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1
GYASI, Razak Mohammed. "Ageing, health and health-seeking behaviour in Ghana." Digital Commons @ Lingnan University, 2018. https://commons.ln.edu.hk/otd/41.
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Rapid ageing of populations globally following reductions in fertility and mortality rates has become one of the most significant demographic features in recent decades. As a low- and middle-income country, Ghana has one of the largest and fastest growing older populations in sub-Saharan Africa, where ageing often occurs ahead of socioeconomic development and provision of health and social care services. Older persons in these contexts often face greater health challenges and various life circumstances including role loss, retirement, irregular incomes and widowhood, which can increase their demand for both formal and informal support. This thesis addresses the effects of the socio-political structure, informal social support and micro-level factors on health and health-seeking behaviour among community-dwelling older persons in Ghana. The theoretical perspectives draw on political economy of ageing, social convoy theory and Andersen5s behavioural model. Using multi-stage stratified cluster cross-sectional survey data of older cohorts (N= 1,200) aged 50 years and older, multivariate generalised Poisson and logit regression models estimated the associations among variables and interaction terms. Although Ghana’s national health insurance scheme (NHIS) enrollment was significantly associated with increased log count of healthcare use (β = 0.237), the relationship was largely a function of health status. Moreover, the NHIS was related with improved time from onset of illness to healthcare use (β = 1.347). However, even with NHIS enrollment, the intermediate (OR = 1.468) and richer groups (OR = 2.149) had higher odds of seeking healthcare compared with the poor. In addition, features of meaningful informal social support including contacts with family and friends, social participation and remittances significantly improved psychological wellbeing and health services utilisation. Somewhat counter-intuitively, spousal cohabitation was associated with decreased health services use (OR = 0.999). Whilst self-rated health revealed a strong positive association with functional status of older persons (fair SRH: β = 1.346; poor SRH: β = 2.422), the relationship differed by gender and also was moderated by marital status for women but not men. The employed and urban residents somewhat surprisingly had lower odds of formal healthcare use. The findings support the hypotheses that interactive impacts of aspects of structural and functional social support and removal of catastrophic healthcare costs are particularly important in older persons’ psychological health and health service utilisation. Nevertheless, Ghana’s NHIS currently apparently lacks the capacity to improve equitable attendance at health facility between poor and non-poor. In contributing to the public health and social policy discourse, this study proposes that, whilst policies to ensure improved health status of older people are recommended, multidimensional social support and NHIS policy should be properly resourced and strengthened so they may act as critical tools for improving health and health services utilization of this marginalized and vulnerable older people in Ghana. Moreover, policies targeting and addressing economic empowerment including universal social pensions and welfare payments should be initiated and maintained to complement the NHIS for older people. The achievement of age-relevant policies and Universal Health Coverage (UCH) as advocated by WHO could be enhanced by adopting some of these suggestions.
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Pappoe, Matilda Ethel. "Household participation in health development : some determining factors." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=41220.
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This dissertation has explored the problem of a yawning gap between policy and the implementation of lay participation in health development activities in Ghana, using data from 577 households in 22 rural communities.A Health Systems model has been applied to data, to explain relationships and four sets of variables--household need for health services, predisposing attributes, participatory patterns, enabling factors--on household use of available health facilities and services.
Overall, results indicate a complex interdependence of factors which influence modern health services use. A multiple regression procedure identifies the presence of children under 5 years, the household's perception of its influence in the community, household participation in community health-related activities, household socio-economic and educational levels, to be significantly related to services use. Results suggest that Need for services is Not a sufficient condition for the Use of available health services.
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Nuhu, Kaamel M. "DETERMINANTS OF HEALTH-SEEKING BEHAVIOR IN GHANA." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1539.
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Health can be described as both a product and a process of life, and is necessary for human wellbeing, overall quality of life and productivity. While health is generally desirable, many factors affect health and health outcomes of individuals and populations the world over. Virtually all individuals will be faced with one health problem or another during their lifetime, that requires some form of health care intervention. Whatever their reasons for seeking care, all health care consumers share a common interest – a desire to get better. In a pluralistic health care environment where different avenues exist for seeking and receiving health care, differential choice of care may be influenced by sociodemographic and related factors. To the extent that the available avenues for seeking and receiving health care do not offer the same opportunities for improving health, significantly different health outcomes may be realized for comparable conditions for which different types and volume of health care are sought and received. Understanding the factors that influence health-seeking behaviors among various populations may therefore, be an important first step in designing intervention programs that nudge health consumers toward better health-seeking behaviors with the goal to improving health and health outcomes among these populations. The purpose of this research was to develop a research instrument for studying health-seeking behaviors based on the Health Belief Model, and to use the instrument to study the factors that influence/predict health-seeking behaviors among Ghanaians. Using a convenience sample of 504 participants recruited from the Greater Accra, Ashanti, Volta and Northern Regions, analyses of the data showed that different sociodemographic characteristics such as age group, gender and health insurance status as well as selected modified constructs of the Health Belief Model such as Perceived Barriers to mainstream care, variously and collectively influence health-seeking behaviors at government and private health facilities, self-medication with herbal and pharmaceutical drugs, faith healing and care from traditional/herbal practitioners. Based on the findings of this study, the author concludes that health-seeking behaviors in Ghana are influenced by a multiplicity of factors including sociodemographic characteristics. Subsequently, recommendations for a more extensive study with a complementary qualitative enquiry are made in order to gain a more wholistic insight of the drivers of health-seeking behaviors in Ghana.
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Akazili, James. "Equity in Health Care Financing in Ghana." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/9390.
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Includes bibliographical references.Financial risk protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". The study (the first of kind in Ghana) measured the relative progressivity of health care financing mechanisms, the catastrophic and impoverishment effect of direct health care payments, as well as evaluating the factors affecting enrolment in the national health insurance scheme (NHIS), which is the intended means for achieving equitable health financing and universal coverage in Ghana. To achieve the purpose of the study, secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other ministries and departments, and further complemented with primary household data collected in six districts. In addition 44 focus group discussions with different groups of people and communities were conducted. In-depth interviews were also conducted with six managers of District NHI schemes as well as the NHIS headquarters. The study found that generally Ghana's health care financing system is progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes which account for over 50% of health care funding. The national health insurance levy is mildly progressive as indicated by a Kakwani index of 0.045. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are associated with significant catastrophic and impoverishment effects on households. The results also indicate that high premiums, ineffective exemptions, fragmented funding pools and perceived poor quality of care affect the expansion of the NHIS. For Ghana to attain adequate financial protection and ultimately achieve universal coverage, it needs to extend cover to the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the NHI. Furthermore, the funding pool for health care needs to grow and this can be achieved by improving the efficiency of tax collection and increasing the budgetary allocation to the health sector.
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Livingstone, Anne-Marie. "Obstacles in primary health care, a three-village study of the Maternal Child Health (MCH) program in Ghana." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ43906.pdf.
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Asomaning, Antwi Abena. "The pathway of achieving the universal health coverage in Ghana : the role of social determinants of health and “health in all policies”." Thesis, Lille, 2019. http://www.theses.fr/2019LIL1A002.
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Le concept de Couverture Santé Universelle (CSU) est désormais mondialement accepté comme un moyen de fournir équitablement des soins de santé aux populations. Découlant du troisième Objectif de développement durable des Nations Unies (ODD). Le Ghana, a lancé en 2003 sa propre forme de couverture sanitaire universelle en créant un Régime national d’assurance maladie et la mise en œuvre de services de santé extrahospitaliers de proximité (community-based). Cependant, après plus d'une décennie de mise en œuvre, la CSU ghanéenne a stagné. Afin de comprendre et d’expliquer ce phénomène, cette recherche examine la mise en œuvre du Régime national d’assurance maladie ghanéen du point de vue des déterminants sociaux de la santé. Il étudie ses implications pour la croissance (en termes d’inscription et de renouvellement) dans le cas où le principe complémentaire de promotion de la santé dans toutes les politiques publiques, pour prendre en compte le rôle des déterminants sociaux de santé. L’étude repose sur une méthode essentiellement qualitative, complétée par des données quantitatives. L’analyse permet de soutenir empiriquement l’argument d’une meilleure prise en compte des déterminants sociaux de santé au Ghana. La recherche montre également que l’existence d’une tension entre une approche purement volontaire de la mise en œuvre de la Couverture Santé Universelle et l’approche quasi obligatoire adoptée au Ghana. En conclusion, la recherche montre que la stratégie actuelle adoptée par le Ghana, n’est pas financièrement soutenableThe Universal Health Coverage (UHC) has become a globally accepted concept and medium of providing healthcare to populations equitably and it’s a goal from the third Sustainable Development Goals (SDG), to be achieved by 2030. It has been described as one of the most progressive concepts to transform lives. Ghana in 2003 initiated its own form of the UHC through the establishment of the National Health Insurance Scheme (NHIS) and the continuation of the Community Health-Based Planning and Services (CHPS) implementation. It was a political decision which brought together different interest groups. The implementation of this decision saw healthcare expenditure shoot up to 10.6 percent as a share of Gross Domestic Product (GDP) in 2007. After more than a decade, the UHC (NHIS) has stagnated in growth. This study looks at the NHIS’ implementation from the point of view of the Social Determinants of Health (SDH) and what it could mean for growth if the Health in All Policies (HiAP) concept was applied. Through the use of Kingdon’s theoretical framework in terms of multiple-streams framework and agendas, alternatives and public policies, the policy process and environment are assessed. The research method used was qualitative case study. Some of the research outcomes were that there are undercurrents of tensions existing between a purely voluntary approach to the implementation of the UHC policy and the quasi-compulsory approach adopted by the country. In conclusion, the research finds that financially, it is not feasible to continue with the current strategy. There is the need to seek better institutional complementarities in pursuant of the UHC and adoption of the SDH
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Iyanda, Ayodeji Emmanuel. "The Geography of Maternal Health Indicators in Ghana." Thesis, University of North Texas, 2017. https://digital.library.unt.edu/ark:/67531/metadc984208/.
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Ghana is identified among the developing countries with high maternal mortality ratio in Africa. This study unpacked the Demographic and Health Survey data by examining the maternal health indicators at the district level using GIS methods. Understanding the geographic patterns of antenatal care, place of delivery, and skilled birth attendants at the small scale will help to formulate and plan for location-specific health interventions that can improve maternal health care behavior among Ghanaian women. Districts with high rates and low rates were identified. Place of residence, Gini-Coefficient, wealth status, internet access, and religious affiliation were used to explore the underlying factors associated with the observed patterns. Economic inequality was positively associated with increased use of maternal health care services. The ongoing free maternal health policy serves as a cushion effect for the economic inequality among the districts in the Northern areas. Home delivery is common among the rural districts and is more prominent mostly in the western part of Northern Region and southwest of Upper West. Educating women about the free maternal health policy remains the most viable strategy for positive maternal health outcomes and in reducing MMR in Ghana.
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Afari-Adomah, Augustine. "Health sector reforms : a study of mutual health organisations in Ghana." Thesis, Sheffield Hallam University, 2009. http://shura.shu.ac.uk/4919/.
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This thesis examines the problems of health financing and the emergence of Mutual Health Organisations under the health sector reforms in Ghana. Governments of sub-Saharan Africa region have embraced the Community-based health insurance schemes concept under the health sector reforms, with momentous enthusiasm. They believe that these newly emerging health financing arrangements could easily be utilised as platforms for initiating Social Health Insurance strategies to reach the economically deprived people. Without such schemes, citizens would become poorer because they would have had to dispose of their family's wealth in order to treat a member who falls sick. Ghana, a developing country in West Africa has introduced a National Health Insurance Scheme, which is fused with Social health insurance and Community-based health insurance schemes. This study examines pro-active plans to address the financial viability of the schemes, to prevent them from going insolvent. The study generally, investigates health sector reforms in the context of Ghana. Four operating District Mutual Health Insurance Schemes (MHOs) were selected using geographical locations, among other criteria, as case studies. Data was gathered through interviews. The findings of the empirical study were analysed and interpreted using social policy and community field theories with the support of available documents. The evidence from the study concludes that government's intervention (implementation of NIH Act 650) has increased and expanded the membership base of the schemes: from small group-based to district-wide schemes under the ambit of the District Assemblies. However, such intervention has equally led to diminished community initiatives in establishing, and the complete collapse of the original small group-based schemes. The study also finds among other things that: - The financial viability of the schemes depends on the provision of long-term government subsidy. However, they may not be financially viable beyond subsidy-funding due to uncontrollable high utilisation rate, occurrence of health insurance fraud, moral hazard and associated exorbitant claims made on them by health care providers.
- There are problems with late release of reimbursement funds for discharging with claims by the central government. This has impacted heavily on the financial and strategic management and decision making processes of health institutions in the operating districts.
- Health managers are unable to fulfil their contractual obligations to their suppliers as their capital funds are locked up with the Mutual Health Organisations that arc also unable to provide front loading for the health providers even up to a period of three (3) months of their financial operational requirements.
- There is therefore. a perceived tension between the schemes and the health institutions as the health institutions prefer to treat clients who come under the 'cash and carry' group since they provide prompt payment to the detriment of insured clients whose reimbursement is delayed causing the institutions to be cash-trapped. This is recommended for immediate attention.
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Baidoo, Rhodaline. "Toward a Comprehensive Healthcare System in Ghana." Ohio University / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1237304137.
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Bekui, A. M. "A health management information system for the district health services in Ghana." Thesis, University of Leeds, 1990. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492369.
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Agyeman-Yeboah, Joana. "A best-practice guideline for facilitating adherence to anti-retroviral therapy for persons attending public hospitals in Ghana." Thesis, Nelson Mandela University, 2017. http://hdl.handle.net/10948/13603.
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The retention of persons on an HIV programme has been a global challenge. The success of any strategy to optimize adherence to anti-retroviral therapy (ART) depends on the intensive and effective adherence counselling and strategies. It is important to research whether persons receiving anti-retroviral therapy in public hospitals in Ghana are receiving the needed service that would optimize their adherence to the anti-retroviral therapy. Therefore, this study explored and described the experiences of healthcare professionals providing care, support and guidance to persons on ART at public hospitals in Ghana, as well as the best-practice guideline that could contribute to facilitating the ART adherence of patients. This study also explored and described the experiences of persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on ART, regarding their adherence to the therapy. The study was organized into three phases. In Phase One: a qualitative, exploratory, descriptive and contextual design was employed. The research population included healthcare professionals, providing services at the HIV clinic at the public hospitals in Ghana, namely the Korle-Bu Teaching Hospital; the 37 Military Hospital and the Ridge Hospital. The healthcare professionals comprised of doctors, nurses, pharmacists and trained counsellors employed in any of the three public hospitals. Persons receiving ART at any of the three public hospitals were also part of the research population. Semi-structured interviews were conducted with healthcare professionals and persons receiving ART. Data were collected from healthcare professionals in relation to their experiences regarding the provision of ART services, their understanding of evidence-based practice and best-practice guidelines, as well as data on the experiences of persons receiving ART in relation to their adherence to the therapy. The data were analysed using Creswell’s six steps of data analysis; and the coding of the data was done according to Tesch’s eight steps of coding. Trustworthiness was ensured by using Lincoln and Guba’s framework which comprised credibility, transferability, dependability, confirmability and authenticity. Ethical principles such as beneficence and non-maleficence, respect for human dignity, justice, veracity, privacy and confidentiality were considered in the study. In phase two, the literature was searched by using an integrative literature review approach and critically appraising the methodological quality of the guidelines in order to identify the best available evidence related to adherence to ART. In Phase Three, a best-practice guideline for facilitating adherence to ART was developed for public hospitals in Ghana based on the findings of the empirical research of Phase One and the integrative literature review in Phase Two. The guideline was submitted to an expert panel for review; and it was modified, according to the recommendations of the panel.
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Mensah, Gwendolyn Patience. "Best practice guideline for the nursing management of women with gestational diabetes mellitus in military health institutions in Ghana." Thesis, Nelson Mandela University, 2017. http://hdl.handle.net/10948/14036.
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Pregnancy is a normal physiological process for the majority of women. These women, their families and significant others normally expect a successful period of pregnancy, labour, delivery and arrival of a normal and healthy baby. However, some of these pregnant women may develop Gestational Diabetes Mellitus (GDM) during this period and if not managed properly, the mother and the foetus in utero are affected in a negative way: there is a likelihood of the mother and baby developing Type 2 Diabetes in the future and also, other risks such as preterm labour, and foetal macrosomia. In order to prevent such occurrences, I set out to develop a best practice guideline for the nursing management of GDM in military health institutions in Ghana in order to help enhance nursing care. The design for this research was qualitative, explorative, descriptive and contextual in nature. The research is organised in three phases: Phase one deals with the data analysis and discussion of the interviews with professional nurses and midwives and women with a history of GDM. The data collected from the interviews were transcribed, analysed and extracted with Tesch’s eight steps of coding used for the coding. The services of an independent coder were employed to assist with the coding process which led to the formulation of key themes. Semi-structured individual interviews provided a means of exploring the perceptions of professional nurses and midwives on the nursing management of GDM: in addition, women with a history of GDM were interviewed so as to elicit their views on the management they had experienced from professional nurses and midwives before and after being diagnosed with GDM. The trustworthiness of the study was ensured by conforming to Lincoln and Guba’s framework of credibility, transferability, dependability, confirmability and authenticity. An independent coder assisted with the coding process. Phase two deals with the Integrative literature review of available evidence-based clinical practice guidelines for the nursing management of GDM. Evidence-based clinical practice guidelines were searched and appraised with assistance from an independent appraiser and themes were then formulated. In Phase three, the themes from Phase one and Phase two were integrated for the development of a draft best practice guideline for the nursing management of GDM in military health institutions in Ghana. The draft guideline was given to an expert panel of reviewers for their comments and recommendations. These were considered in the development of the final best practice guideline for the nursing management of GDM.
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Aakumiah, Prince Osei. "Water Management and Health in Ghana : Caes Study - Kumasi." Thesis, Linköpings universitet, Tema vatten i natur och samhälle, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-15239.
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There have been multiple cases of drinking water related diseases in Ghana, particularly the cities. Kumasi, the second largest city is recording high figures of drinking water related diseases. The Ghana water and sewage company is supposed to provide adequate safe drinking water to the people. However, the company has failed to provide this service effectively. Various reasons have been given by the company on its inability to perform efficiently. Meanwhile the government decided lately to privatise water in the cities to facilitate access to quality water through what is called “FULL COST RECOVERY”. This attracted a lot of international companies to Ghana but this has also generated protest and demonstrations. The argument is that these foreign companies are basically profit oriented and considering the fact that most of the affected people are very poor, suggesting they cannot afford it. The study is aimed at finding out the relationship between water management and health in the study area and how effective water management through full community participation could help provide adequate safe drinking water. The study was a non-interventional descriptive type using both qualitative and quantitative methods. It was conducted in Kumasi, the second largest city in Ghana. A total of 100 residents from the communities was selected through systematic sampling and interviewed. This includes 86 local residents and 14 key informer interviews. The study also relied on observation as well as some selected literature. The results confirmed that drinking water related diseases is on the increase with the most affected people being the poor living in shanty and informal areas of the city. It was also found that most people in the city are willing to render any services to provide safe drinking water. But in relative terms, most of these people are very poor with high percentage of illiterates and may only contribute if there is a good relation and trust among all. It however appears that community participation is a good option for the city provided that stakeholders are made to play effective roles.
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AKUMIAH, PRINCE OSEI. "WATER MANAGEMENT AND HEALTH IN GHANA : CASE STUDY- KUMASI." Thesis, Linköping University, Department of Water and Environmental Studies, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-15239.
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Adams, Orvill (Orvill Bruce Ried) Carleton University Dissertation International Affairs. "Transition to a primary health care system in Ghana." Ottawa, 1991.
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Duah, Ebenezer. "Bullying Victimization, Health Strains and Juvenile Delinquency in Ghana." University of Akron / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=akron1619601395448056.
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Frempong-Ainguah, Faustina. "Measuring a population's health : an exploration of women's health status in Accra, Ghana." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/374700/.
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Ahene-Codjoe, Ama Asantewah. "The effects of education on health and fertility in Ghana." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12642/.
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Using the Ghana Living Standards Survey (GLSS) conducted in 1987/88 and 1998/99, this thesis examines two thematic areas of non-monetary returns to education in Ghana. One of the primary aims is to find the differences in the effects of education over the decade (1987/88–1998/99), using standard and non-standard econometric analysis. In addition, the later survey year serves as a robustness check on the first. The first theme examines health status; measured as illness and its duration, as well as the use of anthropometric indicators. The study finds that parental education is positively associated with child’s reported illness and its duration. Further verification of this outcome using an instrumental variable (2SLS) approach that assumes possible endogeneity of parental education supports the results relating to maternal education in both survey years. In contrast, paternal primary education tends to reduce children’s reported illness; but this is only statistically significant in GLSS 1. These outcomes, although perverse are not uncommon in developing countries, and may be the result of systematic reporting bias. The analysis also reveals inconsistent results regarding adults’ health status between the two survey years. For example, we find that illness and its duration increase with personal education in GLSS 1, but the converse is true in GLSS 4, ceteris paribus. The mixed results of this study imply that the relationship between education and health status varies across health measures, and probably over time. Hence caution should be exercised before broad conclusions are drawn and policies made regarding these two vital socioeconomic indicators (education and health). The last theme analyses fertility in both structural and reduced form functions. The structural function involves a two-stage process. The first stage estimates the effect of education on three proximate determinants of fertility - the duration of breastfeeding, contraceptive use and age at cohabitation. The second stage subsequently models the fertility function by estimating three measures: the probability of having at least one birth; the unconditional number of births; and the number of births conditional on one having occurred, using the predicted values of the proximate determinants as inputs similar to the conventional production function. The reduced form fertility model estimates the impact of women’s education on the number of live births. The findings are that (1) education increases the use of contraception, delays age at cohabitation and shortens the duration of breastfeeding, as anticipated; (2) contraception and age at cohabitation subsequently tend to reduce the overall number of live births, though we observe an ambiguous outcome regarding breastfeeding; (3) education, in a fuller and direct way, also shows a strong negative association with fertility in both surveys; and finally (4) fertility appears to have declined over the period studied. We also find a structural shift in respect of the influence of women’s education from post-primary to primary level on fertility, ceteris paribus.
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Bannister, David. "Public health and its contexts in northern Ghana, 1900-2000." Thesis, SOAS, University of London, 2017. http://eprints.soas.ac.uk/26656/.
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This is a study of the long-term political economy of public health work in northern Ghana, and of the contingent application of medical knowledge under different political regimes. Covering the period from 1900 to 2000, the thesis asks how the north and its people's enduring peripherality - defined in various ways - shaped the evolution of public health institutions and conditioned the state's attention to particular diseases. It assesses key public health transitions across the century, including the creation of the north's Native Authority health system in the 1930s, the entrenchment of church authority for healthcare in the 1950s, and the government's gradual cession of medical oversight to international organisations from the late 1960s, a process which was partially reversed in the late 1990s. It examines specific disease control programmes against sleeping sickness, onchocerciasis, and guinea worm, for what they reveal about the social history of medical work on the margins of the state, and about the political contexts for population-level health interventions. Colonial-era tsetse control inadvertently contributed to the serious prevalence of onchocerciasis in the north at independence, and this high prevalence of onchocerciasis made northern Ghana a focus of international health fundraising ahead of the WHO Onchocerciasis Control Programme, which began in 1974. In the urban south, guinea worm disease was substantially reduced in the early twentieth century, but in the north the disease only received concerted attention from the 1980s. In the historical literature on health in Ghana, there are few studies which adequately disaggregate the north and its particular experiences of public health work. Using sources from northern regional archives, the archives of the World Health Organisation, and interview testimony from government health officials and village communities, the thesis aims to make a contribution to this area.
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Burchett, Helen. "Perceptions of the usefulness of public health research in Ghana." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2010. http://researchonline.lshtm.ac.uk/682424/.
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This study aimed to explore researchers' and policy stakeholders' perceptions of the usefulness of public health research for policy, using the example of maternal health in Ghana. Sixty-nine government decisionmakers, maternal health policy stakeholders and researchers were interviewed. Concepts of research were broad. Research was dichotomised into `big', formal research and 'small', applied research such as operations research. 'Small research' was highly valued, due to its speedy completion and its focus on topics pertinent to service delivery; big research was not always considered necessary. Effectiveness research, one type of `big research', was not highly valued. Interviewees tended to feel that 'effective' policies and programmes could be designed once there was a thorough understanding of the situation. There was an implicit assumption that as long as these interventions were implemented well, they would be effective. Six dimensionso f local applicability/transferabilitwye re identified.T he most influential factors were the ease with which the intervention could be implemented, the study's congruence with interviewees' previous experiences and the perceived need for the intervention. Little attention was paid to study findings. Judgements of an intervention's potential effectiveness tended to be based on the ease of implementation or knowledge of similar projects. Adaptation was considered to be crucial, although often conceptualised not as a factor within local applicability/transferability assessments, but rather a distinct, essential step in the research use process. This study suggests that the factors of local applicability/transferability frequently cited in the literature do not reflect those considered to be most important by stakeholders in Ghana.
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Valeix, Sophie Françoise. "Integrating professionals to address complex global health challenges : veterinarians, zoonoses and One Health in Ghana." Thesis, University of Sussex, 2018. http://sro.sussex.ac.uk/id/eprint/80593/.
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This thesis explores the integration of public veterinarians in zoonosis management policy and action in Ghana with regard to the implementation of the internationally-led policy ideal: 'One Health' (OH). Drawing on theoretical contributions that examine professionalism, integration mechanisms and social processes, I researched vets' potential for OH in a context of new public health imperatives, limited resources and absence of targeted national strategy. During eight months of ethnography in Southern Ghana, I investigated veterinary professional characteristics using participant observation, interviews, document collection and a network survey. I analysed how veterinary perspectives, practices and relationships influenced the scope for integration of vets and their activities in zoonosis management, from the district-level clinics and offices to national-level institutions and international organisations. This work questioned whether and why Ghanaian vets would want to engage in OH integration with regard to their professional values and interests. It also sought to understand which practitioners and practices were professionally promoted or repressed and what were the main dilemmas or opportunities for local vets taking part in local zoonosis surveillance, prevention and control. Furthermore, it studied interactions in networks around zoonoses between Ghanaian vets and other actors, and their potential to create and maintain relationships that favour integration. This research contributes to critical knowledge on global health policy implementation by highlighting the importance of relationships and power dynamics both within and between professionals in relation to integration. This, I argue, can be done through more consideration of their professional values, interests and status, and the heterogeneity of all of these in a national context. The thesis also adds to the scarce literature on veterinary professionalism in low- and middle-income countries by providing 'thick descriptions' of veterinary perspectives, practices and network relationships.
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Okronipa, Harriet. "Infant morbidity in HIV-affected communities in Ghana." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=32540.
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Incidence, prevalence and determinants of infant diarrhoea and acute respiratory infections (ARI) were examined in 292 infants of HIV positive (HIV-P), HIV negative (HIV-N), and unknown HIV status (HIV-U) women in the Eastern region, Ghana. Incidence of diarrhoea and ARI was 1.0 and 1.2 episodes per child per 100-days at risk, respectively. There was no difference in morbidity by infant feeding mode or maternal HIV status. HIV-P women were more likely to be stressed and to report symptoms of postpartum depression (PPD). Maternal stress and PPD were associated with an increase in the risk of diarrhoea. Among HIV-P women only, the risk of infant diarrhea increased 3-fold with PPD and 15% for every unit increase of the maternal stress score. Poor maternal nutritional status and illiteracy, and infant male sex were associated with increased risk of diarrhoea and ARI. Maternal stress and postpartum depression should be taken into account when drafting policies and planning interventions to improve infant health, especially in HIV-affected communities.Le taux, la prévalence et les déterminants de la diarrhée infantile et des infections respiratoires aigues (IRA) ont été examinés chez 292 enfants de mères séropositives, séronégatives ou de statut VIH inconnu dans la région est du Ghana. Les taux de diarrhée et IRA étaient de 1.0 et 1.2 épisodes par enfant par 100 jours d'exposition, respectivement. Le statut VIH de la mère ou le mode d'alimentation des enfants n'avait pas d'effet sur la morbidité de ces maladies. Les mères séropositives avaient plus de tendances d'être stressées et de présenter avec des symptômes de dépression postpartum (DPP). L'augmentation de la diarrhée était associée au stress maternel et au DPP. Parmi les mères séropositives seulement, le risque de la diarrhée infantile a augmenté trois fois avec le DPP et de 15% pour chaque augmentation d'une unité dans le résultat du test de stress maternel. Une prévalence plus élevée de diarrhée et IRA était associée à un mauvais statut nutritionnel, à l'analphabétisme maternel et au sexe de l'enfant, étant plus communs chez les garçons. Le stress maternel, la dépression postpartum et d'autres facteurs devront être pris en considération lors de l'esquisse de politiques et de plans d'intervention visant à améliorer la santé des enfants, particulièrement dans les communautés touchées par le VIH.
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Nordin, Cecilia, and Elin Eklund. "Women's trust in maternal health care : A qualitative interview study about nurses' experiences within primary health care in Ghana." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2255.
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Background: In Ghana, many women die every year due to preventable causes related to pregnancy and child birth. Several national strategies have been made to improve women’s access to essential maternal health care. Still there is a significant inequality in the number of women attending to maternal health care in between different parts of the country. An important determinant that affects women’s utilization of the subsidized maternal health care is the quality of health care, including the health providers’ attitudes to their patients. Aim: The aim of this study was to describe nurses’ experiences of interacting with women in a maternal health care context within primary care in Ghana. Method: Five qualitative semi-structured interviews were conducted at three different primary health care clinics. Content analysis was used to analyse the data. Results: Three main-themes, patient compliance, building trust and nursing strategies and ten sub-themes were identified. Conclusion: Although the nurses expressed a desire to have more women attend maternal health care, they seemed unaware of how their own behaviour might contribute to the current underutilization. A hierarchical power imbalance within the nurse-patient interactions, where the patients were perceived and treated as subordinate passive receivers of the nurses’ expertise, was identified. The nurses’ lack of critical approach towards their own actions might be at the source of this underutilization. Suggestion for further research: The authors recommend further studies to explore nurses’ ability to allow self-reflective critical thinking and also how implementation of a more patient-centred approach in Ghana would affect the quality of health care.Bakgrund: Varje år dör många kvinnor i Ghana på grund av förebyggbara komplikationer relaterade till graviditet och förlossning. Flera nationella strategier har genomförts i syfte att ge fler kvinnor tillgång till nödvändig mödrahälsovård. Trots det råder en signifikant skillnad i andel kvinnor som söker mödrahälsovård mellan olika delar av landet. En viktig faktor som påverkar utnyttjandet av den subventionerade mödrahälsovården är vårdkvaliteten, inklusive vårdpersonalens bemötande. Syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av bemötande av kvinnor i en mödrahälsovårdskontext inom primärvården i Ghana. Metod: Fem kvalitativa semistrukturerade intervjuer genomfördes vid tre olika primärvårdskliniker. Innehållsanalys användes for att analysera insamlad data. Resultat: Tre huvudteman, patientföljsamhet, bygga förtroende och omvårdnadsstrategier och tio underteman hittades i resultatet. Slutsats: Trots att sjuksköterskorna uttryckte en vilja att få fler kvinnor att nyttja tillgänglig mödrahälsovård så verkade de omedvetna om hur deras eget agerande skulle kunna bidra till att kvinnorna väljer att inte söka vård. En hierarkisk maktobalans inom sjuksköterskornas vårdrelation med patienterna framträdde genom intervjuerna, där patienterna sågs och bemöttes som underordnade, passiva mottagare av sjuksköterskornas expertis. Sjuksköterskornas brist på kritiskt förhållningssätt till egna insatser kan göra att de oavsiktligt arbetar emot sina egna mål. Förslag på fortsatta studier: Ytterligare studier för att utforska sjuksköterskors förmåga att tillämpa kritiskt tänkande rekommenderas samt vilken nytta det skulle vara för kvaliteten på omvårdnaden om ett mer patientcentrerat förhållningssätt implementerades inom vården i Ghana.
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Waddington, Catriona Jane. "Health economics in an irrational world - the view from a regional health administration in Ghana." Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317275.
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Amediavor, Rita Laryea. "The Persisting Threats Of Cholera: A Cyclical Public Health Problem In Ghana." Wright State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=wright1598992794308852.
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Sabi, William Kwasi. "Mandatory community-based health insurance schemes in Ghana : prospects and challenges." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9437.
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Includes bibliographical references (leaves 119-124).Community-Based Health Insurance Schemes are new forms of health financing that can increase resources available for a national health system. These schemes are often regarded as not feasible. Evidence from recent experiences however; show that , if they are appropriately designed and managed they can be feasible and sustainable. The successes achieved by such schemes in Ghana motivated the government to make them a mandatory system of health financing. The main objective is that every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against "cash and carry" (i.e. user fees) in order to obtain access to a defined package of acceptable quality needed health services without having to pay at the point of receiving service. This study sought to undertake a critical comparative study of the performance of voluntary and mandatory community health financing schemes in Ghana and assess their prospects and challenges in their effort to improve efficiency, equity and the schemes' sustainability. The study, a qualitative one, employed descriptive survey techniques to evaluate the ability of schemes to finance their activities from their own sources and mechanisms put in place to cater for the poor and vulnerable, i.e. to evaluate with sustainability and equity respectively. The study also considered control measures to minimize cost escalation to assess efficiency. Focus group discussions, key informant interviews and document reviews were used to examine performance of voluntary and mandatory schemes in meeting those criteria. The study found that both voluntary and mandatory schemes were not self-sustainable due to low coverage and inadequate funds mobilized by the schemes. The main reasons for the general low enrolments are poverty, poor quality health service and limited benefit packages. The study showed that including out-patient (OPD) services in the benefit package and quality improvements in health service improve members' acceptability of insurance hence increase membership rates which will eventually increase schemes' sustainability. Efficient and effective administration of risk equalization fund will help reduce differences in districts' ability to raise revenue owing to different levels of economic activities as well as local morbidities. The study showed further that small community-based health insurance schemes (CBHIS) could be sub-district level financial intermediaries for the District Health Insurance Schemes. It was found in this study that a practical means testing mechanism to declare one poor in order to quality for exemption from contribution should be adopted. The study also suggests that alternative reimbursement mechanisms to fee-for-service need to be considered. The study suggests further research on equity in access and means testing. Such study should consider coming up with mechanisms for identifying the very poor in the communities and to put in place workable and sustainable measure to tackle the financial barriers to health care they face.
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Fusheini, Adam. "The implementation of the National Health Insurance in Ghana (2003-2013)." Thesis, University of Ulster, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.627735.
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The study explores the implementation process of the National Health Insurance Scheme (NHIS) policy within the context of the North/South divide (Northern and Southern Ghana); and the rural-urban spatial location in Ghana-a context that has received little attention from implementation researchers yet is very significant to understanding implementation outcomes across regions in Ghana. Four district mutual health insurance schemes were used as cases. These are Nanumba North and South mutual schemes in the Northern region (North) and Ashiedu Keteke and Osu Klottey mutual schemes in the Greater Accra region (South). The analytic process involved in understanding implementation is made simpler by the naturally afforded opportunity to make geographic comparison between the NHIS in poor, remote, under-served regions such as those of the North with those of relatively better-off urban regions like the South.
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Danquah, Augustina. "Exploration of the quality of health care delivery in rural Ghana." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=203831.
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This thesis explores the quality of health care delivery in rural Ghana. In Ghana, the Ministry of Health has been concerned about the quality of health care for sometime, but improvements in quality have been slow to develop and become noticeable: there continue to be complaints about the quality of care given by health workers and received by clients. For their part, health workers have reported the challenges to delivering quality services, while patients describe difficulties of accessibility and technical competence of health workers. It was envisaged that an exploration of the quality of care at the district level would reveal the range of constraints to provision and receipt of quality care, providing an evidence-based analysis incorporating the views of the important stakeholder groups, that could help to contribute to quality improvement in rural Ghanaian health care, especially in primary health care delivery at the local level. The study reported here was carried out in rural Amansie West district in the Ashanti region of Ghana. Using the administrative district as a case study allowed for “multiple sources of evidence gathering”, thus ensuring that the findings are more likely to reflect reality if based on several different sources of information and types of data. The study design was qualitative and involved qualitative data collection methods, including: semi-structured interviews with 66 patients, 25 health workers from seven primary health care facilities and six core members of the district health management team; and focus groups that involved discussions with members from seven communities. These data collection methods explored study participants‟ ideas about the definition of quality of health care, perceptions about the quality of actual health care delivery and feelings about the quality improvement strategy adopted in the primary care facilities studied. Interviews were tape recorded with consent, and translated into English as they were transcribed. Data were analysed manually, using iteration and thematic analysis. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of statements and their meaning to participants. Thematic qualitative analysis of the data suggested that the different provider, recipient and administrative level groups had similar views on what constituted quality of care. In their perceived definitions, all groups tended to emphasise the importance of interpersonal relations, accessibility, technical competence and effectiveness, but these dimensions variously „ranked‟ in importance by stakeholder groups. Perceptions of the quality of actual health care received and the quality improvement process being deployed in Amansie West revealed that many of the obstacles to high quality health care were described as residing within the structure of health care delivery. This study provides new knowledge about perceptions of quality, experience of quality and quality improvement in a rural area of a developing country. It has improved understanding of the differing views held by the different stakeholders. It shows the dimension of understanding about quality added when the views of patients and community members are considered in addition to providers and administrators. Findings suggest improvements could be made to structural aspects of health care provision that could improve quality: for example, appropriate equipment, trained health workers and sufficient numbers of trained workers.
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Awotwi, Dorothy Esi. "Strategies for Improving Utilization of Maternal Health Program Funds in Ghana." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4348.
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Effective utilization of donor resources for maternal health remains a challenge in Ghana. The purpose of this descriptive multiple case study was to identify strategies and processes that recipient partners use to improve the utilization of maternal health program funds. Harrod and Domar's aid-to-investment-to-growth model, Collier's game theory, and Martens' agency theory on aid effectiveness informed the conceptual framework of the study. The study included face-to-face semistructured interviews with 7 program and project managers from 7 UNFPA recipient institutions in Ghana. Data analysis involved assembling, rearrangement, categorizing, and interpreting the data. Member checking and methodological triangulation of interview data with evidence from administrative documents of the 7 recipient institutions occurred to assure the validity of this study's findings. Three themes emerged: clearly identifying and effectively implementing program and project budget support mechanisms, implementing robust aid effectiveness management processes, and utilizing effective project management practices. Findings indicated institutional capacity strengthening, developing and using control mechanisms, and mitigation of funds disbursement delays and activity implementation delays as derivative pathways for maximizing utilization of maternal health program funds. The findings provide potential lessons for similar organizations' improving funds utilization by project management practitioners to sustain or increase donors' interest and mitigate development programs' funding gaps. Implications for social change include the potential for maternal mortality reduction to improve the wellbeing and quality of life of rural, poor, and marginalized women and children in Ghana.
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Arku, Raphael E. "Poverty, Energy Use, Air Pollution and Health in Ghana: A Spatial Analysis." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121156.
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Some of the major themes that characterize the relationship between the environment and population health in the developing world today include poverty, household access to clean cooking fuel, air pollution, sanitation, and infant/child and maternal health. My dissertation research incorporates some of these themes at the interface of community and household energy in the context of economic development in Ghana. Specifically, my dissertation focuses on features of household energy and poverty in both rural and urban areas, as well as air pollution, and child and maternal health in growing urban areas in what is a data and resource-poor setting of Sub‐Saharan Africa (SSA).
Child mortality is declining in most countries. Very few studies have measured child mortality at fine spatial resolutions, which is relevant for assessing community determinants and interventions. The first paper evaluates subnational inequalities in child mortality and its social and environmental determinants in Ghana by applying Bayesian spatial model to Ghana’s 2000 and 2010 National Population and Housing Censuses in 2000 and 2010. The census data were also used to estimate the distributions of households or persons in each of Ghana’s 110 districts for fuel used for cooking, sanitation facility, drinking water source, and maternal and paternal educations. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged between <5% in some northern districts, where under-five mortality had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, leading to higher inequalities. Primary education increased in men and women and more households had access to improved water and sanitation and cleaner cooking fuels over the same period. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Associations for the other social and environmental variables were not consistent or were weak in the different analyses although there were indications of beneficial effects from replacing wood with charcoal or kerosene, from improved sanitation (but not water), and from higher share of mothers and fathers with primary education.
The second paper examines personal particulate matter exposures and locations of 56 students from eight schools in four neighborhoods in of varying socioeconomic status in Accra, Ghana, using gravimetric and continuous PM2.5 data, with time-matched global positioning system coordinates. Personal PM2.5 exposures ranged from less than 10 μg/m3 to more than 150 μg/m3 (mean 56 μg/m3). Girls had higher exposure than boys (67 vs. 44 μg/m3; p-value = 0.001). Exposure was inversely associated with distance of home or school to main roads, but the associations were not statistically significant in the multivariate model. Use of biomass fuels in the area where the school was located was also associated with higher exposure, as was household’s own biomass use. Paved schoolyard surface was associated with lower exposure. School locations in relation to major roads, materials of school ground surfaces, and biomass use in the area around schools may be important determinants of air pollution exposure.
The third paper assesses the feasibility of using hospital administrative records for understanding air pollution health effects on pregnancy outcomes in Accra. This evaluation addresses whether: (i) the available health administrative data can be used to assess PM pollution-related adverse pregnancy outcomes, in particular birth weight; (ii) the health administrative structure and data can be used in the design of follow-up studies in such settings; (iii) the number of births that occur in the city would provide a large enough sample size; and (iv) birth weight distribution in such complex source-pollution environments varies substantially across neighhorhoods. There are six health districts in the Accra metropolis. In addition to other government and private facilities, each district is served by a Government polyclinic, where maternal and child health records in the district are collated. Neonatal and maternal health records, including anthropometric and demographic information are primarily kept by the individual women in cards provided by the Ghana Health Services. There are an estimated 10,000 births annually in each district. The average birth weight across selected facilities was 3,167±458 g, with individual birth weights ranging from 1,200 g to 6,000 g. Mean birth weight was similar across polyclinics. More than 95% of expectant mothers received at least 4 antenatal care visits at a health facility. Child immunization for the full range of vaccines covers over 80% of children born in the metropolis. A retrospective study of the association of air pollution exposure and birth weight in Accra through the use of hospital administrative records is feasible provided mothers are targeted through the public health units, which is responsible for child immunization.Environmental Health
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Domapielle, Maximillian K. "Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.
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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.
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Jonah, Coretta Maame Panyin. "Spatial dimensions of health inequities in a decentralised system: evidence from Ghana." University of the Western Cape, 2014. http://hdl.handle.net/11394/4295.
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Philosophiae Doctor - PhDDecentralisation has been considered by many as one of the most important strategies in public sector reform in several of the developing countries. Both donors and governments have regarded decentralisation as a tool for national development through the realisation of the objectives of enhancing popular participation in development and the management of development at the regional or local level. Countries are expected to reap the benefits of decentralisation through improved service delivery, namely, through bringing service delivery closer to the consumers, improving the responsiveness of the central government to public demands and,thereby,reducing poverty and inequalities, improving the efficiency and quality of the public services and empowering lower levels of government to feel more involved and in control. However, decentralisation also has the potential to widen the gap in fiscal resources at the sub-national leveland this may, in turn, result in inequities in service delivery tocitizens of the same countryanddepending on where they live. Over the years Ghana has experimented with amix of decentralisation reforms with the current policy integrating elements of political, administrative and economic decentralisation. The current system of local government in Ghana is based on a decentralisation programme that was launched in 1988 with the introduction of district assemblies (DAs) by the Provisional National Defence Council (PNDC) government. Nevertheless, years after the launch of the decentralisation process there are still significant disparities and inequities between districts and regions in Ghana as regards health variables. This study set out to investigate the link between decentralisation and health inequities by exploring the spatial dimensions of health equities in Ghana. The thesis used a concurrent mixed method approach by combining a quantitative inequality indices analysis and a qualitative analysis of interviews with policy makers in both the health sector and the decentralised system. The analysis used household level data from the Ghana Demographic and Health Survey 2003 and 2008 to construct inequality curves and indices in order to illustrate the existing inequities across and within regions in Ghana after an increase in the intensity of decentralisation. The study then decomposed the indices to determine the extent to which these inequities were accounted for by variations both within the regions and between the regions. The thesis also used available data from the common fund records of district assemblies to assess the level of inequities in selected health resources across districts. The thesis then investigated the micro-foundations of health decentralisation using the qualitative and quantitative descriptive analyses. The analysis conducted revealed that inequities in maternal health utilisation decreased between 2003 and 2008‒the two data points used based on theresearch design. However,these inequities were attributed primarily to within region inequities as the level of between regions inequities was significantly lower for both the concentration index and the Theil’s index. However, although, at the regional level the general trend revealed that inequities had also decreasedbetween 2003 and 2008, some individual region s had recorded increases. The concentration index, which provided information on the gradient of the inequities, revealed that the health inequities in Ghana‒the total health inequities and also for both years between and within regions‒were pro rich. In the instances of the regional inequities these inequities generally manifested a pro rich nature, with the exception of the Upper East region which had showed pro poor inequities in 2008. The analysis of the district level inequities in selected health resources and as regards health facilities, doctors and nurses indicated that the distribution of these facilities favoured the richer districts as the inequities revealed a pro rich gradient. The inequities in the health facilities at the district level were highest in respect of the nurses, followed by doctors and health facilities with scores of 0.32, 0.29 and 0.084 respectively. The analysis of the qualitative data corroborated the results of the quantitative analysis as it emerged that policy makers at all levels believed that, over the years since the decentralisation, inequities had reduced, albeit marginally. The policy makers highlighted the high levels of the inequities in health resources,especially human resources,as a major area of concern. However, they also raised major concerns regarding inequities within regions, arguing that a number of factors, includingthe nature of the decentralisation regime in Ghana, the variations in the economic strength of districts and certain political factors,continued to cause inequities within the decentralised system. They argued that these factors impacted on the ability of both districts and regions to address inequities at a local level. In addition, they also pointed to the need to re-examine the definition of inequities in the Ghana health sector, inequities which result from focusing the attention on a number of regions and areas to the detriment of others.
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Oduro, Georgina Yaa. "Gender relations, sexuality and HIV/AIDS education : a study of Ghanaian youth cultures." Thesis, University of Cambridge, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609013.
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Hill, Emilie. "Master of Public Health Research Project: Unmarried Women in Ghana, Africa: Predictors of Condom Use- An Analysis of the 2008 Ghana Demographic and Health Survey/Questionnaire Database." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2069.
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Background: Many factors affect whether women will insist that their sexual partners use a condom. This research project will identify some of the predictors of condom use among unmarried women in Ghana, Africa. Methods: This research project evaluated data from the 2008 DHS of women in Ghana, Africa for predictors of condom use among unmarried women. A total of 4,916 women completed the surveys. Of these, 1,966 women were unmarried. The research project employed multiple logistic regression analysis to determine condom use predictors at the time of the last sexual encounter for these 1,966 unmarried women. Results: Women with a secondary education or beyond were 3.2 (95% CI=2-5.2) times more likely to have insisted on the use of a condom than women with a primary education or less. Women ages 15-24 were 5.3 (95% CI=2.5-11.3) times more likely to have insisted on the use of a condom than women ages 35-49. Women ages 25-34 were not significantly different than the women ages 35-49. Women living in an urban area were 1.8 (95% CI=1.3-2.5) times more likely to have insisted on the use of a condom than women living in a rural area. Women with a higher level of literacy (could read a full sentence) were 3.6 (95% CI=2.5-5.1) times more likely to have insisted on the use of a condom than women with a lower level of literacy (were unable to read a full sentence). And in concert, women who read a newspaper or a magazine once a week or more were 2.4 (95% CI=1.6-3.5) times more likely to have insisted on the use of a condom than women who read a news paper or a magazine less than once a week. Similarly, women who watched television once a week or more were 2.9 (95%CI= 1.9-4.3) times more likely to have insisted on the use of a condom than women who watched less than once a week. Women who were determined to have “excellent” knowledge about HIV were 5.8 (95% CI=1.5-22.3) times more likely to have insisted on the use of a condom than women who were determined to have “fair or poor” knowledge. The results for women with a “good” knowledge were not significantly different than for those with “fair or poor” knowledge. Women who were determined, through a series of questions about wife beating, to have a low tolerance for abuse towards women (“strong” attitude about domestic violence/women’s rights) were 1.8 (95% CI=1.2-2.7) times more likely to have insisted on the use of a condom than women who were determined to have a high tolerance for abuse towards women (“poor” attitude about domestic violence/women’s rights). Results for women with a “fair” attitude were not significantly different from those with a “poor” attitude. Total life time sexual partners, frequency of listening to the radio, and interestingly, access to condoms did not significantly affect condom use. After multivariate adjustment, the significant predictors of condom use at the time of last sexual encounter were age, literacy, and amount of television watched. The results were: women age 15-24 (compared to women ages 35-49), women who could read a full sentence, and women who watched television once a week or more were 3.7 (95% CI=1.7-8.1), 2.1 (95% CI=1.4-3.3), and 1.8 (95% CI=1.2-2.8) times more likely to have insisted on the use of a condom during their last sexual encounter, respectively. Conclusion: Education, age, locality, literacy, media exposure (through reading the news paper or a magazine and watching television), knowledge about HIV, and attitude about domestic were predictors of condom use by the sexual partner of unmarried Ghanaian women at the time of last sexual encounter. After multivariate adjustment, only age, literacy, and amount of television watched were significant predictors of condom use at the time of the last sexual encounter.
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Kutufam, Doreen Vivian. "Gendering of health communication campaigns in Ghana cultural relevancy and social identity /." Related electronic resource:, 2007. http://proquest.umi.com/pqdweb?did=1375538411&sid=1&Fmt=2&clientId=3739&RQT=309&VName=PQD.
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Basley, Anthony A. "Selection of medical laboratory and clinical locations in Ghana using decision modeling." Online version, 2009. http://www.uwstout.edu/lib/thesis/2009/2009basleya.pdf.
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Asante, Augustine Danso Public Health & Community Medicine Faculty of Medicine UNSW. "Has resource allocation policy change improved equity? lessons from Ghana." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/23381.
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Equitable allocation of health care resources is crucial for promoting health equity. Since the emergence of the resource allocation working party (RAWP) formula nearly three decades ago, many countries have implemented resource allocation policy reforms aiming to improve equity. Little is known about whether, how and the extent to which, most of these policies have actually improved equity. This study examined whether, and the extent to which, decentralisation of health resource allocation decision-making in Ghana has improved equity in funding within regions and explored the factors that influenced the equitable allocation of resources for health care in Ghana. The study used a mixture of quantitative and qualitative methods. Two of the ten regions in Ghana: Ashanti and Northern, covering the southern and northern sectors of the country, were purposefully selected. Principal component analysis (PCA) was used to measure levels of relative deprivation of districts applied as a proxy of need. An equity-adjusted share index (EAS) was developed and used as a yardstick against which equity in funding was assessed. Factors influencing the equitable allocation of resources were explored qualitatively through open-ended interviews with policy makers and other health sector stakeholders. The study found that resource allocation in the Ashanti and Northern Regions were largely inequitable, in terms of differentially benefiting the most disadvantaged districts. The proportion of variance in the actual share of funds that could be explained by the predicted EAS was below 50% for all the years examined, except for the allocation of government funds to the Ashanti Region for 1999, where the proportion of variance was 56%. Resource allocation in the Northern Region favoured three urban districts over their rural counterparts. However, in the Ashanti Region, there was a significant shift in resources from richer to poorer districts from 2000 to 2002. The Kumasi Metro district, for example, saw its share of donor-pooled funds reduced drastically from 20% of the total budget in 2000 to 7.2% in 2001 and 5.6% in 2002. Key factors influencing resource allocation and equity included low funding of the health system, local capacity to utilise funds efficiently, manpower availability, politics, donor influence and the nature of collaboration with the local government. The study concluded that intra-regional resource allocation in Ghana???s Ashanti and Northern regions was less equitable than expected, despite efforts to redistribute funds. It recommended more effective mechanisms for promoting equity through intra-regional resource allocation in Ghana.
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Kuganab-Lem, Robert Bella. "An empirical analysis of the National Health Insurance policy process in Ghana." Thesis, Keele University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487304.
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Principles of equity of access to health care of individual citizens in need are internal iuaIl health systems and most developing economies are preoccupied with reforming , their health policies to achieve this. Ghana brought in fee for service, a cost recovery system at the behest of the IMP. .This system it Was later observed, rather perpetuated inequities and inequalities in health care access and outcomes.
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Asabir, Kwesi. "International Migration of skilled health professionals from Ghana : Impact and policy responses." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.508815.
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Hushie, Martin. "Sustainability of health sector non-governmental organisations in Ghana : an institutional perspective." Thesis, Keele University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499353.
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Despite the increasing role and prominence of NGOs in the health and social development sectors of many countries, their effectiveness and sustainability, especially in the developing world, has not been clearly understood. The implementation of various social, political, economic and market-based health reforms, particularly from the 1980s onwards, has been cited as the major factor influencing their effectiveness. This thesis proposes that organisational theory provides a useful framework and a set of insights for understanding the behaviour of health care organisations.
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Walker, Benjamin Bronnert. "Reframing international health and development : medical mission in Ghana, c.1919-1983." Thesis, University of York, 2018. http://etheses.whiterose.ac.uk/22059/.
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In analysing medical mission in Ghana this thesis argues for a new historical framework for twentieth-century international health which is not determined by the Cold War, the postwar growth of the international community or by imperial powers working in their former colonies. Instead, this thesis shows how the emergence and growth of national and international health in the Gold Coast (Ghana from 1957) between 1919 and 1983 was formed substantially through the local and global interests, funding and denominational cultures of medical mission.
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Dare, Shadrach. "A multilevel mixed methods study of neonatal mortality in Ghana." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30943/.
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Background: Reducing neonatal mortality rates [NMR] (deaths/1,000 live births within 28 days of delivery) is a key global health goal. Using comparable data from Ghana (West Africa) and Scotland, I investigated NMR, specific causes of death and risk factors in the two countries. By identifying the main causes of excess mortality in Ghana and where they occur, it is hoped more effective strategies can be developed. Methods: This thesis used a multilevel mixed methods study design. Data on live births were obtained from three Health and Demographic Surveillance Systems (HDSS) in the north, middle and south of Ghana respectively: Navrongo (2004-12; 17,016 live births, 320 deaths); Kintampo (2005-10; 11,207 live births, 140 deaths); Dodowa (2006-14; 21,647 live births, 135 deaths). Comparable Scottish data were obtained from the Information Services Division (1992 to 2015; 1,278,846 live births, 2,783 deaths). Each dataset was analysed by neonatal death (dead/alive), using univariate and multivariable logistic regression. The multivariable analyses adjusted for maternal demographic and obstetric characteristics. Missing data were analysed using multiple imputation techniques. Data analyses were complemented by a researcher-developed questionnaire survey of 71 maternity care providers in the three regions of Ghana followed by face-to-face in-depth interviews with 48 maternity care providers who had experience of prematurity, birth asphyxia, neonatal infection and neonatal death. Results: The NMRs in the three HDSS were: Navrongo: 18.8; Kintampo: 12.5; and Dodowa 6.2 and in Scotland it was 2.2; the NMR in both countries is reducing. More than 99% of the neonatal deaths in Scotland occurred in the first week compared to 74% in Ghana. The leading causes of neonatal deaths (NMR) in Ghana were infection (4.3), asphyxia (3.7) and prematurity (2.2). In Scotland, they were congenital malformations (0.6), asphyxia (0.4) and prematurity (0.3). Only 88 deaths (0.07) of neonatal deaths in Scotland were due to infection. Ninety-eight percent of babies born in Scotland were born in a health facility compared to 60% of babies born in Ghana (hospital: 38.1%; clinic: 21.1%). In Ghana, babies born in hospitals had a higher risk of neonatal mortality compared to those born at home (NMR-hospital: 15.6; clinic: 7.1; home: 11.8). Most of the neonatal deaths in Ghana occurred at home (54%); there were more deaths among babies who were born in a hospital but died at home (hosp/home) compared to those born at home but died in a hospital (home/hosp). Asphyxia was the leading cause of death among hosp/hosp, and infection was the leading cause of death among hosp/home, home/home and home/hosp. Neonatal mortality in Ghana was largely influenced by where mothers sought maternity service, or the type of personnel who provided maternity care service. Mothers and babies who were cared for in hospitals by doctors and midwives received relatively better care and proper management of birth complications. Those who were cared for in clinics received basic delivery services and management of uncomplicated asphyxia. Mothers and babies who were cared for at home by traditional birth attendants (TBA) received poor care and poor management of neonatal illnesses based on traditional approaches which increased the risk of death. Women’s maternity choices were influenced by wider societal factors including prominent cultural values, family hierarchical structures and the cost of maternity services, and individual/ family factors including place of residence and availability of transport and beliefs about the cause of disease. Conclusion: There is considerable opportunity for reducing NMR in Ghana, especially deaths due to asphyxia and infections. Most uncomplicated deliveries should be performed by midwives in community clinics. The number of community maternity clinics should gradually be increased to enable home deliveries by TBAs to be phased out. Facilities should be improved for delivery and postnatal care in hospitals and the proportion of sick babies managed by health care workers trained in their care should be increased. Regular postnatal checks in the community by trained staff should be standard.
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Dalaba, Maxwell Ayindenaba. "Impact of National Health Insurance on health seeking behavior in the Kassena-Nankana district of Northern Ghana." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/9391.
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Includes bibliographical references.The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 with the aim of mobilizing additional funds for health care, promoting equal access to reasonable health care, pool health risks, prevent impoverishment, and improve the efficiency and quality of health care. The success of the NHIS in improving access to health care since its implementation and the extent to which it has impacted on health seeking behaviour has not been extensively investigated. This study examines health-seeking behaviours of insured and uninsured households on the mutual health insurance scheme on health care access in the Kassena-Nankana District (KND) of northern Ghana and to determine the factors that influence household decision to enrol into the NHIS. The study is a cross sectional survey of 422 household heads randomly selected to represent rural, peri-urban and urban zones of KND. Data was analysed using STATA version 8.0. A binary logit model was used to determine factors that predict household enrolment into the NHIS. The choice of a particular type of provider with multiple outcomes was analysed using a multinomial logit model. Results showed that 72% of household heads were males and the average age was 51 years. Out of the 422 respondents, 64% were insured. Household heads of age 40 years and above, being a female household head, being married, and economic wealth positively influenced enrolment into the national health insurance scheme. Seventy four percent (74%) of the ill among the insured and 48% among uninsured sought care from public facilities while 14% among the insured and 8% among uninsured sought care from private facility. Also, self treatment among the insured was 13% and 44% among uninsured households. Results also showed that being a member of NHIS and being moderately or severely ill were associated with public health facility utilization. Household heads of 60 years or older was negatively associated with use of public health facilities. Similarly, a household that was insured, being a Muslim and the severity of illness of household member were positively associated with the use of private health care. The findings showed that the insured were more likely to use formal care providers than the uninsured. This implies that the NHI in the KND has improved the health seeking behaviour from the hitherto use of informal providers and self treatment to preferred use of formal providers.
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Denton, Curtis James. "Estimating Buruli Ulcer Prevalence in Southwestern Ghana." Thesis, University of North Texas, 2007. https://digital.library.unt.edu/ark:/67531/metadc3981/.
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Mycobacterium ulcerans is sweeping across sub-Saharan Africa, but little is known about the mode of transmission and its natural reservoirs. Since the only effective treatment is excision of the infection and surrounding tissue, early diagnosis and treatment is the only way to reduce the havoc associated with Buruli ulcer. Using data from a national case search survey conducted in Ghana during 2000 and suspected risk factors this study tests the hypothesized factors and probes the challenges of developing a spatial epidemiological regression model to explain Buruli ulcer prevalence in the southwestern region of Ghana representing 42 districts. Results suggest that prevalence is directly related to the degree of land cover classified as soil, elevation differential, and percent rural population of the area.
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Amuah, Ida Dawsome. "The Effect of Income on Stroke Recovery in Urban Ghana." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7585.
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Stroke recovery is a crucial public health issue in Ghana due to the high rate of mortality and morbidity associated with stroke. The significant role income plays in the onset of stroke has been empirically proven using quantitative research. However, the in-depth insights on the role income plays in stroke recovery are less known and less appreciated, particularly, in middle-income countries such as Ghana. The phenomenological study was purposed to provide in-depth insight into the effect which might exist between income earned by Ghanaian-families and stroke recovery. The theoretical framework underlining this qualitative study was a combination of the Dahlgren-Whitehead Rainbow model and the Ecological model. The research questions were a guide to uncover the perceptions and opinions of stroke survivors on income and environmental risks associated with stroke recovery in Ghana. Using purposive sampling approach, 15 survivors of stroke were interviewed. Data were coded using the Nvivo software package and analyzed thematically. The results revealed that income influences the choice of residence of stroke patients and this increases their exposure to environmental risk which in turn prolongs stroke recovery. Furthermore, the income level of stroke patients influenced their ability to access healthcare delivery thus, receiving medical attention, buying prescribed medication and access to physiotherapy. Positive social change may be benefited through insights provided by this study to affect policy changes in healthcare delivery systems. Thus, incorporating environmental risk issues and income strategies into intervention programs during stroke recovery.
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Sakyi-Addo, Isaac. "Traditional Medicine: a Blessing or Bane? The Case of Ghana." Thesis, University of North Texas, 1996. https://digital.library.unt.edu/ark:/67531/metadc278656/.
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The study examines the socio-demographic characteristics of Traditional Medical Practitioners in Ghana. Their attitudes towards collaboration with biomedical practitioners, their associations, and regulation is also discussed. Data for the study was obtained from a Survey of Traditional Medical Practitioners in Ghana.
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Garshong, Bertha. "Benefit incidence of health services in Ghana and access factors influencing benefit distribution." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/9453.
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Includes bibliographical references (leaves 204-214).Universal coverage is built around financial protection and access to needed care for all members of the society. The main focus in many countries, including Ghana, has been on financial protection. However removing financial barriers does not necessarily remove other access barriers to the use of health care services. The extent to which a population gains access to health care depends on a multiplicity of factors. The study investigated the distribution of health care benefits across socioeconomic groups, assessed if these benefits are distributed according to need and identified health system and community access factors that influence the distribution of benefits from using health care services in Ghana, in order to identify policy options for promoting equitable access to and use of health services in Ghana.
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Arhinful, Daniel Kojo. "The solidarity of self-interest social and cultural feasibility of rural health insurance in Ghana /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2003. http://dare.uva.nl/document/71020.
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Akweongo, Patricia. "Willingness and ability to pay for insecticide : treated nets in Northern Ghana." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/9059.
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Bibliography: leaves 103-111.Insecticide treated nets (ITNs) are a highly cost-effective tool in malaria control and has been associated with reductions in morbidity and mortality in children. Even though their efficacy has been established, the success of their use as a malaria control tool depends on their effective implementation and sustainability. The purpose of this study was to assess factors that would impact on household willingness and ability to pay for insecticide treated nets in the Bolgatanga district of Northern Ghana to provide insights into the sustainability of this tool. The paper presents the results of a survey of 876 household heads from both the rural and urban areas of the district. The survey questionnaire was designed to obtain information on perceived causes of malaria, health seeking behaviour, use of mosquito control products, consumption expenditure, income, possession of assets and demographic characteristics of the sample population. The contingent valuation method was used to elicit households stated willingness to pay for ITNS. The survey data was complemented by focus group discussions. Expressed willingness to pay for ITNs was as high as 92% but current usage of untreated bed nets among respondents was only 17%. The main reasons cited for low usage of nets were lack of ready cash, cost of nets and non availability. Mean maximum willingness to pay was 9120.00 cedis (US$3.8) which is lower than the current factory price of 13200.00 cedis (US$5.5). Willingness to pay was strongly determined by household size, the type of payment mechanism available, the use of untreated nets and possession of radio. Households are also more concerned about acquiring nets for the whole family rather than for the protection of the child. The lack of ready cash coupled with the percentage of income that poor households will require to buy insecticide treated nets will be an obstacle to net use. Poor households will require about 4.5% of total annual expenditure to be able to acquire an average of three nets adequate for the family at the expressed mean willingness to pay. At the present factory price they will need 6.6% to be able to buy three nets on average for family use compared to 1.5% from higher income earners. Inability to purchase nets for cash was also shown by the number of households willing to pay on an instalment basis. About 56% of households were willing to pay on credit basis against 18% that wanted to pay cash. Maximum willingness to pay was also higher among households willing to pay on a credit basis than for households willing to pay cash. Research into the feasibility of different payment schemes in local communities is very critical if this tool for malaria control is to be expanded and sustained. The feasibility of different financing mechanisms would not only reduce the initial cost of buying insecticide treated nets to households but would also increase willingness to pay and make payments for re-impregnation much easier. Research into how to protect the very poor and vulnerable should also be a focus in the promotion and use of ITNs.
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Alatinga, Kennedy A. "Poverty and access to health care in Ghana: the challenge of bridging the equity gap with health insurance." Thesis, University of the Western Cape, 2014. http://hdl.handle.net/11394/3852.
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Philosophiae Doctor - PhDThis study addresses the issue of the low participation in or enrolment of the poor in Ghana’s National Health Insurance Scheme (NHIS). The low enrolment of the poor in the NHIS is attributed to the difficulty in identifying who qualifies for exemptions from paying health insurance premiums. In an attempt to address this problem, the purpose of this study was, therefore, to develop a model for identifying very poor households for health insurance premium exemptions in the Kassena-Nankana District of Northern Ghana in an effort to increase their access to equitable health care