ghanaopendata/ghanaian-research-english huggingface dataset:
Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach

Abstract Background There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services. Methods The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider&#8217;s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis. Results The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery. Conclusion The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources.

Source: UG
The cost of sustaining the Ghana's &quot;cash and carry&quot; system of health care financing at a rural health centre

This paper investigates the sudden fall in clinic attendance at a rural health centre. The pressure to sustain the cash and carry system of procuring drugs is being blamed for over prescription, inconsistent pricing of prescriptions and subsequent fall in clinic attendance. The clinic attendance which was dropping since the introduction of fee-for-service (1985) has now dropped sharply to about 25% after the implementation of the Cash and Carry system (1990). Yet, the average revenue generated per patient has jumped from 201 cedis in 1990 to 348 cedis in 1992. Analysis of the prescription pattern for malaria infection showed that 56% and 89% of patients received injections or were given three or more drugs in the free health service period and in the fee-for-service period respectively. Prescriptions which contained injections or more than three items yielded between 120% and 200% profit to the Health Centre compared to a profit of 60% if only chloroquine and analgesics were prescribed. Consumptions of drugs by staff and non paying patients amounted to about 10% of the revenue generated from the paying patients. It is suggested that, at the health centre level, mechanism for pricing of prescriptions to patients must be reviewed, since motivation for profit could influence the management of diseases and also the use of health facilities. Secondly, refund for drugs consumed by staff and non-paying patients must be recovered in order to remove undue pressure to make profit.

Source: UG
Cost of tracheoesophageal prostheses in developing countries. facing the problem from an internal perspective

Conclusions. All the discussants of our questionnaire agreed that the price of tracheoesophageal (TE) prostheses was too expensive for developing countries. The problem could be addressed in terms of international laws regarding companies' patent rights. TE prosthesis manufacturers from rich countries could move their manufacturing in part to developing countries. High production standards could allow TE prostheses to be exported to developed countries. Another approach to the problem may be based on a partnership between non-profit-making Western laryngological societies with specific medical and technical prosthetic know-how and local manufacturers. The aim of this cooperation could be the low-cost production of advanced TE prostheses in the developing countries. Objectives. In communities in the developing world, most laryngeal and hypopharyngeal carcinomas are diagnosed at advanced stages and require total laryngectomy. Prosthetic TE voice restoration is the method of choice for voice rehabilitation after total laryngectomy in developed countries. Unacceptably high costs are a significant limitation to Third World use of TE voice prostheses. The aims of this paper are to discuss the consequences of the high costs of TE prostheses in developing countries with head and neck surgeons working in Third World hospitals and to propose how European and American laryngological societies can promote TE speech in the developing countries. Material and methods. A questionnaire was given to a group of expert head and neck surgeons working in developing countries and their answers and suggestions discussed. © 2006 Taylor & Francis.

Source: UG
Cost to households in treating maternal complications in northern Ghana: A cross sectional study

Background: The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana. Methods: We carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient's perspective. Analysis was performed using STATA 11. Results: Out of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10% (6) due to anaemia/malaria and 7% (4) due to pre-eclampsia. Most of the women who had complications were primiparous and were between 21-25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2 days - five days for pre-eclampsia. About 33% (6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments. Conclusion: Although maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure. © 2015 Dalaba et al.; licensee BioMed Central.

Source: UG
Cost to households in treating maternal complications in northern Ghana: a cross sectional study

Abstract Background The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana. Methods We carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient&#8217;s perspective. Analysis was performed using STATA 11. Results Out of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10% (6) due to anaemia/malaria and 7% (4) due to pre-eclampsia. Most of the women who had complications were primiparous and were between 21&#8211;25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2&#160;days - five days for pre-eclampsia. About 33% (6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments. Conclusion Although maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure.

Source: UG
Cost-benefit analysis and problems associated with the production of Verano seed by smallholder livestock farmers in Ghana

On-farm seed production of Stylosanthes hamata cv Verano was carried out by smallholder livestock farmers in the Ejura-Sekyedumase District of the Ashanti Region of Ghana. Technical back up was provided by a technical team comprising personnel from the University of Ghana and staff of the Ejura Sheep Breeding Farm of the Animal Production Directorate. The main objective of the project was to establish a local capacity for the production of Verano seed for improving the nations rangelands. The major problems encountered were; weed encroachment, bush fire, insect predation of planted seeds and laborious seed processing. Income per ha earned from Verano production was higher than that obtained from maize and cowpea production. The programme successfully established local capacity for Verano production in Ghana. Total Verano seed production by selected farmers in the study period was about 150 tonnes and the benefit/cost ratio increased from 1.15 (year 1) to 2.05 (year 2) and 7.87 (year 3) showing the economic benefits of Verano seed production. However, there is a need to undertake further research to raise the efficiency of quality Verano seed production.

Source: UG
Cost-Benefit Analysis of Conventional and Integrated Crop Management for Vegetable Production

Smallholder vegetable farmers involved in agricultural production are confronted with numerous challenges which can adversely affect performance. Farmers would prefer to adopt the most profitable vegetable production systems. A cost-benefit analysis of integrated crop management (ICM) and conventional method (CM) systems for vegetable production was conducted. Primary data were solicited from 120 vegetable farmers using questionnaires. Descriptive statistics were used to describe levels of awareness and extent to which farmers understood use of the ICM system. A cash flow projection was done on a 0.4 ha size of land for 5 years. Net present value (NPV) and cost-benefit ratio (CBR) analyses were performed for farmers operating under the ICM and CM production systems. The NPV analysis indicated production of vegetables under both systems was viable. The incremental NPV for cabbage (Brassica oleracea var. capitata L.) and onion (Allium cepa L.) production, and the whole farm enterprise were all positive, indicating the ICM system was more financially viable than the CM system. The NPV increase was GHS 2563.58 (GHS is Ghanaian currency, 1$US = 3.5 GHS in January 2015 when data were collected) for cabbage and GHS 3949.43 for onion, and of the whole farm enterprise, i.e., combined cabbage and onion production, was GHS 6162.75. The CBR analysis indicated that vegetable production under the two systems was viable, confirming results of the NPV analyses. The CBR for cabbage production was 1.58 for the CM and 2.08 for the ICM systems; the CBR for onion production was 2.69 for the CM and 4.36 for the ICM systems. The CBR for whole farm enterprise was 2.42 for the CM and 3.93 for the ICM systems. Sensitivity analyses, under the assumption of a 5% reduction in yield and a 10% cost over-run, indicated positive NPVs for both production systems for cabbage and onion production, and the whole farm enterprise. The NPVs from use of the ICM system were higher than under the CM system. Overall, vegetable production is profitable under both the ICM and CM systems, and awareness is a factor influencing practice of the ICM system.

Source: UG
Cost-benefit analysis of water source improvements through borehole drilling or rehabilitation: an empirical study based on a cluster randomized controlled trial in the Volta Region, Ghana

Background: Despite remarkable progress in water coverage improvements, diseases associated with poor water remain a considerable public health problem in many developing countries. Objective: We aimed to estimate the costs and benefits of drilling or rehabilitating boreholes with handpumps in resource-poor settings and hard-to-reach areas. Methods: Diarrheal reduction in the population was predicted on the basis of the empirical findings from a cluster randomized controlled trial. The full investment and estimated annual running costs were used to calculate the intervention costs. Direct economic benefits of avoiding child diarrheal disease, indirect economic benefits related to health improvements, and non-health benefits related to water improvement were estimated. One-way and multiway sensitivity analyses were performed to determine the robustness of the findings. Results: Our analysis found that the return on a US$ 1 investment was US$ 9.4 for borehole drilling and US$ 14.1 for borehole rehabilitation. Time savings were the main contributor, accounting for 68% of the benefits, followed by the economic benefits of averted child deaths, which contributed to 15% of the benefits. The sensitivity analyses suggested that improving water sources yields high returns under all circumstances, and that borehole rehabilitation is more efficient than borehole drilling. Conclusion: This study explicitly justifies increased investment in water improvement in rural areas and demonstrates the high returns of rehabilitating boreholes. We hope that this study will be used as evidence for informing the policy decisions of governments or international agencies regarding further investments in improved water coverage in rural areas and the selection of appropriately designed interventions.

Source: UG
Cost-effectiveness analysis of alcohol handrub for the prevention of neonatal bloodstream infections: Evidence from HAIGhana study

Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore, this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcoholbased hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit (NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after intervention study using economic evaluation model to assess the cost-effectiveness of a multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water compared to existing practice of using only soap and water. We measured effect and cost by subtracting outcomes without the intervention from outcomes with the intervention. The primary outcome measure is the number of neonatal BSI episode averted with the intervention and the consequent cost savings from patient and provider perspectives. The before and after intervention studies lasted four months each, spanning October 2017 to January 2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving potential when carefully scaled up across the country. Though the cost of the intervention may be more relative to using just soap and water for hand hygiene, the outcome is a good reason for investment into the intervention to reduce the incidence of neonatal BSI and the associated costs from patient and providers’ perspectives.

Source: UG
Cost-effectiveness analysis of unsafe abortion and alternative first-trimester pregnancy termination strategies in nigeria and Ghana.

To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three first-trimester abortion modalities: hospital-based dilatation and curettage, hospital- and clinic-based manual vacuum aspiration (MVA), and medical abortion using misoprostol (MA). Assuming all modalities are equally available, clinic-based MVA is the most cost-effective option in Nigeria. If clinic-based MVA is not available, MA is the next best strategy. Conversely, in Ghana, MA is the most cost-effective strategy, followed by clinic-based MVA if MA is not available. From a real world policy perspective, increasing access to safe abortion in favor over unsafe abortion is the single most important factor in saving lives and societal costs, and is more influential than the actual choice of safe abortion modality.

Source: UG
Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana

Objective: This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS) in the identification of maternal complications in Ghana. Methods: A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena-Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out. Results: Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC) in the intervention health centres (before-intervention= 9 /1,000 ANC attendance; after-intervention= 12/1,000 ANC attendance; P-value=0.010). In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention= 96/1,000 labour clients; P-value=0.305). Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio) decreased from US$17,017.58 (before-intervention) to US$15,207.5 (after-intervention). Incremental cost - effectiveness ratio (ICER) was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS), cost per pregnancy complication detected was US$285. Conclusions: Computer - assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth the additional cost.

Source: UG
Cost-effectiveness of HIV screening of blood donations in Accra (Ghana)

OBJECTIVES: Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP-NAT), or individual donation NAT (ID-NAT) to the HIV-antibody screening at the Korle Bu Teaching Hospital (Accra, Ghana), where currently only HIV-antibody screening is undertaken. METHODS: The residual risk of HIV transmission was derived from blood donations to the blood bank of the Korle Bu Teaching Hospital in 2004. Remaining life expectancies of patients receiving blood transfusion were estimated using the World Health Organization life expectancies. Cost-effectiveness ratios for adding the tests to HIV-antibody screening only were determined using a decision tree model and a Markov model for HIV. RESULTS: The prevalence of HIV was estimated at 1.51% in 18,714 donations during 2004. The incremental cost per disability-adjusted life-year (DALY) averted was US$1237 for p24 antigen, US$3142 for MP-NAT and US$7695 compared to the next least expensive strategy. HIV-antibody screening itself was cost-saving compared to no screening at all, gaining US$73.85 and averting 0.86 DALY per transfused patient. Up to a willingness-to-pay of US$2736 per DALY averted, HIV-antibody screening without additional testing was the most cost-effective strategy. Over a willingness-to-pay of US$11,828 per DALY averted, ID-NAT was significantly more cost-effective than the other strategies. CONCLUSIONS: Adding p24 antigen, MP-NAT, or ID-NAT to the current antibody screening cannot be regarded as a cost-effective health-care intervention for Ghana.

Source: UG