Demographic statistics

Table 1 delineates the distribution of PHC facilities by location and type across Ghana, Niger, and Burkina Faso, alongside the gender demographics of facility leadership and the nature of operating authorities.

The rural-urban divide shows a higher inclination towards rural PHC facilities within the collective dataset, with 57.91% of PHC facilities located in rural areas compared to 42.09% in urban settings. Ghana notably diverges from this trend, with a majority (62.50%) of its sampled PHC facilities situated in urban areas. The majority of the PHC facilities visited in Niger and Burkina Faso were located in rural areas, with 55.00% in Niger and 71.71% in Burkina Faso.

Health Centers serve as the backbone of health service provision, accounting for 81.54% of all PHC facilities across the samples for the three countries. This dominance is particularly pronounced in Niger and Burkina Faso, where Health Centers account for 96.88% and 94.73% of PHC facilities, respectively. Ghana’s sample, however, shows a more diverse health service structure, with Community-based Health Planning and Services (CHPS) compounds (26.25%) and Clinics (37.50%) complementing the traditional Health Center model.

82.86% of the PHC facilities surveyed across the countries. In Niger and Burkina Faso, over 90% of the PHC facilities are under government operation, indicating a strong state-led health service framework. In contrast, Ghana, particularly in the Greater Accra region, presents a more balanced public-private dynamic, with private PHC facilities constituting half of the health service providers in this sample. However, this balance may not reflect the situation in other regions of Ghana, where government-operated PHC facilities might play a more dominant role.

Table 1 Demographic distribution of PHC facilities across countries

Gender representation among the heads of PHC facilities is skewed towards males overall (60.46%). However, Ghana contrasts sharply with its counterparts, with a majority of female-headed PHC facilities (65.00%). This could be due to Ghana’s proactive gender equality policies and targeted initiatives that encourage and support women in leadership roles, particularly in the healthcare sector [28, 29]. Niger and Burkina Faso follow the general trend with a male-dominant leadership in their PHC facilities, with females heading 40% and 25.66% of the PHC facilities, respectively.

Adolescent mental health services

Table 2 details the availability and capacity of PHC facilities across the selected districts of Ghana, Niger, and Burkina Faso to provide AMH services and address specific mental disorders. The data is pivotal in understanding the regional disparities and healthcare capabilities within these West African countries.

Out of a total of 392 surveyed PHC facilities, only 103 (26.28%) offer AMH services. The country-specific breakdown reveals notable differences: in the selected districts from Ghana, 23 out of 80 PHC facilities (28.75%) provide these services, while selected districts in Niger, with 15 out of 160 PHC facilities (9.38%), shows the lowest availability. The districts from Burkina Faso lead in service provision, with 65 out of 152 PHC facilities (42.76%) offering AMH services. This stark contrast among the countries highlights the varied emphasis and resource allocation towards adolescent mental healthcare.

Table 2 AMH Services in PHC facilities across countries

A high percentage of PHC facilities (92.23%) offered basic counselling and psychosocial support services across the selected districts. Selected districts from Ghana lead with 22 out of 23 PHC facilities (95.65%) providing these services, followed closely by selected districts from Burkina Faso with 63 out of 65 PHC facilities (96.92%), while selected districts from Niger trail with 10 out of 15 PHC facilities (66.67%). This indicates a strong regional emphasis on counselling and psychosocial support for adolescents.

Only 24 PHC facilities (23.30%) across all selected districts from all countries provide laboratory screening for substance use. Selected districts from Ghana demonstrate a higher capacity, with 13 PHC facilities (56.52%) offering these services, whereas selected districts from Niger have no PHC facilities providing such screenings. Selected districts from Burkina Faso have 11 out of 65 PHC facilities (16.92%) equipped for this purpose, highlighting a critical shortfall in laboratory support.

Across the selected districts from all countries, 36 PHC facilities (34.95%) offer first-line oral psychoactive medications like Prozac. Selected districts from Ghana lead with 12 PHC facilities (52.17%), followed by selected districts from Niger with 6 PHC facilities (40.00%), and selected districts from Burkina Faso with 18 PHC facilities (27.69%), showcasing varying degrees of medication availability in the region.

Emergency services for conditions like acute psychosis and suicide attempts are available in 48 PHC facilities (46.60%) across the selected districts from all countries. Selected districts from Ghana have the highest provision rate with 12 PHC facilities (52.17%), followed by selected districts from Burkina Faso with 32 PHC facilities (49.23%), and selected districts from Niger with the lowest provision at 4 PHC facilities (26.67%).

Skills and resources in provision of AMH services

Table 3 provides an overview of the availability of essential skills and resources for AMH services in PHC facilities across the selected districts from Ghana, Niger, and Burkina Faso. The study focuses on the presence of national guidelines for mental health services, staff training in AMH services, the provision of basic counseling and psychosocial support, laboratory screening for substance use, availability of first-line oral psychoactive medications like Prozac, and emergency services for acute conditions such as psychosis and suicide attempts.

This metric evaluates whether PHC facilities possess national guidelines for mental health service provision to adolescents. Only 22 out of 103 PHC facilities offering AMS (21.36%) across the selected districts have these guidelines. In the selected districts from Ghana, this is observed in 4 out of 23 PHC facilities (17.39%), Niger shows a higher availability with 7 out of 15 PHC facilities (46.67%), and Burkina Faso has these guidelines in 11 out of 65 PHC facilities (16.92%). Most PHC facilities across all selected districts, therefore, do not have these national guidelines (78.64%).

The study aimed to assess the capacity and skills of healthcare professionals within various PHC facilities to manage a range of psychiatric conditions, specifically targeting alcohol and substance use disorders, depression, anxiety disorders, suicidality and self-harm, and psychotic disorders. When it comes to treating Alcohol and Substance Use Disorders, 58 out of the 103 PHC facilities across all selected districts (56.31%) are equipped to handle these conditions. In the selected districts from Ghana, a significant majority (69.57%) of the AMH-providing PHC facilities can treat these disorders. Niger reports a similar high capacity (73.33%), while Burkina Faso lags slightly behind at 47.69%. These figures indicate a relatively strong focus on addressing substance-related issues in the region’s adolescent population.

Also, for depression treatment, 71 PHC facilities (68.93%) across the selected districts from all countries have staff skilled in providing such services. Selected districts from Ghana again show a higher skilled capacity, with 20 out of 23 PHC facilities (86.96%) equipped to handle depression. Niger follows with 12 out of 15 PHC facilities (80.00%), and selected districts from Burkina Faso have 39 out of 65 PHC facilities (60.00%) providing care for depression. The high percentages across the board suggest a regional acknowledgment of depression as a critical aspect of AMH.

Table 3 Skills and resources in the provision of AMS in PHC facilities across countries

The capacity to treat anxiety disorders is present in 67 PHC facilities (65.05%) across all selected districts. The selected districts from Ghana top the list with 19 out of 23 PHC facilities (82.61%) offering such treatment, while those from Niger and Burkina Faso show capacities of 53.33% and 61.54%, respectively. This demonstrates a substantial regional recognition of anxiety disorders as a significant concern in AMH.

Regarding Suicidality and Self-Harm, 49 PHC facilities (47.57%) across all selected districts provide necessary care. The selected districts from Ghana have 13 PHC facilities (56.52%) addressing these issues, compared to only 3 PHC facilities in the selected districts from Niger (20%). The selected districts from Burkina Faso report care availability in 33 out of 65 PHC facilities (50.77%), indicating a moderate focus on these critical issues.

Lastly, treatment for Psychotic Disorders is available in 52 PHC facilities (50.49%) across the surveyed selected districts. The selected districts from Ghana have the highest capacity with 14 PHC facilities (60.87%), while those from Niger and Burkina Faso report capacities of 33.33% and 50.77%, respectively. This distribution suggests a balanced approach towards psychotic disorders in AMH across these regions.

Rural vs. urban

Table 4 analysis provides a comparison of the availability and capacity for AMH services in urban and rural PHC facilities across the selected districts from Ghana, Burkina Faso, and Niger, encompassing a range of mental health conditions.

Table 4 Comparison of AMH Services in Urban and Rural PHC facilities across the countries

The findings reveal a complex landscape where AMH services show slightly higher availability in rural areas (57%) compared to urban settings (46%) across the selected districts in the surveyed countries. In Ghana, a marginally higher provision of AMH services is observed in urban areas (26%), contrasting with the rural-focused trends seen in Niger and Burkina Faso. The results indicates that urban provision of AMH services is lower in Niger (7%) compared to rural areas (11%), this might reflect a strategic focus on addressing healthcare gaps in rural regions, where access to services is typically more limited. This rural emphasis could be due to targeted interventions by the government or NGOs to improve healthcare availability in underserved areas [30]. Conversely, Burkina Faso’s substantial urban concentration of AMH services (65% in urban areas compared to 34% in rural settings) likely results from the concentration of resources, infrastructure, and trained professionals in urban centers, which are often prioritized for healthcare investments due to their population density and accessibility [31, 32].

When analyzing specific mental health conditions, the data shows a general rural inclination for treating alcohol and substance use disorders, except in Burkina Faso, where urban PHC facilities (61%) surpass rural ones (38%) in providing treatment. Depression treatment shows a relatively balanced approach between urban and rural PHC facilities, with a slight preference for rural settings in Ghana and Burkina Faso. Anxiety disorders are addressed with nearly equal emphasis in both settings, although Ghana has a slightly higher urban capacity. Notably, PHC facilities addressing suicidality, self-harm, and psychotic disorders are more prevalent in rural areas across all countries, underscoring a critical focus on rural mental health needs.

Outpatient department (OPD) attendance for AMH services (2018–2021)

Figure 1 illustrates the trend of outpatient department (OPD) visits for adolescent mental health (AMH) services from 2018 to 2021 across three countries: Ghana, Niger, and Burkina Faso. In the selected districts of Ghana, among the 23 primary health care (PHC) centers providing AMH services, only 8 recorded OPD visits. In Niger, 15 of the surveyed PHC facilities reported OPD visits. Conversely, in Burkina Faso, a more significant number of 63 PHC facilities documented attendance for AMH services, reflecting a higher level of engagement in AMH care in that country.

Fig. 1

Trends in average outpatient visits for adolescent mental health services (2018–2021)

Source: authors’ computations

Between 2018 and 2021, the average number of OPD visits for AMH services in the selected districts of Ghana and Niger was notably low, with PHC facilities in both countries averaging one case or none at all during this period. In stark contrast, the selected districts in Burkina Faso began with a higher average of 9 OPD visits in 2018, which decreased to an average of 7 visits by 2021. This trend indicates a decline in OPD visits for AMH services in Burkina Faso over the four years, while Ghana and Niger remained consistently low throughout the same timeframe.