ghanaopendata/ghanaian-research-english huggingface dataset:
Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana¿s Community-based Health Planning and Services (CHPS)

Abstract Background Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Conclusions Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.

Source: UG
Does the environmental Phillips curve hypothesis hold within the Ghanaian context?

This study examines the relationship between environmental quality and unemployment in Ghana using annual data spanning the period from 1990 to 2019. It also assesses the impact of gender-segregated unemployment rate on environmental quality. The study employed the Autoregressive Distributive Lag (ARDL) error correction model to estimate the relationship among the variables. In addition, the Fully Modified Ordinary Least Squares (FMOLS) and the Dynamic Ordinary Least Squares (DOLS) estimation procedures were employed to check for robustness of the ARDL results. Findings indicate a positive effect of total unemployment rate on environmental quality in Ghana in the long-run and also in the short-run. In the case of the gender-segregated unemployment, the findings reveal that in both short-run and long-run, a rise in female unemployment causes a deterioration in environmental quality in Ghana. The results also validated the Environmental Phillips Curve (EPC) hypothesis in the case of male unemployment. Thus, given that there is no general pattern in the findings, the study concludes that the Environmental Phillips Curve (EPC) hypothesis does not hold within the Ghanaian context.

Source: UG
Does the gender of nurses matter to patients? A qualitative analysis of gender preferences of patients

Background: This study argues that the gender of a nurse could give patients the emotional and psychological support they need in their healing process. Nonetheless, in many developing countries, these intricate preferences of patients are usually ignored due to poor staffing and logistical capacities of health facilities. As a contribution to this professional and operation gap, this paper explores patients’ preference for nurses’ gender in health care at the Komfo Anokye Teaching Hospital in Ghana. The paper further explores the importance of these preferences to the delivery of patient-centred care in Ghana and across Africa. Objective: The paper has two specific objectives: (a) to explore patients’ preferences for the gender of nurses who attend to them while on admission; and (b) to find out the range of factors that inform these preferences. Methods: Qualitative exploratory descriptive design was used to select adult patients who were not seriously ill and nursed by male and female nurses at the medical and surgical wards of the Komfo Anokye Teaching Hospital in Ghana for at least 5days from January to March 2017 and before their discharge. Participants were recruited using purposive sampling technique. A semi-structured interview guide was used to elicit information from 14 participants after seeking their written informed consent. The data were analysed using content analysis. Results: Two major themes emerged. These were: the Preferred Gender of a Nurse in Nursing Care and the Reasons for the Preference or no Preference for Nurses’ Gender in Nursing Care. Under each of these themes, the associated aspects were also discussed. Patients had varying preference for a particular nurse during care but gender was not particularly significant in patients’ preference for nurses. Majority of the participants emphasized their preference for nurses with professional expertise and good virtues to determine a preferred nurse and both genders of nurses can possess these qualities. However, nurses of the same gender as the patient were preferred for intimate procedures to ensure privacy and satisfaction. Conclusion: The gender of a nurse is not on top of the preferences list of patients in the study context. This may be attributed to the long-term practice that the participants have not had the chance to be choosing a preferred nurse’s gender, so most patients are tolerant and familiar with both male and female nurses. Instead, patients’ preferences are determined by the performance and quality of service provided by nurses. Age, maturity and social connections were also found to influence patients’ preferences.

Source: UG
Does the Inverse Farm Size-Productivity Hypothesis Hold Beyond Five Hectares? Evidence from Ghana

We contribute to the inverse farm size-productivity puzzle (IR) literature by examining the relationship using a unique data set from southern Ghana that covers farms between 5 and 70 ha. The study uses an instrumental variable (IV) for land size to mitigate some effects of measurement error in land size. The inverse relationship between farm size and farm productivity is upheld when ordinary least squares estimators (OLS) are applied but becomes insignificant, although still negative in the IV estimation. The results show that measurement error in land size attenuate the IR. While some studies found the IR to flatten and then become positive, this study finds that in Ghana, the IR only flattens.

Source: UG
Does the National Health Insurance Scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

INTRODUCTION: The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households.OBJECTIVE: To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana.METHODS: We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective.RESULTS: Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330).CONCLUSION: Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.

Source: UG
Does the National Health Insurance Scheme provide financial protection to households in Ghana?

Abstract Background Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. Methods Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. Results About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households. Conclusion The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.

Source: UG
Does the National Health Insurance Scheme provide financial protection to households in Ghana?

Background Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. Methods Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. Results About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households. Conclusion The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.

Source: UG
Does the policy cycle reflect the policymaking approach in Ghana?

Based on two cases involving 60 interviews and secondary evidence, this paper investigated whether Ghana's policymaking approach accorded with the policy cycle. The evidence showed that the Ghana industrial policy was largely compliant with the model. But the free senior high school policy bore little resemblance to it. Factors that determined whether or not policymaking followed the policy cycle included the salience of the issue, the sponsor of the issue, the political environment at the time, and the timing of the introduction of the issue. Four conclusions can be drawn from the Ghanaian evidence. First, the rough edges of the policy cycle can be trimmed and applied as a best fit model rather than a best practice model in any jurisdiction. Second, the policy cycle like other policy process theories should not be written off as inappropriate or inefficacious simply because practice failed to adhere to one or two out of the several elements of the theory. Third, an integrated policy process model is likely to be more efficacious than a single one, but there is inattention to such an idea. Finally, drawing lessons from policy process theories is a neglected area, which needs to be emphasized.

Source: UG
“Does the poor matter” in pro-poor driven sub-Saharan African cities? towards progressive and inclusive pro-poor tourism

Purpose – The purpose of this paper is to question the extent to which Sub-Saharan African cities are progressing towards promoting pro-poor economies through pro-poor tourism (PPT). It specifically examines how African cities are resilient towards attaining sustainable urban tourism destinations in light of high urbanization. Design/methodology/approach – The methodological framework is interpretive in nature and qualitative in an operational form. It uses meta-synthesis to evaluate the causal relationships observed within Sub-Saharan African pro-poor economies to enhance PPT approaches, using Accra, Ghana, Johannesburg, South Africa, and Harare, Zimbabwe, as case studies. Findings – Tourism development in Sub-Saharan Africa has been dominantly underpinned by neoliberal development strategies which threaten the sustainability of tourism in African cities. Research limitations/implications – The study is limited to three Sub-Saharan African countries. Further studies may need to be done in other developing countries. Practical implications – It argues for good governance through sustainability institutionalization which strengthens the regulative mechanisms, processes and organizational culture. Inclusive tourism approaches that are resilient-centered have the potential to promote urban tourism in Sub-Saharan African cities. These findings contribute to the building of strong and inclusive Institutions for Sustainable Development in the Sub-Saharan African cities to alleviate poverty. Social implications – These findings contribute to the building of strong and inclusive institutions for sustainable development in the Sub-Saharan African cities to alleviate poverty. Originality/value – The “poor” are always within the communities, and it takes a community to minimise the impact of poverty among the populace. The study is conducted at a pertinent time when most African government’s development policies are pro-poor driven. Though African cities provide opportunities of growth, they are regarded as centres of high inequality.

Source: UG
Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana

The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995–2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.

Source: UG
Does the Resource Capacity of Exporters Differ Significantly from the Non-Exporters? Evidence from SMEs in an Emerging Economy

Compared to the Small and Medium Enterprises (SMEs) that remain continuously focused on a domestic market, it is argued that those that export learn from their exporting. Exporters learn from, for example, international competitors and consumers. Based on this motivation, the internationalisation of SMEs is flourishing across the world because by determining to remain competitive in the international market, the capacity of exporting firms is enhanced. Ghana has hailed the motivation of SMEs’ internationalisation. Consequently, policies andprogrammes are being implemented to encourage SMEs to export. Whilst the Ghanaian exporting sub-sector is growing, it is not known whether or not the resource capacity of exporting firms differs significantly from the non-exporters. The objective of the study is to compare the resource capacity between exporting and non-exporting SMEs and to establish whether or not the Ghanaian evidence compares with findings from otherdeveloping and developed economies, as well as to further inform public policy. The study draws from a firm level panel data set from the World Bank relating to SMEs from the Ghana manufacturing sector from 2000–2002. By employing the independent sample t-test, multivariate analysis of variance and the chi-square test a number of hypotheses are tested. The results show that the capacity of the exporting firms regarding the number of employees, productivity of staff and business experience were higher and differed significantly from the non-exporting firms. Following the results, it is recommended that current export-led programmes by the government of Ghana must be deepened because of the micro returns that are derived from export participation.

Source: UG
Does the United Kingdom’s Local Improvement Finance Trust (LIFT) Scheme for Primary Health Care Enhance Partnership Working?

This article draws on a qualitative case study comparing two U.K. primary health care schemes which were entered into as part of the Local Improvement Finance Trust (LIFT) policy. LIFT takes the form of a social infrastructure Public Private Partnership (PPP) where public procurers and private suppliers work together in active long-term partnering agreements to deliver local primary health care facilities. The organizational structure is that of a joint venture company which is jointly owned by public and private partners, with the expectation that by having both the public and private sector represented on the company board partnership working between the two sectors is enhanced. The two schemes studied delivered contrasting results. One scheme showed how the private sector dominated the board, making partnership working difficult to achieve in the context of directors following their fiduciary role to maximize profits for shareholders. However, the findings from the second scheme showed that partnership working and LIFT success may be dependent on trust, general business ethos, and key personalities working together. Policy makers should therefore pay attention to not only the organizational structures, but also how the private sector controls and governance are exercised to benefit all stakeholders.

Source: UG