Browsing by Subject "Ghana"

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    Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector
    (BioMed Central Ltd, 2012) Abiiro, Gilbert; McIntyre, Di
    BACKGROUND: Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP) policy in Ghana.DISCUSSION:Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing), as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems.SUMMARY:The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It is critical that there is more extensive debate on the advantages and disadvantages of alternative funding mechanisms, supported by a solid evidence base, and with the policy objective of universal coverage providing the guiding light.
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    Age Estimate of GJB2-p.(Arg143Trp) Founder Variant in Hearing Impairment in Ghana, Suggests Multiple Independent Origins across Populations
    (2022-03-21) Aboagye, Elvis Twumasi; Adadey, Samuel Mawuli; Esoh, Kevin; Jonas, Mario; de Kock, Carmen; Amenga-Etego, Lucas; Awandare, Gordon A; Wonkam, Ambroise
    Gap junction protein beta 2 (GJB2) (connexin 26) variants are commonly implicated in non-syndromic hearing impairment (NSHI). In Ghana, the GJB2 variant p.(Arg143Trp) is the largest contributor to NSHI and has a reported prevalence of 25.9% in affected multiplex families. To date, in the African continent, GJB2-p.(Arg143Trp) has only been reported in Ghana. Using wholeexome sequencing data from 32 individuals from 16 families segregating NSHI, and 38 unrelated hearing controls with the same ethnolinguistic background, we investigated the date and origin of p.(Arg143Trp) in Ghana using linked markers. With a Bayesian linkage disequilibrium gene mapping method, we estimated GJB2-p.(Arg143Trp) to have originated about 9625 years (385 generations) ago in Ghana. A haplotype analysis comparing data extracted from Ghanaians and those from the 1000 Genomes project revealed that GJB2-p.(Arg143Trp) is carried on different haplotype backgrounds in Ghanaian and Japanese populations, as well as among populations of European ancestry, lending further support to the multiple independent origins of the variant. In addition, we found substantial haplotype conservation in the genetic background of Ghanaian individuals with biallelic GJB2- p.(Arg143Trp) compared to the GJB2-p.(Arg143Trp)-negative group with normal hearing from Ghana, suggesting a strong evolutionary constraint in this genomic region in Ghanaian populations that are homozygous for GJB2-p.(Arg143Trp). The present study evaluates the age of GJB2-p.(Arg143Trp) at 9625 years and supports the multiple independent origins of this variant in the global population.
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    Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
    (BioMed Central, 2017-05-22) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
    Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.
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    Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
    (2017) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
    BACKGROUND: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana's national health insurance scheme. METHODS: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen's parade of "dwarfs and a few giants" is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. RESULTS: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. CONCLUSION: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana's national health insurance scheme on impoverishment due to OOP healthcare payments.
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    An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
    (BioMed Central Ltd, 2011) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, Alan
    BACKGROUND: Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. METHODS: The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. RESULTS: All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. CONCLUSIONS: Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
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    Cardiovascular risk status of Afro-origin populations across the spectrum of economic development: findings from the Modeling the Epidemiologic Transition Study
    (2017) Dugas, Lara R; Forrester, Terrence E; Plange-Rhule, Jacob; Bovet, Pascal; Lambert, Estelle V; Durazo-Arvizu, Ramon A; Cao, Guichan; Cooper, Richard S; Khatib, Rasha; Tonino, Laura; Riesen, Walter; Korte, Wolfgang; Kliethermes, Stephanie; Luke, Amy
    Abstract Background Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa. Methods In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25–45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described. Results The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score. Conclusions These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event.
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    Contestations and conflicts over land access between smallholder settler farmers and nomadic Fulani cattle herdsmen in the Kwahu Afram Plains South District, Ghana
    (2022) Otu, Bernard Okoampah; Chitonge, Horman
    The study examines the contestations and conflicts over land access between smallholder settler farmers and nomadic cattle herders in the Kwahu Afram Plains South District. Current studies on the farmer-herder conflict in Ghana have emphasised the conflict between indigenous farmers and nomadic herders. This study has contributed to existing knowledge by highlighting the conflict between two migrant groups. As migrants, both settler farmers and nomadic herders are renting land and, in the process, come into conflict. The tension in the area is that both migrant groups have no ownership of land, which exposes their vulnerability to the landowners in the sense that they have no firm land rights. The study's main objective is to examine the root causes of the conflict between crop farmers and nomadic herders in the case study area of the Afram Plains. The environmental scarcity and political ecology theories were utilised to analyse the conflict in the study area. The study adopted the qualitative approach with the purposive and snowball sampling methods used to select participants for the research. The study's findings reveal that increasing land scarcity due to population growth, climate-induced migration, and large-scale land acquisition is a major cause of the land conflict. The study further reveals that, aside from the core issues leading to land scarcity, what instantly ignites conflict between farmers and herders includes crop destruction, burning of grasses, and alleged vices perpetrated by the herders. The findings of the study also reveal that the mitigation measures put in place to address the conflict have been ineffective because of corruption, poor land governance, and greedy chiefs. The study concludes that the farmer-herder conflict is complex and needs to be examined from diverse perspectives to appreciate the nuances of the conflict.
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    Energy Sector Reform and the Poor: Energy Use and Supply: a Four Country Study: Botswana, Ghana, Honduras & Senegal (ESMAP)
    (2006-03) Prasad, Gisela
    The Energy Sector Management Assistance Program (ESMAP) is a global technical assistance partnership administered by the World Bank and sponsored by bi-lateral official donors, since 1983. ESMAP's mission is to promote the role of energy in poverty reduction and economic growth in an environmentally responsible manner. Its work applies to low-income, emerging, and transition economies and contributes to the achievement of internationally agreed development goals. ESMAP interventions are knowledge products including free technical assistance, specific studies, advisory services, pilot projects, knowledge generation and dissemination, trainings, workshops and seminars, conferences and roundtables, and publications. ESMAP work is focused on four key thematic programs: energy security, renewable energy, energy-poverty and market efficiency and governance.
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    Essays on child labour and schooling in Ghana
    (2018) Ayifah, Rebecca Nana Yaa; Piraino, Patrizio
    This thesis consists of three papers on child labour and schooling in Ghana. The first paper examines the correlates of child labour and schooling, as well as the trade-off between work and schooling of children aged 5-17 years with the 2013 Ghana Living Standard Survey data. A bivariate probit model is used since the decisions to participate in schooling and in the labour market are interdependent. The results show that there is a gender gap both in child work and schooling. In particular, boys are less likely to work (and more likely to be enrolled in schools) relative to girls. Whereas parent education, household wealth and income of the family are negatively correlated with child work, these factors influence schooling positively. In addition, parents‟ employment status, ownership of livestock, distance to school, child wage and schooling expenditure increase the probability of child labour and reduce the likelihood of school enrolment. In terms of the relationship between child labour and schooling, the results show that an additional hour of child labour is associated with 0.15 hour (9 minutes) reduction in daily hours of school attendance; and the effect is bigger for girls relative to boys. Also, one more hour of child labour is associated with an increase in the probability of a child falling behind in grade progression by 1.4 percentage points. The second paper estimates the impact of Ghana’s Livelihood Empowerment Against Poverty (LEAP) cash transfer programme on schooling outcomes (enrolment, attendance hours, repetition and test scores) and child labour in farming and non-farm enterprises. Using longitudinal data, the paper employs three different quasi-experimental methods (propensity score matching, difference-in-difference, and difference-in-difference combined with matching). Overall, the results show that the LEAP programme had no effect on school enrolment and test scores, but it increased the weekly hours of class attendance by 5.2 hours and reduced repetition rate by 11 percentage points for children in households that benefited from the programme. In addition, there was heterogeneity in these impacts, with boys benefiting more relative to girls. In terms of child labour, the results show that the programme had no effect on the extensive margin of child labour in farming and non-farm enterprises. However, the LEAP programme reduced the intensity of farm work done by children by as much as 2.6 hours per day. The largest impact of the programme, in terms of iii reduction in the intensity of child labour in farming, occurred in female-headed and extremely poor households. The last paper investigates the impact of mothers‟ autonomy or bargaining power in the household on their children’s schooling and child labour in Ghana. The paper uses a noneconomic measure of women’[s autonomy, which is an index constructed from five questions on power relations between men and women. The paper employs both an Ordinary Least Square (OLS) and an Instrumental Variable (IV) approach. Overall, the results suggest that ignoring the endogeneity of mothers‟ autonomy underestimates its true impact on schooling and child labour. They also show that an increase in mothers‟ autonomy increases school enrolment and hours of class attendance, with girls benefiting more than boys. The paper finds a negative relationship between mothers‟ autonomy and both the extensive and intensive margin of child labour. In addition, it demonstrates that improvement in women’s autonomy has bigger impacts on rural children’s welfare relative to urban children.
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    Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response
    (2020-06-01) Shretta, Rima; Silal, Sheetal P; Malm, Keziah; Mohammed, Wahjib; Narh, Joel; Piccinini, Danielle; Bertram, Kathryn; Rockwood, Jessica; Lynch, Matt
    Background Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005 and 2015. These gains have been facilitated in part, due to increased financial commitment from government and donors. Total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million in 2011. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential donor requirements for increased government contributions. The resulting financial gap will need to be met domestically. The purpose of this study was to provide economic evidence of the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization. Methods A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios of common interventions that allowed the attainment of elimination and those that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option. Results Elimination was predicted using the package of interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana is predicted to cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced health system expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Reducing interventions, predicted an additional 38.2 clinical cases, 2500 deaths and additional economic losses of USD 14.1 billion. Conclusions Malaria elimination provides robust epidemiological and economic benefits, however, sustained financing is need to accelerate the gains in Ghana. Although government financing has increased in the past decade, the amount is less than 25% of the total malaria financing. The evidence generated by this study can be used to develop a robust domestic strategy to overcome the financial barriers to achieving malaria elimination in Ghana.
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    Ethical issues in genomic research on the African continent: experiences and challenges to ethics review committees
    (2014-08-21) Ramsay, Michèle; de Vries, Jantina; Soodyall, Himla; Norris, Shane A; Sankoh, Osman
    Abstract This is a report on a workshop titled ‘Ethics for genomic research across five African countries: Guidelines, experiences and challenges’, University of the Witwatersrand, Johannesburg, South Africa, 10 and 11 December 2012. The workshop was hosted by the Wits-INDEPTH partnership, AWI-Gen, as part of the H3Africa Consortium.
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    Integrating land administration systems in peri-urban customary areas in Ghana
    (2018) Obeng, Williams; Whittal, Jennifer; Mostert, Hanri
    Dual land administration systems operate in many peri-urban customary areas in subSaharan Africa (Burns, 2007), yet the rationality behind them is different, and possibly conflicting (Watson, 2003). The conflicting rationalities between the dual systems have created binaries in land administration discourse. Some scholars have promoted statutory land administration systems over customary systems (Hardin, 1968). Many pre-21st century land administration systems theories were purely economy-based, and sought to discredit customary land administration and tenure systems (De Soto, 2000; Peters, 2009). The weaknesses of customary land administration and tenure systems have been widely articulated in economy-based land administration literature (Demsetz,1967). However, recent research findings seem to suggest that peri-urban customary land management could improve through hybrid land administration, incorporating both customary and statutory systems (Whittal, 2014). In this study, statutory and customary land administration systems are examined to understand how they can be integrated to improve effective land delivery at the peri-urban interface in Ghana. A case study analysis of hybrid forms of land administration was undertaken, using both primary and secondary data. Relatively successful case studies (from Ghana and other parts of sub-Saharan Africa) were deliberately chosen to learn good ways of managing peri-urban customary land. Land administration practices in such areas were assessed using the good land governance framework. The case study analysis reveals that hybrid land administration systems are appropriate in enhancing livelihood sustainability and tenure security of the local people. To this end, the study proposes some improvements in hybrid land administration practices to reduce conflicting rationalities between customary and statutory land administration systems.
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    Linkages in Ghana's gold mining industry: challenging the Enclave Thesis
    (Elsevier, 2011) Bloch, Robin; Owusu, George
    By 2009, Ghana was the second-ranked African producer after South Africa, and had become the world’s ninth largest producer of gold, at some 3.8% of global production, up from 2.6% five years earlier. Gold production volumes and revenues rose significantly over the decade from 2000. Yet gold mining tends to be perceived negatively in Ghana, and is seen as providing far less than it should in terms of public revenue, employment, skills development and spillovers, and localised economic development. Gold mining is often depicted as having an enclave status, disconnected and isolated from the rest of the economy. In contrast, the research findings here demonstrate that after a period of strong investment and growth, gold mining can no longer be viewed as an enclave activity: it is in fact more deeply linked into the Ghanaian economy than hitherto understood, through a set of as yet under-researched but promising economic linkages, notably backward linkages, which can potentially be strengthened by policy and support measures.
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    Socioeconomic inequalities in access and use of skilled birth attendants during childbirth in Ghana: a decomposition analysis
    (2021-12-31) Kpodotsi, Aseye; Baku, Elizabeth A.; Adams, Jo H.; Alaba, Olufunke
    Background Equitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana. Methods Research was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities. Results The results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women. Conclusion This study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.
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    The returns to formality and informality in urban Africa
    (Labour Economics, 2015-05-28) Falco, Paulo; Kerr, Andrew; Rankin, Neil; Sandefur, Justin; Teal, Francis
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    Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system
    (BioMed Central, 2018-10-05) Grieve, Annabel; Olivier, Jill
    Background Faith-based non-profit (FBNP) providers have had a long-standing role as non-state, non-profit providers in the Ghanaian health system. They have historically been considered to be important in addressing the inequitable geographical distribution of health services and towards the achievement of universal health coverage (UHC), but in changing contexts, this contribution is being questioned. However, any assessment of contribution is hampered by the lack of basic information about their comparative presence and coverage in the Ghanaian health system. In response, since the 1950s, there have been repeated calls for the ‘mapping’ of faith-based health assets. Methods A historically-focused mixed-methods study was conducted, collecting qualitative and quantitative data and combining geospatial mapping with varied documentary resources (secondary and primary, current and archival). Geospatial maps were developed, providing a visual representation of changes in the spatial footprint of the Ghanaian FBNP health sector. Results The geospatial maps show that FBNPs were originally located in rural remote areas of the country but that this service footprint has evolved over time, in line with changing social, political and economic contexts. Conclusion FBNPs have had a long-standing role in the provision of health services and remain a valuable asset within national health systems in Ghana and sub-Saharan Africa more broadly. Collaboration between the public sector and such non-state providers, drawing on the comparative strengths and resources of FBNPs and focusing on whole system strengthening, is essential for the achievement of UHC.
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    Valuing and sustaining (or not) the ability of volunteer community health workers to deliver integrated community case management in Northern Ghana: A qualitative study
    (Public Library of Science, 2015) Daniels, Karen; Sanders, David; Daviaud, Emmanuelle; Doherty, Tanya
    BACKGROUND: Within the integrated community case management of childhood illnesses (iCCM) programme, the traditional health promotion and prevention role of community health workers (CHWs) has been expanded to treatment. Understanding both the impact and the implementation experience of this expanded role are important. In evaluating UNICEF’s implementation of iCCM, this qualitative case study explores the implementation experience in Ghana. Methods and FINDINGS: Data were collected through a rapid appraisal using focus groups and individual interviews during a field visit in May 2013 to Accra and the Northern Region of Ghana. We sought to understand the experience of iCCM from the perspective of locally based UNICEF staff, their partners, researchers, Ghana health services management staff, CHWs and their supervisors, nurses in health facilities and mothers receiving the service. Our analysis of the findings showed that there is an appreciation both by mothers and by facility level staff for the contribution of CHWs. Appreciation was expressed for the localisation of the treatment of childhood illness, thus saving mothers from the effort and expense of having to seek treatment outside of the village. Despite an overall expression of value for the expanded role of CHWs, we also found that there were problems in supporting and sustaining their efforts. The data showed concern around CHWs being unpaid, poorly supervised, regularly out of stock, lacking in essential equipment and remaining outside the formal health system. CONCLUSIONS: Expanding the roles of CHWs is important and can be valuable, but contextual and health system factors threaten the sustainability of iCCM in Ghana. In this and other implementation sites, policymakers and key donors need to take into account historical lessons from the CHW literature, while exploring innovative and sustainable mechanisms to secure the programme as part of a government owned and government led strategy.
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    Who are you calling obruni? A case study of African American Immigration to Ghana
    (2017) Davis III, Ephious; Swai, Marlon
    This thesis investigated the migration experiences and subjectivity of belonging of Members of the African American Association of Ghana (AAAG) in obtaining permanent status in Ghana. An estimated three thousand African Americans are living in Ghana (Brown, 2013). Fieldwork was conducted primarily in the Greater Accra Region of Ghana with sixteen Research Participants, including members of AAAG and the African American community at large. Life history interviews were conducted utilizing a twenty-one question instrument that guided the data collection. Participant observation and autoethnography was unique to this study as the Researcher himself; an African American, spent two years living in Ghana prior to submitting this thesis. This thesis offers new data and experiences to the ideas surrounding a “return” migration of the descendants of victims of the Transatlantic Slave Trade to Ghana. Attention was given to the experiences of African Americans being referred to by Ghanaians as obruni, which effectively means “white man and/or foreigner” and what impact, if any, it had on my Research Participants. Necessarily, issues of identity, nationhood, race as well as religion/spirituality was explored with this thesis. Pierre Bourdieu’s cultural capital theory was utilized in looking at the interconnections of cultural capital between my Research Participants and what he describes as the embodied state, objectified state and the institutionalized state (Bourdieu, 1986). The results of this thesis are that the experiences of the Research Participants varied regarding the pursuit of permanent status in Ghana. Moreover, the use of the word obruni had various levels of interpretation and use that were expressed.
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    Who pays for health care in Ghana?
    (BioMed Central Ltd, 2011) Akazili, James; Gyapong, John; McIntyre, Diane
    BACKGROUND:Financial 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". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. METHODS: 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 relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. RESULTS: Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. CONCLUSION: For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.