Why does inaccessibility widely exist in healthcare in Ghana? Understanding the reasons from past to present

Perspectives and Satisfaction of Consumers with Hypertension and Diabetes on Services Provided by Community Pharmacy

Non-communicable diseases are increasing, but detection and control are inadequate. Active involvement of community pharmacies in their management can improve the situation. This is an exploratory study to unearth the perceptions and expectations of customers of services offered by community pharmacies. A cross-sectional study was conducted in two regions of Ghana. A total of 535 clients participated. Counseling was the most patronized (71.0%) service with medication review (38.5%) being the least. The most readily available service was sale of prescription medications (63.7%). Proximity (72.1%) was the most influential factor for selecting a pharmacy to visit. Clients perceived the dispensing of medications (64.3%) as the principal role of the pharmacists. The presence of a pharmacist and good and quick customer service were of statistical significance to customer satisfaction. Customers visited facilities mostly for blood pressure monitoring and to refill their medications, and counseling was the most patronized service. These call for planning multifaceted approaches to improve the care of patients with chronic disease.

Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.

Predicting Health Insurance Policy Subscription Intention: An Empirical Study

Though health insurance policies remain critical to eliminating healthcare access barriers, population-wide subscription in Ghana however remains unsatisfactory. Therefore, this study, while employing a questionnaire survey to elicit data (n= 312) analyzed via the structural equation modeling technique, investigates individual health insurance subscription underpinnings using the theory of planned behavior. The results of data analysis affirmed attitude, subjective norm and perceived behavior control as positively related to health insurance subscription. Similarly, results further revealed personal norm and descriptive norm as significantly related to intention, testifying to individuals' subscription as not anchored on a single factor, but rather on a confluence of behavior-driven elements. The current study, in addition to affirming the TPB's predictive potency, also enriches health insurance research, and underscores the much often-disregarded behavior constituents as imperative to health policy design and implementation. In view of the study results, implications for augmenting subscription, and suggestions for further research are subsequently delineated.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household's wealth index

BACKGROUND

Child mortality is an important social indicator that describes the health conditions of a country as well as determines the country's overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household's wealth index on the association between woman's education and child mortality has also been investigated.

METHODS

The comprehensive dataset of the Pakistan Demographic and Health Survey 2017-18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women's education and household wealth index has been used to investigate the moderating role of the household's wealth index.

RESULTS

The results indicate that the likelihood of child mortality decreases with an increase in women's education, their empowerment, their husband's education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household's wealth index on the association between woman's education and child mortality.

CONCLUSIONS

Household wealth status moderates the association between women's education and child mortality. The absolute slope of the curve showing the association of women's education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household's wealth status strengthens the relationship between women's education and child mortality. With the increase in the household's wealth status, the effect of a mother's education on child mortality becomes more pronounced.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys

Background

Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana.

Methods

In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics.

Results

Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 – 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 – 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 – 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 – 3.243), richer (RRR = 1.908, 95 % CI 1.145 – 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 – 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 – 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 – 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 – 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 – 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 – 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 – 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions.

Conclusions

Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Healthcare in Ghana amidst the coronavirus pandemic: a narrative literature review

The Coronavirus pandemic has caused more deaths than any other single disease since the outbreak was confirmed. The World Health Organization in collaboration with national and international health agencies continues to lead the way in bracing global healthcare systems to fight the pandemic. There are variations in national capacities towards the preparedness and management of the pandemic. The Government of Ghana, through the Ministry of Health and Ghana Health Service, continues to provide policy and operational directions towards the containment of the pandemic. The purpose of this study is to review the setup of the healthcare sector in Ghana in light of the ongoing pandemic. This study is a narrative literature review in which data was extracted from electronic databases such as PubMed, Google Scholar, Scopus and Ebscohost that published Covid-19 research articles from Ghana. Literature was analyzed and discussed based on the structures and systems available in the healthcare sector, as well as trends available from the global perspective. The healthcare sector in Ghana continues to support the citizenry in the wake of the Coronavirus pandemic. The government provides regular updates and continue to pledge their support in dealing with the effects of the pandemic. Challenges with accessibility, workforce, funding, and infrastructure remain the major hindrances in fighting the pandemic. The government and healthcare partners need to continually reform the healthcare system to meet the increasing demand for healthcare during the pandemic.

Climate change, women's workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.

Formalising 'informal' mHealth in Ghana: Opportunities and challenges for Universal Health Coverage (UHC)

While mobile phones promise to be an important tool for bridging the healthcare gaps in resource-poor areas in developing countries, scalability and sustainability of mobile phones for health (mhealth) interventions still remain a major challenge. Meanwhile, health workers are already using their own mobile phones (referred to as 'informal mhealth') to facilitate healthcare delivery in diverse ways. Therefore, this paper explores some strategies for integrating 'informal mHealth' in the healthcare delivery of Ghana, by highlighting some opportunities and challenges. The study mainly employed a combination of literature review, focus group discussions and key informant interviews with community health nurses (CHNs) and other stakeholders, who were purposively selected from the three ecological zones in Ghana. The study found that, while scale-up of 'formal mhealth' remains challenging in Ghana, almost all CHNs in our study are using their personal mobile phones 'informally' to bridge healthcare gaps, thereby promoting universal health coverage. This provides opportunities for promoting (or formalising) 'informal' mhealth in Ghana, in spite of some practical challenges in the use of personal mobile phones that need to be addressed to ensure sustainable healthcare delivery in the country.

Removing barriers to healthcare through an intercultural healthcare system: Focus group evidence

OBJECTIVE

Barriers to healthcare in Ghana are multifaceted. Many people, including patients and providers, face them at different levels. To address these barriers, there is a need to explore the role of an intercultural healthcare system. This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana.

METHODS

Focus group discussions with 35 participants comprising 17 healthcare users, 11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data. Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach.

RESULTS

Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare, especially cultural, social and economic barriers, by fostering an enhanced relationship between culture and healthcare, promoting affordable healthcare and promoting effective communication between healthcare providers and users. Weak institutional support, lack of strong political will and commitment, lack of training to meet standards of practice, poor registration and regulatory measures, and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana.

CONCLUSION

The support for intercultural healthcare system and the agreement on its perceived ability to reduce social, cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training, enforcement of regulatory measures, inclusion of intercultural healthcare in medical school curricula across the country, and community engagement.

Dynamics of health information-seeking behaviour among older adults with very low incomes in Ghana: a qualitative study

Background

Exploration of health information-seeking behaviour among older adults with very low incomes is critical in shaping our understanding of how health information is sought in later life. Although studies have focused on health information-seeking behaviour among older people worldwide, subjective views of older adults, especially those with very low incomes in Ghana remain scant. Thus, this study aimed to fill this significant knowledge gap by exploring health information-seeking behaviour among older adults with very low incomes in Ghana.

Methods

In-depth interviews and focus group discussions were conducted with 30 older adults with very low incomes, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. A thematic analytical framework was used to analyse the data.

Results

The study revealed multiple sources of health information to include healthcare providers, family members, media and friends. The kind of health information sought by older adults with very low incomes consisted of information on diets, causes of chronic non-communicable diseases and medication dosage. The study also identified inadequate knowledge about the benefits of seeking health information, perceived poor attitude of healthcare providers and communication problems as the factors that limit older adults with very low incomes from acquiring health information.

Conclusion

An adequate and reliable source of information is essential to promoting the health of older people. Their inability to secure the right health information could further worsen their health status. Thus, the study provides the need for appropriate health policy interventions on the sources and types of health information sought by older adults with very low incomes in Ghana. Healthcare providers are recommended to remain open, friendly and receptive to older people to allow them to seek and obtain health information as they [healthcare providers] constitute the most reliable health information source.

Lessening barriers to healthcare in rural Ghana: providers and users' perspectives on the role of mHealth technology. A qualitative exploration

BACKGROUND

Key barriers to healthcare use in rural Ghana include those of economic, social, cultural and institutional. Amid this, though rarely recognised in Ghanaian healthcare settings, mHealth technology has emerged as a viable tool for lessening most healthcare barriers in rural areas due to the high mobile phone penetration and possession rate. This qualitative study provides an exploratory assessment of the role of mHealth in reducing healthcare barriers in rural areas from the perspective of healthcare users and providers.

METHOD

Semi-structured interviews were conducted with 30 conveniently selected healthcare users and 15 purposively selected healthcare providers within the Birim South District in the Eastern Region of Ghana between June 2017 and April 2018. Data were thematically analysed and normative standpoints of participants were presented as quotations.

RESULTS

The main findings were that all the healthcare users had functioning mobile phones, however, their knowledge and awareness about mHealth was low. Meanwhile, rural health care users and providers were willing to use mHealth services involving phone call in the future as they perceived the technology to play an important role in lessening healthcare barriers. Nevertheless, factors such as illiteracy, language barrier, trust, quality of care, and mobile network connectivity were perceived as barriers associated with using mHealth in rural Ghana.

CONCLUSION

The support for mHealth service is an opportunity for the development of synergistic relationship between health policy planners and mobile network companies in Ghana to design efficient communication and connectivity networks, accessible, localised, user-friendly and cost-effective mobile phone-based health programmes to assist in reducing healthcare barriers in rural Ghana.

Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

BACKGROUND

Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana.

METHODS

Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach.

RESULTS

Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers).

CONCLUSIONS

Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana.