ghanaopendata/ghanaian-research-english huggingface dataset:
Health systems, population and patient challenges for achieving universal health coverage for hypertension in Ghana

Ghana has signed on to the United Nations Sustainable Development Goal to achieve universal health coverage (UHC), ensuring that all individu als receive the health care they require without financial hardship. Achieving that goal is a difficult task in any setting. The challenges are further exacerbated by a changing disease landscape, as the burden of non-communicable diseases (NCDs) is increasing and creating a dual burden along with infectious diseases. This study explores the existing health system for delivering hypertension care and the challenges of delivering UHC for hypertension in Ghana. Document analysis of national health reports, policies and legislations along with a review of research articles was conducted to explore the challenges of delivering UHC for NCDs in Ghana, and hypertension in particular. The main themes and indicators related to the challenges of delivering UHC for hypertension were mapped and analysed. The main challenges to delivering UHC for hypertension can be grouped into population and patient, on the one hand, and health system factors, on the other. Population and patient factors include (1) unhealthy lifestyles overburdening the health system, (2) poor health-seeking behaviour and (3) poor adherence to medication, which has led to uncontrolled cases and poor clinical outcomes even among treated patients with hypertension. Health system factors include (1) inadequate health system capacity for early diagnosis due to an increasing number of patients, (2) inequitable distribution of health care facilities affecting access, (3) finan cial sustainability of the National Health Insurance Scheme and delays in reimbursement of claims to facilities that affect the health system’s ability to provide timely management of hypertension and (4) health care facilities and practitioners’ use of non-standardized and uncalibrated blood pres sure measuring equipment. Ghana therefore will need to make important decisions to overcome operational and financial challenges on its path to UHC.

Source: UG
Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

Background: Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to beneft package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods: We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results: Half of the 49 papers identifed were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of frst authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specifc examples of progress in HTA in SSA. The frst one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions: Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, frmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable fnancing demands evidence-based processes for efective resource allocation, and cata‑ lysing knowledge-sharing opportunities among countries facing similar challenges.

Source: UG
Health worker transfer processes within the public health sector in Ghana: a study of three districts in the Eastern Region

Introduction: The lack of appropriate policies and procedures to ensure transparent transfer practices is an important source of dissatisfaction among health workers in low- and middle-income countries. In order to alter and improve current practices, a more in-depth and context-specific understanding is needed. This study aims to (1) identify rationales behind transfer decisions in Ghana and (2) examine how transfers are managed in practice versus in policies. Methods: The study took place in 2014 in three districts in Eastern Ghana. The study population included (1) national, regional, and district health administrators with decision-making authority in terms of transfer decisions and (2) health workers who had transferred between 2011 and 2014. Data was collected through semi-structured and structured face-to-face interviews focusing on rationales behind transfer decisions, health administrators’ role in managing transfers, and health workers’ experience of transfers. A data triangulation approach was applied to compare identified practices with national policies and procedures. Results: A total of 44 health workers and 21 administrators participated in the study. Transfers initiated by health workers were mostly based on family conditions and preferences to move away from rural areas, while transfers initiated by administrators were based on service requirements, productivity, and performance. The management of transfers was not guided by clear and explicit procedures and thus often depended on the discretion of decision-makers. Moreover, health workers frequently reported not being involved in transfer decision-making processes. We found existing staff perceptions of a non-transparent system. Conclusion: Our findings suggest a need to foster incentives to attract and retain health workers in rural areas. Moreover, health worker-centered procedures and systems that effectively guide and monitor transfer practices must be developed to ensure that transfers are carried out in a timely, fair, and transparent way.

Source: UG
Health workers perceptions and attitude about Ghana's preparedness towards preventing, containing, and managing Ebola Virus Disease

Background: Ebola virus is highly infectious and the disease can be very fatal. The World Health Organization has declared the 2014-2015 Ebola Virus Disease outbreak a Public Health Emergency of International Concern. In response to this, preparations were made in various health facilities and entry points across Ghana. This study explored health workers perceptions, and attitude about Ghana's preparedness towards preventing and containing Ebola Virus Disease. Methods: We conducted a qualitative study in five (5) of the ten (10) regions in Ghana. Five focus group discussions (N = 44) were conducted among nurses; one in each region. In addition, ten (10) health workers (2 in each region) who are members of regional Ebola Virus Disease task force were recruited and interviewed. In the Greater Accra, Volta and Western regions that have ports, six (6) port health officials: two in each of these regions were also interviewed. The interviews were recorded digitally and transcribed verbatim. Thematic content analysis was used to analyze the transcripts with the aid of NVivo 10 software. Results: The results of this study showed that Ghanaian health workers perceived the screening at various ports as important and ongoing but felt that the screenings at in-land ports were being undermined by the use of unapproved routes. Training of health workers was also being carried out in all the regions, however, there was a general perception among 33 out of 44 nurses that majority of health workers have not received training on Ebola Virus Disease prevention and management. Logistical challenges were also reported as some health facilities did not have adequate Personal Protective Equipment. In facilities where equipment was available, they were stored in places which are not easily accessible to health workers at all times of the day. Human resource preparation was also perceived to be a challenge as health workers (38/44 of nurses) generally expressed fear and unwillingness to work in Ebola treatment centres in the event of an outbreak in Ghana. Conclusions: Our study concludes that preparatory work for Ebola Virus Disease prevention and containment in Ghana is perceived as inadequate by health workers. Ghana needs to strengthen preparation in the area of training of health workers, provision and accessibility of Personal Protective Equipment and incentives for health workers to better position her to contain and manage any Ebola Virus Disease outbreak.

Source: UG
Health, healing and religion: An African view

“All sorts and conditions” of third world My invitation was to read a paper on “Health, healing and religion as under- stood and practised in Asian or African cultures”. I have taken the “or” in the assigned topic seriously not only because I am not confident to wax eloquently on Asia but also because of time constraints. However, there is a deeper rea- son: it is not unusual to treat the so-called South, third world or developing world as one block over against the North or first world or developed world. Such efforts tend to miss out on the “all sorts and conditions’’ of the so-called third world, with the result that solutions emerging from such broad general- izations time and again either do not satisfy anyone or prove impracticable in many a third world region. All sorts and conditions of the African Again, homo Aflicanus is a multi-headed hydra. The Caucasians of South Africa and Namibia are as much African as the Bantu Negroes south of the Equator. The former have known no other home but Southern Africa since the 17th and 18th centuries. Into that polysemous, polyphonous, multivocal African in Southern Africa may be thrown Bushmen from the Kalahari, Hot- tentots and Pygmies from Congo Basin, the Negroes of West Africa, Hamitic Negroes of Northern East and East Central Africa and the nowNegroid Hamites of North Africa, and Arabs. This story of multi-headed homo Afiicanus has implications for the cultures and religions of Africa. There are cultures many; and as Tillich and Niebuhr’ argued, culture is the solvent of religion. Because there are many cultures, there are many religions. Even within the one religion, such as Christianity or Islam, there will be cultural additives, which have everything to do with peo- ples’ perspectives and expressions. This, my paper, at best is an African view, and certainly not the African view.

Source: UG
Health-Related Quality of Life of People with Hepatitis B in the Kumasi Metropolis, Ghana.

Hepatitis B viral infection remains a public health threat worldwide. In Ghana, about 12.3% of the adult population live with hepatitis B. The significant impact of hepatitis B on affected individuals and society spanning social and psychological disturbances, economic constraints and mortality is widely reported. Also, a number of studies have documented the extent of knowledge of hepatitis B, psychological challenges faced by people with hepatitis B, and barriers to care and treatment for PWHB in Ghana. What appear to be missing in the literature is the health-related quality of life of people with hepatitis B in Ghana. The purpose of the study was to assess the quality of life of people with hepatitis B accessing formal care at the Komfo Anokye Teaching Hospital in the Kumasi Metropolis, Ghana by using the health-related quality of life model by Wilson and Cleary (1995) and revised by Ferrans, Zerwic, Wilbur, and Larson (2005). A cross-sectional survey was used to recruit 180 people with hepatitis B assessing formal care at the Komfo Anokye Teaching Hospital. Respondents were selected using convenience and quota sampling techniques. Statistical significance was set at .5. The findings indicate that about 75% of the respondent’s quality of life was low. Explicitly, anxiety and depression negatively predicted quality of life but functional well-being and general health perceptions positively predicted the quality of life. Also, functional status and general health perceptions mediated the relationship between anxiety and quality of life. Environmental factors such as income, education and being on antiviral therapy for hepatitis B had major influence and explained 23.6% of the variation in quality of life. From the findings, it is recommended that support groups of people with hepatitis B are formed in the study area to enhance quality of life. Additionally, there is the need for pre-test and post-test counselling of people with hepatitis B in the health delivery system to allay the anxiety and depression that characterise hepatitis B diagnosis by integrating hepatitis B services with the existing HIV structures.

Source: UG
Health-Seeking Behavior of Persons with Chronic Hepatitis B in Peri-Urban Ghana: Application of the Health Belief Model

Sub-Saharan African countries, including Ghana, are disproportionately affected by hepatitis B. In Ghana, the burden of hepatitis B is unevenly distributed, with the Brong Ahafo region having the highest prevalence (13.7%). Given that people with hepatitis B (PWHB) in Ghana have previously been found to have a lack of understanding of the impact of the infection, we sought to explore their health-seeking behaviour using the health belief model as an organising framework. A qualitative exploratory design was used. In total, 18 people were purposively selected for face-to-face interviews. The data was processed and analysed using QSR NVivo version 11.0 and the Braun and Clarke thematic analysis procedure. The belief that hepatitis B can cause liver cancer and death was the most important determinant of health seeking. Furthermore, access to accurate hepatitis B information, particularly information about availability of effective hepatitis B treatment, influenced a number of participants to seek formal care. However, the high cost of clinical monitoring and treatment to use herbal medicine, despite their concerns about the effectiveness of herbal medicines in managing hepatitis B. Given that hepatitis B information was a factor in health seeking, it is recommended that a hepatitis B awareness campaign focusing on the availability of hepatitis B treatment and where it can be obtained be carried out in the study area. Counselling PWHB at the point of diagnosis should highlight the relevance of life-long clinical monitoring. To remove financial barriers to hepatitis B care in Ghana, the government should include the cost of hepatitis B laboratory investigations and treatment in the health insurance scheme.

Source: UG
Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana

Objectives The study explored the health-seeking experiences of women with obstetric fistula from the onset of the condition until surgical treatment was obtained. It also describes their interactions with health staff and traditional healers. Design Exploratory, descriptive qualitative study. Setting Two secondary-level health facilities in the northern and central regions of Ghana; data collection took place in 2018–2019. Participants A purposive sample of 37women who had experienced fistula resulting from childbirth and were awaiting fistula repair at the two fistula centres in Ghana was obtained. Data analysis Thematic analysis was used to analyse the data. Results Health-seeking experiences and behaviours of women with obstetric fistula were identified. Six major themes were generated: attribution and perceptions of fistula; competing alternatives/multiple sources of care; limited awareness and access to care; financial barriers; psychosocial challenges, and abuse by healers. The results indicate that the health-seeking experiences of women with obstetric fistula were characterised by long delays in care-seeking. The major themes and subthemes are presented with quotes from participants. Conclusion The women experienced winding pathways of treatment-seeking due to lack of awareness and incorrect attribution. The major barriers to health-seeking included poverty, challenges with transportation and inadequate repair centres. Increased awareness of obstetric fistula and access to repair centres could shorten the suffering women go through while awaiting fistula treatment. Improved awareness of obstetric fistula and establishment of more fistula centres would be beneficial.

Source: UG
The health-trash nexus in challenging environments: A spatial mixed methods analysis of Accra, Ghana

Increasing urbanization in Ghana has led to a waste management crisis with multiple public health consequences. The contextualized mapping of what is dumped, where and why might provide vital on-the-ground support to address the problem itself as well as the spillover disease impacts. One of the biggest challenges, however, are the required spatial and temporal granular data. In this paper, we employ a spatial mixed methods approach to investigate the issue of waste management through the lens of health and disparity in Teshie, a suburb of Accra, Ghana.

Source: UG
Healthcare branding: Insights from Africa into health service customers’ repeat patronage intentions

The study explores the relationship between branding in healthcare, brand image and customer re-patronage intentions. A survey approach was employed to gather data from 318 outpatients in hospitals in the Accra Metropolis and the data was analysed using factor analysis and regression analysis. The results indicate that the four dimensions of healthcare branding – brand elements, tangibles, medical personnel quality and critical services – predict healthcare brand image and re-patronage intentions. However, brand elements did not predict customer re-patronage intentions; and a strong significant relationship emerged between healthcare brand image and re-patronage intention. The strategic implications of the results for managing branding in hospitals are discussed in the paper.

Source: UG
Healthcare Digitalisation in Ghana: An Assessment Based on the Realist Social Theory

Healthcare digitalisation is one of the technological innovations within the health sector, with prospects to improve the overall performance and quality of health care around the world. The Ghanaian health sector, as in many developing countries, seeks to continuously improve patient care through the use of various healthcare technologies. The extent of digitalisation within the Ghanaian health sector, however, still remains undetermined. Underpinned by critical realism, this study seeks to understand the generative mechanisms of digitalisation in the health sector of Ghana. The study seeks to answer the following research questions: what are the generative mechanisms of digitalisation in the health sector of Ghana? How are the varying degrees of digitalisation interpreted and explained in the empirical world? We draw on the Realist Social Theory which adopts the principles of critical realism to answer the underpinning research questions.

Source: UG
Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana

Understanding the healthcare provider costs of antimicrobial resistance (AMR) in lower-middle-income countries would motivate healthcare facilities to prioritize reducing the AMR burden. This study evaluates the extra length of stay and the associated healthcare provider costs due to AMR to estimate the potential economic benefits of AMR prevention strategies. We combined data from a parallel cohort study with administrative data from the participating hospitals. The parallel cohort study prospectively matched a cohort of patients with bloodstream infections caused by third-generation cephalosporin-resistant enterobacteria and methicillin-resistant Staphylococcus aureus (AMR cohort) with two control arms: patients infected with similar susceptible bacteria and a cohort of uninfected controls. Data collection took place from June to December 2021. We calculated the cost using aggregated micro-costing and step-down costing approaches and converted costs into purchasing power parity in international US dollars, adjusting for surviving patients, bacterial species and cost centres. We found that the AMR cohort spent a mean of 4.2 extra days (95% CI: 3.7–4.7) at Hospital 1 and 5.5 extra days (95% CI: 5.1–5.9) at Hospital 2 compared with the susceptible cohort. This corresponds to an estimated mean extra cost of $823 (95% CI: 812–863) and $946 (95% CI: US$929–US$964) per admission, respectively. For both hospitals, the estimated mean annual extra cost attributable to AMR was approximately US$650 000. The cost varies by organism and type of resistance expressed. The result calls for prioritization of interventions to mitigate the spread of AMR in Ghana

Source: UG
Healthcare Provider Perspectives on HIV Cure Research in Ghana

The Department of Immunology conducts research in the field of immunology of infectious and non-infectious diseases. The Department has the overall goal of contributing knowledge to better diagnosis, management, control and prevention of infectious and non-infectious diseases in Ghana and worldwide. This is consistent with the overall strategy of the Noguchi Memorial Institute for Medical Research (NMIMR) and in line with the strategy of the College of Health Sciences of the University of Ghana.

Source: UG
Healthcare quality under the National Health Insurance Scheme in Ghana: Perspectives from premium holders

Purpose – The purpose of this study is to examine how premium holders of Ghana’s Health Insurance Scheme (NHIS) perceive the state of quality healthcare delivery in public hospitals in the country. Design/methodology/approach – Questionnaires were administered to a sample of 250 insured patients receiving care in some selected public hospitals accredited by the National Health Insurance Authority in Ghana. Results are presented using descriptive statistics and Chi-square analysis. Findings – The results demonstrate that the human dimensions of service quality (interaction with service provider and attitude of healthcare providers) were perceived by the insured patients to be good, and they constitute significant determinants of perceived service quality. Although waiting time was generally perceived to be long, it is not in any way associated with patient perception of quality of care. Originality/value – The findings of the study provide an important step towards strengthening service quality in public hospitals in the wake of the introduction of the NHIS.

Source: UG