ghanaopendata/ghanaian-research-english huggingface dataset:
Advancing the application of systems thinking in health: Provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme - a systems approach

Background: Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour.Methods: A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results: There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions: As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. © 2014 Agyepong et al.; licensee BioMed Central Ltd.

Source: UG
Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme ¿ a systems approach

Abstract Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

Source: UG
Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana

Abstract Background Although there is widespread agreement that strong district manager decision-making improves health systems, understanding about how the design and implementation of capacity-strengthening interventions work is limited. The Ghana Health Service has adopted the Leadership Development Programme (LDP) as one intervention to support the development of management and leadership within district teams. This paper seeks to address how and why the LDP &#8216;works&#8217; when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams. Methods We undertook a realist evaluation to investigate the outcomes, contexts, and mechanisms of the intervention. Building on two working hypotheses developed from our earlier work, we developed an explanatory case study of one rural district in the Greater Accra Region of Ghana. Data collection included participant observation, document review, and semi-structured interviews with district managers prior to, during, and after the intervention. Working backwards from an in-depth analysis of the context and observed short- and medium-term outcomes, we drew a causal loop diagram to explain interactions between contexts, outcomes, and mechanisms. Results The LDP was a valuable experience for district managers and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system, which triggered the LDP&#8217;s underlying goal of organisational control. Conclusions Consideration of organisational context is important when trying to sustain complex interventions, as it seems to influence the gap between short- and medium-term outcomes. More explicit focus on systems thinking principles that enable district managers to better cope with their contexts may strengthen the institutionalisation of the LDP in the future.

Source: UG
Advancing the application of systems thinking in health: Realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana

Background: Although there is widespread agreement that strong district manager decision-making improves health systems, understanding about how the design and implementation of capacity-strengthening interventions work is limited. The Ghana Health Service has adopted the Leadership Development Programme (LDP) as one intervention to support the development of management and leadership within district teams. This paper seeks to address how and why the LDP 'works' when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams.Methods: We undertook a realist evaluation to investigate the outcomes, contexts, and mechanisms of the intervention. Building on two working hypotheses developed from our earlier work, we developed an explanatory case study of one rural district in the Greater Accra Region of Ghana. Data collection included participant observation, document review, and semi-structured interviews with district managers prior to, during, and after the intervention. Working backwards from an in-depth analysis of the context and observed short- and medium-term outcomes, we drew a causal loop diagram to explain interactions between contexts, outcomes, and mechanisms.Results: The LDP was a valuable experience for district managers and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system, which triggered the LDP's underlying goal of organisational control.Conclusions: Consideration of organisational context is important when trying to sustain complex interventions, as it seems to influence the gap between short- and medium-term outcomes. More explicit focus on systems thinking principles that enable district managers to better cope with their contexts may strengthen the institutionalisation of the LDP in the future. © 2014 Kwamie et al.; licensee BioMed Central Ltd.

Source: UG
“Advancing women into leadership positions through education”

This paper explores the advancement of women into leadership positions through education in South Africa. Despite differences in levels of domination the broad principle remains the same, that is men are in control. Patriarchy is the prime obstacle to women's advancement and development. Patriarchal society gives absolute priority to men and to some extent limits women's human rights. It refers to male domination both in public and private sphere. In this way feminists use the term patriarchy to describe power relationships between men and women ad well as to find the root cause of women's subordination.

Source: UG
Adverse drug reaction reporting by community pharmacists in the Greater Accra Region of Ghana, 2016

Objectives: To assess adverse drug reactions (ADRs) reporting and identify factors to improve ADR reporting among community pharmacists in the Greater Accra Region of Ghana. Design: A quantitative cross-sectional study. Setting: Community pharmacies in the Greater Accra Region of Ghana. Participants: We randomly selected 210 pharmacists from a list community of pharmacies in Accra, Ghana. All participants had been practicing in the past one year, with this study being conducted from June to July 2016. Main outcome measure: Prevalence of ADR reporting by community pharmacists in Accra, Ghana. Results: Of the 210 community pharmacists interviewed 54.0% were males. Mean age was 32±10 years. Majority (96.0%) had heard of ADR reporting in Ghana, yet 18% had never seen the ADR reporting form. Reasons given for failure to report suspected ADRs included unavailability of reporting forms (83.1%), uncertainty about a causal rela tionship between the drug and the suspected ADR and classification of the reaction as “normal” with the medication being taken (23.6%). Only 34.0% of pharmacists had the ADR reporting forms available in their facilities. Marital status was the only factor significantly associated with ADR reporting (OR 3.18, 95%CI 1.02 – 9.12). Conclusion: ADR reporting by community pharmacists in Ghana remains low. To improve the proportion of report ing, ADR forms should be made available in all pharmacies, pharmacists and the general public should be made aware of online reporting systems, with continuous professional development in Pharmacovigilance with the advice that all suspected ADRs should be reported irrespective of uncertainty about causality

Source: UG
Adverse drug reactions in Ghanaian children: review of reports from 2000 to 2012 in VigiBase.

OBJECTIVE: The aim of this article is to describe adverse drug reactions (ADRs) reported for children aged 0 - 17 years in Ghana. METHODS: Paediatric reports submitted by the Ghana National Centre for Pharmacovigilance to the World Health Organisation (WHO) Global ADR database, VigiBase up to December 2012 were extracted. The data were analysed for number of reports per year, types of reporters and suspected ADRs and drugs. RESULTS: A total of 343 reports for children were received during the period. The drug classes most frequently reported were vaccines (115, 31%), antimalarials (106, 28%) and antibiotics (57, 15%). Of the top 20 individual drugs, 19 were anti-infectives. The most frequently reported ADRs were injection site infection, fever and rash. There were 23 deaths reported, and antimalarials were implicated in 12 cases. CONCLUSIONS: Vaccines, antimalarials and antibiotics are the leading medicines reported to cause ADRs in Ghanaian children. There was a high mortality rate, with many of the deaths due to causes explained in the individual case safety reports.

Source: UG
Adverse life experiences and mental health of adolescents in Ghana: a gendered analysis

Adolescents living in sub-Saharan Africa have increased exposure to adverse life experiences (ALEs). The current study examines gender differences in the prevalence of ALEs, mental health outcomes and association between ALEs and mental health outcomes of school-going adolescents in Ghana, West Africa. A sample of 1,886 adolescents (1,174 females) completed mental health and ALEs self-report measures. A series of descriptive and multiple linear regression analysis were conducted. Results revealed girls report higher mental health problems than boys. However, there was gender similarity in the prevalence of ALEs, except for substance misuse and trauma to head were reported more by boys. The effect of ALEs on mental health outcomes was largely invariant across gender, substance misuse, victimization experiences and school-level stress significantly predict depressive symptoms in both boys and girls. Interventions targeting the ALEs investigated in this study would help improve the mental health of boys and girls

Source: UG
Adversity or Opportunity? Exploring the Effect of COVID-19 on Ghana’s Informal Economy

This study purported to explore the effect of the COVID-19 pandemic on the informal sector in Ghana. Particularly, the study sought to explore the nature of adversity, opportunities arising from the pandemic and remedial measures. The study adopted a mixed method and used a sample of 186 small-scale business owners and operators. The study found that the major driver of people into the informal sector were the lack of job opportunities in the formal sector rather than the need to evade government regulations. The adverse effects of the pandemic on informal businesses included lowered sales, shortage of supplies and closure of businesses. However, there were opportunities for informal businesses propelled by business diversification and technology. The study recommended the need for government to support and protect the informal sector to enhance mutual revenue generation amidst this pandemic.

Source: UG
Advertising of unhealthy foods and beverages around primary and junior high schools in Ghana’s most urbanized and populous region

Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer’s characters), while 8% of all food advertisements had premium offers o

Source: UG
Advertising of Unhealthy Foods and Beverages Around Primary and Junior High Schools in Ghana’s Most Urbanized and Populous Region

Introduction: The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana’s most populous and urbanized region, Greater Accra. Materials and methods: Outdoor advertisements for foods and beverages within a 250m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems. Results: A total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra- processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer’s characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables). Conclusions: There is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children’s settings are needed to protect pupils from such advertising practices.

Source: UG
Advisory Commission on the Review of the Constitution of the Federation of Rhodesia and Nyasaland

We were appointed by the Governments of the United Kingdom, the Federation of Rhodesia and Nyasaland, Southern Rhodesia, Northern Rhodesia and Nyasaland with the following terms of reference:- " To survey developments since Federation was inaugurated in 1953, in the economic, political and social spheres and, where possible and appropriate, to make suggestions and analyse the arguments for and against constitutional changes which may he desirable and practicable ", 2, We have discharged the first half of this task in our first Report, the "Survey of Developments since 1953 ", which was prepared in Salisbury in September- October 1959. This second Report, which summarises the results of discussions in London in November- December 1959, is devoted to an examination of suggestions for certain possible cbanges in the Federal Constitution and to an analysis of the main arguments for and against such changes. 3. Our terms of reference do not require us to make recommendations or to indicate any order of preference among the various constitutional adjustments which we have considered. We have therefore confined ourselves to an objective survey of a number of important modifications which may be thought to be possible and desirable within the general ambit of the Federal Constitution. We should perhaps emphasise, at the outset, that:- (a) In considering both the existing constitutional arrangements and possible changes in them we have restricted our examination to elements within the basic structure of the Constitution. In particular, our terms of reference do not extend to matters which are regulated by individual Acts of the Federal Legislature. except in so far as they amend the Constitution. (b) We have naturally not concerned ourselves with the political implications either of the existing Constitution or of the possible modifications of it which we have analysed in this Report. We must emphasise. therefore. that we arc not to be taken as in any way purporting to endorse any of the suggestions discussed in the later chapters of this Report, still less to evaluate their political validity.

Source: UG
An Advocacy Coalition Approach to Water Policy Change in Ghana: A Look at Belief Systems and Policy Oriented Learning

The Advocacy Coalition Framework (ACF) was developed by Sabatier and Jenkins Smith in 1993 to explain and predict policy change. Bloomquist and other scholars have referred to the ACF as one of the most promising theoretical frameworks for studying the policy process. The ACF has been applied widely to policy change in a plethora of substantive policy areas in the United States, as well as in Canada, the United Kingdom and Australia. However, the ACF has not yet been applied to explain the policy process in Africa. Thus, to test the robustness of the framework, this research applies the ACF to explain water politics and the water policy process in Ghana. This research specifically looks at the belief systems and policy oriented learning in water policy change in Ghana. Using a combination of survey methodology and key interviews, the research tests two hypotheses of the ACF; i) Coalition members are more likely to interact with actors they perceive as sharing their beliefs than actors who do not share their beliefs; ii) Policy oriented learning is likely when there is the presence of a professionalized forum than when there is not. The findings show that the ACF offers a good explanation of the water policy process in Ghana.

Source: UG
Aedes-borne disease outbreaks in West Africa: A call for enhanced surveillance

The Department of Parasitology conducts research into parasitic diseases of public health importance with the overall goal of reducing their transmission and the heavy disease burden that they impose on affected populations. The Department maintains focus on parasitic diseases in general. These include major diseases such as malaria, and others listed under the Neglected Tropical Diseases (NTD) control initiative such as, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, trypanosomiasis and leishmaniasis.

Source: UG
Aerobic spore-forming bacteria and chemical composition of some Nigerian fermented soup condiments

A total of 97 strains of spore-forming Bacillus were isolated from 45 samples of three Nigerian fermented condiments, obtained from retail markets located in Southwestern Nigeria. The isolates were identified as B. subtilis (33%), B. pumilus (19%), B. licheniformis (22%), B. brevis (9%), B. megaterium (12%) and B. polymyxa (5%). The microbial load of the condiments showed that the average count of spore-formers was between 107 to 109 cfu/g. The moisture contents of iru, ugba and ogiri were 57.18%, 46.32% and 42.34%, respectively, while the protein contents were 18.26%, 17.17% and 17.96%. The percentage fat was 29.88%, 40.25% and 44.14% for iru, ugba and ogiri. The ash content ranged from 5.8 to 6.1%; a 0.1% titratable acidity and pH values above 7.0 were obtained for the three condiments.

Source: UG