, and positions to policy formulation and implementation and thus influencing the policy process. We analysed multilevel stakeholder interests, positions, power, and their influence on adolescent mental, sexual, and reproductive health policy formulation and implementation in Ghana, West Africa, using a single-case study design with multiple embedded subunits of analysis. The case was defined as actors, their power, interests, positions, and their influence on policy formulation and implementation processes in adolescent mental, sexual, and reproductive health. A conceptual framework of conflict and synergies between stakeholder interests, power, and positions and their influence on policy formulation and implementation was used to guide the analysis. Data were obtained from key informant in-depth interviews with 19 global and national level and 16 subnational level stakeholders. Focus group discussions were also conducted with 4 district health management teams, 9 groups of frontline health workers, and 20 groups of in and out of school adolescents in four districts in the Greater Accra region of Ghana. The multiple stakeholders in adolescent health, including adolescents themselves, had sometimes synergistic and sometimes divergent and conflicting views on policy agendas, formulation, and approaches to implementation. Unresolved conflicts between powerful stakeholders in the public or bureaucratic arena stalled or hampered policy formulation and implementation, whereas consensus and adequate resourcing moved processes forward. It is important to invest effort in understanding actors, their power, positions, and interests in context to inform policy content and framing to increase the chances of consensus and effective policy formulation and implementation processes.